How is syphilis transmitted?

The only way syphilis is transmitted is through direct contact with syphilitic chancres, or sores. These sores tend to develop on or in the:

• mouth
• penis
• vagina
• anus

Syphilis is primarily transmittedTrusted Source sexually. That means you can contract it through oral, anal, or vaginal sex, or direct genital-to-genital contact.

Babies can contract syphilis if their mother has an untreated infection. This is called congenital syphilis. Syphilis can also be transmitted through blood transfusions, although that is extraordinarily rareTrusted Source.

Contrary to myth, you cannot contract syphilis by:

• sharing a toilet
• wearing another person’s clothing
• using another person’s eating utensils

This is because the bacteria that cause syphilis can’t live for very long outside the human body.

Who is most at risk of syphilis?

Anyone can contract syphilis. However, certain factors may increase your chances of contracting an infection. The following groups of people have an increased risk of contracting syphilis:

• people who have sex without a barrier method, like a condom, with multiple partners
• men who have sex with men
• people who have HIV
• people who have partners with syphilis

Stages of syphilis infection

The four stages of syphilis are:

• primary
• secondary
• latent
• tertiary

Syphilis is most infectious during the first two stages.

When syphilis is in the hidden, or latent, stage, the disease remains active but often doesn’t cause symptoms. Tertiary syphilis is the most destructive to health.

Primary syphilis

The primary stage of syphilis occurs about 3 to 4 weeks trusted Source after a person contracts the bacteria. It begins with a small, round sore called a chancre. A chancre is painless, but it’s highly infectious. People may not even notice when they have one. This sore may appear wherever the bacteria entered the body, such as on or inside the mouth, genitals, or rectum.

On average, the sore shows up around 3 weeks after infection, but it can take between 10 to 90 days to appearTrusted Source. The sore remains for 2 to 6 weeks. Sometimes the only symptom will be swollen lymph nodes.

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

Secondary syphilis

Skin rashes and a sore throat may develop during the second stage of syphilis. The rash won’t itch and is usually found on the 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:

• headaches
• swollen lymph nodes
• fatigue
• fever
• weight loss
• hair loss
• aching joints

These symptoms will go away whether treatment is received. However, without treatment, a person still has syphilis.

Secondary syphilis is often mistakenTrusted Source for other conditions, such as:

• pityriasis rosea
• lichen planus
• psoriasis

For this reason, syphilis has been known as the “great imitatorTrusted Source.” Because the symptoms can be so nonspecific, people experiencing symptoms may ignore them, or sometimes clinicians don’t suspect the presence of the infection.

Latent syphilis

The third stage of syphilis is the latent, or hidden, stage. The primary and secondary symptoms disappear, and there won’t be any noticeable symptoms at this stage. However, the bacteria remain in the body. This stage could last for years before progressing to tertiary syphilis.

Tertiary syphilis

The last stage of infection is tertiary syphilis. About 14 to 40 percentTrusted Source of people with syphilis enter this stage. Tertiary syphilis can occur years or decades after the initial infection. Tertiary syphilis can be life-threatening. Some other potential outcomes of tertiary syphilis include:

• blindness
• loss of hearing
• mental health conditions
• memory loss
• destruction of soft tissue and bone
• neurological disorders, such as stroke or meningitis
• heart disease
• neurosyphilis, which is an infection of the brain or spinal cord

Syphilis and pregnancy

If you’re pregnant, your doctor should screen you for syphilis and other sexually transmitted infections (STIs) as part of your regular prenatal care during the first trimester. This is because STIs can increase the risk of pregnancy complications, such as miscarriage, stillbirth, and premature birth.

Doctors also do an STI screening that includes syphilis because it can be transmitted to the fetus. This is known as congenital syphilis. Untreated congenital syphilis can cause severe damage in a newborn and be life-threatening.

A pregnant person will almost alwaysTrusted Source transmit syphilis to their baby. This is why treatment for syphilis is important during pregnancy to protect your health as well as the health of your baby.

