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Over the past several years, the rates of sexually transmitted diseases (STDs) have dramatically increased. The combined cases of syphilis, gonorrhea, and chlamydia are at an all-time high, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC estimates 55,400 people in the United States contract syphilis each year.
There are numerous factors causing the rise in STDs, including syphilis. "Many people are having hook-up, condom-less sex and not having the proper screening evaluation before being intimate with someone," says Dr. Alyse Kelly-Jones, a gynecologist at Novant Health. She goes on to say “When you can go on your phone and find a partner quickly, it makes the risk seem less."
Access, or lack of, to healthcare, also plays a role. "Many of our population have limited or no access to healthcare,” Dr. Kelly-Jones says. “Getting a routine screening for STDs can be expensive and not covered by some of our limited health plans. Going to the health department can be difficult and time-consuming.”
While syphilis can cause long-term damage when untreated, it can be cured with antibiotics, although damage to the body may remain. Researchers continue to look for new, more accessible diagnostic tests and treatments for syphilis—such as urine and saliva tests that detect syphilis instead of a blood test. Additionally, new syphilis treatments could include oral medication rather than needing one or more injections at your doctor's office. Some researchers are conducting research that might eventually lead to a vaccine, according to the National Institute of Health (NIH).
What is syphilis?
Syphilis is a systemic, sexually transmitted disease (STD) caused by the Treponema pallidum bacterium, according to the CDC. It can be spread from person to person through vaginal, anal, or oral sex when there is skin-to-skin sexual contact with syphilis sores or lesions. In the secondary stage, it can also spread by direct contact with mucous membrane lesions. The third way it is transmitted is called vertical transmission and is when pregnant women pass it to unborn babies through the bloodstream. A child born with an infection has congenital syphilis.
There are four main stages of syphilis, according to the CDC Pocket Guide for Providers:
- Primary syphilis: During this stage of syphilis, people are highly infectious, and it is easy to pass the disease to a sexual partner. Symptoms usually appear about three weeks after exposure. They include lesions, called chancres, that present around the external genitals, anus, in the vagina, in the rectum, or in and around the mouth. The lesions are small, firm, round sores, which are painless. They may heal within a few days or weeks, with or without treatment. However, the underlying disease cannot be cured without medication.
- Secondary syphilis: People with syphilis are highly contagious during the secondary stage. Clinical manifestations of this stage include mucocutaneous lesions or rashes on their skin. These usually appear on the torso, but they can also appear on the palms of the hands or soles of the feet. Around one-fourth of those with syphilis will develop condyloma lata, moist wart-like lesions in the genital area. As with primary lesions, secondary stage symptoms also clear up on their own anywhere from two weeks to three months after they appear. Although the lesions might disappear, the underlying infection is still present without antibiotic treatment.
- Latent syphilis: The early latency period is within one year of onset of symptoms. The late latency stage is more than one year after the start of symptoms. People in these stages might or might not have symptoms or may only have mild symptoms that can easily go unnoticed.
- Tertiary syphilis: The tertiary stage occurs when the infection spreads to the skin, bones, brain, and cardiovascular systems. During this stage, the person is not contagious.
When syphilis spreads to the nervous system, it is called neurosyphilis. Neurosyphilis may occur at any stage of infection. Although the nervous system might become infected within hours of exposure, it can take weeks or years before symptoms appear, or symptoms might never appear. Early neurosyphilis can appear as meningitis or meningovascular syphilis. It can affect the neurologic, ophthalmologic, and audiologic systems of the body. Late-stage neurosyphilis can lead to dementia, muscle weakness, and paralysis.
How is syphilis diagnosed?
The diagnostic process for syphilis usually includes a physical examination for lesions, blood tests, reverse sequence screening, and questions about sexual history. Your doctor may order one or more of the following tests:
- A rapid plasma reagin (RPR) blood test detects specific antibodies in your body that are present when you have the syphilis infection.
- A sample of cerebrospinal fluid (CSF) via lumbar puncture can determine if neurosyphilis is present.
- Enzyme immunoassay test (EIA) can help confirm a syphilis diagnosis.
Who should get screened for syphilis?
Anyone can get screened for syphilis, regardless of whether they have any symptoms. Planned Parenthood recommends that anyone who is sexually active should get tested for STDs annually. Women who are pregnant should also get screened because of the high risk to the unborn child.
