What are the symptoms of syphilis in men?

Most men expect an STI to announce itself with pain or discharge. Syphilis often does the opposite. The first sore is usually painless, and it heals on its own within a few weeks even without treatment, which is exactly why it's so easy to miss.

A syphilis test is the reliable way to know, whether or not you've noticed anything. It's a blood test, £85 plus a £50 blood draw (£135 total), with results in about 24 hours, and you can walk in seven days a week at 117a Harley Street.

What does the first sign of syphilis look like?

The first sign is usually a chancre: a small, firm, round sore that's typically painless. It appears where the bacteria entered the body, generally 10 to 90 days after exposure, with an average of around three weeks (BASHH consensus).

In men, the chancre commonly appears on:

• The head or shaft of the penis
• The foreskin
• The scrotum, in less common cases
• The anus or rectum, particularly after receptive anal sex
• The lips, mouth, or throat, after oral sex

Because it doesn't hurt, many men either miss it or put it down to a graze or an ingrown hair. Inside the anus or mouth, it may never be seen at all.

The sore heals by itself within three to six weeks, with or without treatment. That makes it feel as though the problem has gone away, when the infection is still there.

What happens if the chancre is missed?

Untreated primary syphilis moves into a second stage, usually four to ten weeks after the chancre first appeared. This is where the infection becomes more visible, and where it's most often mistaken for something else.

The secondary syphilis rash has a distinctive pattern:

• It commonly appears on the palms of the hands and soles of the feet, which is unusual for most rashes
• It can also spread across the trunk, arms, and legs
• It is typically red or reddish-brown and does not usually itch

Alongside the rash, secondary syphilis can cause flat, greyish growths in warm, moist areas such as the groin folds or around the anus (condylomata lata). Other signs include white patches inside the mouth, a sore throat, swollen lymph nodes, fever and general tiredness.

Like the chancre, these fade on their own after a few weeks to months, and the infection carries on underneath.

What is the latent stage, and can syphilis stay hidden?

Yes. Once the secondary symptoms settle, syphilis can enter a latent stage with no visible signs at all. The bacteria stay in the body, and the infection still shows on a blood test.

Latent syphilis is split into an early phase, within about two years of infection, and a late phase beyond that. A man can feel completely well throughout. This is often when syphilis is finally found. Usually it's because a blood test was done for another reason, such as a routine screening package or a new partner's request.

Left untreated for years, a minority of people go on to develop late-stage complications affecting the heart, brain or other organs. That's the main reason a passing rash is worth checking.

Syphilis stages at a glance

The table below sets out the pattern most men experience, and what each stage is commonly confused with.

When is a syphilis blood test accurate?

Most infections show on a syphilis blood test by around 4 weeks after exposure, but an early test can still be negative. If your first test was negative and taken soon after the exposure, a repeat test at 12 weeks is usually advised.

If you have a sore, come and see us straight away so a clinician can look at it. The blood test can be negative while a chancre is present.

An HIV test is worth booking alongside a syphilis test. The two infections are often picked up together and share some of the same exposure risks.

Is syphilis serious, and is it curable?

Syphilis is curable with antibiotics, and the earlier it's treated, the simpler the treatment. Early syphilis, covering the primary, secondary and early latent stages, is generally treated with an antibiotic injection.

At Sexual Health Clinic London the injection is given in-house, usually at a follow-up visit once your results are back rather than on the day of testing. Left untreated for years, syphilis can damage the heart, brain and other organs, so a painless sore or an unexplained rash is worth testing rather than waiting for it to settle.

If you're diagnosed, current and recent sexual partners need testing too, since they may be infected without knowing it. A clinician can advise on partner notification in a way that keeps your own information confidential.

Regular testing is recommended for men who have sex with men, given the higher rates of syphilis in this group. The early signs are easy to miss in women too, often because the sore is internal, as our guide to syphilis symptoms in women explains.

How testing works at our Harley Street clinic

A syphilis blood test is £85 plus a £50 blood draw (£135 total), with results in about 24 hours. For a broader check, the Bronze package for men, £250, adds chlamydia, gonorrhoea and HIV in the same visit. Results for blood tests come back in about 24 hours, and urine and swab results within 3 working days.

If you need every answer the same day, our same-day screening service offers the FAST Screen Simple, £350, covering syphilis, HIV, chlamydia and gonorrhoea. The FAST Screen Complex, £450, adds hepatitis B and C. Both return all results in 6 hours, as our guide to same-day STI test results explains.

You can walk in seven days a week at 117a Harley Street. The visit is confidential, as with all of our private STI testing in London.

Book a syphilis test or a same-day screen at 117a Harley Street. Walk in seven days a week, or book online.

References

• NHS: Syphilis
• BASHH: UK national guidelines on the management of syphilis
• NICE CKS: Syphilis
• UKHSA: Sexually transmitted infections surveillance data