department of health and human services 

centers for disease control and prevention 

A community-based effort to eliminate syphilis in the United States. 

syphilis–physician’s pocket guide
Syphilis is a systemic, sexually transmitted disease (STD) 

caused by the Treponema pallidum bacterium. 

syphilis transmission 

Three means of syphilis transmission: 

Person to person via vaginal, anal, or oral sex through direct 

contact with a syphilis chancre. 

Person to person during foreplay, even when there is no 

penetrative sex (much less common). 

Pregnant mother with syphilis to fetus. 

signs and symptoms 

If left untreated, syphilis progresses in stages. The stages are: 

primary: 

One or more chancres (usually firm, round, small, and 

painless) appear at the site of infection (most often the 

genital area) 10 to 90 days after infection. 

The chancres heal on their own in 3-6 weeks. 

Patient is highly infectious in the primary stage. 

It is very important for people who test positive for HIV and 

other STDs to get tested for syphilis, since transmission of HIV 

is enhanced by syphilis and other STDs. 
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secondary: 

Rashes occur as the chancre(s) fades or a few weeks after 

the chancre heals. 

Rashes typ cally appear on the palms of the hands the 

soles of the feet, or on the face, but also may appear on 

other areas of the body. 

Sometimes wart-like “growths” may appear in the genital area. 

Rashes and syphilitic warts tend to c ear up on their own 

within 2-6 weeks but may take as long as 12 weeks. 

Patient is highly infectious in the secondary stage. 

early latent: 

Patient is seroreactive within one year of onset of infection, 

but has no symptoms. 

Patient is potentially infectious. 

treatment 

Primary, Secondary, or Latent <1 year 

2.4 million units IM of Benzathine Penicillin G in a single dose 

Latent >1 year, latent of unknown duration, late 

cardiovascular, gumma 

2.4 million units IM of Benzathine Penicillin G in 3 doses at 1 week intervals 

(7.2 million units total) 

Pregnant women 

Treatment during pregnancy should be the penicillin regimen 

appropriate for the stage of syphilis (See CDC Treatment Guidelines) 

Neurosyphilis 

3 to 4 million units IV of Aqueous Crystalline Penicillin G every 4 hours 

for 10-14 days (18-24 million units/day) 

Penicillin allergies 

See CDC Treatment Guidelines 

Note: For treatment information on congenital syphilis and syphilis in children (early, primary, 

secondary, latent—both <1 year and >1 year or of unknown duration, and late latent) please 

see CDC Treatment Guidelines at http://www.cdc.gov/STD/treatment/. 
late latent: 

Patient is seroreactive more than 1 year after onset of 

infection, but has no symptoms. 

Patient is not infectious in late latent stage. 

late (tertiary): 

Manifestations in the skin and bones (gummas), central 

nervous system, and cardiovascular system. 

Patient is not infectious in late stage. 

diagnosis 

Dark-field examinations or direct fluorescent antibody tests 

of chancre tissue are the definitive methods for diagnosing 

primary and secondary syphilis. 

dark-field 

microscopy 

A presumptive diagnosis is possible with sequential serologic 

tests (e.g. VDRL, RPR), using the same testing method each 

time. A fourfold change in titer (e.g. from 1:8 to 1:32) is usually 

considered to be clinically significant. Confirmatory tests 

should be performed. 

Examine patient thoroughly and obtain sexual history, as 

many patients do not notice the signs and symptoms of 

syphilis because chancres can be hidden in the vagina, 

rectum, or mouth. 

Contact local health department for information and 

partner notification. Report presumptive and confirmed 

cases of syphilis within one working day of the diagnosis. 

For more information, visit www.cdc.gov/std/see/ or contact 

your local health department.