Syphilis is caused by bacteria (tiny germs) called Treponema pallidum. Anyone who’s sexually active can easily get and pass on syphilis.

Syphilis is easily passed on through sexual contact.

You can pass syphilis on without knowing you have it because symptoms can be so mild you may not notice or recognise them. It can also be passed on before symptoms are noticeable, or after they’ve gone.

• Syphilis can be passed from one person to another during sex or by any direct contact with the ulcers of someone who has syphilis
• It can be passed on through vaginal/frontal, anal or oral sex, or by sharing sex toys. Using a condom correctly can reduce your chance of getting or passing on syphilis
• If you’re pregnant, it’s possible to pass syphilis to the baby before birth. This is known as congenital syphilis – also see What happens if I get syphilis when I’m pregnant?
• Syphilis can also be passed on by sharing needles and other drug injecting equipment

You can’t get syphilis from sharing baths or towels, swimming pools, toilet seats or from sharing cups, plates or cutlery.

The signs and symptoms can be difficult to recognise and you may not notice them.

Syphilis can develop in stages:

• the early stage (primary and secondary syphilis)
• the latent stage
• the late stage (also called tertiary syphilis)

Early-stage syphilis may cause noticeable symptoms, but not everyone with syphilis will get them. Latent syphilis has no symptoms. Late-stage syphilis may cause symptoms but is rare in the UK.

If you’ve had syphilis before, you may be less likely to get symptoms if you get it again.

If you do get symptoms, you might notice the following at different stages.

Primary syphilis

• One or more ulcers can form, where the syphilis entered the body. These ulcers are called chancres (pronounced ‘shankers’) and are often painless. They often appear about 3 weeks after contact with syphilis but can appear from 9 days to 3 months after, or sometimes even later
• Ulcers may appear on the vulva (external female genitals) or the cervix (the entrance to the uterus (womb) at the top of the vagina)
• Ulcers may appear on the penis or foreskin
• They may be around the anus or the opening of the urethra (tube you pee from)
• Less commonly, ulcers may appear on other parts of the body, such as in the mouth, and on the lips, tonsils, fingers or buttocks (bottom)
• The ulcers of primary syphilis are very infectious and may take 3 to 8 weeks to heal. By this time, if the syphilis hasn’t been treated, it will spread to other parts of the body

Secondary syphilis

If syphilis isn’t treated, some people will develop signs of the secondary stage, usually around 3 to 10 weeks after any ulcers have appeared. Syphilis can still be passed on to someone else at this stage.

Symptoms may include:

• a painless rash that’s not usually itchy; it can spread all over the body, or appear in patches and is often seen on the palms of the hands and soles of the feet
• flat, warty-looking growths on or around the genitals or anus (often mistaken for genital warts)
• flu-like symptoms, such as a high temperature, tiredness, headache and swollen glands (this can last for weeks or months)
• white patches on the tongue, cheeks, or roof of the mouth
• patchy hair loss
• problems with the brain, spine, nerves or eyes

Without treatment, any symptoms usually go away in 3 to 12 weeks. The infection then goes into the latent stage.

Latent syphilis

When syphilis remains untreated, without any signs or symptoms of infection, it’s known as latent syphilis. Diagnosis is made by a positive blood test. People with latent syphilis may still be able to pass on syphilis to someone else.

Tertiary or late syphilis

Untreated syphilis may, after many years, start to cause serious damage to the heart, brain, spine, bones and nervous system.

Late syphilis is rare in the UK and this guide does not cover it.

You can only be certain you have syphilis if you have a test.

If you think you might have syphilis, it’s important not to delay getting a test so you can start treatment, if needed, and don’t pass syphilis on to anyone else.

Consider a test if:

• you or a sexual partner have, or think you might have, symptoms
• you’ve recently had sex without a condom with a new partner
• you, or a partner, have had sex without a condom with other partners
• a sexual partner tells you they have syphilis or another sexually transmitted infection (STI)
• you have another STI
• you’re pregnant or planning a pregnancy

You could still have syphilis even if a partner has tested negative. The only way to make sure you don’t have syphilis is to get tested yourself.

If you have syphilis, you’ll be advised to get tested for other STIs. It’s possible to have more than one STI at the same time.

