Syphilis

Electron micrograph of Treponema pallidum

Electron micrograph of Treponema pallidum

Syphilis is a disease caused by the bacterium Treponema pallidium.

When the infection is transmitted through sexual contact, it is called venereal syphilis while that transmitted from mother to baby during childbirth is called congenital syphilis.

How is Syphilis spread?

Syphilis is spread from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. It can also occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex.

If a women with the disease becomes pregnant, she can pass it to her unborn child. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils

Symptoms of Syphilis

The symptoms of early syphilis is usually mild and difficult to recognise. In faction, it was called “the great imitator” as many of the symptoms of infection is not distinguishable from other diseases.

After exposure, symptoms can take as long as 3 months to appear. The course of the disease is long and is divided into 3 different stages of infection.

Primary Syphilis

In this initial stage of the disease, painless ulcers (also called chancres) appear on the genitalia. In general, it takes about 21 days after sexual contact with an infected person for this to appear.

Unfortunately, chancres are highly infectious and not very noticeable and may be concealed, e.g. in the vagina/cervix or on the penis. It could also appear in the anus or the mouth for individuals who practice anal or oral sex.

These lesions take about 2 to 6 weeks to heal even without treatment and if the infection is not picked up at this point, it progresses to secondary syphilis.

Secondary Syphilis

About 3 to 6 weeks after the chancres appear, the disease enters the second stage. During this time, the patient suffers from a series of non-specific symptoms which include:

  • A flu-like illness, a feeling of malaise with loss of appetite, accompanied by swollen lymph nodes lasting for weeks or months.
  • A rash that is not itchy covering the entire body or certain areas.
  • Flat wart like growth in the cervix or anus.
  • White patches in the oral cavity.
  • Patchy hair loss

During this stage, the patient is still very infectious and can spread the infection to their sexual partners.

Latent and Tertiary Syphilis

If the infection is still not picked up and treatment instituted, it progresses into the latent stage. The infection no longer causes much symptoms but can still be detected with a blood test. After about 10 years or more, the infection starts to affect the nervous system, the heart and other organs of the body. This is called tertiary syphilis.

At this stage, the infection is rather serious and can include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Syphilis and Pregnancy

If a women with syphilis becomes pregnant, she may have a high risk of having a stillbirth (a baby born dead). Babies born are also at a high risk of dying soon after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

Diagnosis of Syphilis

Syphilis can be easily diagnosed by taking a blood test or taking a sample from the chancre and sending it for examination in a laboratory. For women, an internal exam may be needed.

Click here for more Info on When and How to Test for Syphilis

Treatment of Syphilis

Syphilis is easily treated if diagnosed early. Generally it involves one or several injections of penicillin or oral antibiotics. However, patients usually need to return for testing to ensure that the disease is completely eradicated before they can be discharged.

Patients will also be asked about their sexual contacts so that contact screening can be done.
While on treatment, patients should also refrain from sexual activity to avoid further spread of the disease.

One complication however, is that even after treatment, any future blood tests (e.g. for immigration reasons) will still be positive because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis.

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.

Prevention of Syphilis

Barrier contraception can reduce the chances of contracting syphilis. However, it is not completely protective and infected people can still spread to their partners even if they use condoms. The only way is to check for sexually transmitted diseases regularly and treat if infected.

Syphilis also increases the likelihood of spread of other sexually transmitted diseases particularly HIV. There is an estimated 2- to 5-fold increased risk of acquiring HIV if syphilis is present.

Syphilis belongs to the group of sexually transmitted diseases that causes ulcers and sores and these lesions disrupt the barrier that provide protection against infections. The genital ulcers caused by syphilis bleed easily and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Infection with sexually transmitted diseases like syphilis is an important predictor for becoming HIV infected.

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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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85 Comments

  1. I dont have any canker sore develop in my genital area and its on my 8th week or 2months of having protected sex. I still worry of it ? And besides i doubt to have and vdlr test because i am treating my TB and it will get done this thursday im afraid of getting false positive because of it need help

    • TB infection can sometimes cause false positive results for syphilis/HIV.

      • I always check my genital area and dont see any chancre on it, does it mean that i dont contract a syphilis ?

