Syphilis prevention, testing & treatment

  • What is syphilis?
  • Preventing syphilis
  • Syphilis testing
  • Syphilis treatment

What is syphilis?

What is syphilis?

Syphilis is a bacterial infection that can be caught by having sex (vaginal, anal or oral) with someone who has early stage syphilis. The ulcers may be painless and hidden so the person or their partner might not know that the ulcer is present. Syphilis may be passed from mother to child during pregnancy and all pregnant women are routinely tested for syphilis.

Syphilis is effectively treated with antibiotics and transmission from mother to child can be prevented by effective treatment. If left untreated, syphilis can lead to serious and life threatening consequences although these may take many years to develop.

Symptoms of syphilis

There are three stages of syphilis infection and treatment can be started at any stage but the sooner the better.

Early syphilis

The first syphilis symptoms appear between 10 days and 3 months after you come into contact with the infection:

  • painless, red sore(s) at the site of the infection (usually on the penis, vagina or vulva, around the anus or in the mouth). These ulcers or sores typically heal about 2 to 8 weeks after they first appear, and may not be noticed if they are not causing any discomfort and are in a difficult place to see
  • swollen glands in the neck, armpits or groin.

Untreated primary syphilis may progress to secondary syphilis.

Secondary syphilis

Symptoms of the second stage of syphilis will appear in about 25% of people a few weeks after the symptoms of primary syphilis disappear.

These symptoms are highly variable, they may be mild, go unnoticed and will disappear without treatment:

  • blotchy red skin rash, sometimes on the palms of hands or soles of the feet
  • white patches in the mouth
  • both men and women may get wart-like growths near their anus, women may also find these on their vulva
  • patches of hair loss
  • symptoms similar to flu; headache, tiredness, achy joints and a temperature.

Latent syphilis

During the latent stage of syphilis most people have no symptoms.

Late syphilis

Untreated syphilis can cause serious health problems in the later stages. The infection can damage the heart, nervous system, brain and bones. People who develop late syphilis may go on to have strokes, meningitis, dementia, loss of coordination, numbness, blindness, heart attacks or heart failure.

Some people are more likely to get syphilis than others

Syphilis had become rare in the UK, however over the last decade there has been an ongoing increase in the number of diagnoses. The increase has been greatest among men although there have also been growing numbers of infections among women.

In 2018 three quarters of syphilis cases in the UK were among men who have sex with men (MSM) as these things put you at higher risk of catching syphilis:

  • having anal sex without condom
  • having group sex
  • having sex while taking drugs (chemsex).

Public Health England and the British Association for Sexual Health and HIV recommend that MSM who have condomless sex with new or casual partners should have a syphilis test every 3 months.

All pregnant women are screened for syphilis as part of their antenatal care because the infection can be passed from a mother to her baby with serious consequences for the baby. This is very rare in the UK.

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Preventing syphilis

Regular testing

If everyone was tested each time they had a new sexual partner then the spread of syphilis and other STIs would reduce, as early diagnosis and treatment would prevent the infection from being passed on.

Having a test for syphilis means you can receive treatment for the infection if you need it. Our free test kits allow you to safely take a blood sample at home.

It is important to regularly test for syphilis even if you do not think you have any symptoms, as the early and latent stages of syphilis may have few or no symptoms. If you think you are at risk of catching syphilis, you should test every three months. Read more in the when to test section.

All pregnant women are offered testing for syphilis as part of routine antenatal care.

Use condoms and don’t share drug equipment

Having safer sex is the best way to prevent yourself from getting syphilis:

  • using condoms (male or female condoms) for anal and vaginal sex
  • using condoms or dental dams for oral sex
  • not touching sores or rashes which may be a symptom of syphilis
  • not sharing sex toys or, if you do share sex toys, wash them and use a condom on them every time.

Condoms are the only method of contraception which can protect you from syphilis. The pill, implant, injection, coil and other methods of contraception do not protect you from syphilis or other STIs.

Make sure if you use condoms that you are not using them with an oil-based lubricant ‘lube’ (for example, massage oil or Vaseline) as these can weaken condoms and make them split. Water based lubricants are safer and very easy to get hold of from most pharmacies and sexual health clinics.

If you share needles or other injecting equipment (syringes, spoons or swabs), you can be at risk of getting syphilis, HIV and other viruses such as hepatitis C.

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Syphilis testing

When to test

Our tests look for antibodies that your body will be producing if it has an infection, these antibodies take some time to be detectable. This period of time between exposure to an infection and it becoming detectable is known as a window period.

For our self-sampling home test kits, results are most accurate:

  • at least 4 weeks after potential exposure to HIV infection
  • at least 12 weeks after potential exposure to syphilis infection.

If you don’t know when to test, we recommend you test now and again in 12 weeks time.

The blood test we will run on your sample is called the TPPA (Treponema pallidum particle agglutination) test. This test cannot tell the difference between someone who currently has a syphilis infection, and someone who has had syphilis in the past. As we use the TPPA test, we cannot offer you a syphilis test if you know you have had syphilis previously.

