Before we proceed with the treatment of Syphilis, it is important to determine the clinical stage of Syphilis. This will help us determine the right course of treatment for you.
Furthermore, we will discuss any tests and treatment your partner(s) may need to prevent further transmission of this infection.
Method of treatment
a) Penicillin injection
b) Oral antibiotics
Length of treatment
Varies upon stage of syphilis
+ Re-test in 1, 3, 6 & 12 months
+ Treat partner(s)
Cost of treatment
a) Penicillin injection – £200/dose (first dose £260 if tested elsewhere)
b) Oral antibiotics – £100 (or £160 if tested elsewhere)
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Can Syphilis be treated?
Yes, Syphilis can be treated.
What is the treatment for Syphilis?
A special type of antibiotics from the Penicillin group, administered by the injection in buttocks, is the most effective treatment for all types of Syphilis. It is important to note that commonly used penicillin antibiotics do not effectively treat Syphilis.
If you are allergic to penicillin, there are other types of antibiotics we can use. This will be discussed at the time
The duration of course of antibiotics depends on what stage of Syphilis infection you have.
How effective is the treatment for Syphilis?
Syphilis is a curable infection after the correct treatment is given.
In early Syphilis, adequate treatment of Syphilis cures the symptoms, prevents complications and stops transmission to sexual partners.
In late Syphilis, treatment of Syphilis prevents further complications and progress of the disease although it may not reverse the symptoms that have already set in. There is no concern about transmission of the infection to others in late Syphilis.
Failure of treatment is uncommon, and is recognised by monitoring of Syphilis blood tests, and may warrant further courses of antibiotics.
Are there any side effects of Syphilis treatment?
Most patients receive treatment of Syphilis without much problem and achieve a cure.
The side effects of treatment can be considered as follows:
Side effects of the antibiotics
Penicillin injections: pain at the injection site and allergic reactions
Oral antibiotics: nausea, sickness, abdominal pain, skin rash
Effect from death of Syphilis producing bacteria due to the antibiotics
The patients develop fever, headache, body pains and chill within 24 hours of starting the course of antibiotics, and often following the first dose.
These symptoms usually last for 24-48 hours and is believed to result from release of toxins from the dying Syphilis bacteria. This tends to be more noticeable in the stages of Syphilis where Syphilis bacterial load is high, as in secondary Syphilis.
This reaction has been described as the Jarisch Herxheimer Reaction. General measures like bed rest, drinking plenty of fluids to keep hydrated and paracetamol is all that is needed to deal with this.
However, special precautions are needed in pregnant women and those with Syphilis of delicate organs like the brain, heart and eyes.
Will my sexual partner need the treatment for Syphilis?
If their Syphilis test result is positive, they will be given treatment based on the stage of their Syphilis – this will be determined at the time of the test.
If their Syphilis test result is negative, the way forward can be either repeating the Syphilis blood test at a later date, or give them a course of antibiotics on an epidemiological basis.
How long do I have to wait before having sex?
The exact length of time varies depending on the case. Precise instructions will be given to you during your appointment to ensure you do not pass the infection onto your partner.
For most patients, it is recommended waiting at least 7 days after completing the course of antibiotics before you have sex. However, in specific cases, this period can be further extended by up to 2 weeks.
Late Syphilis, which is more than 2 years after acquiring the Syphilis infection, is not infectious. However, it is often recommended to avoid sexual contact for 7 days after completing the course of antibiotics as a matter of precaution.
When do I have to get retested?
The effectiveness of Syphilis treatment is assessed by repeating the blood test at regular intervals, usually 3, 6 and 12 months after completion of treatment. Occasionally an earlier follow-up blood test is done a month later.
Patients with underlying HIV infection have their Syphilis test done every year for the rest of life.
This is to monitor the level of a non-specific reaction in the blood called RPR or VDRL which rises in new infection and drops with successful treatment and passage of time. When RPR / VDRL eventually becomes negative or stable at a particular level, it indicates that a satisfactory outcome has been achieved.
Can I get Syphilis again?
Yes, you can get Syphilis again. Getting Syphilis infection once does not make you immune from getting it a second time. There are reported cases where patients got the Syphilis infection multiple times due to repeated exposure to the infection.
What happens if I don’t get treatment?
Syphilis is a serious infection. If left untreated (or undiagnosed for that matter), it can cause symptoms as seen in primary, secondary and tertiary Syphilis (click here on the link leading to the stages of Syphilis).
Long term damage to the nervous system, eyes and heart are serious concerns.
In women with untreated Syphilis, this can lead to miscarriages, stillbirth and congenital Syphilis of the newborn, the most serious form of Syphilis.
This is the routine test for syphilis looking for presence of antibodies – results in 20 minutes.
Those experiencing ‘chancres’ which are suspected to be Syphilis may require a DNA PCR test from the lesion.
Why be treated at a specialist clinic?
However, and more importantly, we see all sorts of sexual health problems (including those referred to us by GPs) on a daily basis.
This puts us in a helpful position of being able to understand the problems you come to us with and put you on the right path in as little time as possible.
We follow guidelines set by
NICE National Institute for Health and Care Excellence
BASHH British Association for Sexual Health and HIV
BHIVA British HIV Association
FSRH Faculty of Sexual and Reproductive Healthcare
Medicine is a complicated subject and sometimes these guidelines don’t always hold the answers.
For example, treating an STI in a patient who has developed a resistance to routinely used antibiotics.
Unlike most private clinics, we have medical consultants here to help you navigate through such problems and get you on the right track in no time.
Page reviewed by Dr. Manoj Malu (Clinical Director)
Last reviewed date: 3 March 2020
Next review due: 3 March 2023
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
References & Further Reading
- Clinical Infectious Diseases: Treatment of Syphilis, 1993 | Clinical Infectious Diseases
- JAMA: Serological Response to Syphilis Treatment: A New Analysis of Old Data
- Expert Opinion on Pharmacotherapy: Syphilis treatment: old and new