What is Syphilis?

Syphilis is a highly contagious bacterial infection caused by the bacterium Treponema pallidum. Syphilis can be contracted during oral, vaginal and anal sex and occurs in stages.

The Centers for Disease Control and Prevention (CDC) estimates that more than 55,000 new syphilis infections are contracted annually.

Of these new cases, nearly 13,000 are of primary and secondary syphilis, which are the earliest and most infectious stages of the disease.

Syphilis is curable in its earlier stages, but can cause very serious and possibly irreversible complications if the infection goes untreated.

People who have syphilis may not be aware they have it because many of its symptoms are indistinguishable from other diseases. For this reason, syphilis is often referred to as “the great imitator.”

Common signs and symptoms of syphilis

Syphilis is transmitted sexually, through direct contact with a syphilis sore, rash, or mucous membrane during unprotected oral, vaginal, or anal sex.

Sores, or chancres (pronounced SHANG-ker), occur on the lips and mouth, vagina, penis, anus, and/or rectum.

Primary syphilis chancres most frequently appear on the genitals, but can also occur on the fingers, mouth, lips, tongue, tonsils, anus and breasts and nipples.

Syphilis symptoms can either go unnoticed or be misdiagnosed as the flu for many years. There are three stages to the syphilis infection: Primary, secondary and latent/late. If left untreated during these stages, syphilis becomes deadly.

Syphilis stages:

The primary stage is the first stage of syphilis and usually includes small painless sores known as chancres.

These sores occur from about 2 weeks to 3 months after exposure. This makes it possible to have syphilis without being aware of the infection.

If a patient has been infected for a year or less, the disease is referred to as an “early case.” Early case syphilis infections are more infectious and easier to spread.

That being said, any stage of a syphilis infection makes it easier to transmit or contract HIV. Syphilis-related vision loss and irreversible damage to the brain and other organs can occur in as little as one year.

The secondary stage of syphilis lasts between one and three months and usually begins between six weeks and six months after exposure to the bacteria.

Secondary syphilis is characterized by a flat rosy-colored, non- itchy rash that usually covers the palms of the hands and soles of the feet.

In some cases, the rashes may occur on other parts of the body or resemble rashes caused by other ailments.

Additional signs of secondary syphilis include hair loss, white patches inside the mouth, genital warts, and flu-like symptoms such as fever and swollen lymph glands that last for weeks or even months.

Secondary stage symptoms include fever, fatigue, headaches, sore throat, weight loss, muscle aches, swollen lymph glands and patchy hair loss.

Although symptoms disappear after the primary and secondary stages, the latent (hidden) and late stages are more severe.

Without treatment during the primary or secondary stages, syphilis progresses to the latent stage, at which time the infection becomes dormant and does not cause symptoms for an extended period of time, up to 20 years.

During the latent stage, the infection is still detectable by blood testing, despite the lack of symptoms. A syphilis infection can be treated and cured at this stage, but any damage done to internal organs is irreversible.

If the syphilis infection progresses through the latent stage without treatment, it enters the terminal tertiary stage.

The tertiary stage of syphilis typically occurs between 10 and 30 years after the initial infection. At this time, entirely new and life-threatening symptoms occur.

Debilitating side-effects include, but are not limited to blindness, loss of motor skills, dementia, and damage to the central nervous system and internal organs, such as the heart, brain, eyes, kidneys, and bones.

In most cases, tertiary stage syphilis is distinguished by a descent into mental illness, followed by death.

How syphilis is transmitted

The most common way syphilis is transmitted is through contact with sores of an infected person.

This usually occurs during sexual intercourse syphilis sores occur on the external genitals, vagina, anus or in the rectum, and the infection is typically transmitted through oral, vaginal and anal sex.

These sores may also occur on the lips and in the mouth. In addition, pregnant women can also transmit the syphilis infection to their unborn children.

How syphilis testing works

The only way to know for sure if you have syphilis is to get tested. Our doctors recommend the RPR (Rapid Plasma Reagin) with Reflex to Quantitative RPR test.

This Syphilis Test is a simple blood test that looks for antibodies the body creates to combat syphilis. If test results return positive, a confirmatory TP (Treponema pallidum) test will be done to confirm the initial diagnosis.

Our doctors recommend testing for anyone with symptoms of a primary or secondary syphilis infection.

Pregnant women in particular should get tested during pregnancy and at delivery, because long-term untreated syphilis infections can lead to death for developing infants.

Can doctors cure syphilis?