If you have been treated for syphilis in the past, you will need to go to a sexual health clinic or GP to have a different kind of test such as the RPR (rapid plasma reagin) test. This test can check whether antibodies in your blood are due to a past infection or a current infection.

Our home testing service is quick, free and confidential.

Reactive results

A reactive result means that the test has reacted with something in your blood, but it may not necessarily be syphilis or syphilis antibodies. A reactive test result is not the same as a positive test result. If you have a reactive test result it means that you need to have a further test in a sexual health clinic.

If you receive a negative test result, and it is at least 12 weeks since you were potentially exposed to syphilis, this result means you do not have syphilis. If you receive a negative result and have had a possible exposure to syphilis within the last 12 weeks, we recommend that you test again 12 weeks after your most recent exposure.

Diagnosing syphilis

If you have a reactive test, we will explain this to you and support you find a local sexual health clinic for further testing.

A doctor or nurse at the clinic will examine you for any sores or rashes that could be a sign of syphilis infection. They will also offer you another blood test to confirm whether or not you currently have syphilis.

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Syphilis treatment

Syphilis treatment

Syphilis can be cured with a course of antibiotics. For most people, treatment is penicillin injected into your buttock at a sexual health clinic. If you are allergic to penicillin there are other treatments available.

If your test results show you have had syphilis for more than two years, then you will need a longer course of antibiotics or additional antibiotic injections.

Once you have finished treatment, the clinic will recommend follow-up blood tests to make sure your treatment has been successful.

It is common to experience some side effects from syphilis treatment, though these do not usually last more than 24 hours:

  • headache
  • achy joints and muscles
  • a high temperature.

In rare cases some people have an allergic reaction to treatment. The staff at the clinic will monitor you and are able to treat you if you do have a bad reaction.

It is important that you do not have anal, vaginal or oral sex or, any close sexual contact until two weeks after you have finished your treatment. This is to make sure that your treatment has worked and to stop the infection being passed on to anyone else. It is best to wait until blood tests have shown that your infection is cured before you have sex.

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Myths & FAQs

How common is syphilis in the UK?

Although syphilis is not the most common STI in the UK, the numbers of people being diagnosed has been increasing for the last 10 years, especially among men who have sex with men.

Data from Public Health England shows that in 2018 there were a total of 7,541 new diagnoses of syphilis:

  • 75% were men who have sex with men
  • 85% were aged 25 and older.

Is there a link between syphilis and HIV?

Among men who have sex with men, syphilis is more common among men who know that they have HIV. There are a number of possible reasons for this. It may be linked to an increase in HIV positive men having sex without a condom. Having HIV may also make it easier for you to catch syphilis.

If you have HIV, syphilis can get worse faster than if you do not have HIV and it can be harder to treat.

If you do not have HIV, having syphilis can make it easier for you to contract HIV.

You only need to provide one blood sample to enable us to test for both HIV and syphilis.

Can I get syphilis from kissing?

You catch syphilis from close contact with a syphilis sore, this contact usually happens when you are having sex with someone who has syphilis. Syphilis is not normally caught through kissing. However, it is possible for syphilis to cause sores in the mouth of someone who has it and, in this case, prolonged or very intimate kissing could put you at risk of catching syphilis.

Can syphilis be passed on to my baby?

Syphilis can be passed from mother to baby during pregnancy. When this happens it can lead to serious complications for the baby (congenital syphilis).

All women in the UK are offered screening for syphilis as part of their routine antenatal care. It is easy to treat syphilis in pregnancy and treatment is safe for the baby. Routine testing during pregnancy and treatment for women who have the infection mean that congenital syphilis is very rare in the UK.

Can syphilis be passed through menstrual (period) blood?

Yes, syphilis can be transmitted through infected blood. Therefore if a woman has syphilis her menstrual blood may contain the infection carries a risk of infection.

Is syphilis testing free?

Freetesting.hiv is commissioned to provide free home test kits to people in England only. Whether you can get a free kit or not depends on whether your local authority are funding this service and whether they have chosen to offer HIV kits or, HIV and syphilis kits.

There are lots of other places to get tested: sexual health clinics, GP surgeries or A&E departments. The NHS provides free and confidential testing for everyone in the UK, regardless of immigration or residency status.

What are the symptoms of late syphilis infection?

There are three stages of syphilis and syphilis can also have a periods with no symptoms (latent syphilis). After the initial sore has healed, without treatment, the second stage of syphilis can include a blotchy red rash, white patches in the mouth, patches of hair loss, wart like growths in the genital area and flu like symptoms. The third stage of infection is when complications occur. These can problems in your heart, nervous system and bones. During latent syphilis, there are no symptoms but you can still pass on the infection to others.

Will I die young if I am diagnosed with syphilis?

Protect yourself from syphilis by using condoms and having regular STI tests. If you are diagnosed with syphilis and start treatment immediately, you are less likely to experience syphilis related health complications, as symptoms will have less time to start developing.

Syphilis can be cured with a course of antibiotics. Once the syphilis infection has been cured you will not experience any further symptoms and the infection will no longer be in your body. If syphilis is not treated for many years it can lead to serious complications, some of which may be life threatening. However, it is important to remember that these complications take many years to develop.