Syphilis overview

Overview

Syphilis is a sexually transmitted infection (STI) caused by bacteria. It can be cured with antibiotics, but if left untreated, it can cause serious health problems over many years.

Syphilis is less common than some other STIs, but cases have been increasing in many parts of the world, especially among men who have sex with men.

Anyone who is sexually active can get syphilis. It affects people of all ages, genders, and backgrounds. Pregnant women can pass it to their baby, which can cause serious health problems for the child.

Symptoms

Common symptoms

• Painless sores (called chancres) on the genitals, anus, or mouth – these appear in the first stage and often go away on their own.
• A rash that may cover the whole body, including the palms of the hands and soles of the feet – this is common in the second stage.
• Fever, sore throat, muscle aches, and feeling tired – these can happen in the second stage.

Symptoms in children

• Babies born with syphilis (congenital syphilis) may have a rash, fever, swollen liver or spleen, or problems with their bones.
• Some infants have no symptoms at first but later develop serious health issues if not treated.

Symptoms in older adults

• Symptoms in older adults are the same as in younger adults. However, because syphilis can stay hidden for many years, older adults may be diagnosed in the late stage when complications (like damage to the heart or brain) appear.

Causes

Main causes

• Infection with the bacterium Treponema pallidum, which is spread through direct contact with a syphilis sore during sexual activity.
• From a pregnant person to their baby during pregnancy or childbirth (congenital syphilis).

Risk factors

• Having unprotected sex (vaginal, anal, or oral) without using condoms or dental dams.
• Having multiple sexual partners or a partner who has multiple partners.
• Being a man who has sex with men (higher rates of syphilis in this group).
• Having other sexually transmitted infections, including HIV.

When to see a doctor

See a doctor urgently if:

• If you have any sores or rashes on your genitals, anus, or mouth.
• If you think you may have been exposed to syphilis through sexual contact.
• If you have any of the emergency symptoms listed above.

Book a routine appointment if:

• If you are sexually active, talk to your doctor or a sexual health clinic about routine STI testing, including syphilis.
• If you are pregnant, syphilis testing is usually offered as part of prenatal care.
• If you have had a partner diagnosed with syphilis, even if you have no symptoms.

Diagnosis

Doctors diagnose syphilis with a simple blood test. If you have a sore, the doctor may also take a swab from the sore to test for the bacteria.

Tests that may be done

• Blood test to look for antibodies against the syphilis bacteria.
• Swab of a sore or rash, if present.
• In some cases, a spinal tap (lumbar puncture) to test the fluid around the brain and spinal cord, if late-stage syphilis is suspected.

What to expect at your appointment

The tests are quick and usually painless. The blood test involves a small needle like any other blood draw. Your doctor or nurse will explain the results and what they mean. If the test is positive, you will need treatment and possibly a follow-up test to make sure the infection is gone.

Treatment

Syphilis is treated with antibiotics that kill the bacteria. The type and length of treatment depend on the stage of infection. Treatment is most effective when started early. It is important to finish all the medicine as prescribed, even if symptoms go away.

Self-care at home

• Take the full course of antibiotics exactly as your doctor tells you.
• Avoid any sexual contact until your doctor says the infection is completely gone.
• Tell your sexual partners so they can get tested and treated if needed – this helps stop the spread.
• Attend all follow-up appointments to confirm the infection is cured.

Medical treatments

Antibiotics are given, usually as an injection or a course of tablets. The specific medicine and dosage will be decided by your doctor. For people who are allergic to certain antibiotics, alternative treatments are available. It is important to complete the full treatment, even if you feel better.

When is surgery considered?

Surgery is not needed to treat syphilis itself. In very rare cases of late-stage syphilis that has caused damage to organs like the heart or brain, other procedures may be needed for those complications.

Living with this condition

After treatment, most people recover fully from syphilis. You can return to normal activities once your doctor confirms the infection is gone. If you have late-stage syphilis, you may need ongoing care for any damage that has already happened.

Lifestyle tips

• Use condoms or dental dams consistently and correctly to avoid getting syphilis again or passing it to others.
• Get tested for STIs regularly if you are at risk.
• Avoid alcohol or drugs before sex – they can lead to risky sexual behavior.

Diet and exercise

No special diet or exercise is needed for syphilis. Maintaining a healthy lifestyle helps your immune system stay strong. If you have complications from late-stage syphilis, follow any specific advice from your healthcare team.

Mental health and emotional wellbeing

Being diagnosed with an STI can be stressful and may cause feelings of shame, anxiety, or worry about relationships. It is important to remember that syphilis is a medical condition and nothing to be ashamed of. Talk to your doctor or a counselor if you are struggling. If you have thoughts of harming yourself, please reach out to a crisis support line immediately.

Prevention

Yes, syphilis can be prevented. The most effective way is to use condoms or dental dams during vaginal, anal, and oral sex. Limiting your number of sexual partners and having open conversations about STI testing with your partner also reduce risk.

Vaccines

There is no vaccine for syphilis.

Screening programmes

Regular STI testing is recommended for sexually active people, especially those with multiple partners or other risk factors. Pregnant women are usually screened for syphilis early in pregnancy to prevent transmission to the baby.

Complications

If left untreated

• Damage to the heart, blood vessels, and brain (such as aneurysms, dementia, or paralysis).
• Blindness or hearing loss.
• Nerve damage that can cause numbness, pain, or weakness.
• Increased risk of getting or transmitting HIV.
• For pregnant women, risk of miscarriage, stillbirth, or severe health problems in the baby (congenital syphilis).

Long-term outlook

With prompt treatment, syphilis is completely curable and most people make a full recovery without long-term problems. Even in later stages, antibiotics can stop further damage, though some damage may not be reversible. The key is to get tested and treated as early as possible.

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