Babies born with congenital syphilis may develop:

• developmental delays
• seizures
• rashes
• fever
• swollen liver or spleen
• anemia
• jaundice
• infectious sores

Untreated congenital syphilis can lead to late-stage syphilis. This can cause damage to a baby’s:

• bones
• teeth
• eyes
• ears
• brain

Penicillin is the main treatment for syphilis during pregnancy. If you have a penicillin allergy, your doctor can still administer penicillin over the course of several hours. This allows your body to receive the drug without having an allergic reaction.

Testing for syphilis at home

You can test for syphilis with an at-home testing kit. Any result, either positive or negative, should be followed up with a doctor’s appointment.

There are several at-home syphilis tests on the market. If you have an increased risk of contracting syphilis for any reason, testing regularly at home may be beneficial.

Syphilis testing is also readily accessible through routine clinic appointments or at most city health departments. These tests are often available at little to no cost.

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 antibiotic, such as:

• doxycycline
• ceftriaxone

If you have neurosyphilis, you’ll get daily doses of penicillin intravenously. This will often require a brief hospital stay. 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 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. Don’t resume sexual activity until you and your partner have completed treatment.

The Jarisch-Herxheimer reaction (JHR) is a common, short-term side effect of syphilis treatment. Fewer than 30 percentTrusted Source of people with primary or secondary syphilis may experience JHR symptoms within 24 hours of treatment.

JHR is an immune system reaction. It causes temporary symptoms that range from very mild to more severe, including:

• fever
• chills
• skin rash
• gastrointestinal symptoms, such as nausea and vomiting
• headache
• joint or muscle pain

JHR symptoms usually dissipate within several hours.

How to prevent syphilis

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

• Use a dental dam (a square piece of latex) or condoms during oral sex.
• Avoid sharing sex toys.
• Get screened for STIs and talk with your partners about their results.

Syphilis can also be transmitted through shared needles. Avoid sharing needles if using injected drugs.

Untreated syphilis can have devastating effects, including:

• gummas, which contain masses of dead, swollen, fiber-like tissue. They’re most often found in the liver. They can also occur in the brain, heart, skin, bones, eyes, and testis.
• blindness
• hearing loss
• brain damage
• paralysis
• meningitis
• heart valve damage
• aneurysm
• aortitis (inflammatory aortic disease)

HIV

People with syphilis have a significantly increased chance of contracting 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 with your doctor about how to recognize syphilis symptoms.

When should I test for syphilis?

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

• have had unprotected (condomless) sex with someone who might have had syphilis
• are pregnant
• are a sex worker
• are in prison
• have had condomless sex with multiple people
• have a partner who has had condomless sex with multiple people
• are a man who has sex with men

If the test comes back positive, it’s important to complete the full treatment. Make sure to finish the full course of antibiotics, even if symptoms disappear. Also avoid all sexual activity until your doctor tells you that it’s safe. Consider getting tested for HIV as well.

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.

When to talk with a doctor

If you believe there’s a chance you’ve been in contact with syphilis, visit a doctor. The signs and symptoms of syphilis may be difficult, or impossible, to detect without a blood test.

Talk with a doctor if you:

• notice what you think could be syphilis sores
• have been told by a sexual partner that they have syphilis
• are sexually active but have never had an STI test

Also be aware that all pregnant people should receive a syphilis test in their prenatal appointments as part of standard care. If it doesn’t look like this test will be included in your initial prenatal blood panel, ask for it.

Is syphilis 100 percent curable?

Yes. Syphilis can be cured by taking the antibiotics your doctor administers. However, any damage that has already been done by this disease cannot be undone by taking antibiotics.

What are the signs of syphilis in a person with a penis?

The early symptoms of syphilis often go overlooked. A syphilis sore called a chancre usually occurs where the infection enters the body. This can be the penis, scrotum, anus, or mouth. The sore is usually painless and resolves on its own. As the disease progresses, rashes will occur on parts of the body including the palms of the hands and soles of the feet.

How long can you have syphilis without knowing it?

Untreated syphilis progresses into the latency (hidden) stage after the second stage rash resolves. During this stage you’ll have no symptoms. Latency can last anywhere from 1 to 20 years, or longer. If you suspect you may have contracted syphilis years ago, see your doctor for a blood test. You can still have treatment that cures the disease and stops future damage from occurring.

