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Syphilis

Syphilis At A Glance

  • Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.
  • It usually spreads through direct contact with an infectious sore during vaginal, anal, or oral sex and can also pass during pregnancy.
  • Early symptoms may include a painless sore, while later stages can cause rash, swollen lymph nodes, fever, fatigue, or no symptoms at all.
  • Untreated syphilis can remain in the body for years and eventually damage the brain, nerves, eyes, ears, heart, blood vessels, or other organs.
  • Diagnosis usually involves blood testing, sometimes combined with direct testing of a sore.
  • Syphilis can be cured with appropriate antibiotics, although treatment may not reverse damage that has already occurred.

Table of Contents

Table of Contents

What Is Syphilis?

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It usually spreads through direct contact with a syphilis sore during vaginal, anal, or oral sex. It can also pass from a pregnant person to a fetus and cause serious illness or death in the baby.

Syphilis develops in stages and is sometimes called the “great imitator” because its symptoms can look like many other conditions. A person may have no symptoms for years while the infection remains in the body. Antibiotics can cure syphilis, but treatment may not reverse damage that has already occurred.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

Syphilis – NIH MedlinePlus
https://medlineplus.gov/syphilis.html

Offers reliable patient education about symptoms, testing, treatment, and prevention.

How Common Is Syphilis?

Syphilis remains an important public-health problem in the United States. Anyone who has sexual contact can acquire it, and many people do not know they are infected because sores may be painless or hidden.

Rates are higher in some groups, including men who have sex with men and people living with HIV. Congenital syphilis has also increased, making early and repeated pregnancy testing especially important for people at risk.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

What Symptoms Might You Notice?

Symptoms vary by stage and may disappear without treatment even though the infection remains:

  • Primary Stage: One or more firm, round sores called chancres, often painless, at the genitals, anus, rectum, lips, or mouth.
  • Secondary Stage: A rough red or reddish-brown rash, often on the palms or soles; mouth, genital, or anal sores; swollen lymph nodes; fever; sore throat; patchy hair loss; headache; muscle aches; fatigue; or weight loss.
  • Latent Stage: No visible symptoms, sometimes for years.
  • Tertiary Stage: Rare but serious damage to the heart, blood vessels, brain, nerves, eyes, bones, or other organs.
  • Neurologic, Eye, or Ear Disease: Severe headache, weakness, confusion, personality change, vision changes, eye pain, ringing in the ears, dizziness, or hearing loss can occur at any stage.

A sore or rash may heal on its own, but that does not mean the infection is gone. Testing is the only reliable way to know.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

How Is Syphilis Diagnosed?

A healthcare provider asks about symptoms, sexual exposures, prior tests or treatment, pregnancy, medicines, and neurologic, eye, or hearing changes. They may examine the mouth, skin, genitals, anus, lymph nodes, nervous system, eyes, and ears.

Diagnosis usually requires a blood screening test plus a different confirmatory test. The result is interpreted with symptoms, examination, past treatment, and possible exposure because no single blood test can answer every question.

Learn More

Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

Provides clinical guidance about diagnosis, staging, treatment, follow-up, HIV testing, and partner care.

Syphilis Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/syphilis-tests/

Explains blood testing, sore testing, preparation, and what results may mean.

Syphilis infographic – click to enlarge

What Causes Syphilis?

Syphilis is caused by bacteria passed through direct contact with an infectious sore or rash. Common routes include:

  • Vaginal, anal, or oral sex
  • Skin-to-skin sexual contact with a syphilis sore
  • Sharing sex toys without cleaning them or changing condoms
  • Transmission through the placenta during pregnancy
  • Rare transmission through blood exposure in settings where blood is not screened

Syphilis is not spread by toilet seats, door handles, swimming pools, bathtubs, shared clothing, or casual contact. Sores may be inside the vagina, rectum, mouth, or under the foreskin and may not be noticed.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

What Can Make Syphilis Worse?

