Table of ContentsView AllTable of ContentsTransmissionSymptomsCure RatesTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Transmission
Symptoms
Cure Rates
Treatment
Prevention
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNetdermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNetdermnetnz.org2023.
Understanding Syphilis Transmission
TheTreponema pallidumbacterium that causessyphilisis spiral-shaped and can pass through tiny breaks in the skin or intact (unbroken)mucous membranesof the mouth, genitals, and anus.
Syphilis is mainly transmitted (passed) through oral, vaginal, or anal sex. This generally occurs when you come into contact with a syphilis sore or rash. The odds of infection from someone with early syphilis run anywhere from 51% to 64%.
Cases of syphilis have been linked to blood transfusions and organ transplants, but these are considered rare.
How Common Is Syphilis Today?According to the Centers for Disease Control and Prevention (CDC), there were 203,500 reported cases of syphilis in the United States in 2022—an increase of nearly 80% since 2018. The number of congenital syphilis cases also rose from 1,325 in 2018 to 3,755 in 2022—an almost threefold increase over five years.
How Common Is Syphilis Today?
According to the Centers for Disease Control and Prevention (CDC), there were 203,500 reported cases of syphilis in the United States in 2022—an increase of nearly 80% since 2018. The number of congenital syphilis cases also rose from 1,325 in 2018 to 3,755 in 2022—an almost threefold increase over five years.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet dermnetnz.org 2023
Reproduced with permission from © DermNet dermnetnz.org 2023
What Are the Symptoms Associated With Syphilis?
Syphilis is often called the “great imitator” because the symptoms are so diverse that they can easily be mistaken for other diseases or medical conditions.
Primary Stage
Primary syphilis happens two to 12 weeks after exposure toT. pallidum.During this stage, a smooth, hard sore called achancrewill develop on your genitals, anus, or mouth. Most cases involve just a single sore, but it is possible to have more than one.
Because chancres are generally painless, you may not even know that you have the infection. This is especially true if the sore is in the vagina or anus or under the foreskin, where it may go unnoticed.
The chancre will eventually clear on its own within a few weeks or months. However, this doesn’t mean that the infection is clear; you are still highly contagious and can transmit the infection to others.
It is important to get treatment, even if your sore goes away. Left untreated, around 1 in 4 people with primary syphilis will progress to secondary syphilis.
Secondary Stage
Secondary syphilis occurs four to 10 weeks after the syphilis sore disappears, leading to the spontaneous outbreak of a bumpy, red to reddish-brown rash. The rash can cover the entire body, including the palms of your hands and the soles of your feet. The rash is usually non-itchy.
Other symptoms of secondary syphilis may include:
These symptoms may persist for 12 weeks or even longer before spontaneously disappearing.Even so, you are still contagious during the secondary stage and can readily transmit the infection to others.
The symptoms will resolve whether or not you get treatment, butgetting treated is the only way to prevent the disease from progressingto the next stage.
Latent Stage
If syphilis is not treated during the primary or secondary stages, it can go into an extended period of low disease activity—called latency—that can last up to 20 years or longer. Although there may be no outward signs or symptoms, the disease can progressively damage your heart, bones, nerves, and other organs.
Latent syphilis is largely silent, but roughly 1 in 4 people will experience an occasional flare-up of symptoms, which can easily be mistaken for an allergy or drug reaction.
During the early-latent stage (defined as up to one year following the initial infection), you can still transmit the infection to others. Thereafter, your risk of transmission rapidly declines. After two years, it is rare for transmission to occur.
Tertiary Stage
While tertiary syphilis can affect any organ system, it most commonly manifests as:
Neurosyphilis, Ocular Syphilis, and Otosyphilis May Occur at Any StageWithout treatment, syphilis may spread to the nervous system eyes, or ears at any stage of the disease:Neurosyphilis symptoms can include severe headache, muscle weakness, and changes in mental state.Ocular syphilis symptoms can include eye pain, red eyes, and changes in vision.Otosyphilis symptoms can include hearing loss, tinnitus (noises in the ear), and dizziness or vertigo (feeling like everything is spinning around you).
Neurosyphilis, Ocular Syphilis, and Otosyphilis May Occur at Any Stage
Without treatment, syphilis may spread to the nervous system eyes, or ears at any stage of the disease:Neurosyphilis symptoms can include severe headache, muscle weakness, and changes in mental state.Ocular syphilis symptoms can include eye pain, red eyes, and changes in vision.Otosyphilis symptoms can include hearing loss, tinnitus (noises in the ear), and dizziness or vertigo (feeling like everything is spinning around you).
