Syphilis

Fact sheet about syphilis

What is syphilis?

Syphilis is a common sexually transmitted infection (STI) that will get worse over time and cause severe health problems if left untreated. There are four stages of syphilis with different signs and symptoms, and the final stage can result in organ failure and even death. An individual can be infected more than once with syphilis; however, there are steps that can reduce their risk of getting syphilis in the future.

How does syphilis spread?

• Syphilis spreads through sexual contact. It is most commonly spread through unprotected sex, including vaginal, anal, or oral sex, with someone who has the infection.
• A pregnant person with syphilis can give the infection to their baby during birth.

Syphilis cannot be spread through contact with objects, such as:

• Toilet seats
• Doorknobs
• Swimming pools
• Hot tubs
• Bathtubs
• Sharing clothing, or eating utensils

What are the signs and symptoms of syphilis?

There are four stages of syphilis (primary, secondary, latent, and tertiary), each with different signs and symptoms.

Primary stage

• Single or multiple sores that occur in, on, or around the penis, vagina, anus, rectum, lips, or in the mouth
  • These sores are usually firm, round, and often painless. They usually last three to six weeks.
  • Even though the sores heal without treatment, it is critical to receive treatment to prevent the infection from getting worse.

Secondary stage

• Skin rashes may appear in one or more areas of the body while the primary sore is healing or weeks after it has healed. These rashes are often found on the palms, the bottom of the feet, and are rough, red, or reddish-brown in color. They usually do not itch.
• Sores on the mouth, vagina, or anus. 

Other symptoms:

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

The symptoms will go away even without treatment, but it is critical to receive treatment to cure the infection and prevent health issues in the future.

Latent stage

• During the latent stage of syphilis, there are no visible signs or symptoms.
• The disease will be dormant (inactive) in the body, and this stage can last for years. 

Tertiary stage (occurs 10–30 years after initial infection)

• Most people with untreated syphilis do not develop tertiary syphilis. 
• If syphilis does get to this stage, it can affect many organ systems and can cause organ failure and death. 

Syphilis can spread to different areas of the body and cause problems. This can happen at any stage of syphilis:

• Neurosyphilis is when the disease has spread to the brain and nervous system, and can have the following symptoms:
  • Severe headache
  • Muscle weakness and/or trouble with muscle movements
  • Changes to mental state (trouble focusing, confusion, changes in personality)
  • Dementia (problems with memory, thinking, and/or decision-making).
• Ocular syphilis is a form of neurosyphilis and occurs when the disease spreads to the eye, and can cause:
  • Eye pain and/or redness
  • Changes in vision or even blindness
• Otosyphilis is a form of neurosyphilis and occurs when the disease spreads to the ear and can cause: 
  • Hearing loss
  • Ringing, buzzing, roaring, or hissing in the ears
  • Dizziness
  • Vertigo (feeling like you or your surroundings are moving or spinning)

Congenital syphilis occurs when people pass syphilis to their babies during pregnancy. For more information, access our congenital syphilis fact sheet. 

What are my testing options?

You should see a healthcare provider if you experience symptoms of syphilis or have been exposed to syphilis. Laboratory tests, such as blood tests, can diagnose syphilis.

Syphilis Testing Recommendations:

In Massachusetts regular syphilis testing is recommended for all sexually active individuals. Certain individuals may benefit from more frequent testing. Speak with a healthcare provider to determine your individual risk and how often syphilis testing is appropriate.

More frequent testing may be recommended for individuals who:

• Are a gay, queer, or bisexual man
• Have HIV
• Are taking pre-exposure prophylaxis (PrEP) for HIV prevention
• Have sexual partner(s) who have tested positive for syphilis
• All pregnant people should get syphilis testing at their first prenatal visit, during their third trimester, and may also need testing at delivery.

What are my treatment options?

Syphilis can be treated with the right medication from a healthcare provider. It is important to take all prescribed medication to cure the bacterial infection that causes syphilis. Follow-up blood testing is necessary to make sure the treatment is successful. It is possible to get syphilis multiple times, even after being previously treated. 

What happens if syphilis is left untreated?

Untreated syphilis can cause many health issues including problems with the eyes (blurry vision, blindness), ears (hearing loss), heart (aneurysms), or brain (dementia). In addition, syphilis infections that are not treated may increase your chances of getting or spreading HIV – the virus that causes AIDS. 

How can I prevent syphilis?

There are a few steps you can take to stay safe and lower your risk of syphilis:

• Use condoms the right way every time during sex and consider other barrier methods like dental dams. However, condoms may not cover all syphilis sores, so it’s important to avoid any contact with sores.
• Limit your number of sexual partners with unknown STI status. 
• Talk to a health care provider about Doxy PEP – medication that can prevent syphilis, gonorrhea, and chlamydia infections after a sexual encounter. For more information, access our Doxy PEP page here: [link]
• Get tested if you have symptoms of syphilis.

These steps can also help reduce your risk for syphilis and other STIs. Medications like doxycycline post-exposure prophylaxis (Doxy PEP) can help prevent bacterial STIs after exposure, while HIV pre-exposure prophylaxis (HIV PrEP) can reduce your risk of acquiring HIV. Take charge of your sexual health and talk to your provider about what methods are right for you.

Where can I get more information?

• Your doctor, nurse, or sexual and reproductive health provider
• Your health center or family planning clinic
• The Centers for Disease Control and Prevention (CDC)
• The Massachusetts Department of Public Health, Division of STD Prevention & HIV Surveillance, Partner Services Program at [phone].
• Doxy PEP information from the Massachusetts Department of Public Health

HIV PrEP information from the Massachusetts Department of Public Health