Syphilis guide


What is Syphilis?

Syphilis is sometimes referred to as "the great imitator" because many of its early signs and symptoms mimic those of other diseases. According to the Centers for Disease Control and Prevention (CDC), the number of syphilis cases has been steadily rising since 2000, predominately among women and men who have sex with men (MSM) … in fact, about 62% of reported new syphilis cases are among MSM.*

Syphilis is caused by a bacteria, Treponema pallidum, that can be passed from person to person through direct contact with a syphilis sore during unprotected vaginal, anal and oral sex. Sores can occur on the penis, vagina, anus or rectum, or on the lips and inside the mouth. It's also possible for a mother to pass syphilis to her baby during pregnancy or delivery, potentially causing miscarriage or stillbirth, or seizures and developmental delays in the baby.

The good news is that syphilis, in its early stages, is easily treated and curable with antibiotics … most commonly, penicillin. Left untreated, however, syphilis can lead to serious health problems down the road — including brain, cardiovascular and organ damage — and increase your risk of getting other STDs, like HIV.

Syphilis is most infectious during the primary and secondary stages of infection … and the earlier syphilis is diagnosed, the more successfully it can be treated and cured.



Syphilis risk factors

How do people get infected with syphilis?

Anyone can get syphilis … usually through direct contact with an infectious lesion during sexual activity, including kissing or touching a person who has lesions in or around the genitals, on the lips or inside the mouth. The most common risk factors are:

  • A history of unprotected sex
  • A new sexual partner
  • Multiple sexual partners
  • Men who have sex with men (MSM)
  • Pregnant women
  • Being HIV-positive

Due to reporting disparities and a number of other variables, there is a higher prevalence of syphilis among sexually active African-Americans. Generally-speaking, some ethnic/minority groups are more likely to use public clinics that report STD cases. As well, awareness of STDs and how to prevent them, and access to regular healthcare are inconsistent among populations that are disadvantaged by poverty and other social determinants … these groups may therefore be more likely to engage in risky sexual activity.

What are some ways that syphilis cannot be spread?

You cannot get syphilis from doorknobs, eating utensils, bath tubs, hot tubs, or swimming pools.

If I get syphilis once, is it possible to get it again?

Even if you've been treated for syphilis, you're not immune … you can be re-infected. That's why sexual partners should be treated at the same time so that an untreated partner still carrying the bacteria doesn't re-infect the treated partner.

Want to learn more?


Syphilis signs and symptoms

While syphilis can be silent for years, its symptoms typically occur in the following three stages, with symptoms and complications becoming more serious over time. Caught early, syphilis can be cured. That's why getting tested is so important.

Primary stage syphilis symptoms (within 2-3 weeks after exposure)

  • No obvious symptoms (a painless sore could be small or hidden)
  • A single sore (or chancre) that's round, firm and painless and can appear wherever the body was first infected (vagina, penis, anus, rectum or the mouth area). The sore may be internal — inside your throat or anal canal — so you may not know you have it.

Note: The sore may seem to heal without treatment within three h5 But, without treatment, the infection will potentially advance to the more serious secondary stage.

  • Swollen lymph glands (groin, armpit or neck)
  • Multiple round, firm and painless sores
  • Skin rash (rough, red or reddish-brown spots, usually on the soles of feet or palms of hands)

Secondary stage syphilis symptoms (within 2-12 weeks after primary stage symptoms)

People who don't get treated for syphilis in its primary stage generally stay infected with the secondary stage for up to one year. As in the primary stage, secondary stage sores may go away without treatment, but the syphilis infection will continue to advance and spread through the bloodstream.

  • Swollen lymph glands (groin, armpit or neck)
  • Headaches and fatigue
  • Sore throat
  • Skin rash
  • Sores on the vulva, vagina, penis, anus, rectum or mouth area
  • Moist, wart-like patches in skin folds or on the genitals (condylomata lata)
  • Loss of appetite and unintended weight loss
  • Fever and chills
  • Muscle aches
  • Hair loss

Latent stage syphilis symptoms (symptoms may be hidden for up to 30 years)

  • No obvious symptoms
  • Swollen lymph glands (groin, armpit or neck)
  • Headaches and fatigue
  • Sore throat
  • Sores on the vulva, vagina, penis, anus, rectum or mouth area
  • Moist, wart-like patches in skin folds or on the genitals (condylomata lata)
  • Loss of appetite and unintended weight loss
  • Fever and chills
  • Muscle aches
  • Hair loss
  • Muscle weakness and lack of coordination (walking can become difficult)
  • Problems with internal organs (brain, heart, kidney or liver functions)
  • Bone or joint deformities
  • Numbness or paralysis
  • Blindness
  • Impaired speech
  • Dementia (memory loss, difficulty concentrating, impaired judgment)


Syphilis complications

What if syphilis is untreated?

