Syphilis

What is syphilis?

Syphilis is a bacterial sexually transmitted infection or STI. It is caused by the bacterium, Treponema pallidum. This STI spreads through direct skin-to-skin contact during vaginal, oral, or anal sex.

How does syphilis enter your body?

Syphilis enters the body through direct contact with a person with syphilis during oral, vaginal, or anal sex.

Syphilis can also be passed from a pregnant person with syphilis to their baby during pregnancy or childbirth. This is known as congenital syphilis and can be very dangerous for the baby.

Can syphilis be treated?

Yes! Syphilis can be treated. The most common treatment is a long-lasting penicillin injection. If you are pregnant, penicillin is the only recommended treatment. If you're allergic to penicillin, talk with a health care provider about other treatment options.

If left untreated, syphilis can progress and lead to more serious and even life-threatening health problems.

Things to keep in mind after treatment:?

  • Follow-up testing: After syphilis treatment, it's important to get tested again to be sure the infection is gone.
  • Partner testing and treatment: Your sexual partner(s) also need to be tested and treated if they have syphilis. This prevents reinfection.
  • Past infections: If you've had syphilis before, inform your health care provider so they can provide the most appropriate treatment for you.

What are the symptoms of syphilis?

Syphilis symptoms and effects on the body depend on the stage of disease. There are four stages of syphilis. If it is left untreated, syphilis will damage the body over time.

The Four Stages of Syphilis:

1. Primary – First stage of syphilis:

The first stage of syphilis is also the most infectious. It typically begins with a sore appearing where the infection entered your body. Sometimes, there can be more than one sore. These sores can show up on the penis, lips, or around the vagina, anus, or mouth.

  • This stage occurs 10 to 90 days after infection.
  • The sore is usually firm, round, and painless, although some people experience pain.
  • You might not notice the sore, or you could mistake it for something else.
  • The sore may heal on its own within 3-6 weeks, but without treatment, the infection stays in your body.
  • Some people also feel tired, have swollen glands, or get headaches during this stage.
  • Without treatment, syphilis can progress to the next stage.

2. Secondary – Second stage of syphilis:

After the primary sore(s) heals, syphilis can cause a rash. It usually appears about 4-10 weeks later.

  • The rash commonly appears on the palms of your hands, the soles of your feet, or on your upper body.
  • Even without treatment, the rash may go away on its own. However, syphilis remains in your body and requires treatment to prevent it from progressing.

3. Latent – Third stage of syphilis:

The latent stage of syphilis is sometimes called the third stage. Symptoms are hidden:

  • This stage occurs years to decades after infection.
  • There are no signs or symptoms. Even though you don't see or feel anything, the infection is still in your body.
  • This stage can last for years if syphilis isn't treated. During this time, syphilis can quietly cause serious damage to your organs without you knowing.

4. Tertiary – Final stage of syphilis:

In the final stage of syphilis, the infection can cause serious health problems years later if it's not treated. The problems may include:

  • Blindness, hearing loss, memory problems, nerve damage, and heart disease.
  • These complications can develop sooner than expected, especially without early treatment.

Note about symptoms of syphilis:

  • Some people may not have any symptoms, or they may not notice symptoms.
  • Sometimes symptoms go away on their own, but that doesn't mean the infection is gone.
  • Syphilis can look like other health problems – like pimples, rashes, or allergic reactions. This is why syphilis is known as the "great imitator."

Is there a test for syphilis?

Yes! Most of the time, health care providers use a blood test to detect syphilis. Sometimes, they may test fluid from a sore or use a rapid finger-stick syphilis test. They can also look at your sores or rashes to help make a diagnosis. If you use an at-home syphilis test, you still need to see a health care provider to confirm the result and get treatment.

It's important to tell the health care provider if you've had syphilis in the past and if you've been treated for it. This will help them provide the best care for you.

How do I prevent syphilis?

