Testing and Treating Syphilis

If you think you may have syphilis, or have had intimate contact with someone who does, it is important that you get tested. Though rare, if left untreated, syphilis can proceed to chronic stages, causing blindness, dementia, brain damage, and death.

Diagnosis and Syphilis Testing

Syphilis can be diagnosed by your doctor at any stage, but this diagnosis can be a difficult one. Because syphilis symptoms resemble those of other illnesses, it is hard to come to a firm diagnosis. Obviously, the sooner the disease is diagnosed, the sooner you can begin treatment. But syphilis is too often ignored in its early stages. The first chancres that appear may not be visible to you, as they can appear internally. These chancres also disappear on their own, preventing many people from visiting their doctor.

The first step to diagnosing syphilis is to have a talk with your doctor and to have a physical exam. Your doctor will ask you questions about your sexual history and about any sexual protection that you use. Your doctor will also ask about any symptoms you might be experiencing, and when those symptoms first occurred. Try to be as detailed as possible about your symptoms. It is important that your doctor get as much information as possible in order to provide a correct diagnosis.

Testing by Stages

If you are in the first stage of infection, your doctor will examine you for chancres, which are open sores on your body. She will especially examine your genitals, mouth, and anus, as most chancres usually develop in these areas. Your doctor will then take a fluid sample from the chancre to conduct a darkfield exam. In this exam, the fluid from the chancre will be analyzed using a special microscope, called a darkfield microscope. This instrument allows the syphilis bacteria to be seen. This exam is only possible during early stages of infection, when sores are still apparent on your body.

If you are experiencing secondary syphilis, your doctor will examine your lymph glands and look for evidence of a brown rash on your body. He will be sure to examine the bottoms of you feet and the palms of your hands. Your doctor will also order a blood test, and will draw blood from you for this purpose.

Your doctor may order a Rapid Plasma Reagin Test (RPR) or a Venereal Disease Research Laboratory slide test (VDRL). These tests are essentially the same, measuring antibodies produced in your body. If antibodies are present in your body, this may indicate the presence of the syphilis bacteria. If this test turns out positive, another blood test will be performed to confirm the result. This test is called the Fluorescent Treponemal Antibody Absorption Test (FTA-ABS). This test is more accurate than either the RPR or the VDRL.

If you are in the late stage of infection, or if you have experienced problems with your central nervous system, your doctor will probably have to draw fluid from a special area in your spine. This fluid can give information to your doctor about the syphilis infection. A test called a Cerebrospinal Fluid Test will be performed in order to assess the magnitude of the infection.


Prior to the development of penicillin, syphilis was treated using a combination of mercury and arsenic. This treatment was often more awful than the disease itself, and led to early death. Today, much better treatments for syphilis exist, and, if caught early, treatment can be extremely straightforward and effective. The best treatment for syphilis infection is penicillin. The dosage and length of treatment you receive will depend upon the stage of infection that you are in.

If you are in the first or second stage of infection and have had syphilis for less than two years, you will be treated with benzathine penicillin. This will be administered in a single, intramuscular injection. After 24 hours you will no longer be infectious.

People that have had syphilis for more than two years, or are in the later stages of the disease, will be treated with procaine penicillin. This treatment consists of one injection every week for three weeks. For those who have suffered serious central nerve damage, you will receive penicillin intravenously every 4 hours for 10 to 14 days, or you will have penicillin injections every day for two weeks. If you are infected and pregnant, you must take penicillin injections. If you are allergic to penicillin, you will be desensitized to the medicine through supervised exposure.

Other medications are available for those who can’t take injections or have trouble sticking to long courses of medication. Doxycycline is administered to those in ea

rly and late stages of infection, and consists of a short course of tablets that are taken orally. For those who are allergic to penicillin, other antibiotics are also effective in attacking the syphilis bacteria. You will probably receive a short course of oral antibiotics.


Left untreated, people infected with syphilis can suffer serious health problems. The majority of health problems associated with syphilis occur in those with tertiary syphilis. During this phase of the infection, syphilis can spread to other parts of the body and affect the nerves, heart, brain, eyes, internal organs, joints, liver and bones. Moreover, it can cause a person to have troubles coordinating their movements as well as cause numbness, paralysis, gradual blindness and even dementia.

Follow Up

It is essential that you complete the treatment that your doctor has given you. Take all medications prescribed, no matter how you feel. Ensure that your partner gets treated to prevent reinfection. Abstain from sex until you have completed your medications and test negative for the syphilis bacteria.

If you are suffering from primary or secondary syphilis, return to your doctor for another syphilis test after 6 months, and again after 1 year. If you are suffering from tertiary syphilis you will be tested after 6 months, 1 year, and again after 2 years. If you have contracted HIV as well as syphilis, you will be required to return for tests every 3 months for 2 years.

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