Syphilis testing: who should be tested, what the test involves and what happens next

The NHS says the symptoms of syphilis are often mild and hard to notice when you are first infected, tend to change over time and may come and go. Sometimes the symptoms improve or go away completely, but if you have not been treated the infection is still in your body, you can still pass it on and you are at risk of serious problems later on.

Those later problems can be serious. The NHS lists heart problems such as angina, aortic aneurysm and heart failure, brain problems such as fits, memory problems, personality changes and dementia, nerve problems, and problems with the skin, bones, testicles, liver and other organs, and says some may not appear for many years after infection. Early testing and treatment is the way to avoid them.

The NHS says to go to a sexual health clinic or see a GP if you or a sexual partner have symptoms of syphilis, if a sexual partner has told you they have syphilis or another STI, if you have recently had sex with a new partner and did not use a condom, if you are pregnant or planning to get pregnant and think you might have syphilis, or if you have injected drugs using a needle that has been used by someone who might have syphilis.

NHS inform adds that you could be at higher risk if you are a man who has sex with men, have had sex overseas or have had multiple sexual partners. It also says syphilis occurs more often in people living with HIV, and that anyone diagnosed with syphilis should be offered an HIV test.

At first, the NHS says symptoms you may notice are small sores (ulcers) on the penis, vagina or around the bottom, which are usually painless and you may only have one, and sores in other areas including the mouth, lips or hands. You may not notice sores that are inside the bottom or vagina.

Later symptoms the NHS lists include white or grey warty growths, a rash on the palms of the hands and soles of the feet that is not usually itchy and may spread, white patches in the mouth, flu-like symptoms, swollen glands and patchy hair loss on the head, beard and eyebrows. The first symptoms can take 3 weeks or more to appear, and later symptoms may come up to 3 months later.

NHS inform describes three stages: primary, with a painless sore between 10 days and 3 months after infection; secondary, with a non-itchy rash and other symptoms beginning a few weeks after the sore disappears; and a latent stage with no symptoms. It says 1 in 3 people who are not treated develop serious symptoms eventually, which is tertiary syphilis.

The NHS says that if you have symptoms, a doctor or nurse will check the penis, vagina and bottom for syphilis sores. They may use a swab, like a cotton bud, to collect fluid from any sores, and will check the rest of your body for other signs such as a rash, sores or wart-like growths. They may also take a blood sample, and you may be offered tests for other sexually transmitted infections at the same time.

NHS inform says that the only reliable way to tell is a blood test, usually sent to the laboratory, though some sexual health services can run a same-day test if you have symptoms. You can be tested at a sexual health service or by contacting your GP practice, and the NHS says you can also be tested during an antenatal appointment if you are pregnant or by using a self-test kit.

The NHS pages used for this guide do not give a single figure for how long after exposure a blood test becomes reliable, so it is best to ask the sexual health clinic what timing applies to you. The practical point from the NHS is that symptoms can take 3 weeks or more to appear, so a lack of symptoms soon after exposure does not rule out infection. A clinic can advise on whether to test now and again later.

If you have had unprotected sex, NHS advice is to attend a clinic rather than wait for symptoms, because early infection is often not noticed.

The NHS says syphilis is treated with antibiotics, which you may have as injections, tablets or capsules, and that treatment may be started before your test result is known. How long you need treatment depends on the stage of the syphilis. Some people get flu-like symptoms such as a high temperature, headache and aching muscles within the first 24 hours of treatment.

NHS inform says antibiotics will treat the infection even during pregnancy, and that you may be given one or more doses depending on the stage. The NHS says you need to go back to the GP surgery or sexual health clinic several times in the first 12 months after starting treatment to be retested, and NHS inform specifies retesting at 6 and 12 weeks.

You should avoid sex, including oral sex and sex using a condom, until you and your partner or partners have finished treatment. The NHS says not to have sex until 2 weeks after you and your partner have finished treatment, and NHS inform says to wait until tests have shown the treatment has worked.

If you have syphilis, the NHS says your current and any recent sexual partners will also need to be tested and treated, and that a GP or sexual health clinic can advise on contacting them, which can be done without naming you. NHS inform says that partners are generally offered treatment regardless of their test result, because the infection can be hard to spot in the early stages.

The NHS says that if you are pregnant and have syphilis you can pass it to your baby before birth, known as congenital syphilis, and that syphilis in pregnancy can increase the risk of miscarriage, premature birth and stillbirth. It says you will be offered screening for syphilis if you are pregnant so it can be found and treated before it causes serious problems. NHS inform says the same for Scotland.