--- title: "Syphilis: Symptoms, Causes & NHS Treatment | HealthAnswers" description: "Syphilis — stages, symptoms, blood testing, NHS antibiotic treatment, and why cases are rising in the UK." url: https://healthanswers.co.uk/conditions/syphilis/ robots: noindex --- # Syphilis: Symptoms, Causes & NHS Treatment | HealthAnswers Health A–Z Syphilis — stages, symptoms, blood testing, NHS antibiotic treatment, and why cases are rising in the UK. Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026 ## Quick answer What is syphilis? Syphilis is a bacterial STI that progresses through stages — painless sore (chancre) first, then rash and flu-like illness, then latent years without symptoms, and finally serious organ damage if untreated. Diagnosed by blood test; cured with penicillin injections. Cases are rising in the UK — test if at risk. All pregnant women are screened — untreated syphilis harms the baby. ## Who is this page for? This page is for people in the UK who want a plain-English overview of Syphilis, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally. ## Who should skip this page? Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland. On this page 7 sections ## Key facts about syphilis - Syphilis cases have risen sharply in England — especially among men who have sex with men. - Primary syphilis — usually painless genital, anal, or oral ulcer — heals in weeks but infection persists. - Blood tests detect syphilis — may take up to 3 months after exposure to turn positive. - Penicillin injection is first-line treatment — cure at all stages though late damage may be irreversible. - Routine antenatal screening detects syphilis in pregnancy — treatment prevents congenital syphilis. ## Syphilis — the great imitator **Syphilis** is a **bacterial STI** caused by *Treponema pallidum* — historically devastating, now **curable with penicillin** — yet **cases are rising** in England, particularly among **men who have sex with men** and **heterosexual young adults**. It progresses through **distinct stages** if untreated — many symptoms mimic other diseases — earning the nickname **“great imitator”**. ## Stages of syphilis ### Primary syphilis (3 to 3 weeks post-exposure) - painless ulcer (chancre) — genitals, anus, mouth, or other contact site - firm, round , clean base - heals in 2 to 6 weeks without treatment — infection continues ### Secondary syphilis (weeks to months later) - widespread rash — often includes palms and soles — unusual in other rashes - flu-like illness , fever - generalised lymphadenopathy - patchy hair loss - condylomata lata — moist warty lesions - resolves — enters latent phase ### Latent syphilis - no symptoms — years to decades - detectable on blood test only - still infectious in early latent period ### Tertiary syphilis (rare in treated era) - cardiovascular — aortic aneurysm - neurosyphilis — dementia, tabes dorsalis, stroke-like syndome - gummas — destructive tissue lesions **Early detection prevents tertiary disease.** ## Testing **Sexual health clinic:** - blood test — EIA screen, TPPA/TPHA confirm - HIV test — offered concurrently - swab from chancre — PCR if ulcer present **Window period:** test **12 weeks** after exposure if initial negative — or earlier if symptomatic. **Antenatal screening:** **all pregnant women** — routine blood test. ## Treatment **First-line:** **Benzathine penicillin G** — **intramuscular injection** - dose schedule depends on early vs late syphilis **Penicillin allergy:** desensitisation or **doxycycline** — specialist protocols — not simple allergy label without assessment. **Follow-up blood tests:** - RPR/VDRL titres fall after successful treatment - failure or reinfection if titres rise **Partner notification** — trace and treat contacts. ## Neurosyphilis — urgent **Symptoms:** - vision loss , hearing loss - facial weakness - meningitis-like illness - dementia , personality change - stroke in young person **Hospital assessment** — lumbar puncture, IV penicillin. ## Syphilis and HIV **Co-infection common** — syphilis may progress faster with HIV — **regular screening** if at risk. ## Prevention - condoms — reduce but not eliminate — chancre may be on uncovered skin - regular STI screens — 3-monthly if multiple partners MSM (national guidance) - prompt treatment and partner tracing Syphilis is **entirely curable early** — the rise in cases reflects **testing and behaviour**, not untreatability. **Painless sore or rash on palms** — sexual health clinic, not ignore. ## ! When to see a GP about syphilis Attend a sexual health clinic or see a GP for STI testing if you have had unprotected sex, a painless genital sore, a widespread rash (including palms and soles), or a partner diagnosed with syphilis. Call **111** for urgent same-day advice if you cannot get a clinic appointment. Seek emergency care — call **999** or go to A&E — for sudden severe headache, confusion, seizures, stroke-like weakness, or sudden vision or hearing loss, which can be signs of neurosyphilis. Pregnant women with a positive screening test need prompt treatment via antenatal and sexual health services. ## Common questions about syphilis What are the symptoms of syphilis? Primary — painless ulcer (chancre) at infection site 3 weeks after contact. Secondary — rash (often palms/soles), swollen glands, fever, hair loss, wart-like growths — weeks later. Then latent (no symptoms) for years. Tertiary — heart, brain, nerve damage if untreated — rare now with testing. Is syphilis curable? Yes — penicillin antibiotics cure the infection at all stages. Early treatment prevents progression. Late-stage organ damage already done may not fully reverse — another reason to test early. How is syphilis tested? Blood tests — EIA screening then confirmatory tests. Swab from ulcer if present. Repeat test 12 weeks after potential exposure if initial test negative. HIV test offered alongside — co-infection common. How is syphilis treated on the NHS? Benzathine penicillin intramuscular injection — dose and duration depend on stage. Azithromycin or doxycycline alternatives if penicillin allergy — specialist guidance. Follow-up blood tests confirm treatment success — titre should fall. Can syphilis come back after treatment? Treatment cures current infection — does not prevent reinfection. Retest if new exposure. Rising titre on follow-up blood tests suggests treatment failure or reinfection — needs reassessment. What is congenital syphilis? Infection passed to baby in pregnancy — miscarriage, stillbirth, or serious infant disease. Prevented by antenatal screening and treating mother early in pregnancy — UK routine screening programme. ## Sources - [NHS — Syphilis](https://www.nhs.uk/conditions/syphilis/) - [BASHH — Syphilis guidelines](https://www.bashh.org/)