Skip to main content
Guidance

Appendix 1. Background information: syphilis

Published 26 August 2026

Applies to England

© Crown copyright 2026

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/guidance-on-expedited-syphilis-testing-and-treatment-for-inclusion-health-groups/appendix-1-background-information-syphilis

Symptoms of syphilis

Symptoms include:

  • small sores (ulcers) on the penis, vagina, or around the anus – these are usually painless and there may only be one of them
  • sores in other areas, including in the mouth or on the lips, or hands
  • white or grey warty growths (Condylomata Lata) most commonly on the penis, vagina or around the anus
  • macular or papular rash on the palms of the hands and soles of the feet that can sometimes spread all over the body – this is not usually itchy
  • white patches in the mouth
  • flu-like symptoms, such as a high temperature, headaches and tiredness
  • swollen glands
  • patchy hair loss on the head, beard and eyebrows

Complications from syphilis

If untreated, syphilis can cause serious and potentially life-threatening problems including:

  • heart problems including angina, aortic aneurysm and heart failure
  • brain problems including fits (seizures), memory problems, personality changes and dementia
  • neurological problems like shooting pains (Tabes dorsalis), pins and needles
  • joint pain and gradual damage the joints
  • problems with the skin, bones, testicles, liver and any other organ

Having syphilis during pregnancy can increase the risk of miscarriage, premature birth and stillbirth.

Tests for syphilis

For most people, blood (serology) testing for syphilis is completed using a 2-stage, laboratory-based testing process which includes treponemal testing (usually an enzyme immunoassay or EIA) and a non-treponemal test (RPR). Testing begins with a treponemal antibody screening test, which can detect antibodies to syphilis but cannot distinguish between active and past infections. Stage 2 includes a second treponemal antibody test to confirm the result. Then, as part of the same process, a non-treponemal test (RPR) is used to measure disease activity and treatment response may distinguish prior versus current active infection.

Laboratory-based treponemal tests can be performed on finger-prick taken samples including:

  • dried blood spot testing (DBST)
  • capillary testing

Non-treponemal tests are conducted on a venous blood sample in a laboratory environment. It may also be possible from DBST or capillary samples if the volume is sufficient.

Back to top