Left undiagnosed and untreated, the first three stages of syphilis evolve into its final, most serious stage … often decades after the initial exposure. In this tertiary stage, internal lesions and other long-term complications from the bacteria can result in damage to the nerves and arteries, heart problems, seizures or paralysis, speech and hearing impairment, blindness, dementia and other serious illnesses … even death. That's why getting tested is so important.

Syphilis and HIV

According to the Centers for Disease Control and Prevention (CDC), people with syphilis are two to five times more likely to get HIV, the virus that causes AIDS … and anyone with syphilis should be also be tested for HIV.

In general, someone who has one STD is at greater risk for infection with other STDs, including HIV. That's because STDs that cause ulcers, sores, or otherwise break the skin or mucous membranes make carriers more susceptible to infection … also, people with one or more STDs may have a weakened immune system that makes them more vulnerable to other diseases.

Syphilis and pregnancy

In the latent stage of syphilis, there's a risk that a mother infected by the bacteria can transmit it to her baby (congenital syphilis) which can cause physical deformity and neurological complications in the baby, or stillbirth … according to the CDC, untreated syphilis in pregnant women results in infant death in up to 40% of cases. But complications from syphilis in pregnancy can be greatly reduced by early testing and treatment with antibiotics.

If you're pregnant and concerned about syphilis, be sure to consult your regular doctor.


Syphilis testing

How do I get tested for syphilis?

We make getting testing for syphilis simple. We offer the Rapid Plasma Reagin (RPR) blood test that looks for antibodies that are present in the blood of people who are infected with the bacteria. The RPR With Reflex to Quantitative RPR and Confirmation test is easy and safe (no undressing or swabbing required!) … and it's the most accurate and reliable syphilis test available today. Sometimes, an RPR can be positive in a person without syphilis … so we always follow up with a confirmatory test.

What syphilis test results mean

A positive test result means that you may have either a past or current, active syphilis infection that — in its earlier stages — can be easily treated and cured with antibiotics. A negative test result doesn't necessarily mean that you are free of the bacteria … sometimes the infection, or signs of the infection, don't show up right away.

If you test positive, we're here to help. You'll have the opportunity to consult with a doctor on the phone right away. We'll answer your questions and help you determine the next steps based on your specific circumstances.

Understanding false-positive or false-negative test results

As with most medical tests, there's a slight chance (1-4%) that a positive test result indicates an infection when there isn't one (false-positive); or a test comes back negative, despite the presence of infection (false-negative). For example, a false-negative test result can happen if an infected person tests too early for an infection to be detected … that means it's possible to get a negative test result but still have an STD. And if you test negative but you know that you've definitely been exposed to syphilis, some physicians may recommended that you get treated anyway … just to be safe.

If you're concerned about the reliability of your test results for any reason (e.g., timing, or your sexual history, or your partner's sexual history), we recommend that you get re-tested three months after your possible exposure to the bacteria to confirm your results … and to minimize the risk of being a carrier and potentially developing more serious symptoms down the road.

Learn more about "testing windows" — the recommended amount of time between potential exposure to an STD infection, and when screening is expected to identify the infection (or re-infection); for example, if you had unprotected sex last night and became infected with syphilis, the bacteria wouldn't necessarily show up right away … it could take up to three months to test positive, though often it shows up much earlier. Most specialists agree that the majority of people with syphilis will test positive within six weeks of exposure.


Even if you were treated for syphilis, you could be at risk for re-infection … especially if your partner has not been treated. We recommend that you get tested again to make sure that you haven't been re-infected.


Syphilis treatment

Is there a cure or treatment for syphilis?

Yes. Once you've been tested and diagnosed with syphilis, it can be easily and effectively treated and cured with antibiotics — most commonly, with an injection of penicillin. If the infection is in a later stage, additional injections may be necessary in one-week intervals … in rare cases, an intravenous infusion may be necessary.

Six months after you've been treated, you'll be tested again to verify that the penicillin treatment has successfully destroyed or substantially decreased the presence of the bacteria … this is called a "test of cure."

Syphilis can recur

Once you've been treated for syphilis, you're not immune … you can be re-infected. That's why sexual partners should be treated at the same time so that an untreated partner still carrying the bacteria doesn't re-infect the treated partner … and you'll want to avoid sexual contact altogether until treatment has been completed.

Be sure to continue to use latex condoms to minimize the risk of re-infection.

Pregnancy and antibiotics

In general, syphilis can be cured during pregnancy with antibiotics. Consult your regular doctor about the risks involved, and to identify a treatment that's best for you and your baby.

Concerned about Syphilis?

Find out if you should get tested today; peace of mind has never been easier. Questions about our process? See how our STD testing works.