Screening for syphilis is an essential part of preventing the spread of sexually transmitted infections (STIs), according to the U.S. Preventive Services Task Force. It recommends the following populations receive regular screenings because of their elevated risk:
- Men who have sex with men
- Women and men who are living with HIV infection
Dr. Kelly-Jones adds, "If I have a patient that has unprotected sex with a new partner, I would be screening for syphilis. Any patient that has signs or symptoms suggestive of syphilis, any pregnant woman, any person that has been in contact with someone who has had syphilis would all be reasons to screen."
Anyone who notices a sore in the genital area and those who have had unprotected sex should seek health care from a doctor or clinic for STI testing. You can receive diagnostic tests and treatment for syphilis through your primary care physician or gynecologist. You can also search for a sexual health clinic or general health clinic that tests for and treats STIs on the American Sexual Health Association website. You should notify your sex partners if you receive a syphilis diagnosis, as they should be tested and treated too.
Doctor-patient discussions
Talking with a physician about STDs, such as syphilis symptoms, is not easy. It can be embarrassing, and you might worry that the doctor will judge you for your choices. However, most doctors who diagnose and treat STDs are not judgmental and want to make sure you stay healthy and continue to make healthy choices.
During these doctor's appointments, a physician will ask about a patient's general health history in addition to their sexual health history and their recent sexual activity, including the reason they're seeking STD screening.
Just as necessary as it is for you to share information with your doctor, you should ask questions to make sure you understand your risks and, if needed, treatment options. The Office of Disease Prevention and Health Promotion (ODPHP) suggests you ask your doctor the following questions:
- Am I at risk for syphilis?
- Do I need to get tested for syphilis?
- How often do you recommend I get tested for syphilis?
- What happens during the test?
- How will I find out my test results?
- When will I get my test results?
- If I have syphilis, what will happen next?
- Can you give me some information about syphilis to take home with me?
Syphilis treatment options
Antibiotics can cure syphilis. Early detection and management of syphilis are important. Although the treatment can eradicate the syphilis infection, it cannot undo the damage the infection might have caused, according to the CDC.
An intramuscular injection of long-acting Bicillin L-A (penicillin G benzathine) is used for primary to early latent syphilis. However, late latent syphilis requires three weekly doses of the same medication.
Doxycycline and tetracycline are some options for those allergic to penicillin.
For neurosyphilis, penicillin or ceftriaxone are the first choices of drugs. When neurosyphilis is involved, your doctor might suggest clinical and laboratory follow-ups to monitor whether the medication is effective.
Syphilis medications
Antibiotics treat syphilis. Bicillin L-A (penicillin G benzathine) is the most commonly used antibiotic for syphilis. Depending on the stage, you might need a single injection or a weekly shot for three weeks.
Some common side effects include:
- Nausea
- Vomiting
- Diarrhea
- Flushing
- Headache
- Drowsiness
Other brand-name antibiotics that are available for those allergic to penicillin include:
- Acticlate (doxycycline)
- Avidoxy (doxycycline)
- Doryx (doxycycline)
- Mondoxyne NL (doxycycline)
- Oracea (doxycycline)
- Vibramycin Hyclate (doxycycline)
- Tetracycline HCl (tetracycline)
Some of the common side effects for these medications include:
- Nausea
- Vomiting
- Diarrhea
- White patches or sores in your mouth
For neurosyphilis, penicillin, or the cephalosporin antibiotic, Rocephin (ceftriaxone), is used. The medication is injected into a muscle or given intravenously for 10-14 days. People with a penicillin allergy should not take these medications. Some common side effects of ceftriaxone include:
- Black, tarry stools
- Chest pain
- Cough
- Fever
- Painful urination
- Shortness of breath
- Sore throat
Researchers are also looking at the antibiotic azithromycin as a treatment for syphilis.
What is the best medication for syphilis?
Syphilis treatment options are limited. The first-line treatment is Bicillin L-A, which is an injection of penicillin. Other medications are available for those who are allergic to penicillin. The following lists the primary drugs used for syphilis:
| Best medications for syphilis | ||||
|---|---|---|---|---|
| Drug name | Drug type | Administration route | Standard dosage | Common side effects |
| Bicillin L-A (penicillin G benzathine) | Antibiotic | Injection | For primary, secondary, or latent stages: 1 injection of 2,400,000 units For the tertiary stage: 3 injections at 7-day intervals of 2,400,000 units | Injection site pain; nausea or vomiting |
| Doxycycline hyclate (many brand names available) | Antibiotic | Oral | For early syphilis, <1 year since onset: 100 mg/2x day for two weeks For late syphilis: 100 mg /2x day for four weeks | Nausea, vomiting, or diarrhea; oral thrush |
| Tetracycline (many brand names available) | Antibiotic | Oral | For early stages: 500 mg capsule every 6 hours for 14 days For latent and tertiary: 500 mg capsule every 6 hours for 28 days | Stomach upset, mouth sores, sore throat |
| Rocephin (ceftriaxone) | Antibiotic | Injection | Optimal dosing not defined | Injection site irritation is most common but serious reactions may occur |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of syphilis medication?
