Syphilis – Diagnosis and Treatment
Diagnosis
Doctors use different medical tests to identify syphilis. They often start with a physical exam if someone has symptoms like a painless sore (chancre), rash, or swollen lymph nodes.
Doctors confirm the infection and determine the stage, such as primary, secondary, latent, or tertiary syphilis, using laboratory methods.
Key ways to check for syphilis include:
| Sample Tested | What It Detects | Main Use |
|---|---|---|
| Blood | Antibodies to Treponema pallidum | Finds current or past infection |
| Fluid from a sore | Bacteria under the microscope | Confirms diagnosis if sore present |
| Cerebrospinal fluid | Signs of neurosyphilis | Used if brain or nerve symptoms |
Healthcare teams usually start with serologic testing. They use nontreponemal tests (such as VDRL or RPR) and treponemal-specific tests to screen for syphilis and confirm infection.
These tests help show if someone has a new or past infection. This information is important in all stages of syphilis, including late, gummatous, or cardiovascular syphilis.
If someone has brain or eye symptoms, such as those linked to neurosyphilis or ocular syphilis, doctors may recommend a lumbar puncture to check the cerebrospinal fluid.
Some people use at-home kits. However, a healthcare professional should confirm any positive result before starting treatment. Partner services help notify sexual partners so they can get tested and treated if needed.
Treatment
Common Medicines Used
Doctors typically treat syphilis using an injectable antibiotic from the penicillin class. This is often given as a single dose for early-stage infections or in multiple doses for later stages.
For people who are pregnant, penicillin-based treatment is the only approved option. If someone is allergic to penicillin, a specialist may perform a process called desensitization, which allows the person to safely receive the medication under controlled medical supervision.
For those who cannot receive penicillin, doctors may prescribe alternative antibiotics, such as:
- Tetracycline-class antibiotics
- Cephalosporins
- Macrolide antibiotics (less commonly used and with limitations)
While these alternatives can be effective, penicillin-based treatment remains the preferred and most reliable choice, especially in advanced or high-risk cases.
Some individuals may experience a Jarisch-Herxheimer reaction after the first dose, which can cause temporary symptoms like fever, chills, headache, or body aches as the bacteria are destroyed.
The reaction is temporary and usually goes away within 24 hours.
| Medicine | How Itโs Used | Special Notes |
|---|---|---|
| Penicillin-based injection | Shot, 1-3 doses, by provider | First choice, needed for pregnant people |
| Tetracycline-class antibiotic | Pills, 14 days | Not for pregnant patients |
| Cephalosporin-class antibiotic | Given through injection or IV | Used when penicillin cannot be used |
| Macrolide antibiotic | Single dose pill (rarely used) | Not recommended for most patients |
Checking Progress After Treatment
Follow-up care helps with recovery and prevents the spread of syphilis. Health care providers schedule blood tests at 3, 6, and 12 months after treatment.
These tests confirm that the infection has cleared. People should not have sex with new partners until testing shows the infection is gone.
Any sores should heal before resuming sexual activity. Partners should also get tested and treated as needed to stop the infection from spreading.
Health care teams recommend testing for HIV because people with syphilis have a higher risk of other infections. Ongoing check-ups help ensure the treatment worked and keep the person healthy.
Emotional Support and Managing Feelings
Learning about a syphilis diagnosis can cause many emotions, such as anger, shame, or confusion. Some people worry about health problems like fever, headache, fatigue, or HIV infection.
Tips to cope:
- Pause before blaming anyone. Infection could have come from past partners.
- Share feelings with someone trusted.
Talking to a healthcare provider can offer support. Knowing symptoms such as weight loss or fatigue helps in monitoring health.
Both men and women, including men who have sex with men, benefit from professional advice and open conversations.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
Being prepared for a medical visit about a sensitive health issue is important. Here are some helpful steps:
- Check for Any Instructions: Ask if any actions are needed before the appointment, such as fasting or avoiding certain activities.
- Record Any Symptoms: Write down any health changes or problems, even if they seem unrelated.
- List All Medicines and Supplements: Make a list of all medicines, vitamins, and supplements taken, including amounts.
- Write Questions To Ask: Prepare questions ahead of time to make the conversation with the health care provider more useful.
Here are some ideas for questions:
| Example Questions to Ask the Health Care Team |
|---|
| What is the medical name for this infection? |
| How can it be passed to others? |
| Does it affect future chances of having children? |
| Can a pregnant person pass it on to their baby? |
| Is it possible to get this infection again? |
| Could this be from one-time contact? |
| Can I give this to a partner with just one sexual contact? |
| How long might I have had it? |
| Do I need to avoid certain activities? |
| Should my partner also get treatment or testing? |
Anyone who thinks they may have a sexually transmitted infection should consider telling their partner. This helps both people get the care they need.
What Your Provider Will Likely Ask
During the visit, the care team will want to understand each person’s health and sexual history. Some typical questions include:
What symptoms have been noticed, and for how long?
Has there been one partner or multiple partners recently?
What is the length of time involved with current or past partners?
Has there ever been use of injected drugs, or contact with someone who has?
What steps are taken to lower the risk of catching or spreading infections?
Has the person ever been told by a provider that they have chlamydia, herpes, gonorrhea, syphilis, or HIV?
Has there been past treatment for discharge, sores, pain when urinating, or other infections?
How many partners have there been in the last year or last two months?
When was the most recent sexual experience?
Being honest and open helps the health team give the best advice and care. All information shared stays private.
Things to Do While Waiting for Your Appointment
If you think you have syphilis or another infection, avoid any type of sexual activity until you talk to your health provider.
If you do have sex, always use a condom or other protective methods to lower the risk of spreading or catching infections. Tell any partners who may be at risk so they can get tested and treated if needed.