Untreated infection can remain in the body and eventually damage major organs. These factors increase the chance of complications or reinfection:

  • Delaying testing or treatment after an exposure or symptom
  • Missing penicillin doses or follow-up blood tests
  • Having sex before treatment is complete and partners have been evaluated
  • A new exposure to an untreated partner
  • Pregnancy without early prenatal testing and treatment
  • HIV or another condition that affects the immune system
  • Ignoring new vision, hearing, or neurologic symptoms

Alcohol or recreational drug use may increase sexual risk or make follow-up harder, but neither causes syphilis. Symptoms disappearing without antibiotics does not mean the infection has cleared.

Prevention

There is no vaccine for syphilis. Risk can be lowered by:

  • Using condoms or dental dams correctly every time
  • Avoiding sex when either partner has an unexplained sore or rash
  • Reducing the number of sexual partners or choosing mutual monogamy with a tested partner
  • Getting regular syphilis and other STI testing based on your sexual practices and local guidance
  • Testing early in every pregnancy and repeating later when required or when risk continues
  • Making sure partners are treated before sex resumes
  • Using HIV PrEP when appropriate and continuing STI screening while taking it
  • Avoiding shared needles and not sharing sex toys unless cleaned and covered

Condoms do not cover every possible sore. Testing and prompt treatment are central to preventing transmission and congenital syphilis.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

Condom Use – CDC
https://www.cdc.gov/condom-use/

Shows how to use condoms correctly and explains how they reduce STI risk.

Getting Tested for HIV – CDC
https://www.cdc.gov/hiv/testing/index.html

Explains HIV testing options, timing, and where to get tested.

Learn More About Syphilis

The following video content is provided to help you better understand this condition. These resources are intended for educational purposes and should not replace personalized medical advice from your healthcare provider.

Labs

Syphilis testing may include:

  • RPR or VDRL: Nontreponemal blood tests that produce a titer used to help diagnose infection and monitor response to treatment.
  • Treponemal Test: Confirms exposure to syphilis bacteria; it often stays positive for life, even after cure.
  • Direct Test From a Sore: Darkfield microscopy or a molecular test may identify the bacteria when available.
  • HIV Test: Recommended for everyone diagnosed with primary or secondary syphilis and generally offered with any syphilis diagnosis.
  • Other STI Tests: Gonorrhea, chlamydia, hepatitis, or pregnancy testing may be offered based on risk.

Very early infection can produce a negative blood test. Repeat testing may be needed after a recent exposure. Follow-up usually uses the same type of nontreponemal test so titers can be compared accurately.

Learn More

Syphilis Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/syphilis-tests/

Explains blood testing, sore testing, preparation, and what results may mean.

Getting Tested for HIV – CDC
https://www.cdc.gov/hiv/testing/index.html

Explains HIV testing options, timing, and where to get tested.

Diagnostics

Most people do not need imaging. Additional evaluation depends on symptoms:

  • Lumbar Puncture: Tests spinal fluid when neurologic findings suggest neurosyphilis or when a clinician has another specific concern.
  • Complete Eye Examination: Needed urgently for eye pain, redness, light sensitivity, or vision change.
  • Hearing and Balance Evaluation: Used for sudden hearing loss, ringing, dizziness, or balance problems.
  • Brain or Heart Imaging: May be ordered when late complications are suspected.
  • Pregnancy Ultrasound: May assess the fetus when syphilis is diagnosed later in pregnancy, but it must not delay treatment.

Routine spinal-fluid testing is not needed simply because a blood test is positive. Examination findings and symptoms guide the decision.

Learn More

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

Syphilis During Pregnancy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm

Provides guidance about testing, penicillin treatment, fetal evaluation, and follow-up during pregnancy.

Treatment & Management

Treatment Options

Penicillin G is the preferred treatment for every stage. The specific form, dose, route, and number of doses depend on the stage, duration, symptoms, pregnancy status, and whether the brain, eyes, or ears may be involved.

