Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if it is not treated. Syphilis is divided into stages (primary, secondary, latent, and tertiary). There are different signs and symptoms associated with each stage. Syphilis can be passed from mother to baby during pregnancy. Incidence of syphilis has been increasing among Monterey County residents since 2010.

What are the signs and symptoms of syphilis?

Symptoms of syphilis in adults vary by stage:

Primary Stage

During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. Sores are usually (but not always) firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore usually lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage.

Secondary Stage

During the secondary stage, you may have skin rashes and/or mucous membrane lesions. Mucous membrane lesions are sores in your mouth, vagina, or anus. This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.

Latent Stage

The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms.

Tertiary Stage

Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10–30 years after your infection began.  In tertiary syphilis, the disease damages your internal organs and can result in death.

Neurosyphilis and Ocular Syphilis

Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis) or to the eye (ocular syphilis). This can happen during any of the stages described above.

Symptoms of neurosyphilis include

• severe headache;
• difficulty coordinating muscle movements;
• paralysis (not able to move certain parts of your body);
• numbness; and
• dementia (mental disorder).

Symptoms of ocular syphilis include changes in your vision and even blindness.

Syphilis Prevention

The only way to avoid STIs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis;
• Using external and internal latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore. Free condoms are available from the Health Department at 1270 Natividad Road in Salinas.  Call 831-755-4626 to check availability or stop by during normal business hours.  Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

Any sexually active person can get syphilis through unprotected vaginal, anal, or oral sex. Have an honest and open talk with your health care provider and ask whether you should be tested for syphilis or other STDs.

• All pregnant women should be tested for syphilis at their first prenatal visit and ideally during the third trimester and again at the time of delivery.
• You should get tested regularly for syphilis if you are sexually active and
  • are a man who has sex with men;
  • are living with HIV; or
  • have partner(s) who have tested positive for syphilis.

Syphilis Surveillance Data

Please click to view the Communicable Disease dashboard with local syphilis data available in English and Spanish.

California data is available at the California Department of Public Health’s syphilis website.

United States data is available at the Centers for Disease Control and Prevention’s syphilis website.

For More Information

• Visit the California Department of Public Health's syphilis website by clicking here.
• Visit the Centers for Disease Control and Prevention's syphilis website by clicking here.

For Healthcare Providers

Recommendations for Healthcare Providers

• Test for syphilis. Syphilis serology testing should include a rapid plasma regain (RPR) with titer that reflexes to a treponemal test if the RPR is reactive.
  • Pregnant women should be screened for syphilis at their first prenatal care visit. Testing should be repeated during the third trimester and at delivery for women who are at high risk for syphilis.
  • Sexually active gay, bisexual, and other men who have sex with men should be screened annually or sooner following disclosure of high risk sexual activity.
  • An algorithm from the Health Department is available to assist with interpreting screening results.
• Follow the Centers for Disease Control and Prevention’s (CDC’s) guidelines for treatment.
  
  • All providers are encouraged to treat patients and their partners in their practice. Family PACT, Medi-Cal, and private insurances normally cover testing and treatment for syphilis.
• All patients with syphilis should be tested for HIV if not already known to be HIV-infected. From 2013 to 2015, 42% of all reported early syphilis cases in Monterey County were also HIV positive.
• Promptly report all suspected syphilis cases to the Health Department’s Communicable Disease Unit (phone: 831-755-4521; fax: 831-775-8076).

For additional information about syphilis, please contact the Communicable Disease Unit at 831‑755‑4521 or visit the CDC’s STI treatment guidelines website.  For consultation regarding clinical management of syphilis, contact the California Department of Public Health STD Control Branch provider warm-line at (510) 620-3400 or by email at stdcb@cdph.ca.gov 8 a.m. to 5 p.m. Monday through Friday.

 As of October 11, 2024, the FDA Drug Shortages webpage continues to report that both the supplies of 2.4 million Units/4 milliliter Bicillin L-A® and 1.2 million Units/2 milliliter Bicillin L-A® are available.  When available, health care providers should treat patients with syphilis with Bicillin L-A® as appropriate per CDPH and CDC's standard guidance.  The pediatric presentation, 600,000 Units/1 milliliter Bicillin L-A®, remains unavailable, with an estimated recovery in March 2025.  If you are experiencing Bicillin L-A® supply issues, please notify the County of Monterey Health Department's Communicable Disease Unit at 831-755-4521.

Health Alerts and Advisories

• CDPH Health Update: Syphilis Screening Recommendations - October 14, 2024

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