      • And how do rash occur in secondary syphilis ? I am confuse because of many sources i viewed on internet 🙁 sorry for always asking im afraid 🙁

  2. Hello. I tested negative 2 times with RPR testing method, one month and 16 months after potential exposure. 16 month syphilis testing is considered almost 100% conclusive locally. Pregnant women are also screened with rpr method in my country. Had no symptoms no chancre no rash at least I haven’t seen one. Should I still worry?
    Thank you for your time

  3. Hiya,
    I have a painless, colourless lump on my vaginal outer lip which I noticed a week ago, since it has reduced in size (barely noticeable) ..should I be concerned??

  4. Dear Dr:
    I have just two questions – thanks in advance:
    1) If I was diagnosed with syphilis and just recently had Strep throat, will the Strep Throat antibiotics cure the syphilis? (the antibiotic was Penicillin V – 1000mg per day for 10 days, orally).
    Or do I need to have the actual Penicillin shot for Syphilis?
    I just don’t want to take unnecessary antibiotics at the same time.
    2) Do Syphilis blood tests check for syphilis in the anus?
    thanks!

    • 1) It would most likely partially treat the syphilis. Treatment for syphilis is Penicillin G, which is a different type of penicillin V. I suggest you get a proper treatment, i.e. Penicillin G injection.
      2) Syphilis blood test check for presence of syphilis in your body, regardless of where it is. It does not specifically target anal syphilis.

      • Young couple

        Dear Dr, we are going to have a baby soon but i am not pregnant at the moment. 4 months ago my husband and me had Syphills blood test 2 monts period both RPR and Tpha 2 different lab 3 times. All result was same that my TPHa positive ( titr 1:2 ) RPR negative but my husband’s result all negative. Doctors says you have old infection so it is not infected to your husband. i am really worry about my new baby. if i got pregnant is it fine for my baby or Should i take strong antibiotic penicillin G before pregnant.

        • Your results sound like a previous infection. Unfortunately, we cannot give medical advice over the internet. You are welcomed to come in to our clinics to get a consultation.
          http://drtanandpartners.com/where-to-find-us/

          • Young couple

            Thank you Sir, Actually we are contacting from Uzbekistan i was searching information on interned. Just in case of an previous infection and if test result is mentioned as above.Do you think is it required to take Pencillin G before get pregnant. Thank you so much

  5. Boobguy

    Hi doc,
    Just a question, based on this article if you had a hiv 4th gen test with a syphilis test of TPHA or TPPA both would be conclusive at 4 weeks? How about the rpr? Does the same rule apply regarding syphilis testing? Thank you!

    • Dr Justin Sim

      Syphilis tests can only be fully conclusive at 12 weeks or more regardless of testing.

      • Boobguy

        Sorry if I just got confused. Previous advice by dr. Tan said that the test TPHA is conclusive at 4 weeks. And the technician who did the test aslo said that the test can be considered conclusiveat 4 weeks. I guess I was just looking for additional reaasurance here. Or is it more proper to test at 4 weeks than retest at 3 months? Sorry am very anxious.

        • Dr Justin Sim

          4 weeks will give us a clear indicator and if your are negative at that point then that is good. But to be safe it is advisable to repeat in 3 months which will be conclusive.

  6. Mandeep

    Hello dr , may i know i know what dose white patches in the oral.cavitity means it is given for one of the symtoms for syphilis . Dose it can be oral g

  7. william

    Dear Dr Tan.Do you have an email?i want to show you a picture of bulge in both of my upperhand,many doctor that i visited said that it’s not syphilis but since i live in Indonesia and Indonesia medication in indonesia still far behind other country i can’t really get a peace of mind.I am so anxious because i had an protected sex once with regulated sex worker in geylang at 15 januari 2015(first time having sex).and contracted Chlamydia.i didn’t see any painless ulcer on my genital.Thank you.

    • I’m sorry this forum is not for medical consultations. Neither are we allowed to provide email consultations. Please continue to follow up with your doctor. You are also welcome to visit our clinics anytime.

