Syphilis

What is syphilis?

Syphilis is a sexually transmitted infection (STI) that spreads when you have vaginal, anal or oral sex with someone who has the infection. A bacteria causes it. Antibiotic medication treats syphilis. Untreated syphilis can lead to serious health problems, including blindness and damage to your brain, heart, eyes and nervous system.

What are the stages of syphilis?

Syphilis can progress through four different stages. The infection causes different symptoms in each stage. People are very contagious in the first and second stages and can easily pass the infection to their sex partners. The stages of syphilis are: primary, secondary, latent and late (tertiary) syphilis.

Primary syphilis: The first stage happens two to 12 weeks after exposure to someone with syphilis. During this stage, a smooth, hard sore called a chancre develops on your genitals or mouth. A chancre is small and usually painless, so you may not even know it’s there. The sore goes away on its own in a few weeks or months. However, this doesn’t mean you don’t have syphilis anymore. If you don’t receive treatment with medication, the infection moves to the second stage. You can pass syphilis through vaginal, anal or oral sex during this stage.

Secondary syphilis: About one to six months after the syphilis sore goes away, a rough, bumpy syphilis rash appears. The rash can cover your entire body, including your palms and soles (bottoms) of your feet. The rash doesn’t usually itch. You may also have symptoms such as:

• Fever.
• Fatigue.
• Wart-like sores.
• Muscle aches.
• Weight loss
• Headaches.
• Hair loss.
• Swollen lymph nodes.

You can pass syphilis infection during this stage during vaginal, anal or oral sex. These symptoms can come and go for months or years. Just because the syphilis rash is gone or you aren’t having any of the above symptoms doesn’t mean you no longer have the infection. You still need treatment with medication. Without treatment, the infection will move to the latent stage.

Latent syphilis: If you don’t receive treatment during the first two stages, the infection moves into the latent stage. In this stage, there are no outward signs or symptoms of syphilis. Some people experience mild flare-ups from time to time. At this stage, the infection can damage your heart, bones, nerves and organs. This stage can last up to 20 years. It’s rare to pass syphilis to your sex partners during the latent stage. Without treatment, the infection progresses to the late stage.

Late (tertiary) syphilis: For many people, symptoms don’t progress past the latent phase, either because the infection cures itself or because symptoms are too mild to notice. About 20% of people progress to the late syphilis phase, which causes a range of serious health problems. These problems occur slowly and include:

• Brain damage, dementia and cognitive health problems.
• Heart disease.
• Movement disorders and muscle problems.
• Nerve damage.
• Seizures.
• Vision problems, including blindness.

What is congenital syphilis?

Congenital syphilis occurs when a pregnant person passes the infection to the fetus during pregnancy. Syphilis causes severe health problems (including death) in babies and young children. Your pregnancy care provider should screen you for STIs at one of your first prenatal visits. It’s important to receive treatment right away if you have syphilis.

How common is syphilis?

According to the Centers for Disease Control and Prevention (CDC), there were about 134,000 cases of syphilis in 2020. The infection is more common in men and people assigned male at birth (AMAB). Men who have sex with men (MSM) are diagnosed with syphilis more than any other group.

Who might get syphilis?

Anyone who’s sexually active can get syphilis, but your risk is higher if you:

• Have unprotected sex, especially if you have several partners.
• Are a man who has sex with men (MSM).
• Have HIV.
• Have had sex with someone who’s tested positive for syphilis.
• Tested positive for another STI, such as chlamydia, gonorrhea or herpes.

What are the symptoms of syphilis?

Syphilis symptoms vary depending on the stage of the infection. You’re most contagious in the early stages, when you’re most likely to notice symptoms. During the first stage, one or more sores develop on your genitals. You may not notice them or mistake them for a pimple or other skin lesion.

During the second stage, you may get a rash and experience flu-like symptoms, such as fatigue, fever, sore throat and muscles aches.

After the second stage, the symptoms of syphilis are hidden (latent stage). Just because you don’t have symptoms doesn’t mean the infection is gone. The only thing that cures the infection and prevents it from progressing is treatment with medication.

What does syphilis look like?

In the first stage of syphilis, a small, smooth sore develops on your genitals, mouth or lips. It may resemble a pimple and be so small and harmless that you don’t even notice. This sore goes away on its own in about six weeks.

In the second stage of syphilis, a rough, red or brown rash develops. It begins in one area but will eventually cover your entire body — including the bottom of your feet and palms. You may have skin rashes and/or sores in your mouth, vagina or anus.

Where can you get syphilis?

Syphilis affects your entire body. However, the first sign of syphilis is an ulcer-like sore. It develops where the bacteria came into contact with your skin during sex. The following areas are where you’re most likely to find a syphilis sore (chancre):

In women and people assigned female at birth (AFAB)

• On your vulva (external genitals).
• In or around your vagina.
• Around your anus or inside your rectum.
• On your lips or in your mouth.

In men and people assigned male at birth (AMAB)

• On your penis or scrotum.
• Under the foreskin of your penis.
• Around your anus or inside your rectum.
• On your lips or in your mouth.

What causes syphilis?

The bacteria Treponema pallidum causes syphilis. An infected person spreads the bacteria through vaginal, anal or oral sex. The bacteria can enter your body through your anus, vagina, penis, mouth or broken skin. The bacteria continues to spread throughout your body, which can eventually damage certain organs.

How does syphilis spread?

Syphilis is contagious, especially in the primary and secondary stages when you have sores, ulcers or a rash. Syphilis typically spreads from person to person during sexual contact, even if there’s no penetration or ejaculation. However, you can get it if any part of your body touches the sore or rash of someone with syphilis.