If you’re receiving treatment for HIV you may be advised to have regular tests for syphilis. Your HIV doctor or nurse will discuss this with you.

It’s important not to delay getting a test if you think you might have syphilis.

A test can be done straight away but you may be advised to have another test later to confirm the result. You can have a test even if you don’t have signs and symptoms.

If you have a face-to-face appointment, a doctor or nurse:

• will ask you to give a blood sample may examine your genitals – this may include an internal examination of the vagina, or an examination of the penis, foreskin and opening of the urethra (the tube you pee from)
• may examine in and around your anus
• may check your skin for any rashes, ulcers or warty growths
• may check your mouth and throat area

They’ll use a swab to collect a sample of fluid from any ulcers. A swab looks like a cotton bud but is smaller and rounded. It sometimes has a small plastic loop on the end rather than a cotton tip. It’s wiped over any ulcers. This only takes a few seconds and isn’t painful, though it may be uncomfortable for a moment.

If you do a home test for syphilis then you’ll need to take a sample of blood from your finger. Instructions will be included with the test. Also see Where can I get a syphilis test?

Cervical screening (smear) tests and routine blood tests don’t detect syphilis. If you donate blood in the UK, your blood sample will be checked for syphilis. But don’t rely on this for a test – it may delay you getting treatment and put others at risk. Use a service listed here.

If you’re not sure whether you’ve been tested for syphilis, just ask.

There are different services you can go to. Choose the one you feel most comfortable with.

If you have any signs or symptoms, always get tested at a sexual health service.

A free syphilis test can be done at:

• A genitourinary medicine (GUM) or sexual health clinic
• A GP surgery (ask a doctor or practice nurse). If you do have syphilis, you’ll need to get treatment from a sexual health or GUM clinic.

Some services may offer you a telephone call, video call or online consultation instead of a face-to-face appointment.

In many areas, free home self-sampling tests are available to order online from your local sexual health service. This is where you take your own sample and send it to be tested at a lab.

You can also choose to buy a home self-sampling or rapid results syphilis test from a private provider (the accuracy of private home tests may vary) or pay for a syphilis test at a private clinic.

If a home test shows that you may have syphilis, it’s important to get another test at a sexual health clinic to confirm the result and start treatment as soon as possible. The test should have instructions explaining what to do.

Buying a Self-sampling Test from the Family Planning Association:

A STI Four Screen Self-Sampling Test Kit is available here – this test covers syphilis, gonorrhoea, chlamydia and HIV and.

Before buying a test it’s worth checking if there are free tests available in your area first.

For information on how to find a service see Where can I get more information and advice?

If you’re pregnant, you’ll be offered a syphilis test when you attend for antenatal (pregnancy) care – also see What happens if I get syphilis when I’m pregnant?

No tests are 100% accurate, but syphilis tests should pick up almost all syphilis infections if done at the right time.

All positive results will be confirmed with a second test.

It can sometimes take up to 3 months before syphilis shows up on a test. So sometimes a test result can be negative even if you do have syphilis. If you do a test less than 3 months after possible exposure to syphilis, you may be advised to do another test later.

• Syphilis is treated with antibiotics. This may be a single injection, a course of injections, tablets or capsules. Penicillin is the recommended treatment for syphilis. If it’s not possible to use penicillin, there are different antibiotics that can be used. Let the doctor or nurse know if you’re allergic to penicillin
• If you have any complications you may also need other treatment
• If there’s a high chance of you having syphilis, treatment may be started before your test results are back. You’ll usually be given treatment if a sexual partner has syphilis
• If you’re at an increased risk of getting syphilis, DoxyPEP might be a helpful treatment – see below – Can I use DoxyPEP?
• Complementary therapies (treatments outside of mainstream healthcare) can’t cure syphilis
• Treatment can safely be given during pregnancy – also see What happens if I get syphilis when I’m pregnant?

• Primary and secondary syphilis: Treatment is very effective. As long as the treatment is taken correctly, the syphilis will be completely cured.

• Latent syphilis: Syphilis can be treated and cured effectively without any long-term problems developing.

• Tertiary or late syphilis: Syphilis can be treated and cured, but any damage already done to your body won’t be reversed.

Your doctor or nurse will discuss any possible side effects of the antibiotic used.

