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What Is Syphilis?

Syphilis is a sexually transmitted infection caused by a type of bacteria known as Treponema pallidum. According to the Centers for Disease Control and Prevention (CDC), in 2013, more than 56,400 cases of syphilis were reported in the United States. According to the Mayo Clinic, the rate of women infected with syphilis has been declining in the United States, but the rate among men, particularly homosexual men, has been rising.

The first sign of syphilis is a small, painless sore. It can appear on your sexual organs, rectum, or inside your mouth. This sore is called a chancre. People often fail to notice it right away.

Syphilis can be challenging to diagnose. You can be infected without showing any symptoms for years. However, the earlier you discover the infection, the better. Syphilis that remains untreated for a long time can cause major damage to important organs, like the heart and brain.

Syphilis is only spread through direct contact with syphilitic chancres. It can’t be transmitted by sharing a toilet with another person, wearing another person’s clothing, or using another person’s eating utensils.

Stages of Syphilis Infection

The four stages of syphilis are:

  • primary
  • secondary
  • latent
  • tertiary

Syphilis is most infectious in the first two stages.

When syphilis is in the hidden, or latent, stage, the disease remains active but often with no symptoms and is not contagious to others. Tertiary syphilis is the most destructive to your health.

Primary Syphilis

The primary stage of syphilis occurs about three to four weeks after you’re infected with the bacteria. It begins with a small, round sore called a chancre. A chancre is painless, but it’s highly infectious. This sore may appear wherever the bacteria entered your body, such as on or inside your mouth, genitals, or rectum.

On average, the sore shows up around three weeks after infection, but it can take between 10 and 90 days to appear. The sore remains for anywhere between two to six weeks.

Syphilis is transmitted by direct contact with a sore. This usually occurs during sexual activity, including oral sex.

Secondary Syphilis

During the second stage of syphilis, you may experience skin rashes and a sore throat. The rash won’t itch and is usually found on your palms and soles, but it may occur anywhere on the body. Some people don’t notice the rash before it goes away.

Other symptoms of secondary syphilis may include:

These symptoms will go away whether or not you receive treatment. However, without treatment you’ll still be infected.

Secondary syphilis is often mistaken for another condition.

Latent Syphilis

The third stage of syphilis is the latent or hidden stage. The primary and secondary symptoms disappear, and you won’t have any noticeable symptoms at this stage. However, you will still be infected with syphilis. The secondary symptoms can reappear, or you could remain in this stage for years before progressing to tertiary syphilis.

Tertiary Syphilis

The last stage of infection is tertiary syphilis. Approximately 15 to 30 percent of people who don’t receive treatment for syphilis will enter this stage. Tertiary syphilis can occur years or decades after you’re initially infected. Tertiary syphilis can be life-threatening. Some other potential outcomes of tertiary syphilis include:

How Is Syphilis Diagnosed?

If you think you might have syphilis, go to your doctor as soon as possible. The doctor will take a blood or urine sample to run tests, and they’ll also conduct a thorough physical examination. If a sore is present, your doctor will take a sample from the sore to determine if the syphilis bacteria are present.

If a doctor suspects that you’re having nervous system problems because of tertiary syphilis, you may need a spinal tap, or lumbar puncture. During this procedure, your spinal fluid is collected so that your doctor can test for bacteria.

If you’re pregnant, the doctor might screen you for syphilis because the bacteria can be in your body without you knowing it. This is to prevent the fetus from being infected with congenital syphilis. Congenital syphilis can cause severe damage in a newborn. It can even be fatal.

Treating and Curing Syphilis

Primary and secondary syphilis are easy to treat with a penicillin injection. Penicillin is one of the most widely used antibiotics and is usually effective in treating syphilis. People who are allergic to penicillin will likely be treated with a different oral antibiotic, such as doxycycline, azithromycin, or ceftriaxone.

If you have neurosyphilis, you’ll get daily doses of penicillin intravenously. This will often require a brief hospital stay. Unfortunately, the damage caused by late syphilis can’t be reversed. The bacteria can be killed, but treatment will most likely focus on easing pain and discomfort.

During your treatment, make sure to avoid sexual contact until all sores on your body are healed and your doctor tells you it’s safe to resume sex. If you’re sexually active, your partner should be treated as well. You shouldn’t resume sexual activity until both of your treatments are complete.

How to Prevent Syphilis

The best way to prevent syphilis is to practice safe sex. Using condoms during any type of sexual contact is a good idea. In addition, it may be helpful to:

  • avoid having sex with multiple partners
  • use a dental dam (a square piece of latex) or condoms during oral sex
  • avoid sharing sex toys
  • get screened for sexually transmitted infections and talk to your partners about their results

Syphilis can also be transmitted through shared needles. Avoid sharing needles if you’re going to use drugs.

Complications Associated with Syphilis

Pregnant Mothers and Newborns

Mothers infected with syphilis are at risk for miscarriages, still births, or premature births. There’s also a risk that an infected mother will pass the disease on to her fetus. This is known as congenital syphilis.

Congenital syphilis can be life-threatening. Babies born with congenital syphilis can also have the following:

If a baby has congenital syphilis and it isn’t detected, the baby can develop late-stage syphilis. This can lead to damage to their:

  • bones
  • teeth
  • eyes
  • ears
  • brain


People with syphilis have a significantly increased chance of getting HIV. The sores the disease causes make it easier for HIV to enter the body.

It’s also important to note that those with HIV may experience different syphilis symptoms than those who don’t have HIV. If you have HIV, talk to your doctor about how to recognize syphilis symptoms.

When Should I Test for Syphilis?

The first stage of syphilis can easily go undetected, and the symptoms in the second stage are also common symptoms of other illnesses. This means that if any of the following applies to you, you should probably be tested for syphilis. It doesn’t matter if you’ve ever had any symptoms. Get tested if you:

  • have had unprotected sex with someone who might have had syphilis
  • are pregnant
  • are a sex worker
  • have exchanged sex for drugs
  • are in prison
  • have had unprotected sex with multiple people
  • have a partner who has had unprotected sex with multiple people
  • are a man who has sex with men

If your test comes back positive, it’s important to complete your full treatment. Make sure to finish your full course of antibiotics, even if your symptoms disappear. You should also avoid all sexual activity until your doctor tells you that it’s safe. You might also consider being tested for HIV.

People who have tested positive for syphilis should notify all of their recent sexual partners so that they can also get tested and receive treatment.

Content licensed from:

Written by: Shannon Johnson
Medically reviewed on: Oct 19, 2015: Steven Kim, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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