  • Early Syphilis: Usually one intramuscular injection of long-acting benzathine penicillin G.
  • Late Latent or Unknown Duration: Usually three benzathine penicillin G injections, given one week apart.
  • Neurosyphilis, Ocular Syphilis, or Otosyphilis: Usually high-dose intravenous penicillin for 10–14 days.
  • Pregnancy: Penicillin is the only proven treatment that treats the fetus and prevents congenital syphilis.
  • Penicillin Allergy: Some nonpregnant adults may have alternatives, but close follow-up is essential; pregnancy requires allergy evaluation or desensitization followed by penicillin.

Treatment regimens must be prescribed by a clinician. Do not use leftover antibiotics or substitute oral penicillin products, which do not provide reliable treatment for syphilis.

Learn More

Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

Provides clinical guidance about diagnosis, staging, treatment, follow-up, HIV testing, and partner care.

Primary and Secondary Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm

Explains recommended treatment and follow-up for early symptomatic syphilis.

Latent Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/latent-syphilis.htm

Explains treatment and monitoring when syphilis is present without symptoms.

Lifestyle Changes

Treatment works best when paired with steps that prevent reinfection:

  • Avoid sexual contact until treatment is complete, sores are healed, and your clinician says it is safe.
  • Make sure recent partners are notified, evaluated, and treated when recommended.
  • Use condoms or dental dams correctly for vaginal, anal, and oral sex.
  • Keep every follow-up blood-test appointment.
  • Test for HIV and other STIs as recommended.
  • Discuss HIV PrEP if ongoing exposure risk is possible.
  • Avoid sharing sex toys, or clean them and use a new condom for each person or body area.

Condoms lower risk but may not cover a sore outside the protected area. Regular testing remains important when exposure risk continues.

Learn More

Condom Use – CDC
https://www.cdc.gov/condom-use/

Shows how to use condoms correctly and explains how they reduce STI risk.

Getting Tested for HIV – CDC
https://www.cdc.gov/hiv/testing/index.html

Explains HIV testing options, timing, and where to get tested.

Medications

Common treatment medicines include:

  • Benzathine Penicillin G: A long-acting injection used for primary, secondary, early latent, late latent, or unknown-duration syphilis.
  • Aqueous Crystalline Penicillin G: Intravenous treatment used for neurosyphilis, ocular syphilis, and otosyphilis.
  • Alternative Antibiotics: Doxycycline or ceftriaxone may be considered for selected nonpregnant adults with penicillin allergy; follow-up must be reliable.
  • Penicillin Desensitization: A supervised process used when penicillin is essential, especially during pregnancy.

Within 24 hours after treatment, some people develop a Jarisch-Herxheimer reaction: fever, chills, headache, muscle aches, or worsening rash. This is a response to dying bacteria, not usually a penicillin allergy. Contact your clinician for guidance; pregnancy symptoms such as contractions or reduced fetal movement need urgent obstetric care.

Learn More

Penicillin Allergy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

Explains allergy evaluation and why penicillin is essential for syphilis during pregnancy and certain serious forms.

Syphilis During Pregnancy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm

Provides guidance about testing, penicillin treatment, fetal evaluation, and follow-up during pregnancy.

Procedures

Most syphilis care involves examination, blood testing, and antibiotic treatment rather than surgery. Procedures may include:

  • Intramuscular Injection: Long-acting penicillin is placed deep into a large muscle; soreness is common.
  • Intravenous Therapy: A vein catheter delivers frequent or continuous penicillin for serious neurologic, eye, or ear disease.
  • Lumbar Puncture: Collects spinal fluid after numbing the lower back when neurosyphilis is suspected.
  • Eye or Hearing Examination: Specialists test vision, eye structures, hearing, and balance when symptoms occur.
  • Penicillin Desensitization: Carefully increasing doses are given in a monitored setting for certain allergic patients.

Ask why a procedure is needed, what discomfort or risks to expect, and how the result will change treatment.

Learn More

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

Penicillin Allergy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

Explains allergy evaluation and why penicillin is essential for syphilis during pregnancy and certain serious forms.