After the first treatment, some people get a reaction known as the Jarisch-Herxheimer reaction. This is a flu-like illness with high temperature, headache and aches and pains in muscles and joints. It starts within 12 hours of treatment and lasts for up to 24 hours. This reaction isn’t dangerous and will get better on its own. It may help to rest, drink plenty of water and take some painkillers.

All tests are free through NHS services. Treatment is also free.

Yes. You’ll usually need to have follow-up blood tests 3 months, 6 months and 12 months after treatment. This is to check the syphilis has gone and that you haven’t got syphilis again.

If you’re living with HIV or other health conditions, you may be advised to have regular blood tests every 6 months to check there are no changes, monitor your condition and make sure all is OK.

If you have any questions, ask the doctor or nurse and make sure you know how to protect yourself in the future – also see How can I help protect myself from syphilis and other sexually transmitted infections?

Even after successful treatment and cure, any future blood tests you have for syphilis are likely to be positive. So, if you need documents for emigration or any other reason, ask your clinic for a certificate explaining your treatment.

If it’s not treated, syphilis can spread to other parts of the body causing serious, long-term complications.

It may start to cause very serious damage to the heart, brain, eyes, other internal organs, bones and nervous system. In some cases, this damage could lead to death.

No. If you delay getting treatment you risk syphilis causing long-term damage and you could pass on syphilis to someone else.

If you have syphilis you may have a higher chance of getting HIV if you have sex with someone who’s living with HIV and not on effective treatment.

If you have syphilis when you’re living with HIV and not on effective treatment, you may have a higher chance of passing on both syphilis and HIV to a partner.

Effective HIV treatment reduces the amount of virus in the body to such a low level that there’s zero chance of HIV being passed on to sexual partners. This is known as U=U (Undetectable equals Untransmittable).

Don’t have any sex, including vaginal/frontal, anal or oral sex, until 2 weeks after you and your partner(s) have finished the treatment and any follow-up treatment. If you or a partner have any ulcers or rashes, avoid any kind of sexual contact until sores are fully healed and 2 weeks after treatment is finished.

This helps prevent you getting syphilis again or passing on syphilis to someone else.

The test can’t tell you how long you’ve had syphilis.

It can be helpful for your healthcare professional to know if you’ve tested negative for syphilis in the past, and when this was.

If you feel upset or angry about having syphilis and find it difficult to talk to a partner or friends, don’t be afraid to discuss how you feel with the staff at the clinic or GP surgery.

If you have syphilis, it’s very important that your current sexual partner(s) and any other recent partners are also tested and treated.

No. There’s no evidence that syphilis will affect your fertility.

If you have untreated syphilis, you may pass the infection to your baby before the birth. This can lead to miscarriage, premature (early) birth or stillbirth, or the baby being born with syphilis.

If you’re pregnant, you’ll be offered a blood test for syphilis as part of your pregnancy care.

If syphilis is found, you can safely be treated during pregnancy. This can help stop the baby from getting syphilis.The treatment will not harm the baby.

If you finish your treatment less than 4 weeks before the birth, it’s recommended that the baby is given treatment once it’s born.

If you have sex without a condom with a new partner or think you might have been exposed to syphilis, it’s very important to get tested again, even if you’ve had a negative test before – also see – Where can I get a syphilis test?

No. Syphilis does not cause cervical cancer.

The following will help protect you from getting and passing on syphilis and most other sexually transmitted infections (STIs).

Can I use DoxyPEP?

If you’re at an increased risk of getting syphilis, DoxyPEP might be a helpful treatment.

DoxyPEP is an antibiotic that can help to prevent syphilis, if it’s taken within 3 days of potentially being exposed to syphilis during sex. Its effectiveness is higher when it’s taken as soon as possible.

At the moment, DoxyPEP is not endorsed by the British Association for Sexual Health and HIV or the UK Health Security Agency, but this is likely to change in future.

When any new guidelines or recommendations about DoxyPEP are published, we’ll update this guide.

In the meantime, it’s a good idea to talk to a healthcare professional at a sexual health service if you think you may benefit from DoxyPEP.

It’s important to know that DoxyPEP refers to the antibiotic Doxycycline. Any other type of antibiotic is unlikely to be effective at preventing syphilis. Always check with a healthcare professional before taking any type of antibiotic, to make sure it’s suitable for you.