  8. Dr Tan

    I am a sexually active 50yo homosexual man. In 2013 I spent 89 days in hospital, Royal Prince Alfred in Sydney and St Vincents also Sydney. I was diagnosed with MSSA infective endocarditis with 14mm vegetation on mitral valve . I was placed on a flucloxacillin drip for six weeks to cure the infection, followed by admission to another hospital for 2 x open heart surgeries (1st MV repair – failed after six weeks) then a MV replacement. Now in permanent Atrial Flutter and on warfarin At no time was a syphilis test performed in any of the hospitals (only HBV, HCV, HIV, gonorrhoea and chlamydia – all negative, except HBV carrier state since age 22). On the first admission I had 2 x rash on trunk, which they put down to amiodarone. I had a TIA on 7/11/2014 and pericarditis 3/12/2014. I tested positive for syphilis 15/12/2014 1:4 and treated, now 1:2 on 18/2/2015. I am now having a brain MRI with contrast next week followed by a lumbar punch as there appears with be chronic microhemorrhages on December 2014 MRI that the neurologist says are higher than usual even after open heart surgery. Are you surprised that no testing was performed for syphilis even with 89 days in hospital and two invasive surgeries performed?

    • Wow. You went through a lot. I hope you are feeling better. Since I am not privy to the actual clinical scenario at the time, it would be very unfair for me to comment on the action or inaction of the medical team in charge of your care. As the saying goes “retro-scopes are really accurate”. Trying to put myself in their shoes, I would say that I would not automatically think of Syphilis in a case of infective endocarditis. As you know, syphilis is more associated with aortic conditions rather than valve conditions. Ruling out HIV would be at the top of my mind. As part of a comprehensive STI check, especially given your orientation, I am surprised that a Syphilis test was not done. It is usually a knee jerk reaction to test for HIV, Syphilis and HCV in such scenarios.

  9. Hello MD chan

    I tested negative for syphilis with a VDRL and TPHA at 4 weeks. Should I go for another test at 12 weeks. I am confused.

    • Officially you should as 12 weeks is the officially recommended window period for Syphilis testing. However, I noticed that you did a TPHA as a screening test. This is not usual but it does make your test at 4 weeks as good as 100% accurate.

  10. Are the syphilis rash and hiv rash similar? Will the syphilis rash last for 3 weeks to 4 weeks in the trunk area? Cold both rashes start at 15 weeks past exposure?

    • Hmm. They can look rather similar. But a trained eye will be able to tell them apart mostly. Syphilis rash can start at 15 weeks post exposure but not the HIV rash.

  11. Hi Dr. Tan,

    I was wondering if a treated syphilis has any effect on the processing (i.e. approval) of a work visa for foreigners wishing to work in Singapore? It would be really great to hear from you.

    • If your Visa application requires a Syphilis test, it may show up as positive due to serologic scarring. In such a situation, it would be best for you to have a letter from your treating doctor stating that you have been treated and this is only a serologic scar. Exactly how MOM will handle this issue I am not sure. But I am rather confident they will see reason and approve the work visa.

  12. Hi doctor,

    I have many pimple-like spots at the bottom of my scrotum and penis for nearly a year. They are very very itchy most times. After reading through many posts, I trust those are Sebaceous Cysts which are harmless.

    Last night, I had unprotected oral sex with a sex worker followed by protected sex. I also kissed her on the mouth. Just a moment ago while bathing, I felt a pain below my scrotum. I looked and saw a small swollen pimple-looking lump and it felt pain. I tried to squeeze a little and noticed there seems to be cyst and blood coming out. Then I stopped squeezing it. Now I just confirmed that yes there is a little blood coming out from it.

    I am now very worried. The more I read, the more confused I get now. Should I go get tested for STD now or should I wait a few more days? Does such Sebaceous Cyst get swollen and outbreak with blood one day after an unprotected oral sex? It could have been there since last night or this morning, though I only noticed while bathing a while ago. What happen if it was already there during the unprotected oral sex though I did not notice. Will it mean there is a high risk of getting HIV as well since there is an “blood” opening?

    Please help to advise. Thank you very much for your help.

  13. Tangkw

    Dr. Sim, may I know y after after took one shot of penicillin. I may few my body itchy and whole body numb even could feel my body feel hot for fews day. It is normal?….

  14. Tangkw

    May I know whole treatment may incur for syphilis treatment including injection

    • Consultation $35. Penicillin injection $20. Before GST.

      • Tangkw

        Dr.tan, im currently on medication. If I allergies to ceplexin, can I take up penicillin injection?

