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JAMA Patient Page
February 18, 2009


JAMA. 2009;301(7):792. doi:10.1001/jama.301.7.792

Syphilis, a disease caused by the Treponema pallidum bacterium continues to be an important public health problem. Syphilis is a sexually transmitted infection (STI) and can be transmitted by all types of intimate contact including genital, oral, and anal sex. Use of a condom during all sexual activity can reduce the risk of infection. Individuals who are infected with the human immunodeficiency virus (HIV) are particularly susceptible to contracting and spreading syphilis and are often unaware of either diagnosis. Treatment at any stage is important because untreated syphilis can result in life-threatening illness. The February 18, 2009, issue of JAMA includes an article about treatment of syphilis.

Signs and symptoms

Primary Syphilis
A chancre is a painless sore or ulcer that occurs in primary syphilis, the first stage of syphilis. It can appear anywhere on the body but usually appears on the genitals, rectal area, or mouth. A chancre may appear from 10 days to 3 months after the infection begins and occurs at the place where the infection entered the body. The chancre usually disappears within 6 weeks, even without treatment. However, the affected person continues to be infected.

Secondary Syphilis
Skin rashes characterize secondary syphilis, which may occur while the chancre is healing or several weeks after. The rash may occur anywhere on the body (including the palms of the hands and bottoms of the feet) as rough red or brown spots. The rash usually does not cause itching but may be associated with fever, swollen lymph nodes, sore throat, headache, muscle aches, and fatigue.

Tertiary Syphilis
Late-stage or tertiary syphilis can cause abnormalities of both the heart and brain, including strokes, loss of vision and hearing, dementia, and death if untreated. Tertiary syphilis can cause areas of tissue destruction called gummas in affected organs and tissues.

At all stages, infected persons may have no signs or symptoms of infection, a condition known as latent syphilis. Transmission can occur from a pregnant woman to her fetus. This congenital syphilis can cause serious illness, including death of the fetus.


  • Identification of the T pallidum bacterium using a special microscope called a dark-field microscope, by examining a tissue sample taken from a chancre

  • Blood tests to determine if antibodies (specific proteins produced by the body to protect against invasion by foreign substances) to the T pallidum bacterium are present


  • Penicillin is the treatment of choice for all stages of syphilis.

  • Other antibiotic regimens can be used for individuals with penicillin allergy.

  • All sexual partners of an infected person should be notified and encouraged to seek treatment.

For more information

Centers for Disease Control and Prevention

Inform yourself

To find this and other JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at Many are available in English and Spanish. A Patient Page on syphilis was published in the July 26, 2000, issue.

Source: Centers for Disease Control and Prevention

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