Syphilis, is a bacterial infection usually spread by sexual contact that starts as a painless sore. Syphilis develops in stages and symptoms vary with each stage.

What is it?

  • It is caused by bacteria and can cause serious health problems if left untreated
  • It is easy to cure if found early
  • It is rarer in Australia but the numbers are increasing, especially in men who have sex with men and young Aboriginal and Torres Strait Islander people living in Northern Australia

Signs and Symptoms

Clinically the disease has 3 stages however about 50% of people will have no symptoms and will only be diagnosed by serological testing.

Primary Syphilis:
  • Patients may present with a genital ulcer or chancre(s) that is usually painless
  • The ulcer tends to be non-tender and usually have a well-defined margin with an indurated base
  • May be unnoticed especially if on anal skin or on the cervix or in the mouth
  • Incubation period 10-90 days (average 3 weeks)
  • In about 30% of cases there may be multiple chancres
  • Inguinal lymph nodes are usually enlarged, rubbery and non-tender
  • Even if untreated the chancre usually spontaneously heals within a few weeks
Secondary Syphilis:
  • The patient may present with constitutional symptoms such as fever, malaise, headache and lymphadenopathy
  • The skin involved in over 90% of cases
  • The rash is usually generalised involving the trunk but may just affect the palms and soles
  • The rash can be easily confused with drug eruptions, pityriasis rosea or guttate psoriasis
  • There may be alopecia and condylomata lata (warty growths in the ano-genital area)
  • There may also be neurological signs of cranial nerve palsies, ophthalmic signs and meningitis
  • Incubation period 2-24 weeks (average 6 weeks)
  • If untreated symptoms slowly resolve over a period of weeks, but may recur
Tertiary Syphilis:
  • Late symptoms/complications may develop months or years later in about one third of cases if not treated
  • Complications include skin lesions (gummas), cardiovascular or neurological disease


  • Diagnosis is by a combination of serology, history and clinical assessment
  • If serology is negative, repeat testing after 2 weeks if clinical suspicion of syphilis


  • Treated with antibiotics such as benzyl penicillin
  • It is safest not to have sex, even with a condom, until after you have completed the full course of treatment as it is very infectious, particularly during the early stages

Recommended follow-up

  • Advise no sexual contact for 7 days after treatment is administered
  • Advise no sex with partners from the last 3 months (primary syphilis) and 6 months (secondary syphilis) until the partners have been treated if necessary
  • Repeat testing at 3 months, then at 6 months and if necessary at 12 months after completing treatment
  • Consider testing for other STIs at three-month visit, if not undertaken at first presentation or retesting post window period

Contact tracing

  • Primary syphilis: 3 months plus duration of symptoms
  • Secondary syphilis: 6 months plus duration of symptoms
  • Late latent syphilis: long term partners only
  • Partners should be traced back for 6 months
  • Contacting all sexual contacts during potential time of infection

For more information

Information about Syphilis in other languages