What is syphilis?

Syphilis is a bacterial infection that spreads easily and can have long-term health implications. While less common than some STIs, numbers are rising. It is usually caught by having sex with someone who is infected (including oral sex) and occurs in three distinct stages. Getting tested early is vital because if you reach stage three, any damage that’s already been done will be permanent. Treatment depends on the stage of infection but is generally a single antibiotic injection or course of antibiotic injections.

Listen to Jill Ladlow, one of our expert Sexual Health Nurses, give an overview on Syphilis in the video below. She explains about symptoms, how people catch it, how you can get tested and what the treatment usually involves.

What are the symptoms?

Syphilis develops in three stages. Each stage has its own symptoms, which are similar to many other illnesses. Men and women will have the same symptoms at the same stages.

Stage one (primary syphilis)

Painless ulcers/sores may appear at the site of the infection. This is usually on the penis, vagina, rectum (bottom), inside the mouth/throat and occasionally on the fingers and the buttocks. Glands near the sore may swell. These sore are very infectious and take up to eight weeks to heal. Once healed, the infection enters stage two and occasionally stages one and two may overlap so you may experience the symptoms of both stages at the same time.

Stage two (secondary syphilis)

A rash may appear on your body shortly after the sore disappears – this may spread onto your hands and/or soles of your feet. Lumps similar in appearance to warts can appear on the genitals or anus and you may experience flu-like symptoms, as well as patchy hair and weight loss.

Symptoms of stage two will disappear in a few weeks but the infection will still be there.

Stage three (tertiary syphilis)

Although rare in the UK, syphilis at this stage can seriously damage your vital organs and nervous system. This includes numbness, paralysis and blindness.

If you are concerned about any of these symptoms, the best place to get advice and tests for syphilis is at a sexual health or GUM clinic.

How do you get it?

Syphilis bacteria are spread through direct contact with sores that appear during stage one, or with the rash that appears during stage two. This is typically through skin-to-skin contact during sex without a condom (including oral sex), but it can also be passed on through sharing sex toys and from a mother to her baby. All pregnant women in the UK are offered a blood test for syphilis and if found to have the infection, would be given treatment to help prevent transmission to their baby.

It is extremely rare for syphilis to be spread through blood transfusions, as all blood transfusions in the UK are tested for syphilis.

Syphilis cannot be spread by using the same toilet, clothing, cutlery or bathroom as an infected person, as the bacteria cannot survive for long outside the human body.

How can you prevent it?

You can take steps to reduce your risk of catching syphilis and other STIs by:

  • Always using a condom (male or female). This must cover the sore or rash
  • Using a dental dam (a square of plastic) or condom during oral sex. Again, this must cover the sore or rash
  • Never sharing sex toys

Because people can have syphilis without having symptoms, regular STI check-ups are a good idea, especially if starting a new relationship and/or you want to stop using condoms with your partner.

How do you get tested?

A blood test for syphilis is included in the routine sexual health screens offered at sexual health clinics. This blood test check whether you have any antibodies that are produced when the body’s immune system reacts to syphilis. These antibodies take up to three months to be detectable so if you have had a recent risk, you will be advised to have a repeat test after these three months to be absolutely sure.

If you have symptoms, your doctor or nurse will want to examine you to see if you have any signs of syphilis. This may include looking at your skin, inside your mouth, and/or inside your vagina or anus.

If you have a sore (stage one), the fluid inside will probably be tested with a swab. This looks like a small cotton bud and should be painless.

What treatment is available?

Syphilis treatment depends on the stage of your infection. Generally, you will be given a single antibiotic injection, or course of antibiotic injections. After treatment, you will have regular blood tests to ensure the infection has been properly treated.

Treatment is very effective for first and second stage syphilis. Third stage syphilis can also be treated, but you cannot reverse any damage that has already been done. Treatment for syphilis does not make you immune from getting it again.

It is important that you do not have sex if you have syphilis, or any other sexually transmitted infection, until follow-up tests confirm that you no longer have the infection.

If your test comes back as positive, people you’ve had sex with also need to get checked so they can get treated if needed. Your sexual health clinic can support you with this.

Useful links

  • BAASH (British Association for Sexual Health and HIV) has a comprehensive patient information leaflet on syphilis
  • NHS Choices has lots of information about STIs including a specific page on syphilis
  • Brook has more information and advice on STIs written for people under 25, including syphilis
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