Syphilis can be easily treated and cured with antibiotics when caught early on. In the early stages of syphilis infection, a single dose of penicillin is effective.

Treatment will kill the Treponema pallidumbacterium and prevent further damage, but it cannot reverse any damage that has already been done.

This is why treating the disease during its primary and secondary stages is so important. If you are being treated for syphilis, abstain from sexual activity until the syphilis sores are completely healed and treatment is finished.

Partners should get syphilis treatment together in order to avoid becoming reinfected with the bacteria.

Our doctors also recommend follow-up testing to be sure that all of the bacteria that causes syphilis has been cleared from your system.

Effects of untreated syphilis

In the latent or late stages, the effects of syphilis infection can be severe. If left untreated, syphilis can result in damage to the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.

Also, according to the CDC, a person with syphilis sores is 2 to 5 times more likely to acquire HIV. Pregnant women with syphilis may miscarry or transmit the infection to their babies.

Ways to prevent syphilis

The only way to prevent contracting syphilis 100% is abstinence. Otherwise, practicing safer sex by consistently using latex or polyurethane condoms or dental dams can help avoid contracting syphilis.

Condoms lower the risk for spreading syphilis, which is particularly high among men who have sex with men, but do not eliminate the risk of contracting the infection from sores on areas of the body that a condom doesn’t cover.

Being in a mutually monogamous relationship with someone who is not infected with syphilis will also prevent infection.

Discussing sexually transmitted diseases (STDs) and testing with your new partner before engaging in sexual relationship is another way to help prevent getting syphilis.

Syphilis and pregnancy

Syphilis is very harmful to infants and unborn babies. It can cause a mother to miscarry or the baby to be stillborn.

Syphilis can easily be transmitted to a fetus from the placenta or transfer to the baby in the birth canal during delivery. It can cause serious or even fatal infections.

Infants with congenital syphilis are often born prematurely and if left untreated, syphilitic babies will likely develop serious issues in internal organs like the heart, brain, skin, eyes, ears, bones and teeth.

Syphilis can be treated during pregnancy with antibiotics to both decrease the risk of spreading it to the baby and stop the infection’s progression in the mother.

If a chancre is present on the breast or nipple, mothers should not breastfeed.

Primary stage syphilis symptoms can appear 10-90 days after infection

Most individuals who contract syphilis experience their first symptom 10 to 90 days (average time is 21 days) after the initial infection.

The most common symptom is a firm, round, painless sore called a chancre (pronounced SHANG-ker). The chancre typically appears at the original site of infection.

For women, chancres are typically found on the vulva, vagina, cervix, anus or rectum, while for men they may appear on the penis, anus or rectum.

Chancres can also develop on the mouth, tongue, lips or any other body part that has come into direct contact with an infected sore.

The chancre usually lasts between 3-6 weeks and heals on its own. However, this does not mean that the infection itself has left your system and treatment is still required to kill the Treponema pallidum bacterium that causes syphilis.

In addition to chancres, many people may experience swollen lymph nodes depending upon where the chancre develops. The most commonly affected lymph nodes are located in the neck, armpit and groin.

Secondary stage syphilis symptoms can appear 2-8 weeks after first chancre

The secondary stage of syphilis lasts between one and three months and usually begins between six weeks and six months after exposure to the bacteria.

Secondary syphilis is characterized by a flat rosy-colored, non-itchy rash that usually covers the palms of the hands and soles of the feet.

In some cases, the rashes may occur on other parts of the body or resemble rashes caused by other ailments.

Additional signs of secondary syphilis include hair loss, white patches inside the mouth, genital warts, and flu-like symptoms such as fever and swollen lymph glands that last for weeks or even months.

Other symptoms that some people may experience include swollen eyes, kidney, liver, spleen bones or joints, fever, weight loss, muscle ache and loss of appetite.

Although symptoms disappear after the primary and secondary stages, the latent (hidden) and late stages are more severe.

Latent stage syphilis begins when primary and secondary symptoms disappear

During the latent stage, the syphilis infection remains in the body even though it is not displaying obvious symptoms.

During the latent stage, the syphilis infection becomes dormant and does not cause symptoms for an extended period of time, up to 20 years.

During the latent stage, the infection is still detectable by blood testing, despite the lack of symptoms.

A syphilis infection can be treated and cured at this stage, but any damage done to internal organs is irreversible. If the syphilis infection progresses through the latent stage without treatment, it enters the terminal tertiary stage.

Tertiary syphilis

The terminal tertiary stage of syphilis typically occurs between 10 and 30 years after the initial infection.