Some common side effects of antibiotics include:
- Nausea
- Vomiting
- Diarrhea
Another potential problem of antibiotics when used to treat syphilis is the Jarisch-Herxheimer Reaction (JHR). Symptoms of JHR can include shaking, chills, fever, muscle pain, headache, anxiety, and exacerbation of skin lesions. JHR usually occurs within hours after taking the antibiotic and clears up quickly, with the average length of symptoms being nine hours, according to a study published in 2018. Approximately 28% of people with syphilis treated with antibiotics will develop JHR, although estimates of occurrence vary widely.
Please note this is not a full list of potential side effects. It would be best if you discussed all of the possible side effects with your doctor or pharmacist before starting any medication.
What is the best natural remedy for syphilis?
There isn’t any effective, natural treatment for syphilis. You might hear or read about using natural and herbal remedies, such as garlic, vitamin C, and zinc, but these are unproven remedies for syphilis.
Because syphilis can cause serious health problems when untreated, it is not a good idea to spend time searching for a natural treatment. When caught early, one single shot of antibiotics can cure syphilis.
Additionally, the syphilis sores and lesions are painless, and after the first outbreak, mild, so that you might not even notice them. The sores clear up on their own.
Lifestyle changes
Lifestyle changes cannot cure or improve symptoms of syphilis. However, there are lifestyle choices you can make to reduce the chance of becoming reinfected. When you contract this infection, you are not immune, as you are with other diseases, such as measles. Practicing safer sex is the best way to reduce your risk of contracting syphilis and other STDs, such as gonorrhea and chlamydia. Some of the steps you can take include:
- Use condoms, dental dams, and internal condoms every time you have oral, anal, or vaginal sex. While these methods are not foolproof in protecting you from STDs, they do reduce the risk to the area covered by the condoms or dental dams.
- Get tested for STDs regularly. For sexually active people, annual testing is essential, or even more frequently in some cases, according to the CDC.
- Talk with your doctor if you were exposed to syphilis or other STDs. Your doctor might suggest getting a shot to prevent certain STDs.
- Avoid having sex with anyone unless you know they have been screened and do not have an STD. When you enter a new relationship, both people should get tested before becoming intimate. If it can’t wait, protection can provide an extra layer of safety.
Refraining from a sexual relationship is the only way to avoid developing an STD. However, people in monogamous relationships have a reduced risk of syphilis if both partners are tested and do not have an STD.
Frequently asked questions about syphilis
What happens if you don't treat syphilis?
Untreated syphilis can result in serious complications involving the brain, heart, and nervous system, and can lead to organ failure. However, because syphilis is a bacterial infectious disease, antibiotics can cure it.
Does syphilis go away?
Symptoms of syphilis, such as sores, will resolve and go away. However, the underlying disease does not go away without antibiotics. With treatment, syphilis is curable.
Can you get syphilis non-sexually?
Syphilis spreads through sexual, skin-to-skin contact during vaginal, anal, or oral sex. You cannot get syphilis through non-sexual ways except when newborns contract the infection from their mothers.
Can you get syphilis from a toilet seat?
You cannot get syphilis from casual contact, like sitting on a toilet seat or touching objects someone with syphilis touched, according to Planned Parenthood.
Is a syphilis rash itchy?
The syphilis rash is not itchy, according to the CDC. It appears as rough, red, or reddish-brown spots on the palms of the hands and bottom of the feet. Less noticeable rashes can appear on other parts of the body.
What are the four stages of syphilis?
The four stages of syphilis are:
- Primary: Painless sores called chancres appear; sores heal in about three to six weeks. This is a highly contagious stage.
- Secondary: A rash appears over the body, often on the palms of hands and soles of feet. This is also a highly contagious stage. Symptoms can clear within two weeks to three months.
- Latent: If untreated, the patient enters the latent stage. This can be anywhere from one to twenty years. Although the person may not have symptoms, he or she may still be contagious.
- Tertiary: The infection may spread to the skin, eyes, bones, brain, and cardiovascular system.