Syphilis is caused by the bacteria Treponema pallidum and is sexually transmitted.

It is increasing in prevalence among men who have sex with men, and more common in ATSI populations.

Syphilis has 3 stages, but 50% of people have no symptoms and are only detected with testing.


Primary syphilis

  • Patients may have a genital ulcer or chancre that is painless
  • Might be on the anal skin, cervix or in the mouth
  • It can present 10-90 days after infection (but usually around 3 weeks)
  • In 30% of people there are multiple chancres
  • Even untreated the chancres tend to resolve within a few weeks
  • Lymph nodes in the groin are usually enlarged

Secondary syphilis

  • Fever, tiredness, headaches and enlarged lymph nodes
  • Most people have a rash all over, but sometimes only on the palms and soles
  • There can be weakness in the nerves of the face
  • Meningitis is possible
  • It can present between 2-24 weeks after infection (average 6 weeks)
  • Symptoms tend to resolve if untreated but can recur

Tertiary syphilis

  • Left untreated about a third of cases develop tertiary syphilis
  • Skin lesions called gummas
  • Heart disease
  • Neurological disease

How is it diagnosed?

By taking a careful history and performing an examination the signs of syphilis are usually there. However it is often picked up with blood tests in patients with no symptoms.

If there are chancres (ulcers) a swab may be positive before blood tests are.

What do I do if I have syphilis?

Your doctor will inform you of the results with a phone call if a follow up appointment hasn’t already been arranged.

You will be provided with antibiotics to treat the infection, and advised not to have sex with anyone for the next 7 days, even if you are using barrier protection like condoms.

Also avoid sex with any partners from the last 3-6 months until they have been tested and treated if necessary.

You will need to inform any partners over the last 6 months that they should get tested also.

What next?

If you had symptoms they should have resolved. If they didn’t then it’s advised to see your doctor to check if there was treatment failure (very very rare), reinfection, or if there is another cause.

Repeat testing is necessary at 3 months and 6 months to ensure the blood tests are improving indicating a test of cure.

If you’re interested in doing an STI screen, or are worried you might have symptoms book in with our doctors for an STI check. If you want to know how often you should get tested, have a look at our page on how often should I have a sexual health check for more information.

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