What Should You Expect Long-Term?

Correct antibiotics cure the infection and prevent future damage, but they may not repair injury already caused to the brain, eyes, hearing, heart, or other organs. Blood titers usually fall after successful treatment, but a treponemal test often remains positive for life.

Follow-up blood tests are essential. Timing depends on the stage, pregnancy, HIV status, and clinical situation. A rising titer, new symptoms, or a new exposure may mean reinfection or treatment failure and requires reevaluation.

Learn More

Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

Provides clinical guidance about diagnosis, staging, treatment, follow-up, HIV testing, and partner care.

Primary and Secondary Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm

Explains recommended treatment and follow-up for early symptomatic syphilis.

Latent Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/latent-syphilis.htm

Explains treatment and monitoring when syphilis is present without symptoms.

What Can You Do At Home?

After diagnosis and treatment:

  • Follow the exact treatment and follow-up schedule.
  • Do not have sex until your clinician’s recommended waiting period has passed and sores are fully healed.
  • Tell recent partners or ask the health department for confidential partner-notification help.
  • Write down the treatment date, medicine, dose, and test titers for future care.
  • Expect possible injection-site soreness and ask which pain reliever is safe for you.
  • Contact the clinic for fever or body aches after treatment and urgently report pregnancy warning signs.
  • Seek immediate help for new vision, hearing, severe headache, confusion, weakness, or balance changes.

Do not attempt to treat syphilis with herbs, supplements, topical products, or leftover antibiotics. Only the correct antibiotic regimen can cure it.

Frequently Asked Questions

Can syphilis go away without treatment?

Symptoms can disappear, but the bacteria remain in the body. Only appropriate antibiotics cure the infection.

Can I get syphilis from a toilet seat?

No. It is not spread through toilet seats, pools, bathtubs, clothing, or casual contact.

Does one positive test prove active syphilis?

Not always. Providers interpret two types of blood tests with your history, symptoms, and prior treatment.

Will my syphilis test always be positive?

Treponemal tests often remain positive for life. RPR or VDRL titers are used to follow treatment response and may become negative or remain low-positive.

Can I spread syphilis with no symptoms?

Sexual spread is most common during early stages when sores or rashes may be unnoticed. Pregnancy transmission can occur during latent infection.

Does syphilis treatment protect me in the future?

No. Treatment cures the current infection but does not create immunity. Reinfection is possible.

Can syphilis affect pregnancy?

Yes. It can cause miscarriage, stillbirth, premature birth, newborn death, or congenital syphilis. Prompt penicillin treatment is essential.

Is the treatment reaction an allergy?

The short-term Jarisch-Herxheimer reaction is caused by the body’s response to treatment and is usually not a penicillin allergy, though severe allergic symptoms still require emergency care.

Questions To Ask Your Provider

Consider asking:

  • What stage of syphilis do I have?
  • Do I need repeat testing because exposure may have been recent?
  • What do my RPR or VDRL titer and confirmatory test mean?
  • Which penicillin regimen do I need?
  • What should I expect after the injection?
  • When is it safe to have sex again?
  • When should my blood tests be repeated?
  • Which partners need evaluation or treatment?
  • Should I be tested for HIV or start HIV PrEP?
  • Do my eye, hearing, or neurologic symptoms need urgent specialist care?
  • How does this diagnosis affect pregnancy or future pregnancy?

Specialist Referrals

Many cases can be managed in primary care or an STI clinic. Referral may be made to:

  • Infectious Disease Specialist: For neurosyphilis, unusual disease, treatment failure, HIV, or complex allergy.
  • Ophthalmologist: Urgent evaluation for eye pain, redness, light sensitivity, or vision change.
  • Ear, Nose, and Throat Specialist or Audiologist: Urgent evaluation for hearing loss, ringing, dizziness, or balance problems.
  • Neurologist: For severe headache, weakness, numbness, confusion, memory change, or other nervous-system symptoms.
  • Obstetrician or Maternal-Fetal Medicine Specialist: For syphilis during pregnancy or fetal concerns.
  • Cardiologist: For suspected late cardiovascular involvement.
  • Allergist: For penicillin allergy testing or treatment planning.

