What Is Syphilis?

Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum. It develops in stages, and each stage has different symptoms, which makes it easy to miss. Syphilis spreads through direct contact with a syphilis sore during vaginal, anal, or oral sex. Cases have been rising in the United States in recent years, and the infection can cause serious health problems if left untreated, including damage to the brain, nerves, and heart. The good news is that syphilis is highly curable with penicillin when caught early. This guide covers the symptoms of each stage, how syphilis spreads, how testing works, treatment, and prevention.

Symptoms

Syphilis symptoms depend on the stage. Primary syphilis usually starts with a single, painless sore called a chancre at the site of infection, often on the genitals, mouth, or anus. The sore heals on its own in three to six weeks, even without treatment, which leads many people to think the problem is gone.

Secondary syphilis brings a rash, often on the palms of the hands and soles of the feet, along with fever, sore throat, fatigue, and swollen lymph nodes. These symptoms also fade without treatment. The infection then enters a latent stage with no symptoms, which can last for years. Late-stage syphilis can damage the brain, nerves, eyes, and heart.

How It Spreads

Syphilis spreads through direct contact with a syphilis sore during vaginal, anal, or oral sex. The sores can be hidden inside the vagina, anus, or mouth, so a person may not know they have one. A pregnant person with syphilis can pass the infection to their baby, which can cause serious complications, so prenatal screening is routine.

You cannot get syphilis from toilet seats, doorknobs, hot tubs, or sharing utensils. Condoms reduce the risk, but they only protect the areas they cover, since sores can appear elsewhere. Testing is the only reliable way to know your status.

Testing

Syphilis testing is a blood test. The most common screening test is the RPR, which looks for antibodies your body makes in response to the infection. A positive RPR is confirmed with a second, more specific test, because RPR can occasionally be positive for other reasons.

Antibodies take time to build up, so testing too soon after exposure can miss the infection. The window period is usually two to twelve weeks, and most experts recommend testing about four to six weeks after exposure. Early testing matters because syphilis is easiest to cure in its early stages, and untreated syphilis can cause lasting damage.

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Treatment and Cure

Syphilis is curable. Penicillin is the standard treatment, and a single injection cures primary, secondary, and early latent syphilis. Later stages may need multiple doses. People allergic to penicillin can use other antibiotics, though pregnant people with syphilis are usually treated with penicillin regardless.

Treatment stops the infection, but it cannot repair damage already done to the brain, nerves, or heart. That is why early detection matters. After treatment, follow-up blood tests confirm the infection is gone, and you should avoid sex until your sores have healed and treatment is complete.

Prevention

Condoms reduce the risk of syphilis, but they only protect the skin they cover, since sores can form anywhere. Regular testing is important, especially if you have new or multiple partners, and the CDC recommends yearly syphilis screening for people at higher risk.

If you test positive, tell your partners so they can be tested and treated. Pregnant people should be screened early in pregnancy, since treatment protects the baby. Open communication about testing before sex is one of the simplest ways to prevent syphilis.