The symptoms of syphilis usually follow the stage of the disease. The latent stage of the disease has no outward symptoms. The stages of syphilis with accompanying symptoms are as follows:

Primary Stage

• Painless Sore/Chancre

Secondary Stage

• Rash all over the body
• Muscle aches
• Fever
• Sore throat
• Lymph node swelling

Tertiary Stage

• Memory loss
• Trouble thinking
• Heart conditions
• Liver disease
• Joint pain
• Bone disease

There are three stages to syphilis:

Primary. This is when the chancre first appears. The incubation period for syphilis is around 10 to 90 days, but symptoms average about 21 days after infection. The sore/chancre is most often small, round, and isn’t painful. Wherever the chancre is found is the site of transmission. These sores last from 3 to 6 weeks and treatment needs to be started at this time to prevent transmission to others and progression of the disease.

Secondary. Between 6 weeks and 3 months after the chancre heals, the secondary stage of syphilis begins. A rash appears on the body but does not itch. These are rough, red, and brown spots that most often occur on the soles of the feet and palms of the hands. If there is no treatment, the disease progresses to latent syphilis.

Latent/Tertiary. This stage appears after the one-year mark and can persist up to 30 years or longer. There are usually no symptoms of syphilis, but you are still infected. This stage can cause damage to the organs and nervous system. There is even a possibility of death from latent/tertiary syphilis.

Syphilis is transmitted sexually. You cannot contract syphilis from the public or shared spaces, such as toilet seats, doorknobs, or swimming pools. The following behaviors do raise your risk of infection:

• Not using a condom during sex
• Compromised immune system (HIV, AIDS, or other conditions that weaken immunity)
• Gay men
• Multiple sexual partners
• Street drug use
• Pregnant women with syphilis can spread the infection to their baby
• Touching a chancre on someone’s skin

Any tests for syphilis need to look for the spirochete, treponema. They can also look for antibodies to the bacteria which build up over time. Testing can be on blood, spinal fluid, or the fluid from the chancre. They include:

VDRL – Venereal Disease Research Laboratory and RPR – Rapid Plasma Reagin. These are the first line of testing for sexually transmitted diseases, but will not tell you if you are infected with syphilis. They can also be positive due to other disease processes “false positive.” Your doctor will usually start with these tests and then move on to a more specific test.

Treponema Testing – FTA-ABS, TP-PA, and EIA. These tests detect the pregnant antibodies to the syphilis bacteria. This test needs to be performed on every pregnant woman during the prenatal screening tests and at the third-trimester workup. These tests should also be done on newborns born to mothers that have positive test results for syphilis, even if the infection is not active.

Cultures. A sample of fluid from either the spinal fluid or an active chancre can reveal the bacteria. Syphilis is often diagnosed before needing this test but can be helpful in later stages where there are neurological symptoms. In that case, a lumbar puncture may be performed and testing is done on the spinal fluid.

The doctor will ask about sexual history and the history of partners if you know it. If you receive a positive diagnosis, you will have to give the names of all sexual partners since the infection started. This information legally must be reported.

The only way to clear a syphilis infection from the body is with penicillin. Currently, no home remedies or alternative medicine treatments have been proven to cure syphilis. If you catch syphilis early, you will only need one injection of Benzathine penicillin G given at a dose of 2.4 million units. This treatment works for syphilis in the primary stage, the secondary stage, or even latent syphilis. People who have late-stage syphilis receive three doses given one dose per week for three weeks.

It is important to understand that if the infection goes untreated long enough to cause damage in the late stages, the three-dose treatment will only cure syphilis and not reverse any damage caused to the body by the infection.

There are not enough studies to show that other antibiotics or medications will treat syphilis. Some studies show that Tetracycline drugs may be effective. If another drug is used, it will be important to have your labs checked to make sure it is treating the infection effectively.
If you are diagnosed with syphilis, it is important to not have sex until you are finished with treatment. Using a condom is not helpful in the early stages, especially if the chancre is outside the reproductive organs. You will also need to notify any sexual partners that you came in contact with during the period you believe you were infected. They will need evaluation and treatment for syphilis. In partners of those diagnosed, they usually give the penicillin injection whether they contracted the infection or not.

Treatment after Care

• Follow-up with your doctor as they recommend for re-testing
• Do not have sex until the infection has cleared from your body
• Get tested for HIV and other STD’s
• Report any unusual side-effects of medication to your doctor
• Tell your doctor if you develop new sores or symptoms of syphilis

Complications of Treatment

Jarisch-Herxheimer Reaction. Spirochetes release toxins into the body when they die off during treatment. After the injection is given and treatment begins taking effect you may notice the symptoms of this including; headache, chills, fever, aches, and nausea. This goes away quickly, but let your doctor know if it happens.

Allergies to Penicillin. Since penicillin is the only recommended effective treatment for syphilis, doctors may opt to treat a penicillin allergy and give the medication anyway. You can either be “pre-medicated” with Benadryl before the injection or go through “desensitization.”

Re-infection. One important reason to notify your partner(s) and make sure they get treated is that syphilis does not confer immunity. You can get it over and over again. If you undergo treatment and sleep with a partner that is still infected, you can catch it again.

• Practice abstinence
• Choose long-term partners that will be monogamous (one partner only)
• Use a condom every time you have sex if you are not monogamous
• Use a female diaphragm with a spermicide

Birth control such as hormones or sterilization does not protect against sexually transmitted diseases. Get tested for STDs regularly if you are not in a long-term monogamous relationship. Encourage your partner to get tested.

Chronic sores. Over a long-term period of time, chronic sores can develop. These are known as gummata. They can form on the organs inside the body or on the skin.

Cardiovascular syphilis. Syphilis can cause the aorta to become inflamed. A “gumma” (above) may also form on the heart muscle. Either of these can damage the heart and is often a cause of death in late syphilis.

Neurosyphilis. Late-stage syphilis can invade the brain, spinal cord, and nervous system. It can cause numerous symptoms including; trouble walking, confusion, headache, dementia, numbness in the extremities, neck stiffness, and many other neurological symptoms.

Other complications of syphilis include:

• Hypopituitarism (low hormone secretion from the pituitary gland)
• Increased risk for HIV infection
• Gastric syphilis
• Childbirth and pregnancy complications

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Centers for Disease Control and Prevention. (2017, June). Syphilis – CDC fact sheet. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/std/syphilis/syphilis-factsheet.pdf

Clement, M. E., Okeke, N. L., & Hicks, C. B. (2014, November 12). Treatment of syphilis: A systematic review. JAMA, 312(18), 1905-1917. Retrieved from National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690208/

Dawson, M. (2018, May 07). Complications of syphilis. Retrieved from Everyday Health: https://www.everydayhealth.com/syphilis/complications/

World Health Organization. (2021). 3.4. Syphilis. Guidelines for the Management of Sexually Transmitted Diseases. Retrieved from World Health Organization: https://www.who.int/reproductivehealth/topics/rtis/treatment_syphilis.pdf