Summary
Why get tested?
Primary, secondary and tertiary syphilis
Testing for syphilis can be requested by your doctor or clinic if you:
Syphilis is classified in stages:
Syphilis and pregnancy
Syphilis can cause severe complications in pregnancy and result in a premature baby, a miscarriage or stillbirth. It can also be passed on to the baby as congenital syphilis. In some cases, the baby is born without symptoms but, without treatment, they may go on to develop a range of serious health problems and can die.
Usually, these symptoms develop in the first few weeks, but sometimes they do not show up until months or years later. If you are pregnant, it is important that you are tested for syphilis at your first prenatal visit and if needed, in the final trimester. You may also be tested at the time and soon after the birth of your baby.
Types of testing
Serology tests
Syphilis is caused by the Treponema pallidum bacteria. To find out if you have syphilis, you will first need to have tests that look for the antibodies your body makes to fight the bacteria. These types of tests are called serology tests. It can take a couple of weeks after you are infected before they can show a positive result.
All the available serology tests for syphilis have limitations and no single test can confirm a diagnosis by itself. Because of this, serology tests for two types of antibodies are usually used.
These are:
If either your treponemal or non-treponemal tests are positive, your sample can be used for further, more specialised tests that may be needed to make your diagnosis.
Your antibody test results together with the history you provide your doctor will help work out what stage of the disease you may be in and will help decide what treatment will be appropriate.
PCR testing
If you have primary syphilis and a swab can be taken from a sore or ulcer, a PCR test can be performed. This detects the DNA of the T. pallidum bacteria and is an extremely accurate test. A positive test shows that you have a current infection. In the early stages of the disease, this test can be positive before antibodies are produced. However, because these sores are often painless, they can go unnoticed and the opportunity to test them is missed. If you have any symptoms at all that could be primary syphilis it is important to seek medical advice. Both PCR testing and syphilis serology tests can be performed at the same time.
If you have tertiary syphilis, you may be asked to have a procedure to take a sample of the fluid from around your spinal cord called cerebrospinal fluid (CSF). This can be tested using PCR.
Having the test
Sample
Any preparation?
None.
Your results
The results of treponemal and non-treponemal tests are given as positive or negative.
Non-treponemal tests are more likely to give false positive results (a positive result when you are not infected) than the treponemal tests because they can be affected by other health conditions.
In treponemal tests, if the result is negative, it is extremely unlikely that you have syphilis. However, in the first two weeks after infection, all test results may be negative, so you may need further testing in two to four weeks.
If the treponemal test result is positive, and it is unlikely that you have been infected previously with syphilis in the past, other syphilis specific tests will be carried out.
Treatment
Syphilis is usually treated with the antibiotic penicillin but other antibiotics can be used if you are allergic. New infections can be cured easily. A longer treatment is needed if you have been infected for more than two years or if it is unsure when you were infected. Follow-up blood testing is usually done after treatment to make sure the infection has resolved. Someone who has been previously treated can become re-infected with syphilis if they are exposed again.
Questions to ask your doctor
The choice of tests your doctor makes will be based on your medical history and symptoms. It is important that you tell them everything you think might help.
You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely.
Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods or supplements. These may affect your results. Ask:
More information
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