At this time, entirely new and life-threatening symptoms occur. Debilitating side-effects include, but are not limited to blindness, loss of motor skills, dementia, and damage to the central nervous system and internal organs, such as the heart, brain, eyes, kidneys and bones.

In most cases, tertiary stage syphilis is distinguished by a descent into mental illness, followed by death.

Syphilis Symptoms – Primary Stage

Most Common
  • Single firm, round, painless sore (chancre)
Less Common
  • Swollen lymph glands in neck, armpit or groin
  • No obvious symptom (painless sore could be small or inside genital opening)
Least Common
  • Multiple firm, round, painless sores (chancres)

Syphilis Symptoms – Secondary Stage

Most Common
  • Flu-like symptoms
  • Swollen lymph glands in neck, armpit or groin
  • Sore throat
  • Headaches
  • Fatigue
Less Common
  • Sores in mouth, vagina, anus and penis (mucous membrane lesions)
  • Moist, wart-like patches on the genitals or skin folds (condylomata lata)
  • Patchy hair loss
  • Swollen eyes, kidney, liver, spleen bones or joints
Least Common
  • Fever
  • Weight loss
  • Muscle aches
  • Loss of appetite

Syphilis Symptoms – Latent Stage

  • No symptoms are caused as syphilis lies dormant during this stage

Syphilis Symptoms -Tertiary Stage

Most Common (Tertiary Stage Complications)
  • Internal organ damage (brain, nerves, eyes, heart, blood vessels, liver, bones and joints)
  • Loss of motor skills
  • Paralysis
  • Numbness
  • Gradual blindness
  • Dementia
  • Mental illness

How syphilis is transmitted

Syphilis is transmitted sexually, through direct contact with a syphilis sore, rash, or mucous membrane, usually during unprotected oral, vaginal or anal sex.

Sores, or chancres (pronounced SHANG-ker), occur on the lips and mouth, vagina, penis, anus, and/or rectum.

Pregnant women with syphilis can also pass the infection along to their unborn children. Syphilis cannot be contracted from doorknobs, toilet seats, swimming pools, hot tubs, bathtubs, shared clothing or eating utensils.

How can I prevent getting or spreading syphilis?

The only way to prevent contracting syphilis 100% is abstinence. Otherwise, practicing safer sex by consistently using latex or polyurethane condoms or dental dams can help avoid contracting syphilis.

Condoms lower the risk for spreading syphilis, which is particularly high among men who have sex with men, but do not eliminate the risk of contracting the infection from sores on areas of the body that a condom doesn’t cover.

Being in a mutually monogamous relationship with someone who is not infected with syphilis will also prevent infection.

Discussing sexually transmitted diseases (STDs) and testing with your new partner before engaging in sexual relationship is another way to help prevent getting syphilis.

Getting tested for STDs regularly for syphilis and other STDs can potentially save your life. Syphilis is easiest to cure in the earlier stages and it is important to cure this disease before it causes internal organ damage.

What you need to know about the stages of syphilis

The primary stage is the first stage of syphilis and usually includes small painless sores known as chancres.

These sores occur from about 2 weeks to 3 months after exposure. This makes it possible to have syphilis without being aware of the infection.

If a patient has been infected for a year or less, the disease is referred to as an “early case.” Early case syphilis infections are more infectious and easier to spread.

That being said, any stage of a syphilis infection makes it easier to transmit or contract HIV. Syphilis-related vision loss and irreversible damage to the brain and other organs can occur in as little as one year.

The secondary stage of syphilis lasts between one and three months and usually begins between six weeks and six months after exposure to the bacteria.

Secondary syphilis is characterized by a flat rosy-colored, non- itchy rash that usually covers the palms of the hands and soles of the feet.

In some cases, the rashes may occur on other parts of the body or resemble rashes caused by other ailments.

Additional signs of secondary syphilis include hair loss, white patches inside the mouth, genital warts, and flu-like symptoms such as fever and swollen lymph glands that last for weeks or even months.

Secondary stage symptoms include fever, fatigue, headaches, sore throat, weight loss, muscle aches, swollen lymph glands and patchy hair loss.

Although symptoms disappear after the primary and secondary stages, the latent (hidden) and late stages are more severe.

Without treatment during the primary or secondary stages, syphilis progresses to the latent stage, at which time the infection becomes dormant and does not cause symptoms for an extended period of time, up to 20 years.

During the latent stage, the infection is still detectable by blood testing, despite the lack of symptoms.

