Syphilis. What you Need to Know About This Sexually Transmitted Infection

Syphilis cases are on the rise. Here is what you need to know.

Sexually Transmitted Infections have reached all-time highs. A new press release from the CDC evaluating the US data through 2019 shows staggering numbers.

  • 2.5 million reported cases of chlamydia, gonorrhea, and syphilis
  • A nearly 30% increase in these reportable STDs between 2015 and 2019.
  • The sharpest increase was in cases of syphilis among newborns which nearly quadrupled between 2015 and 2019.

Syphilis is on the rise worldwide. Australia also is reporting record numbers with Melbourne calling it a syphilis epidemic.

Until recently, most cases of syphilis occurred in MSM (men who have sex with men). Now, we are seeing an increasing number of cases in heterosexual men and women. The incidence is highest in women ages 20–24 and men ages 35–39.

What is Syphilis?

Syphilis is a common and curable sexually transmitted disease caused by the spirochete Treponema pallidum. Syphilis is transmitted from person to person through skin-to-skin contact. Syphilis is easy to treat with antibiotics, but it often goes undiagnosed. Untreated syphilis can lead to serious medical consequences.

How do people catch syphilis?

Syphilis is passed via direct skin-to-skin contact. Some STDs are transmitted from skin to skin contact, and others are passed via fluid transmission. Syphilis is transmitted when a person has direct contact with a syphilitic sore. These sores are commonly called a “chancre.”

Syphilitic ulcer ulcus durum and close-up view of syphilis bacteria Treponema pallidum on the surface of a penis, 3D illustration Dr_Microbe Istock/Getty Images

Syphilitic chancres can appear on the external genitals, vagina, anus, rectum, lips, or mouth. Because of the variety of locations of chancres, syphilis can be transmitted during vaginal, anal, or oral sex.

Syphilis can also be passed through the placenta to a fetus during pregnancy. It is not spread through casual contact or contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, or shared clothing.

What are the symptoms of syphilis?

Historically, physicians referred to syphilis as the “Great Pretender,” as it can lead to a wide variety of vague symptoms often confused for other diseases. There are three stages of syphilitic infections and each stage presents with different symptoms.

Stage One (Primary Syphilis)

During the first stage of syphilis a painless ulcer appears. These sores are commonly called a chancre. Chancres will last about ten days before resolving on its own.

They can appear on the external genitals, vagina, anus, rectum, lips, or mouth. Some people will not notice the lesion because the chancres are painless.

The chancre is quite contagious, which allows syphilis to be transmitted during vaginal, anal, or oral sex. Because the syphilitic chancres are painless and disappear on their own, people often do not seek treatment.

Stage Two (Secondary Syphilis)

The second stage can appear up to two years after infection. Symptoms can range from vague flu-like symptoms to a non-itchy rash. Classically, the rash appears on the palms and soles.

Other rashes, oral ulcers, enlarged lymph nodes, hair loss, weight loss, and fatigue are other symptoms. Syphilis can also lay latent for years during stage two, causing no symptoms at all.

Syphilis is often diagnosed during this stage through routine STD screening.

Stage Three (Tertiary Syphilis)

Fortunately, tertiary syphilis is rare in today’s world. It can occur 10–30 years after the initial infection. It is known to cause neurologic disorders (neurosyphilis) but can affect many other organ symptoms are well.

Historical figures such as Leo, Tolstoy, Al Capone, Guy De Maupassant, Toulouse Le Trec, Friedrick Nietzsche all suffered from neurosyphilis.

How do doctors diagnosis syphilis?

Health providers can find evidence of syphilis during a physical exam. A painless ulcer (chancre) or signs of secondary syphilis may increase suspicion.

To confirm the diagnosis, one needs blood testing. The most common blood test is called an RPR. Other labs use more advanced tests such as a VDRL or a Treponemal Antibody.

How do doctors treat patients with syphilis?

Fortunately, syphilis is a curable STD easily treated with antibiotics. Penicillin is the most common treatment.

Health departments perform contact tracing to evaluate, test, and treat all sexual partners who may have been exposed. Contact tracing is a crucial step in reducing the spread of syphilis.

If all partners are not treated, then one may be reinfected by an untreated partner or the infection spread to future partners.

After treatment with syphilis, people must abstain from unprotected sexual contact until they and their sex partners have completed their antibiotics.

Doctor consulting with male patient. Pornpak Khunatorn Istock/Getty Images

Who need syphilis testing?

The CDC recommends all sexually active individuals undergo routine STD screening unless in a stable, monogamous, long-term relationship.

In the US, all pregnant women are required to be tested during pregnancy.

Anyone with a known partner who has syphilis should be tested.

The CDC also recommends routine screening for anyone with HIV or men who have sex with men (MSM).

In addition, anyone with any signs or symptoms should be tested.

Woman giving to a man a condom. Prevention of sexually transmitted diseases. Albina Gavrilovic Istock/Getty Images

Condoms reduce the risk of syphilis.

Prevention is best achieved by the use of latex condoms consistently and correctly. Condoms can significantly reduce the risk of transmission. Condoms are highly effective at preventing STDs. It is important to note that with skin-to-skin transmitted infections like syphilis, some areas of the body will still come into contact.

Water-based lubricants should be used with latex condoms to provide the most protection.

If you are going to play, then play safe.


Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

Dr Jeff Livingston
Dr Jeff Livingston
Jeff is Co-Founder of Medika Life. He is a Board Certified Obgyn and CEO of MacArthur Medical Center in Irving, Texas. He is a nationally recognized thought leader, speaker, writer, blogger, and practicing physician who is considered an expert in the use of social media to educate patients, using new and innovative technology to improve care outcomes and the patient experience.


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