  15. make me sick syphilis

    Dear drtan
    i have syphilis since august2013 my vdrl1:64 i have 3times penicillin shot weekly , after 1month my vdrl1:8 drop , after that my doctoc told me no need injection need to wait another 3month blood test again after 3month my vdr become 1:16 my doctoc told me no need injection need to wait another 3month bloods again .. now really worry i need your advise pls. thank u
    from ron

  16. Why my question is not answered yet!

  17. Dear Dr.
    I am married now for over two year. My first baby is 14 months. Now I am pregnant. I tested positive for VDRL. I am waiting now for confirmatory test. I tested negative for VDRL for the first pregnancy.
    I need to know few things. Is it possible that I will be carrying syphilis since before marriage ans tested positive just now?
    If my husband has it since before marriage is it possible that he just passed now. I knew he had affairs during my first pregnancy.
    I know I didn’t been with anyone since we got married. How we can for sure who infected who here?
    I had a tiny lesion inside my lip after oral sex with him a couple of time. he complained of rough small round brownish area on his penis at the same time i had the tiny lesion.
    Please help.

    • There are many causes of a false positive VDRL. You are assuming that you have Syphilis even before the confirmatory test is out. VDRL tests turn positive well within 3 months from infection. There is no way to determine who infected who except from the history.

  18. Hi Dr, I’m going to get tested for syphillis this week. The problem is that I am allergic to pennicilin. In the event that I test positive. What treatment is available? Thanks.

  19. Hey DrTan how much is it for a Syphilis shot and where can I go to receive the shot. I received syphilis by having unprotected sex with my boyfriend of 1 year. My case is vaginal and I need help.

    • We charge $20 for a Penicillin injection for Syphilis. If you are still in the early stage you need only 1 shot. If you are in the late stage you need 3 shots. There is also a consultation fee of $35. All prices before GST. After getting treated, you will need to follow up with regular blood tests for 2 years.

  20. If I have syphilis rash is it very contagious and can my children get it

    • Syphilis skin lesions are contagious. If you suspect that you have a Syphilis rash please seek treatment as soon as you can. Meanwhile, minimise contact with your children and anyone else for that matter.

  21. Dear Dr. Tan , I’m 34 years man, and. Hv been tested positive for syphilis in year 2010.i have took treatment for syphilis . 3 penicillin jab was been given. My reading for a first tome was 1:8, and subsequently drop to 1:2 after treatment. It was shot again to1 :8 a years later. Latest blood test was done in may 2013 and the reading was 1:4 and tested positive for herpes type 1 &2. My only exposure are unprotected oral sex . I have been told that I’m reinfected. Can I have ur advise pls.

    • This is very difficult to interpret. There is really no good way to confirm the eradication of Syphilis. Generally speaking, a 4 fold rise in VDRL Titre can indicate a re-infection or a failure of the initial treatment. Also, it could mean neuro-syphilis. HIV infection also can complicate the interpretation. I cannot make any logical conclusion from here. You will need to see a doctor. He has to go through the exposure history in detail, look for the signs and symptoms and make a call on whether or not there is a need for re-treatment. Please post follow up questions on http://www.askdrtan.com

  22. Hi Drtan,

    i tested for syphilis after 2 weeks after exposure.
    it came nagative is it accurate.

  23. Doc,

    Will getting an oral dose of Antibiotics and a penicilin shot minutes before a blood draw for a syphilis test affect the outcome and give a false negative?

  24. Jame2

    Hi doctor Tan, i am a man, 26 year olds. i had a syphilis test (RPR and TPHA compo) after 9 weeks exposure. the test result is negative for both. I know that this test is not conclusive and i must re-test after 3 months exposure. However, i am confused now because after i did the 9 weeks syphilis test i took oral dose of azithromycin which treat for my current chlamydia disease. so whether such antibiotic affect syphilis test and the 3 months-test for syphilis which i intend to test will not be conclusive for me? if not which test is conclusive, how long i must wait for??. thank you very much doctor

  25. Hi doctor, i am a man, 26 year olds. i had a syphilis test (RPR and TPHA compo) after 9 weeks exposure. the test result is negative for both. I know that this test is not conclusive and i must re-test after 3 months exposure. However, i am confused now because after i did the 9 weeks syphilis test i took oral dose of azithromycin which treat for my current chlamydia disease. so whether such antibiotic affect syphilis test and the 3 months-test for syphilis which i intend to test will not be conclusive for me? if not which test is conclusive, how long i must wait for??. thank you very much doctor

  26. Hi Dr Tan,

    If I had Syphilis, will it be dangerous if I stay with my family???