A syphilis infection can be treated and cured at this stage, but any damage done to internal organs is irreversible. If the syphilis infection progresses through the latent stage without treatment, it enters the terminal tertiary stage.

The tertiary stage of syphilis typically occurs between 10 and 30 years after the initial infection. At this time, entirely new and life-threatening symptoms occur.

Debilitating side-effects include, but are not limited to blindness, loss of motor skills, dementia, and damage to the central nervous system and internal organs, such as the heart, brain, eyes, kidneys, and bones.

In most cases, tertiary stage syphilis is distinguished by a descent into mental illness, followed by death.

When is syphilis most contagious?

Syphilis is the most contagious during the early (primary and secondary) stages, but it can be contracted at any stage.

A single sore appears during the primary stage (approximately 21 days post exposure) and syphilis is easiest to spread when this sore is present.

These sores or chancres look like a mucous patch (lesion) or wart-like patch in or on the vulva, vagina, penis, cervix, anus, rectum, lips, tongue or on the original infected area during sexual contact.

If a syphilis infection is detected during the primary or secondary stage, it can be easily and quickly cured with a round of antibiotics.

Can I become infected with syphilis more than once?

Yes, you can get reinfected with syphilis because it is caused by bacteria. Even after successful treatment, it is still possible (and very likely) to get reinfected with syphilis if your partner has not been treated.

Since syphilis sores can be out of sight in the vagina, anus, under the foreskin or in the mouth, it may not be apparent that you or your partner has been infected.

For this reason, it is advisable that both you and your partner get tested and treated together, and abstain from sexual activity until the syphilis sores have healed and the treatment is complete for both partners.

What complications can result from untreated syphilis?

During the tertiary stage of syphilis, small, rubbery lesions may develop on the bones, skin, nervous system tissue, and/or arteries of the heart or the brain.

Due to these lesions and other health complications, these individuals are susceptible to heart attack, paralysis, blindness, stroke, numbness and dementia.

Tertiary syphilis is lethal. While antibiotics can cure a syphilis infection even during these late stages, they cannot reverse any permanent damage done to the body by syphilis-related complications.

If you have syphilis, it is important to tell your partner(s)

You should inform your partner about your syphilis infection as soon as possible. Syphilis is not only a highly contagious disease, it is a potentially fatal one as well.

If you test positive for syphilis, chances are your sex partner has it as well. For this reason, it is wise for you and your partner to get tested and treated for syphilis together, so that you can minimize your chances of re-acquiring the infection or passing it along to someone else.

If you are pregnant, get tested for syphilis

Syphilis is very harmful to infants and unborn babies. It can cause a mother to miscarry or the baby to be stillborn.

Syphilis can easily be transmitted to a fetus from the placenta or transfer to the baby in the birth canal during delivery. It can cause serious or even fatal infections.

Infants with congenital syphilis are often born prematurely and if left untreated, syphilitic babies will likely develop serious issues in internal organs like the heart, brain, skin, eyes, ears, bones and teeth.

Syphilis can be treated during pregnancy with antibiotics to both decrease the risk of spreading it to the baby and stop the infection’s progression in the mother.

If a chancre is present on the breast or nipple, mothers should not breastfeed.

HIV and syphilis

According to the CDC, a person is 2-5 times more likely to contract HIV if exposed when syphilis sores are present. Oral, anal, vaginal, or penile syphilis sores also make it easier to contract HIV and spread it to others.

It is easier to contract or transmit because syphilis sores bleed easily and are more likely to come in contact with mucous openings in the penis, vagina, anus and/or mouth.

Is There a Syphilis Cure?

Yes, there is a cure for syphilis. There are treatment options that can eradicate the disease from your body.

How is Syphilis Treated?

Syphilis can usually be treated with a single round of penicillin. Penicillin is an antibiotic that eliminates the bacterium which causes syphilis and is most often administered through an intramuscular injection.

If you test for syphilis and the results are positive, you are eligible for a phone consultation with one of our doctors. During this call, the doctor can provide more insight on how to move forward with treatment.

There are no existing over-the-counter drugs or at-home remedies that will cure or treat syphilis.

Treatment in Different Stages of Syphilis

A single penicillin shot is intended for someone who has early-stage syphilis, however, multiple shots may be required for someone with syphilis that is in its later stages.

If the infection has progressed too far, it may be too late to reverse complications. This is why it is so important to be tested regularly for STDs.

What To Expect When Being Treated for Syphilis

Treatment will kill the bacterium causing the infection, but it will not repair the damage that has already been done to your body.

