Entirely curable with penicillin, and seriously damaging if left. A blood test settles it.
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Syphilis is a bacterial infection passed on through sex and from a pregnant woman to her baby. It was close to disappearing in Britain. It is now at its highest recorded level since 1948, and cases of babies born with it — congenital syphilis — have risen alongside.
The most important thing about syphilis is the reason it gets missed: the first sore does not hurt. A painless ulcer appears where the infection entered, often somewhere you cannot easily see, and then it heals by itself over a few weeks. Nothing was painful, and the problem apparently went away.
It has not gone away. The infection continues silently, and untreated it can eventually damage the brain, the nerves, the heart and the major blood vessels — sometimes decades later.
The good news is genuinely good. A blood test diagnoses it, penicillin cures it, and treated early there is no lasting harm. This is one of the most treatable serious infections in medicine — the whole difficulty is that people do not know to look.
These symptoms also resolve on their own, and the infection moves into a latent phase with no symptoms at all.
Detectable only by a blood test. Most people who are diagnosed in the UK are found at this stage, through screening.
Contrary to what is often assumed, the nervous system can be affected early as well as late. Headache, confusion, personality change, stroke, difficulty walking, hearing loss, or visual change including sudden loss of vision.
Every pregnant woman in the UK is offered a syphilis blood test, and it is one of the most worthwhile tests in antenatal care.
Untreated syphilis in pregnancy causes miscarriage, stillbirth, premature birth, and serious lifelong damage to the baby. Treated in pregnancy, transmission is largely preventable. Accept the test.
Syphilis is diagnosed on serology. Screening uses a treponemal test (EIA or CLIA), and a positive result is followed by confirmatory tests and by a quantitative test such as the RPR or VDRL, which measures how active the infection is and is used to track the response to treatment.
Antibodies can take up to 12 weeks to appear. A test within a few weeks of a risk may be negative even though infection has occurred, so testing is usually repeated at 6 and 12 weeks after the exposure.
Where a chancre is present, a swab can be tested by PCR, which gives an answer without waiting for antibodies.
The treponemal test usually stays positive for life, even after complete cure. It does not mean the infection is still there.
The quantitative test is the one that matters for cure — the level should fall substantially after treatment. This distinction causes a great deal of unnecessary alarm, particularly when someone treated years ago has a routine test.
A painless genital ulcer could also be herpes (usually painful), a fixed drug eruption, Behcet's disease, or a cancer. The rash of secondary syphilis is mistaken for pityriasis rosea, psoriasis, a drug rash or a viral rash — the involvement of the palms and soles is the clue that should prompt a test.
Syphilis is called the great imitator for good reason, and the test is cheap.
Treatment is an injection of long-acting penicillin — usually into the buttock, sometimes a course of them depending on the stage. There is no equivalent tablet regimen we could prescribe that matches it.
Beyond that, syphilis needs staging, partner notification, testing for HIV and other infections, and repeat blood tests over months to confirm it has been cured. That is a coordinated pathway, and sexual health clinics run it properly and free.
Go to an NHS sexual health clinic. Free, confidential, no referral, and nothing reaches your GP record without your agreement.
These can occur at any stage of syphilis, including early on. Say that you have or may have syphilis — it changes what gets tested.
Fever, chills and aching within 24 hours of the injection is a recognised reaction — covered below — and is not an allergy. But a rash with swelling of the face or lips, or difficulty breathing, is, and needs emergency treatment.
Within a few hours of the first injection, many people develop fever, chills, headache and aching. This is the Jarisch-Herxheimer reaction, caused by the bacteria dying in large numbers. It settles within 24 hours and it is not an allergy to penicillin.
Knowing about it beforehand prevents a great deal of panic, and it is frequently not explained. In late pregnancy it needs monitoring, so tell your midwife.
Being cured gives no protection against catching it again. Reinfection is common, and it is a real risk in the months after treatment.
There is no version of private care that improves on this for syphilis, and we would rather tell you that than sell you a consultation.
This page follows BASHH — the British Association for Sexual Health and HIV — UK national guidelines on the management of syphilis, alongside NICE Clinical Knowledge Summaries and UK Health Security Agency surveillance and antenatal screening guidance.
UKHSA has reported infectious syphilis diagnoses at their highest level since 1948, with a concurrent rise in congenital syphilis, underpinning the emphasis on testing, antenatal screening and partner notification.
Reviewed against BASHH, NICE CKS and UKHSA guidance current at the date shown above.
No — and this is the single most important point on the page. The first sore heals by itself in three to six weeks whether or not you are treated.
The infection carries on regardless, silently, and the sore healing is not recovery. Get a blood test.
Because that is characteristic of syphilis, and it is precisely why the infection is missed so often.
People expect something serious to hurt. A painless ulcer that heals itself does not feel like something to act on — but it is.
Antibodies take up to 12 weeks to appear, so an early negative test does not settle it.
Testing is usually repeated at 6 and 12 weeks after a risk. If you have a visible sore, a swab can give an answer sooner.
Completely, with penicillin. Treated early there is no lasting damage at all.
Damage already done at a late stage cannot be reversed, which is the whole argument for testing rather than waiting.
Because it needs an injection of long-acting penicillin, plus staging, partner notification and follow-up blood tests over months.
Sexual health clinics do all of that free, and better than any remote service could.
Almost certainly not. The treponemal antibody test usually stays positive for life once you have had syphilis.
The quantitative test is the one that shows whether infection is active — and this misunderstanding causes a great deal of unnecessary fear.
They reduce the risk substantially but not completely, because sores can be on skin a condom does not cover.
Use them, and test regularly as well — the two together are what works.
Almost certainly not — that is the Jarisch-Herxheimer reaction, caused by large numbers of bacteria dying at once. It settles within 24 hours.
Swelling of the face or lips or difficulty breathing is different and needs emergency care.
Yes, without hesitation. It is offered to every pregnant woman in the UK for good reason.
Untreated syphilis in pregnancy causes stillbirth and serious lifelong harm to the baby; treated, it is largely preventable.
Yes, and it is one of the most useful clues there is — very few rashes involve the palms and soles.
It is regularly mistaken for something else, so ask directly for a syphilis test if you have one.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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