In 2000, eliminating the sexually transmitted infection syphilis nationwide seemed possible. Cases were at an all-time low in the United States, with fewer than 6,000 reported.
Now, syphilis rates are the highest since the 1950s, according to a report from the Centers for Disease Control and Prevention. In 2022, there were 203,500 cases of syphilis in the United States, a nearly 80 percent increase in five years. At the same time, rates of congenital syphilis, in which the infection is passed from mother to baby during pregnancy and childbirth, jumped 183 percent, to 3,755 cases.
“The most common misconception about syphilis is that it’s a thing of the past and no longer an issue,” says UNC Health family medicine physician Rick Moore, MD. “Cases are increasing in every community.”
Syphilis can be tricky to recognize, and if it’s left untreated, it can cause serious damage to your health. Once diagnosed, however, syphilis is completely treatable. Dr. Moore explains what you need to know to stay safe.
Stages and Symptoms of Syphilis
Syphilis is caused by the bacteria Treponema pallidum and progresses through several distinct stages.
The first stage, primary syphilis, begins with a sore called a chancre that develops in the genital area, rectum or mouth. Direct contact with the sore spreads syphilis, so unprotected oral, vaginal and anal sex are the most common methods of transmission.
The sore is usually painless and small, resembling a pimple, which can lead people to overlook it as a symptom.
“The sore typically goes away on its own, so you might think it was a blister that healed,” Dr. Moore says.
Secondary syphilis, which immediately follows the first stage, is distinguished by a rash that tends to appear on the palms of the hands and the soles of the feet, and sometimes flu-like symptoms. The rash can be faint and painless, again causing many people to overlook an issue.
The primary and secondary stages of syphilis usually last for less than six weeks each. If you’re showing active symptoms of syphilis, there’s a risk of transmitting the disease to another person.
If syphilis isn’t treated in the primary or secondary stage, it enters a latent stage in which the disease cannot be transmitted through sexual contact. This stage can last for decades and may never progress, but it is possible to develop tertiary syphilis, or neurosyphilis. Neurosyphilis may begin with changes in mental state and ocular symptoms, such as double vision or eye tracking issues. It can progress to cause brain damage, heart problems, nerve damage, movement disorders, seizures and blindness.
Active or latent syphilis can trigger significant problems during pregnancy and infancy. Congenital syphilis, or syphilis passed from mother to fetus, is associated with miscarriage, stillbirth and premature birth. In the first few weeks of life, infants may have skin issues, a higher risk of jaundice, liver and spleen complications, and vision issues; without treatment, they may experience significant effects. Congenital syphilis is treatable once it’s identified.
Diagnosis and Treatment of Syphilis
Syphilis is diagnosed with a blood test, though Dr. Moore says that identifying a chancre can be sufficient to start treatment. A blood test can also detect syphilis if it’s in a latent stage without active symptoms.
For people with syphilis in the primary or secondary stage, a shot of penicillin will completely treat the disease, Dr. Moore says. A single shot is also the course for early latent cases in which it’s been less than a year since infection, confirmed through regular testing for sexually transmitted infections.
If it’s been more than a year since infection, a person will require three injections of penicillin, delivered weekly. For tertiary syphilis, a person is usually admitted to the hospital for IV penicillin.
Infants with congenital syphilis are also treated with penicillin.
Because of the recent increase in syphilis cases, the type of penicillin used in treatment has been experiencing shortages since April 2023, and existing supply has been prioritized for pregnant women. (Click here for the latest information about the supply.)
“The second-line treatment for syphilis is doxycycline,” Dr. Moore says. “We have good safety and efficacy data for this treatment, which is important while we’re in this penicillin shortage.”
If you find out you have syphilis, it’s important to contact previous sexual partners so they can be tested and treated. Your local health department may be able to handle the disclosure process for you so that you can remain anonymous. Also, some health departments can offer testing and treatment if you don’t have insurance. (Visit this CDC site for testing locations year you.)
“Syphilis is treatable and completely curable, so knowing your diagnosis is a form of empowerment,” Dr. Moore says. “The vast majority of cases are identified before neurosyphilis and significant complications. This is not something that people have to live with.”
Preventing the Spread of Syphilis
Syphilis can affect anyone, though there are significantly higher rates of infection for men who have sex with men, Dr. Moore says. If you’re sexually active, you can prevent spread by using a condom. Regular testing for sexually transmitted infections increases the chances of diagnosing and treating syphilis, particularly if you didn’t have major symptoms at the time of infection.
Currently, 42 states have laws requiring that women be tested for syphilis at their first prenatal appointment to prevent the spread of congenital syphilis. North Carolina requires testing at the first visit, between 28 and 30 weeks of gestation, and at delivery.
“There’s effective treatment at every stage of syphilis, but you may not know you have it and can’t always rely on noticing the symptoms,” Dr. Moore says. “Make testing a part of your routine.”
Talk to your doctor about getting tested for sexually transmitted infections. Need a doctor? Find one near you.