Syphilis is a sexually transmitted infection (STI) caused by bacteria. There are four stages of syphilis. The infection is curable, especially with early diagnosis and treatment. Untreated syphilis can lead to severe health complications affecting the heart, brain, and other organs.
In some cases, damage from advanced untreated syphilis can be permanent. Treatment for syphilis involves taking antibiotics like penicillin. Treatment becomes more challenging as the infection becomes more advanced.
Syphilis has four different stages: primary, secondary, latent, and tertiary. Although the stages occur in order, the time a person is in each stage varies. If you are sexually active, being aware of the different stages, especially the early ones, can help you seek treatment earlier for syphilis.
Primary Stage
If you are exposed to the bacteria that causes syphilis, it can take about 3-4 weeks for the first symptoms to show.
In the first stage of syphilis, you will develop a type of sore called a chancre around your vagina, anus, penis, or mouth. They are usually round and painless.
It can be challenging to recognize that you have syphilis at this stage because you may only develop a single sore. These sores will heal on their own, making people think the underlying issue has been resolved.
Secondary Stage
You may enter the secondary stage before or after the primary sore has healed. In this stage, you will likely develop skin rashes where the sore was or on other areas, like the palms of your hands and the bottoms of your feet. These rashes are usually red and don’t itch—you might not notice that you have them.
You may experience additional symptoms in this stage, such as:
- Fever
- Sore throat
- Muscle aches
- Headache
- Tiredness
Like the primary stage, these symptoms usually go away on their own. Without treatment, though, you will still have syphilis, and the infection will continue to progress.
Latent Stage
Once the symptoms of the previous stages resolve, you will enter the latent stage. During this time, you won’t experience any symptoms for weeks or years.
You still have syphilis, and left untreated, the infection can advance to the tertiary stage. For this reason, it’s important to regularly test for sexually transmitted diseases—even if you have no symptoms of syphilis, you will still test positive.
Tertiary Stage
If your syphilis remains untreated, you may develop tertiary syphilis up to 30 years after the initial bacterial infection. Tertiary syphilis is a serious health condition that can affect several areas of your body, including your heart.
Treatment is possible but more challenging during the tertiary stage, as the underlying damage from the infection may be permanent. In severe cases, syphilis can result in death.
Syphilis is an infection from the bacteria Treponema pallidum and can be diagnosed through several methods. You must complete two types of blood tests or a special microscope test to receive a syphilis diagnosis.
If you have symptoms of syphilis in the brain and spinal cord, your healthcare provider may also order a test using your cerebrospinal fluid (fluid surrounding the brain and spinal cord).
Nontreponemal Tests
A nontreponemal test is a blood test that looks for evidence that the syphilis bacteria Treponema pallidum is in your body.
The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests are two examples of nontreponemal tests. The VDRL test screens your blood sample for the presence of antibodies to the syphilis bacteria.
Antibodies are proteins that form as an immune response to harmful compounds, like infectious bacteria. The presence of certain antibodies would signal the presence of an infection.
Treponemal Tests
Treponemal tests are more advanced blood tests that also look for the presence of Treponema pallidum in your body. These tests are typically used to confirm a syphilis diagnosis if you test positive on a nontreponemal test.
These tests can also help determine if you’ve previously had a syphilis infection.
Dark-Field Microscopy Test
During this test, a specialist will take a small sample of your blood and place it under a microscope. They will immediately examine the blood through the microscope under special lighting that allows them to detect bacteria that cause syphilis.
Cerebrospinal Fluid Test
Some people with syphilis develop symptoms related to neurosyphilis—a type of syphilis that affects the brain, spinal cord, and eyes. To determine if you have this type of syphilis, you’ll need to have a cerebrospinal fluid (CSF) test.
For this test, a medical provider will inject a local anesthetic into your lower back. They will then use a needle to withdraw a small amount of cerebrospinal fluid from between two vertebrae (spine bones). The lab will test this fluid for the presence of syphilis-causing bacteria.
Since syphilis is a bacterial infection, antibiotics can treat it. Benzathine penicillin G (BPG) is the most effective antibiotic for syphilis. Options such as doxycycline and ceftriaxone are available for those allergic to penicillin.
Syphilis is a curable sexually transmitted disease, especially when diagnosed early. However, untreated syphilis can cause permanent organ damage and, in some cases, can lead to death.
Untreated syphilis can have serious health complications, including neurosyphilis, ocular syphilis, otosyphilis, and congenital syphilis. Untreated tertiary syphilis can also cause organ damage to your heart.
Neurosyphilis
When the bacterial infection reaches the brain and spinal cord, you may develop neurosyphilis, with symptoms including dementia, confusion, muscle weakness, and severe headaches. Neurosyphilis can occur during any stage of syphilis but becomes more likely as the infection goes untreated.
Ocular Syphilis
The bacterial infection causing syphilis can also spread to the eyes, causing inflammation. When this occurs, you may experience eye pain or redness, vision changes, and vision loss—which may be permanent.
Otosyphilis
Otosyphilis is a complication of syphilis to the ears. It occurs when the infection spreads to the ear structures and nerves. Symptoms include dizziness, vertigo, hearing loss, and other changes in your hearing.
Congenital Syphilis
If you’re pregnant and have syphilis, it is very important to receive treatment right away. Syphilis may be passed from the pregnant parent to the fetus through the placenta during pregnancy. Congenital syphilis can cause stillbirth, premature birth, death of the infant, and long-term health concerns.
Syphilis is easily curable at early stages, and there are strategies you can use to prevent infection. The only 100% effective way to prevent syphilis is abstinence. Other strategies to reduce your chances of infection include:
- Use condoms consistently and correctly
- Have open and honest communication about STIs with your sexual partners
- Test regularly for STIs
- Be in long-term monogamous relationships
Having syphilis does not make you immune to future infections; you can have many new syphilis infections over your lifetime. It’s important to practice safe sex and get tested regularly for STIs, especially since the early stages of syphilis are often overlooked.
Some risk factors increase your risk of syphilis infection. You may be more likely to get syphilis if you:
- Have an HIV diagnosis
- Are sexually active with multiple partners
- Are a man who has sex with men
- Are a part of a racial or ethnic minority group
- Are a young woman (age 24 and under)
If you are at higher risk for syphilis, getting regular testing—even when you aren’t showing any symptoms—can help identify and treat syphilis infections as early as possible.
Syphilis is a sexually transmitted infection (STI) that progresses through four stages: primary, secondary, latent, and tertiary.
It starts with painless sores, followed by rashes, and then enters a symptom-free latent phase. Some people may develop tertiary syphilis, which can cause organ damage and be life-threatening if untreated.
Diagnosis requires blood or microscope tests, and treatment is primarily antibiotics like penicillin. If untreated, syphilis can lead to severe complications, including neurosyphilis and congenital syphilis. Condom use, regular testing, and other safe sex practices can help prevent syphilis.