If you have syphilis and have sex, you can infect your partner. If you’re pregnant and have syphilis, you can pass it to the fetus. But, you can’t get syphilis by touching objects like toilet seats, utensils and doorknobs. This is because the bacteria that cause syphilis can’t survive on objects.

How long am I contagious?

Even if you don’t have outward symptoms of syphilis (like a sore or rash), the infection is still in your body until you take antibiotics. If you have syphilis and don’t get treatment, you’re contagious whether you notice a sore or not. If you have symptoms of infection or believe you’ve been exposed, contact a healthcare provider for treatment right away.

Can you get syphilis from kissing?

Yes. While it’s rare to get syphilis from kissing, you can get syphilis by having direct contact with a syphilis sore. This means if you kiss your partner’s sore, you’re putting yourself at risk of infection. You can even get syphilis through broken skin. This is why getting treatment is important if you think you have syphilis or were exposed to it.

Can syphilis cause problems during pregnancy?

Yes. If you have syphilis and don’t get treatment, you can pass the infection to your child. Up to 40% of babies born to people with untreated syphilis die from the infection. It’s most common to spread the infection to the fetus during pregnancy. But, it can also happen during delivery if your baby has direct contact with a syphilis sore on your vagina. If a baby’s born with syphilis, it’s called congenital syphilis.

Syphilis during pregnancy can also cause:

• Miscarriage.
• Premature birth.
• Low birthweight (weighing less than 5 pounds, 8 ounces at birth).
• Issues with the umbilical cord.
• Stillbirth.
• Death within the first 28 days of life. This only occurs if you don’t receive treatment for syphilis.

These potential complications are why attending your prenatal visits and getting tested for STIs is so important. Treatment before 26 weeks of pregnancy leads to the best outcomes.

What are the health complications of syphilis?

If you don’t receive treatment and syphilis progresses to the last stage of the infection, you’re at risk for life-threatening complications. Damage to your body gets worse the longer you have syphilis. That’s why it’s so important to get treatment right away. Untreated syphilis can cause blindness and paralysis and lead to problems with your heart, brain, spinal cord and other organs.

How is syphilis diagnosed?

Your healthcare provider will ask about your sexual history, including whether you practice safe sex. It’s important to be honest during this discussion. Your provider can help assess your risk and recommend tests for other STIs.

To test for syphilis, your provider will examine you and take a blood sample to look for signs of the infection. Your provider may remove some fluid or a small piece of skin from a syphilis sore and look at it under a microscope. The only way to know for sure if you have syphilis is by visiting your healthcare provider and getting a lab test.

How is syphilis treated?

Your healthcare provider treats syphilis with antibiotics. Antibiotics are a type of medication that treats bacterial infections. Penicillin is the most commonly used medication for syphilis. How much medication you need and how long you take it depends on your syphilis stage and symptoms.

You must finish all your antibiotics even if the sore or rash goes away. It’s important to contact anyone you’ve had sex with within the last two years and let them know they should be tested.

Your healthcare provider will test your blood after syphilis treatment to make sure the infection is gone. You can get syphilis again after getting treated, so be sure to practice safe sex and get tested regularly if you have an increased risk of syphilis.

Is syphilis 100% curable?

Yes. Your healthcare provider can treat syphilis with antibiotics. Antibiotics will cure the infection, but there’s no way to repair organs damaged by syphilis.

How can I reduce my risk of getting syphilis?

The only way to prevent syphilis (and other STIs) is to abstain from sex. If you’re sexually active, you can reduce your risk of infection by always using a condom or dental dam during sex. It’s important to use a condom properly to lower your chance of getting the infection.

Ask your sexual partners about their history and if they’ve been tested for STIs. If your partner has syphilis, they can reinfect you. It’s important that they get treatment, too.

What is the outlook for people with syphilis?

Antibiotics can treat syphilis in the early stages. Syphilis doesn’t cause long-term health problems if you receive treatment early. Without treatment, syphilis can cause severe health problems. It can damage your heart, bones, brain, eyes, muscles and nerves, and it can be fatal.

Can I get syphilis again after I’ve been treated?

Yes. You can get the infection again after treatment. That’s why it’s important to practice safe sex and get tested often if you have a high risk of infection.

How do I take care of myself?

Syphilis and other sexually transmitted infections (STIs) cause serious health problems. They require immediate medical care from a healthcare provider. If you receive a diagnosis, it’s important to complete treatment, so you don’t spread the infection. Other things you should do include:

• Contact anyone you’ve had sexual contact with to let them know so they, too, can receive treatment.
• Practice safe sex by using a condom or a dental dam.
• Get tested for syphilis and other STIs regularly.
• Minimize the number of sexual partners you have.
• Don’t be afraid to ask new partners about their sexual history.

When should I see a healthcare provider?

If you have skin ulcers or a rash on your genitals or mouth, don’t wait to contact a healthcare provider. They can test you for syphilis and begin treatment if you have the infection. The sooner you get treatment, the less likely you are to have long-term complications.

Is syphilis an STD or STI?

There’s no real difference between an STI and an STD. They both describe conditions that can pass from person to person through unprotected sexual activity. However, the term “STI” is more accurate and comes with less historical and political baggage than “STD”.

A note from Cleveland Clinic

Syphilis is a treatable STI. It’s important to get tested so you can get treatment in the early stages of the infection. Untreated syphilis can lead to long-term health problems. You should have an open and honest conversation with your healthcare provider about your sexual history. Your provider can help you assess your risk, take precautions and make a plan to stay healthy.