When you receive a penicillin injection, you may experience the following symptoms:

  • Nausea
  • Chills
  • Muscle aches
  • Joint Pain
  • Headaches
  • Fever

Side effects are common in the first 24 hours. If they continue, contact your primary healthcare provider.

What Happens if a Syphilis Infection is Not Treated?

If a syphilis infection is left untreated it can reach advanced stages and cause irreversible damage to the heart, brain, and nervous system.

Other side effects include blindness, paralysis, and increased vulnerability to HIV. Additionally, syphilis is highly contagious and can spread to sexual partners.

Can I Get Re-Infected With Syphilis?

Yes, you can get syphilis more than once. Back to back cases often occur in patients whose partners were not also tested and treated or those who did not abstain from sexual activity during treatment.

We advise getting tested again 3 months after treatment is complete to ensure that the bacteria is completely gone.

Getting treated for syphilis does not protect you from re-infection. That’s why it’s recommended to test for syphilis and other STDs at least once a year.

When is the right time to test for syphilis?

Our test can detect syphilis antibodies as early as 1 – 2 weeks post exposure. However, the test is most accurate at 12 weeks post exposure.

If you’re experiencing symptoms, get tested now! If you’re worried but not experiencing symptoms, wait at least 2 weeks before testing.

Should I test for other STDs?

Yes! If you had a recent potential exposure to syphilis, it is likely that you were also potentially exposed to other STDs.

Both chlamydia and gonorrhea are two other bacterial infections that tend to happen simultaneously.

Both tend to be asymptomatic, and both have risk of developing severe consequences if left untreated. If you haven’t yet, be sure to check out our chlamydia and gonorrhea panel.

Additionally, having a syphilis infection causes you to be 2 – 5 times more likely to develop HIV. If you’re worried that you may have been exposed to syphilis, we highly recommend getting tested for HIV as well.

What is syphilis rash?

Syphilis rash is a symptom of the syphilis STD. It is a rash that can appear anywhere on the body. Its emergence indicates that syphilis has entered the body, progressed past its primary stage, and is now entering its secondary stage.

When does it appear?

The rash appears 2 to 8 weeks after the initial syphilis infection. The initial stage of the syphilis rash is characterized by a round, painless bump called a chancre.

Multiple chancres can appear, but typically there is only one. The rash can emerge while the chancre is still visible, or after the chancre has gone away.

How long does it stay?

The rash will go away on its own, but it can stay for 2 to 6 weeks at a time, and it may come and go for up to 2 years.

Why is it called secondary syphilis rash?

You may hear the term “secondary syphilis rash” because the appearance of the rash indicates that syphilis has entered into the secondary stage of its infection.

In the secondary stage, the disease becomes systemic. This means that it begins to involve various organs and systems in the body. This is also why the rash can appear on any part of the body.

What does the rash look and feel like?

The rash is made up of small, red or reddish-brown bumps. The bumps typically feel rough to the touch, but they can sometimes be smooth.

Unlike typical rashes, a syphilis rash is not itchy, and it can be very faint. This is why the rash may be hard to recognize and may not even be noticed at all.

Where does it occur?

The biggest indicator that any given rash is a syphilis rash is if the rash appears on the palms of the hands and/or soles of the feet. Though this is a typical symptom, the rash does not always appear there.

The rash can occur all over the body or it can be centralized to one location. Additionally, the rash can come and go for up to 2 years and may appear in different locations each time it reemerges.

Is syphilis rash contagious?

The rash is a highly contagious vector for spreading syphilis. Worst of all: Because the rash can occur on the palms, syphilis can even be passed through casual contact, such as a handshake

Can other symptoms occur along with a rash?

The following symptoms may appear with, after, or instead of a syphilis rash. All of these symptoms mean that syphilis is in its secondary stage:

  • Headache
  • Fever
  • Patchy hair loss
  • Sore throat
  • Swollen lymph nodes
  • Lesions in the mouth, throat, nostrils, vagina, anus, or any other mucous membrane

How can I treat the rash?

There is no way to cure the rash without treating the root cause. The rash will go away on its own, but syphilis will not without diagnosis and antibiotics.

What to do if you have a syphilis rash

If you think you have a syphilis rash, get tested. Don’t wait! After its secondary stage, syphilis enters into its latent stage, where the STD can lay dormant for decades. This may trick you into thinking that the syphilis has cleared up on its own, which is false.

The secondary stage is your last chance to catch syphilis before it can begin to severely affect other organs, including your brain. Getting treated early is the only way to prevent syphilis from causing irreversible damage. Get tested for syphilis.