  27. Hi Doctor Tan,

    Quick question: 3 weeks after oral with CSW ( 25th November) had what appeared to be a single “blister” type growth inside mouth,almost like a small ball. This went down and disappeared in about 36 hours and have no other ulcer type sores since. I have had soar throat , as low as larynx, and swollen glands under chin and the small pea sized node in left collarbone area for last 2 weeks. Also have few rash type spots on both sides of abdomen. I came into clinic and had rapid tests done this week, all negative. As you do, i forgot to mention the blister in the mouth to your good doctor there and would like to know if he’s advice would be the same. i.e after 9 weeks the negative test is pretty accurate. Also is it an option to have a “pre emptive” penicillin shot or do you need to have positive result first.

    Thanks again

    Jed

    • Hi Jed,

      If you suspect Syphilis you should have the test repeated after 90 days. However, if your ulcer was really a Syphlitic chancre, the test would have turned positive by now. There is no place for prophylactic treatment for Syphilis.

      rgds

      Dr Tan

  28. Dear Dr. Tan,

    Thanks for the information provided.

    The doctor took a tube of my blood on my arm, tested on Syphilis and Herpes Type 2, which resulted in a week after. I am wondering how accurate is the rapid syphilis blood test that results in 20min? Should I get tested again to make sure, and my only exposure was unprotected oral sex.

    Thanks a lot again!
    Moo

    • Hi MOO,

      The rapid Syphilis test is very accurate. But as with every screening test, it has a chance to be false positive.

      rgds

      Dr Tan

  29. Dear Dr. Tan,

    Is syphillis curable or just treatable? I mean what if people didn’t realize they had it until it already enters the late periods, can people still survive? And what are the chances to have it via oral sex? Thanks a lot in advance, I am very worried.

    • Hi Lydia,

      You can certainly contract Syphilis via oral sex. You should get yourself screened. Syphilis is curable in the early stages but can cause irreversible damage if left untreated for too long. I really do not know the difference between ‘curable’ and ‘treatable’.

      rgds

      Dr Tan

  30. Hi, I am a 14 year old teen and I wanna ask if I can take the test …

    • I have rashes on my palms, weight loss . But i’ve went to a dermatology for help with my rashes and he didn’t say anything about Syphilis . Am i contracted with Syphilis ?

      • Hi teen,

        Rashes are a sign of secondary Syphilis. Of course, there are many other diseases that can also cause rashes. If you have had a potential exposure to Syphilis then you definitely should get tested.

        rgds

        Dr Tan

    • Hi teen,

      There are no age limits to testing. You certainly can take any test that is medically relevant.

      rgds

      Dr Tan

      • If I’m really contracted with Syphilis, may I ask, how much is the treatment ?

        • Hi teen,

          The treatment for Syphilis is not so straightforward. You would require 1 or 3 injections of Penicillin depending on what stage of infection you are at. This is usually quite cheap. We charge $20 per injection. But then you would be required to be followed up for 2 years with monthly then 3 monthly then 6 monthly VDRL titre tests. At any stage if we should suspect a resurgence or inadequate treatment of the disease, you might require more injections. All in all, the entire treatment sum including all the blood test and consultations might come up to almost $500.

          rgds

          Dr Tan

          • Ok then how much do the 1st test costs? Do we know the results on that day we do the test? So what do I tell the counter staffs if I want to take the syphilis test?

          • Hi teen,

            Rapid Syphilis Test – $50. Results in 20 minutes. VDRL with Titre: $20. TPHA w/o titre: $25. Both test 1 to 2 working days turnaround time. Just come in and register. You can tell the doctor your situation and that you want to do a Syphilis test.

            rgds

            Dr Tan

          • Darren Tang

            DR.TAN, I have been diagnosed contract secondary stage of syphilis. Im now on medication and would to try penicillin injection. 1.Do I still need to screened again?
            2. Currently on medication, but feel that my body inside have bug walking around. It is medicine effect or body reaction against bacteria?

          • drtan

            1. For what? I thought the diagnosis was already made? 2. It is you overthinking the matter.

  31. DEAR DR TAN
    Why syphilis must test again at 90 days post exposure?is it possible 5 week post exposure NEGATIVE,and test again at 90 days become POSITIVE?

    • Hi miao,

      Syphilis tests will turn positive within 2 weeks of onset of symptoms i.e. a painless ulcer known as a chancre. The chancre can take up to 90 days to appear. Most chancres appear within 4 weeks of infection. So the fact that your tested negative at 5 weeks means most likely you do not have syphilis. However, you should still test to be sure.

      rgds

      Dr Tan

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