Will I always test positive for syphilis?

You may. The antibodies produced by syphilis may stay in your body, even after treatment has occurred. This means that you may always test positive for this disease, even if you no longer have the bacteria.

Can syphilis be cured?

Yes, syphilis can be cured. The bacterial infection can be resolved by undergoing a full treatment regimen of prescription antibiotics. Any damage done to your body’s organs cannot be reversed by treatment, but further damage will be prevented.

How is syphilis transmitted?

Syphilis is caused by a spirochete (a spiral-shaped bacteria) called Treponema pallidum. You can get the bacteria in the following ways:

• direct contact with a syphilis sore (usually found on the vagina, anus, rectum, in the mouth, or on the lips)
• during vaginal, anal, or oral sex with an infected person
• an infected mother can pass syphilis to her unborn child, which can result in serious complications or even death of the unborn child

The primary and secondary stages of syphilis are extremely contagious. Tell your previous sexual partners if you are diagnosed with syphilis so that they can get tested to see if they have the disease.

You can’t catch syphilis from doorknobs, toilet seats, swimming pools, clothing, bathtubs, or silverware.

There is a high correlation between syphilis and HIV since HIV can be transmitted through syphilitic sores. Since the behaviors that lead to the spread of STIs are the same for both syphilis and HIV, having syphilis is an indicator that you are also at risk for contracting HIV.

What are the symptoms of secondary syphilis?

Primary syphilis usually presents itself as a single sore. This sore typically appears three weeks after the initial infection but could show as soon as 10 days or as late as 90 days. This sore, called a chancre, is small, firm, round, and painless. It appears at the original infection site, usually the mouth, anus, or genitals. You may not even notice it. Untreated, the initial sore heals in a month or so.

If you don’t receive treatment during this initial appearance of symptoms, the bacterium that caused this STI will spread through your bloodstream, and you’ll soon have secondary syphilis.

The symptoms of secondary syphilis develop two to eight weeks after a person first becomes infected with primary syphilis. The secondary stage is usually marked by a non-itchy rash.

The rash might be confined to one part of your body, or it could spread over several parts. The appearance of the rash varies. One common manifestation is rough, reddish-brown spots on the bottoms of your feet and on the palms of your hands.

Usually, the rash feels scaly, but it could also be smooth. Sometimes, the rash looks like one caused by another disease, making diagnosis trickier. It may also be so faint that it’s overlooked.

Other symptoms of secondary syphilis include:

• sore throat
• fever
• swollen lymph glands
• headaches
• fatigue
• muscle aches
• wart-like patches around skin folds or genitals
• loss of appetite
• joint pain
• enlarged lymph nodes

How is secondary syphilis diagnosed?

To diagnose secondary syphilis, your doctor will do a physical examination and ask you questions about your medical history. If you have sores, your doctor might use a microscope to examine material taken from your sores. The syphilis bacteria will show up under the microscope. This technique is known as darkfield microscopy.

Testing your blood with a rapid plasma regain (RPR) test is also a reliable, inexpensive way for your doctor to determine whether you have syphilis. Your body makes antibodies that try to fight off infections and foreign invaders. If the blood test reveals these syphilis antibodies, then you have been infected with syphilis. The RPR test is important for pregnant women, as undiagnosed syphilis can be passed on to their unborn child, and could be life-threatening for the baby.

Your doctor can also determine whether you have tertiary syphilis by testing your spinal fluid.

How is secondary syphilis treated?

Syphilis can’t be cured by over-the-counter treatments or home remedies. If it’s caught early enough, however, you’ll only need one penicillin injection. If you’ve had the STI for a longer period of time, several doses will be necessary.

People with penicillin allergies can use other antibiotics, such as doxycycline or tetracycline. Penicillin is the best drug if you’re pregnant, however, since other antibiotics may harm your developing baby or fail to protect them from syphilis.

Antibiotics will kill the syphilis bacterium and stop it from further damaging your body. However, antibiotics can’t repair any damage that has already occurred.

If you’re receiving treatment for syphilis, do not have sex until your sores heal completely and you have completed your full course of antibiotic treatment. Let your sexual partners know about your condition so they can also get help and avoid spreading the infection. They should also be treated if they have syphilis to avoid passing the infection back and forth.