Learn More

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

Syphilis During Pregnancy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm

Provides guidance about testing, penicillin treatment, fetal evaluation, and follow-up during pregnancy.

Is Syphilis Curable?

Yes. Syphilis is curable with the correct antibiotics. Treatment stops the infection and prevents additional injury, but it may not reverse damage that already occurred before treatment.

A person can get syphilis again after being cured. Partners must be evaluated, and ongoing prevention and repeat testing may be needed.

Learn More

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

Emergency Symptoms / When To Seek Immediate Help

Seek urgent or emergency care for:

  • Sudden vision loss, blurred vision, eye pain, redness, or strong light sensitivity
  • Sudden hearing loss, severe ringing, dizziness, or loss of balance
  • Severe headache, stiff neck, confusion, personality change, weakness, numbness, trouble walking, or seizure
  • Chest pain, fainting, severe shortness of breath, or stroke-like symptoms
  • A severe allergic reaction with trouble breathing, facial or throat swelling, fainting, or widespread hives
  • Pregnancy with fever, contractions, bleeding, fluid leakage, or reduced fetal movement after treatment
  • A newborn possibly exposed to untreated or inadequately treated syphilis during pregnancy

Brain, eye, ear, heart, and pregnancy complications can cause permanent injury or death. Do not wait for a routine appointment when these symptoms occur.

Learn More

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

Syphilis During Pregnancy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm

Provides guidance about testing, penicillin treatment, fetal evaluation, and follow-up during pregnancy.

CALL 911

APNS does not provide emergency medical services. If you believe you are experiencing a medical emergency, including (but not limited to) chest pain, difficulty breathing, stroke symptoms, severe allergic reactions, anaphylaxis, uncontrolled bleeding, seizures, loss of consciousness, or any other potentially life-threatening condition, you are instructed to call 911 immediately or go immediately to the nearest emergency department.

Official Resources / External Links

About Syphilis – CDC
https://www.cdc.gov/syphilis/about/index.html

Explains symptoms, spread, testing, treatment, pregnancy risks, and prevention in patient-friendly language.

Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

Provides clinical guidance about diagnosis, staging, treatment, follow-up, HIV testing, and partner care.

Primary and Secondary Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm

Explains recommended treatment and follow-up for early symptomatic syphilis.

Latent Syphilis – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/latent-syphilis.htm

Explains treatment and monitoring when syphilis is present without symptoms.

Neurosyphilis, Ocular Syphilis, and Otosyphilis – CDC
https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

Describes urgent evaluation and treatment when syphilis affects the brain, eyes, or hearing.

Syphilis During Pregnancy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm

Provides guidance about testing, penicillin treatment, fetal evaluation, and follow-up during pregnancy.

Penicillin Allergy – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

Explains allergy evaluation and why penicillin is essential for syphilis during pregnancy and certain serious forms.

Syphilis Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/syphilis-tests/

Explains blood testing, sore testing, preparation, and what results may mean.

Syphilis – NIH MedlinePlus
https://medlineplus.gov/syphilis.html

Offers reliable patient education about symptoms, testing, treatment, and prevention.

Getting Tested for HIV – CDC
https://www.cdc.gov/hiv/testing/index.html

Explains HIV testing options, timing, and where to get tested.

Condom Use – CDC
https://www.cdc.gov/condom-use/

Shows how to use condoms correctly and explains how they reduce STI risk.

This guide is for education only and does not replace medical advice, examination, testing, diagnosis, or treatment from a healthcare professional. Syphilis symptoms may be absent or resemble other conditions, so testing and clinician-directed treatment are essential. Seek urgent care for vision or hearing changes, severe headache, confusion, weakness, seizure, serious allergic symptoms, pregnancy warning signs after treatment, or possible newborn exposure.

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