Syphilis Testing

Syphilis doesn’t always cause symptoms. Even when it does, signs can be so mild that many people don’t realize they have the infection. If you believe you may have had sexual contact with an infected person, you should get a syphilis test even if you don’t notice any signs. The CDC also recommends undergoing syphilis testing if you’re pregnant at your first prenatal appointment. You may need to retest at 28 weeks gestation and again at delivery if you’re at high risk of contracting the infection.

If you have multiple sexual partners, have a partner with an STI, have HIV, or live in a community where syphilis is prevalent, the CDC reccomends that you get tested regularly.. If you have an increased risk of contracting the infection, you may need to undergo testing every three to six months, notes the CDC..

Because syphilis symptoms can look like those of several other diseases, it’s often called “The Great Pretender” and can only be diagnosed via lab testing. According to the CDC, the infection typically progresses in stages, which can last for weeks or even years, depending on the person. If you have any of the following symptoms—even if you think they may be due to another condition—you should get tested just to be safe.

Symptoms of primary stage syphilis

If you have symptomatic syphilis, you may notice one or more sores at the site where the infection entered your body (usually the genitals or anus). These sores are typically round, firm, and painless and heal after three to six weeks even without treatment, according to the CDC..

Symptoms of secondary stage syphilis

The CDC advises that if you don’t get tested and treated for primary-stage syphilis, the infection can progress to its second stage within a few weeks to a few months. The CDC says that secondary-stage symptoms typically begin as a reddish-brown rash somewhere on the body. You may also develop sores in various mucous membranes, including the anus, vagina, or mouth.

In addition to rashes and/or sores, the CDC warns that you may develop a sore throat, fever, swollen lymph nodes, fatigue, muscle aches, or headaches. Patchy hair loss or weight loss may also occur. Like primary stage symptoms, secondary stage symptoms will eventually go away whether or not you receive treatment. But without appropriate treatment, the infection will progress.

Symptoms of latent stage syphilis

Without treatment, the CDC notes that secondary syphilis could eventually become a latent (hidden) infection. During its latent stage, syphilis does not produce any noticeable signs or symptoms but remains in the body. This stage of the disease can last for several years, depending on the person.

Symptoms of tertiary stage syphilis

According to the CDC, syphilis usually progresses to its tertiary stage within 10 to 30 years after entering the body. This stage of the disease is rare and can cause irreparable damage to various organ systems, including the brain, heart, nerves, liver, and blood vessels. Late-stage syphilis can be fatal if left untreated, and symptoms can vary widely, depending on the organ system affected.

Other syphilis symptoms to watch for

During any of its stages, syphilis can infect your nervous system, eyes, or ears. According to the CDC, this can cause:

• Severe headaches
• Muscle weakness, numbness, or difficulty moving
• Confusion, focus problems, memory problems, or difficulty making decisions
• Blurry vision or floaters
• Sensitivity to light
• Eye redness or pain
• Vertigo, dizziness, or trouble balancing
• Tinnitus (buzzing, ringing, or hissing in the ears)
• Hearing loss

You can get a syphilis test at your primary care doctor’s office or a walk-in clinic, such as an urgent care center. Most urgent care clinics welcome walk-in patients and can perform same-day syphilis testing, as well as testing for other sexually transmitted infections.

If you can’t travel to a clinic or feel uneasy about undergoing in-office testing, many urgent care clinics offer virtual appointments. During one of these video visits, you can chat with a physician about your concerns and any symptoms you may be experiencing. Your doctor can then order you an at-home syphilis test kit and have it sent to your address. The kit will include instructions for collecting test samples, which you’ll mail to a lab for analysis.

You can also order an at-home syphilis test kit online if you’d like to test yourself as discreetly as possible. However, these tests are non-specific and cannot confirm whether you have an active infection. If you take any type of at-home test and it comes back positive, you’ll need to follow the test directions and schedule a visit with a doctor who can perform further testing and evaluation.

According to the National Institutes of Health (NIH), your doctor may perform various types of syphilis tests to diagnose the infection, including:

• Nontreponemal antibody tests: These tests require a blood sample and are used to detect non-specific antibodies that the immune system creates in response to syphilis. Depending on your symptoms, these tests may require a sample of cerebrospinal fluid in addition to a blood sample.
• Treponemal antibody tests: These blood tests are used to detect antibodies that are highly specific for syphilis. Once created, these antibodies stay in your system for life even after successful treatment.
• Dark-field microscopy: This type of test is relatively uncommon and used for direct detection of the Treponema pallidum bacterium. It requires a cell sample scraped from the surface of a suspected syphilis sore, which undergoes examination under a dark-field microscope.
• Molecular testing: This type of test is fairly uncommon and used to detect Treponema pallidum genetic material present in an active sore, blood, or cerebrospinal fluid.

The NIH notes that usually, testing involves two phases, the first of which screens for non-specific antibodies associated with the infection. If your initial screening shows that you have syphilis-associated antibodies, you’ll need to undergo a second phase of testing. This phase looks for syphilis-specific antibodies that your immune system only creates to fight off a syphilis infection.

You don’t need to do anything special to prepare for a syphilis test that requires a blood sample or sore scraping, according to the NIH. But if your doctor wishes to collect a sample of cerebrospinal fluid, you may need to empty your bowels or bladder before undergoing a lumbar puncture.

To perform syphilis testing, your healthcare provider will most likely take a blood sample from a vein in your arm, according to the NIH. To do this, they’ll insert a thin needle into the vein, collect a small amount of your blood in a vial or test tube, and then remove the needle. You may feel a minor sting during the needle insertion or removal, but any discomfort should dissipate quickly. The entire process usually takes less than five minutes.

If your symptoms indicate that you may have a syphilis infection of the brain or nervous system, your healthcare provider may order cerebral spinal fluid (CSF) testing. This type of test requires a lumbar puncture (spinal tap) to collect fluid from your spinal canal.

During this simple outpatient procedure, your healthcare provider will have you sit on an exam table or lie on your side. You’ll be given an anesthetic that numbs the area, so you don’t feel pain during the spinal tap. Once you’re numb, your provider will insert a hollow, thin needle into the lower portion of your spinal canal to withdraw a sample of CSF.

The NIH advises that you must remain very still during the fluid-withdrawal process, which takes approximately five minutes to complete. If you get a headache after the procedure, lying flat for a few hours may help alleviate the discomfort.

According to the CDC, if your initial, non-specific antibody screening comes back negative, you probably don’t have a syphilis infection. However, if your provider believes you should take another screening test to confirm, they’ll let you know when to do that.

When a non-specific antibody test comes back positive, that means you have antibodies that may be from syphilis or another health condition, according to the CDC. You’ll need to undergo follow-up testing for syphilis-specific antibodies to confirm whether or not you have the infection.

If you end up being diagnosed with syphilis, be sure to inform anyone you’ve had sexual contact with, so they can get syphilis testing, too, in accordance with CDC recommendations.

If your follow-up syphilis test comes back positive, your doctor will prescribe a course of antibiotics to treat the infection. According to the NIH, antibiotics can completely cure most primary, secondary, and early latent stage syphilis infections. They can also treat late-stage syphilis, but unfortunately, they cannot reverse any damage a long-standing infection may have caused.

After treatment, you’ll likely need to undergo additional follow-up testing so your doctor can determine whether the treatment is working. You should avoid any type of sexual contact until your doctor confirms the infection is cured.