Syphilis is divided into stages (primary, secondary, latent, and tertiary), with different signs and symptoms associated with each stage: • Primary syphilis usually occurs a week to three months after getting the infection, presenting as a sore or sores at the site where the infection was passed. These sores start as firm, raised, and painless, but eventually break down to form an ulcer that heals on its own; these sores can usually be seen on or around the genitals, around the anus or in the rectum, or in or around the mouth. • Secondary syphilis, on the other hand, occurs weeks to months after the initial sores. Symptoms include a non-itchy skin rash (on the hands, feet, or groin, or in the mouth), sore throat, swollen lymph nodes, and fever. These symptoms usually go away on their own after a few weeks. • During the latent stage, which may last for years, there are no signs or symptoms present. • Tertiary syphilis usually happens years after the initial infection. It is associated with severe complications, because the infection can damage the eyes, heart, brain, liver, bones, or joints. Symptoms during this can include severe headache, convulsions, blindness, chest pain, muscle weakness, numbness, problems with balance and memory, loss of bladder control, and small bumps (called gumma) on the skin, bones, or internal organs.

Syphilis is usually diagnosed using two types of blood tests which look for 1) antibodies against substances commonly produced in syphilis patients, like cardiolipin, and 2) antibodies against the bacteria itself. If there are sores present, samples can be taken and studied under a microscope to look for the bacteria which cause syphilis. In rare cases where the bacteria has spread to the brain, an individual’s cerebrospinal fluid (the fluid found within the nervous system) is also tested alongside his/her blood sample. The preferred treatment against syphilis is penicillin G, an antibiotic, which is given through the muscle or directly to the blood depending on the severity of the infection. Those taking the antibiotic should be aware of the Jarisch-Herxheimer reaction, which appears within 24 hours of treatment; this reaction usually presents with fever, chills, headache, and muscle pain. Although the reaction can go away on its own, patients who present with these symptoms should still be closely monitored. In addition, it is important to inform the sexual partner/s of a person with syphilis to have them screened earlier for the disease and have them treated if needed.

The best way to avoid STIs including syphilis is to avoid sexual intercourse altogether. However, if a person is sexually active, there are a few ways to help prevent the spread of the infection: • maintain a sexual relationship with only one person (who does not have syphilis) • use condoms properly Screening for syphilis should be done in certain populations such as pregnant women, people living with HIV, and men who have sex with men. This is to help detect the infection earlier, allowing for earlier treatment. It is also important to know that people who have had the infection before can still catch it in the future. This means that they should still follow the preventive measures mentioned above to avoid getting infected again.