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What is Syphilis?

Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if it is not treated. Infection develops in stages:

  • Primary
  • Secondary
  • Latent
  • Tertiary

Each of these stages have different signs and symptoms.

Babies can also get syphilis, called congenital syphilis. Congenital syphilis is the disease that happens when a pregnant person passes syphilis to their baby during pregnancy. Congenital syphilis has its own fact sheet. See About Congenital Syphilis | Syphilis | CDC for more information.

What are the signs and symptoms of Syphilis?

Each stage has its own signs and symptoms.

Primary stage

During the first (primary) stage of syphilis, a person with syphilis may notice a single or multiple sores. The location of the sore(s) is where the syphilis infection has entered the body.

These sores usually occur in, on, or around the following:

  • Penis
  • Vagina/ vulva
  • Anus
  • Rectum
  • Lips or in the mouth

Sores tend to be firm, round, and painless. Because the sore is painless, a person may not notice it. The sores usually last 3-6 weeks. The sores will heal whether or not a person receives treatment, but treatment is important to prevent the infection from moving to the secondary stage.

Secondary stage

During the secondary stage, a person may have skin rashes and sores in the mouth, vagina/vulva or anus. This stage usually starts with a rash on one of more areas of the body. The rash can show up when the primary sore is healing or several weeks after the sore has healed. The rash can be on the palms of your hands and the bottoms of the feet. The rash will appear:

  • Rough
  • Red to reddish- brown

The rash is not usually itchy, and sometimes it is so faint that a person may not notice it.

Other symptoms may include:

  • Fever
  • Swollen lymph glands
  • Sore throat
  • Patchy hair loss
  • Headaches
  • Weight loss
  • Muscle aches
  • Feeling very tired (fatigue)

The symptoms from this stage will go away whether or not the infected person gets treatment, but without treatment the 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. Without treatment, syphilis can live in the body for years.

Tertiary stage

Most people with untreated syphilis do not develop tertiary syphilis; however, when it does happen, it can affect many different organs such as heart and blood vessels, andthe brain and nervous system.

Tertiary syphilis is serious and occurs 10-30 years after infection. In tertiary syphilis, the disease damages internal organs and can result in death. A healthcare provider can usually diagnose tertiary syphilis with the help of multiple tests to confirm this serious infection.

Neurosyphilis, ocular syphilis, and otosyphils

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

Signs and symptoms of neurosyphilis can include:

  • Severe headache
  • Muscle weakness and trouble moving muscles
  • Changes to mental status, meaning trouble focusing, confusing, and personality changes, and dementia (problems with memory, thinking, and decision making)

Signs and symptoms of ocular syphilis can include:

  • Eye pain and redness
  • Changes in vision and 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).

Risk Factors

Sexually active people can get syphilis through vaginal, anal, or oral sex without a condom with a partner who has syphilis.

If you are sexually active, you should have an open and honest talk with your healthcare provider and ask them if you should get tested for syphilis along with other sexually transmitted infections or diseases (STI’s/STD’s).

Syphilis may be more common in some racial/ethnic and sexual minority communities, including those who use and share needles to for intravenous drugs. Gay and bisexual men are also disproportionately impacted by syphilis. In addition, people from racial and ethnic minority groups like those people who are a part of Black and Hispanic communities are disproportionately experiencing the burden of the current congenital syphilis epidemic, due to social, cultural, and economic conditions that make it difficult for sexually active people to stay healthy. In 2022, nationally the annual rates of syphilis were higher among Black and Hispanic women than among white heterosexual women. Additionally, younger women in these communities had a larger number of cases of primary and secondary syphilis.

Syphilis and HIV

If a person is HIV positive, they may be at higher risk for getting syphilis. Also, having syphilis may make a person more susceptible to getting HIV. Having a sore or break in the skin from an STI (such as syphilis or Mpox) may allow HIV to enter a body more easily, just as having a syphilis sore may allow HIV to more easily enter the body.

How does syphilis spread?