Without treatment, syphilis may spread to the nervous system eyes, or ears at any stage of the disease:
Congenital Syphilis
If left untreated, congenital syphilis can lead to hearing loss, blindness, bone pain, and deformity of the nose, bones, and teeth.
A Word From VerywellPrevention is the cornerstone of managing syphilis. Regular screening, safe sexual practices, and prompt treatment of any detected infections are essential strategies to curb the spread of this disease.—SOMA MANDAL, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Prevention is the cornerstone of managing syphilis. Regular screening, safe sexual practices, and prompt treatment of any detected infections are essential strategies to curb the spread of this disease.—SOMA MANDAL, MD, MEDICAL EXPERT BOARD
Prevention is the cornerstone of managing syphilis. Regular screening, safe sexual practices, and prompt treatment of any detected infections are essential strategies to curb the spread of this disease.
—SOMA MANDAL, MD, MEDICAL EXPERT BOARD
Is Syphilis Curable?
Syphilis is curable at all stages. It is far easier to treat during the early stages of infection, often with a single dose ofpenicillin G. During the primary, secondary, and early-latent stages, between 94.5% and 100% of treated individuals will experience complete clearance of the infection.
After that, response rates steadily decline. By late latency, a single shot of penicillin G will deliver a response (cure) rate of only 56% to 63%.Because of this, multiple doses of penicillin G are needed over several weeks to ensure a complete cure.
Early detection is key to protecting yourself and others from this widespread and increasingly complicated STI.
How Syphilis Is Diagnosed
Syphilis Treatment Options
Penicillin G is preferred over othertypes of penicillinbecause it can reach parts of the body, such as the brain and spinal cord, that other forms of penicillin cannot.
The type used in the United States is called Bicillin L-A (benzathine penicillin G).Bicillin L-A is slowly absorbed after the injection, providing antibiotic action for as long as two to four weeks.
Depending on the stage of infection, the CDC recommends penicillin G in the following dosages:
Common side effects of penicillin G include injection site pain, nausea, and diarrhea.
Alternatives to Penicillin G
Other antibiotic drugs may be used if you are allergic to penicillin, some of which are highly active againstT. pallidum.These include:
Doxycycline was reported to have a response rate of between 83% and 100% in people with early syphilis, while ceftriaxone was reported to have a response rate of between 65% and 100%.
Even so, penicillin G remains the gold standard of treatment, particularly for people with tertiary syphilis.If a person with tertiary syphilis has a penicillin allergy, they should be treated in consultation with an infectious disease specialist.
Does My Sex Partner Need Treatment?If you have been treated for syphilis (primary, secondary, or early latent), your sex partners may likely need to be treated as well. The following factors determine the decision to treat or not treat:Sexual contacts within the past 90 days should be treated even if their test results are negative.Sexual contacts made more than 90 days ago should be treated if their results are unavailable and the chances of their returning for testing are low. If their results are negative, treatment is not needed.Long-term sex partners of someone with late latent syphilis should be treated based on the results of syphilis testing.
Does My Sex Partner Need Treatment?
If you have been treated for syphilis (primary, secondary, or early latent), your sex partners may likely need to be treated as well. The following factors determine the decision to treat or not treat:Sexual contacts within the past 90 days should be treated even if their test results are negative.Sexual contacts made more than 90 days ago should be treated if their results are unavailable and the chances of their returning for testing are low. If their results are negative, treatment is not needed.Long-term sex partners of someone with late latent syphilis should be treated based on the results of syphilis testing.
If you have been treated for syphilis (primary, secondary, or early latent), your sex partners may likely need to be treated as well. The following factors determine the decision to treat or not treat:
Complications of Untreated Syphilis
Syphilis Prevention and Management
Despite ongoing public awareness campaigns, syphilis rates continue to climb in the United States. By 2023, the rate of new infections had become so high that shortages of Bicillin L-A were reported nationwide. This led to the temporary importation of an alternative form of benzathine penicillin G called Extencilline.
To help reduce the spread of syphilis and protect yourself and others from infection:
Is Syphilis a Reportable Disease?
With that said, don’t assume that these systems are infallible. Consider contacting your partners yourself and explaining the situation without accusation or blame. If you feel too uncomfortable or embarrassed to do so, ask your healthcare provider to notify them for you (or with you).
Summary
Penicillin G is the treatment of choice for all stages of syphilis. Primary, secondary, and early-latent syphilis can usually be cured with one intramuscular injection. Late-latent and tertiary syphilis can usually be resolved with three intramuscular injections given over three weeks. Congenital syphilis may be treated with IV or IM penicillin for 10 days.
Sexual partners should also be tested and treated.
Which STIs Are Curable and Incurable?
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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