What is Syphilis?

Syphilis is a curable, bacterial sexually transmitted infection (STI) that can cause serious health problems​ if left untreated. Infection develops in stages (primary, secondary, latent, and tertiary). Each stage can have different signs, symptoms, and treatment(s). Having a syphilis infection may increase one’s risk of becoming infected with HIV.

Anyone who is sexually active can get syphilis through vaginal, anal, or oral sex without a condom or with the use of doxy-PEP. If you are sexually active, have an honest and open conversation with your health care provider and ask them if you should get tested for syphilis or other STIs, and if doxyPEP is right for you.​

If you are sexually active, you should get tested for syphilis. You should get tested more frequently for syphilis if you:

• Are a gay or bisexual cisgender man

• Are a transgender or gender diverse person

• Have HIV
  

• Are taking pre-exposure prophylaxis (PrEP) for HIV prevention

• Are taking doxy-PEP

• Have partner(s) who have tested positive for syphilis or other STIs
  

All pregnant people should receive syphilis testing  at their first prenatal visit and again during the third trimester. delivery. Additionally, many, but not all pregnant people should also be tested for syphilis at delivery.​

You can get syphilis by direct contact with a syphilis sore (called a chancre) during sex. These sores can be anywhere on the body, but most commonly occur at sites of sexual contact like the vagina, penis, anus, and mouth.. Syphilis can also spread from a pregnant person with syphilis to their unborn baby during pregnancy. You cannot get syphilis through casual contact with objects, such as:

• Toilet seats

• Doorknobs

• Swimming pools

• Hot tubs

• Bathtubs
  

• Sharing clothing, or eating utensils
  

Signs and symptoms

There are four stages of syphilis (primary, secondary, latent, and tertiary). Each stage has different signs, symptoms, and treatment(s).

Primary Stage

During the first (primary) stage of syphilis, you may notice a single sore (called a chancre) or even multiple sores. The sore is the location where syphilis entered your body. These sores can occur anywhere on the body, but usually occur in, on, or around the:

• Penis

• Vagina or front hole

• Anus or back hole

• Rectum

• Lips or in the mouth
  

Sores are usually (but not always) firm, round, and painless. Because the sore is painless, you may not notice it. The sore usually lasts three to six weeks and heals regardless of whether you receive treatment. Even after the sore goes away, you must still receive treatment. Syphilis treatment will stop your infection from moving to the next stages (and prevent you from passing it to someone else).

Secondary Stage

During the secondary stage, you may have skin rashes, sores in your mouth, and/or wart like growths around the vagina, penis, or anus. This stage usually starts with a rash on one or more areas of your body. The rash can show up when your initial, or primary sore(s) is healing or several weeks after the sore(s) has healed. The rash can be on the palms of your hands and/or the bottoms of your feet and look:

• Dry or rough appearing

• Red

• Reddish-brown

The rash usually won’t itch, and it is sometimes so faint that you won’​t notice it. Other symptoms may include:

• Fever

• Swollen lymph glands

• Sore throat

• Patchy hair loss

• Headaches
  

• Weight loss

• Muscle aches
  

• Fatigue (feeling very tired)

The symptoms from this stage will go away whether you receive treatment or not. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.

Latent Stage

The latent stage of syphilis is a period when there are no visible signs or symptoms of infection. Without treatment, syphilis will remain in your body. And although you will not have symptoms of syphilis during this stage, syphilis can still cause complications by infecting your brain (called neurosyphilis), eyes (called ocular syphilis), ears (called otosyphilis) and/or with  pregnancy (called congenital syphilis) should you become pregnant while infected.​

Tertiary Stage

Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen, it occurs 10 to 30 years after your infection began. Tertiary syphilis is very serious and can result in death. It may damage many different organ systems including the nerves, brain, blood vessels, heart, skin, bones, and liver. A health care provider can usually diagnose tertiary syphilis with the help of multiple tests.

Neurosyphilis, Ocular Syphilis, and Otosyphilis

Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis). This can happen during any of the stages described above.

Signs and symptoms of neurosyphilis can include:

• Headache
  

• Muscle weakness and/or trouble with muscle movements

• Changes to your mental state (trouble focusing, confusion, personality change) and/or dementia (problems with memory, thinking, and/or decision making)

​Signs and symptoms of ocular syphilis can include:

• Eye pain and/or redness
  

• Changes in your vision or even blindness
  

Signs and symptoms of otosyphilis may include:

• Hearing loss

• Ringing, buzzing, roaring, or hissing in the ears (“tinnitus​​”)

• ​Dizziness or vertigo (feeling like you or your surroundings are moving or spinning)

Testing

Most of the time, health care providers will use a blood test to test for syphilis. Some will diagnose syphilis by testing fluid from a syphilis sore.

Prevention

If you are having sex, you can do the following things to lower your chances of getting syphilis:

• Have sex only with partner(s) who have been tested and who do not have syphilis.

• Use  condoms every time you have sex

• Use doxyPEP - talk to a health care provider to see if doxyPEP is right for you
  

Condoms prevent the spread of syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

If you think you’​​ve been exposed to a syphilis sore or someone who has tested positive for syphilis, tell your health care provider. You may need treatment to prevent developing syphilis yourself. Also, ask your provider about doxy-PEP. Doxy-PEP is a medication you take within 72 hours of having sex to reduce your risk of infection from syphilis, chlamydia, and gonorrhea.

Syphilis is curable!

Syphilis is curable with the right antibiotics from your health care provider. However, treatment might not undo any damage the infection can cause so it’​s important to get treatment as soon as possible. Having syphilis once does not protect you from getting it again. Regular testing is the best way to identify infection early so you can get treatment and prevent complications from syphilis. Speak with a health care provider to determine how often you should get tested.​