Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Once considered a disease of the past, syphilis has made a dramatic resurgence in the United States. The CDC reported over 207,000 total cases in 2023, representing a 17% increase from the previous year. This trend affects communities across Maryland, Washington state, and Delaware, making awareness and early detection more important than ever.
The good news is that syphilis is highly treatable when caught early. The challenge is that symptoms can be subtle, painless, or easily mistaken for other conditions. Understanding what to look for at each stage empowers you to seek testing and treatment before complications develop.
How Syphilis Spreads
Syphilis spreads primarily through direct contact with a syphilis sore during vaginal, anal, or oral sexual activity. These sores can appear on the genitals, rectum, lips, or mouth. The infection can also pass from a pregnant person to their baby during pregnancy or delivery, a condition called congenital syphilis that has been rising at alarming rates.
Syphilis is not transmitted through casual contact. You cannot get syphilis from toilet seats, doorknobs, swimming pools, shared clothing, or eating utensils. The bacterium requires direct mucosal or skin-to-skin contact with an active lesion to spread.
The Four Stages of Syphilis
Primary Syphilis
The first sign of syphilis is a chancre — a firm, round, usually painless sore that develops at the site where the bacterium entered the body. This appears approximately 10 to 90 days after exposure, with an average incubation period of 21 days.
Key characteristics of a primary chancre include a single sore (though sometimes multiple), painless presentation that may go unnoticed, firm raised edges with a clean base, and typical location on the genitals, rectum, or mouth. The chancre heals on its own within three to six weeks regardless of whether treatment is received. However, without treatment, the infection progresses to the secondary stage.
Secondary Syphilis
Secondary syphilis develops four to ten weeks after the chancre appears and is characterized by systemic symptoms as the bacteria spread through the bloodstream. The hallmark sign is a skin rash that often appears as rough, reddish-brown spots on the palms of the hands and soles of the feet, though it can appear anywhere on the body.
Additional symptoms during this stage include mucous membrane lesions in the mouth or genital area, patchy hair loss, fever, swollen lymph nodes, fatigue, weight loss, and muscle aches. These symptoms will resolve without treatment, but the infection continues to progress.
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Frequently Asked Questions
What does a syphilis sore look like?
A primary syphilis sore (chancre) is typically a firm, round, painless ulcer that appears at the site of infection. It usually has raised edges and a clean base. Because it is painless, many people do not notice it. It typically appears 3 weeks after exposure and heals on its own within 3 to 6 weeks, but the infection remains if untreated.
Can syphilis be cured completely?
Yes, syphilis can be cured with appropriate antibiotic treatment, typically penicillin G benzathine. Early-stage syphilis (primary and secondary) is cured with a single intramuscular injection. However, any organ damage that occurred before treatment cannot be reversed, which is why early detection is critical.
How long after exposure do syphilis symptoms appear?
Primary syphilis symptoms typically appear 10 to 90 days after exposure, with an average of about 21 days. Secondary symptoms develop 4 to 10 weeks after the primary chancre appears. Some people may not notice primary-stage symptoms and first present with secondary-stage signs.
Can you get syphilis from kissing or sharing drinks?
Syphilis is transmitted primarily through direct contact with a syphilis sore during vaginal, anal, or oral sex. It is not spread by casual contact such as sharing food, drinks, or utensils. In rare cases, it can be transmitted through direct contact with an active lesion during kissing if a sore is present on the mouth or lips.
How often should sexually active people get tested for syphilis?
The CDC recommends at least annual syphilis screening for sexually active men who have sex with men (MSM), people living with HIV, and those with multiple partners. People with new or multiple partners should discuss testing frequency with their healthcare provider. Pregnant individuals should be tested at the first prenatal visit.
Can I get tested for syphilis through telehealth?
Yes. A telehealth provider can order a syphilis blood test (RPR or treponemal-specific test) that you complete at a partner lab in Maryland, Washington, or Delaware. Results are typically available within 1 to 3 days. We follow up with you about results, treatment, and partner notification. Confidential STI screening panels for HIV, gonorrhea, chlamydia, and hepatitis can be ordered together.
Where is syphilis treatment administered?
Standard treatment is a benzathine penicillin G intramuscular injection, which must be given in-person. After diagnosis through telehealth, we coordinate with your local health department, urgent care, or primary care office for the injection. State and local health departments often provide free or low-cost STI treatment, including in Maryland, Washington, and Delaware.
What if I'm allergic to penicillin?
For non-pregnant adults with a true penicillin allergy, doxycycline 100 mg twice daily for 14 days (early syphilis) or 28 days (late syphilis) is a recognized alternative. Tetracycline and ceftriaxone are other options depending on stage. Pregnant individuals with penicillin allergy should be desensitized and treated with penicillin, as alternatives are not adequate to prevent congenital syphilis.
Do I need to notify past sexual partners?
Yes. Partner notification is essential to prevent reinfection and reduce community spread. Generally, partners from the past 3 months for primary syphilis, 6 months for secondary, and 1 year for early latent should be notified, tested, and treated. State health departments offer free, confidential partner notification services in Maryland, Washington, and Delaware that protect your identity if you prefer.
Can adolescents be evaluated and tested for syphilis at InnoCre?
Yes. We see patients 12 and older. Maryland, Washington, and Delaware all allow minors to consent to STI testing and treatment without parental involvement, and we follow each state's confidentiality requirements. A telehealth visit can confidentially discuss risk, order testing at a local lab, and coordinate any needed in-person treatment.
Atul S. Vellappally, DNP, CRNP, FNP-BC
Founder, InnoCre Telehealth. Board-certified Family Nurse Practitioner with doctoral-level training in evidence-based and precision medicine. Licensed in Maryland, Washington, and Delaware.
This article is for informational purposes only and does not constitute medical advice. If you are experiencing a medical emergency, call 911.
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