A person can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. A pregnant person can also pass syphilis to their baby during pregnancy. You can find more information about this here: About Congenital Syphilis | Syphilis | CDC2

How can syphilis be prevented?

The only way to completely avoid all sexually transmitted infections (STI’s) is to not have vaginal, anal or oral sex. If you are sexually active, you can do the following things to lower your chances of getting syphilis:


Syphilis and pregnancy

Pregnant people who have syphilis can give the infection to their baby. Having syphilis while pregnant can lead to poor pregnancy outcomes, including low-birth weight, premature delivery (giving birth before the baby has finished growing and developing), or even stillborn birth (a baby born dead).

Pregnant people should be tested for syphilis at least once during their pregnancy and should be treated right away if the test is positive.

At birth, a baby with a syphilis infection may not have signs or symptoms of disease. However, if the baby does not receive treatment right away, the baby may develop serious problems within a few weeks. These babies can have health problems, such as cataracts, deafness, or seizures, and can die.

You can read more about syphilis and pregnancy and congenital syphilis here: Syphilis During Pregnancy – STI Treatment Guidelines (cdc.gov)4 and here: About Congenital Syphilis | Syphilis | CDC.

Testing for and diagnosing syphilis

To test for syphilis in all persons, healthcare providers will use a blood test to test for syphilis, and possibly by testing the fluid from a syphilis sore.

A sexually active person should get tested for syphilis and other STI’s regularly. This is especially true for people who:

  • Are pregnant or trying to become pregnant
  • Are a man who has sex with other men
  • Have HIV or other STIs
  • Are taking pre-exposure prophylaxis (PrEP) for HIV prevention
  • Have partner(s) who have tested positive for syphilis
  • Have certain risk factors for syphilis, like living in a community with high rates of syphilis and other sexually transmitted infections.

All pregnant persons should receive syphilis testing at their first pre- natal visit. Some pregnant persons need to receive syphilis and other STI testing at the beginning of their pregnancies and again in the third trimester at 28 weeks and then at delivery.

Treating syphilis

Is there a cure?

Yes. Syphilis is curable with the right antibiotics from a healthcare provider. However, it is important to understand that the antibiotic treatment might not undo any damage the infection has already caused. Getting treated as soon as possible is important!

Can I get syphilis again , even after I get treatment for a current infection?

Having syphilis once does not protect you from getting it again. Even after successful treatment, you can get syphilis again. Only laboratory tests can confirm whether you have 4syphilis. Follow-up testing by your healthcare provider is necessary to make sure the treatment was successful.

It may not be obvious that a sex partner has syphilis. Syphilis sores in the vagina, anus, mouth, or under the foreskin of the penis, can be hard to see, which is why it is important for all potential sex partners be tested before having sex. The proper use of condoms every time a person has sex can also help prevent all sexually transmitted infections and re-infections.


References

  • CDC. About Syphilis. Syphilis. Published May 21, 2024. Accessed June 26, 2024. https://www.cdc.gov/syphilis/about/index.html
  • CDC. About Congenital Syphilis. Syphilis. Published June 6, 2024. Accessed June 26, 2024. https://www.cdc.gov/syphilis/about/about-congenital-syphilis.html
  • CDC. Condom Use: An Overview. Condom Use. Published May 9, 2024. Accessed June 26, 2024. https://www.cdc.gov/condom-use/index.html
  • Syphilis During Pregnancy – STI Treatment Guidelines. Published July 14, 2021. Accessed June 26, 2024. https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm
  • Martin EG, Ansari B, Rosenberg ES, Hart-Malloy R, Smith D, Bernstein KT, Chesson HW, Delaney K, Trigg M, Gift TL. Variation in Patterns of Racial and Ethnic Disparities in Primary and Secondary Syphilis Diagnosis Rates Among Heterosexually Active Women by Region and Age Group in the United States. Sex Transm Dis. 2022 May 1;49(5):330-337. doi: 10.1097/OLQ.0000000000001607. Epub 2022 Feb 25. PMID: 35121717; PMCID: PMC8994035.