  • Use barriers to reduce the risk of STIs:
    • Condoms: Condoms act as a protective barrier. Always use a latex or polyurethane condom during oral, vaginal, or anal sex. Using condoms consistently and correctly helps lower the risk of syphilis, HIV, pregnancy, and other STIs.
    • Dental dams: Dental dams are thin sheets of latex or other materials used during oral sex. Place a dental dam over the vagina, anus, or other genital areas during sexual contact. Dental dams create a barrier that helps reduce the risk of spreading syphilis and other STIs.
      Note about protective barriers: Condoms and dental dams don't fully protect you if the syphilis sore or rash is on a body part not covered by the barrier.
  • Ask a health care provider about Doxycycline Post-Exposure Prophylaxis or Doxy-PEP: If you sometimes or usually have condomless sex, ask a health care provider about Doxy-PEP. When taken within 24-72 hours after sex, Doxy-PEP can lower your chance of getting syphilis, chlamydia, and/or gonorrhea. Doxy-PEP is not recommended for pregnant people. Learn more about Doxy-PEP.
  • If your sexual partner has symptoms, delay sexual contact. Avoid having anal, oral, or vaginal sex. This is called abstinence. It is an effective way to prevent syphilis and other STIs. This is especially important if your partner(s) has symptoms of syphilis or they are being treated for it.

What if I've been exposed to syphilis?

Syphilis can be hard to spot. Many people don't notice symptoms, or they may heal on their own. But the infection stays in the body and can spread to others through skin-to-skin sexual contact if it's not treated. That's why it's important to get tested and treated.

Some helpful suggestions:

  • If you are sexually active, get tested for syphilis and other STIs.
  • If you are pregnant, get tested for syphilis and other STIs.
  • If you or your sexual partner(s) have a new partner, your partners should also get tested before you start having sex.

If you are diagnosed with syphilis:

  • Start treatment right away. Your sex partner(s) must also be treated for syphilis to prevent reinfection. If only you or your partner are treated, it is easy to pass the infection back and forth and to others.
  • Do not have vaginal, anal, or oral sex until at least 7 days after you and your partner(s) finish all medicine.
  • Follow-up testing is important to ensure the infection is gone.

Find testing:

What about syphilis and HIV?

Having syphilis can increase your risk of getting HIV. Having HIV can increase your risk of getting syphilis. People who have both untreated HIV and syphilis are also more likely to transmit HIV to their sex partner(s). The best way to protect yourself and others is to know your status, get tested and, if needed, start treatment.

What about syphilis and pregnancy??

Having syphilis during pregnancy can seriously affect a baby's health. The infection can be passed to the baby during pregnancy or during vaginal delivery. This is called congenital syphilis. How syphilis affects the baby depends on how long the pregnant person has had the infection. It also depends on whether the infection is treated in time. Regular prenatal care and early testing are important.

Syphilis during pregnancy can cause:

  • Miscarriage – losing the baby during pregnancy
  • Stillbirth – baby born without signs of life
  • Premature birth – baby born too early
  • Low birth weight or other birth problems – baby weighs less than expected, which may affect development
  • Death of the baby shortly after birth – due to severe infection or organ damage

Pregnant people should be tested for syphilis 3 times during pregnancy:

  • At the first prenatal visit – at first checkup during pregnancy
  • At the beginning of the third trimester – 28-32 weeks, ideally at 28 weeks
  • At delivery – when the baby is born

If you are pregnant, getting tested and treated for syphilis early is important for both you and the baby's health. Ask a health care provider about syphilis testing at your next health care appointment, prenatal care visit, urgent care visit, or emergency room visit. Ask about syphilis testing anywhere you receive health care during your pregnancy.

For more information on syphilis during pregnancy, visit: Congenital Syphilis

Other reminders about sexual health:

  • Have a sexual health routine. Have a plan for sexual activity and preventing STIs.
  • Watch for symptoms of STIs. Stay aware of changes in your body like sores, rashes, unusual discharge, or pain.
  • Talk openly with your partner(s) about sexual health. It builds trust and helps everyone make informed choices.
  • Get routine STI testing. Many STIs have no symptoms. You may not know you have an STI unless you get tested. Get Tested | Centers for Disease Control and Prevention; AIDS Institute Provider Directory
  • Know your HIV status: Get tested for HIV and talk to a health care provider about your options to prevent HIV:
  • HIV PrEP – medicine to prevent HIV before exposure
  • HIV PEP – emergency medicine to take after a possible HIV exposure
  • If you are living with HIV, keep taking your medicines and see your health care provider regularly.
  • Stay up to date on vaccines: Vaccines and Immunization
    • Human Papilloma Virus (HPV) vaccine
    • Hepatitis B vaccine
    • Mpox vaccine