Complications of treatment

Without treatment, your syphilis will likely continue to progress. It can be 10 or 20 years before you experience the worst effects. Eventually, untreated syphilis can lead to damage to the brain, eyes, heart, nerves, bones, joints, and liver. You could also become paralyzed, blind, demented, or lose feeling in the body. Untreated syphilis can also lead to stillborn or developmentally delayed babies.

Even if you have been cured of syphilis, you could still get it again.

People being treated for syphilis are also at risk for Jarisch-Herxheimer reaction within 24 hours of your first dose. As your body breaks down the syphilis bacteria, a reaction may be triggered. Symptoms of Jarisch-Herxheimer include:

• chills
• rash
• fever of up to 104 degrees Fahrenheit
• tachycardia (rapid heart rate)
• hyperventilation
• headache
• muscle aches
• joint pain
• nausea

The Jarisch-Herxheimer reaction is common and potentially serious. If you experience such symptoms, be sure to seek immediate medical treatment.

Additionally, open syphilis wounds increase your chances of contracting HIV and other STIs. Because of this, it’s a good idea to get tested for HIV and other STIs if you have secondary syphilis.

How to prevent getting secondary syphilis

You can prevent getting secondary syphilis by getting treatment for primary syphilis before it develops into the secondary stage. You can also prevent getting primary syphilis by practicing safe sex practices, such as using a condom. You should be regularly tested for syphilis and other STIs if you are sexually active and have unprotected sex or multiple partners.

People who should be regularly tested for syphilis include:

• pregnant women
• people who are at greater risk of syphilis (including men who have sex with men and people in prison)
• people with HIV
• people who have a sexual partner who has syphilis

If you notice any unusual sore or rash, especially near your genitals or anal area, stop having sex and go see a doctor. The earlier syphilis is caught, the easier it is to treat and the better your outcome. Notify all of your sexual partners immediately so that they can be treated as well. Syphilis is a very contagious disease.

Prevention

Vaccine

As of 2018, there is no vaccine effective for prevention.^[rx] Several vaccines based on treponemal proteins reduce lesion development in an animal model but research continues.

Sex

Condom use reduces the likelihood of transmission during sex, but does not eliminate the risk.^[rrx] The Centers for Disease Control and Prevention (CDC) states, “Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.^[rx] However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom.”^[rx]

Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis. The CDC states, “The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.”^[rx]

Congenital disease

Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected.^[rx] The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women,^[rx] while the World Health Organization (WHO) recommends all women be tested at their first antenatal visit and again in the third trimester.^[rx][rx] If they are positive, it is recommended their partners also be treated.^[rx] Congenital syphilis is still common in the developing world, as many women do not receive antenatal care at all, and the antenatal care others receive does not include screening. It still occasionally occurs in the developed world, as those most likely to acquire syphilis are least likely to receive care during pregnancy.^[rx] Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries.^[rx] Point-of-care testing to detect syphilis appeared to be reliable although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies.^[rx]

Screening

The CDC recommends that sexually active men who have sex with men be tested at least yearly. The USPSTF also recommends screening among those at high risk.^[rx]

Syphilis is a notifiable disease in many countries, including Canada,^[rx] the European Union,^[rx] and the United States.^[rx] This means health care providers are required to notify public health authorities, which will then ideally provide partner notification to the person’s partners.^[rx] Physicians may also encourage patients to send their partners to seek care.^[rx] Several strategies have been found to improve follow-up for STI testing, including email and text messaging of reminders for appointments.^[rx]

Long-term outlook

If syphilis is diagnosed and treated early enough, it can be thoroughly cured. With treatment, secondary syphilis will most likely go away within a few weeks to a year.

If secondary syphilis goes untreated and your symptoms go away, you will still have the latent form of syphilis. The latent stage is a symptom-free period that can last for many years. You may never again develop symptoms.

Without treatment, however, you have a greater chance of progressing to the tertiary stage of syphilis. This can lead to many serious complications, including brain damage and death. Make an appointment with your doctor as soon as you have any concerns so you can be tested and treated as soon as possible.