Syphilis

What Is Syphilis?

Syphilis is a bacterial STI caused by Treponema pallidum. It progresses through stages if left untreated, but here's the good news: it is completely curable with antibiotics at any stage. The key is catching it early.

Syphilis was considered rare in Ireland for decades, but cases have been increasing significantly since the 2010s. It affects people of all genders and sexualities. Men who have sex with men (MSM) have seen a particularly sharp rise, but syphilis can affect anyone who is sexually active.

Because early symptoms can be mild or easy to miss, many people don't know they have it — which is why regular testing is so important.

How Do You Get It?

Syphilis spreads through direct contact with a syphilis sore (chancre) during sexual activity. This includes:

• Vaginal, anal, or oral sex
• Skin-to-skin contact with an active sore
• Sharing sex toys without cleaning or using condoms
• From a pregnant person to their baby during pregnancy or birth (congenital syphilis)

You cannot get syphilis from toilet seats, door handles, swimming pools, shared clothing, or cutlery. It needs close, direct contact with a sore to pass on.

Stages and Symptoms

Syphilis is a stage-based infection. Symptoms change depending on how long it's been present.

Primary Syphilis (Week 1–12 after infection)

• A painless sore called a chancre — usually on the genitals, anus, lips, or mouth
• The sore is firm, round, and painless — which is why people often miss it
• It heals on its own within 3–6 weeks even without treatment, but the infection stays in the body

Secondary Syphilis (Weeks 4–10 after the chancre appears)

• A non-itchy rash — often on the palms of the hands and soles of the feet
• Flu-like symptoms: fever, tiredness, swollen glands
• Sore throat and headaches
• Patchy hair loss
• Mouth ulcers or white patches inside the mouth
• Flat, wart-like growths in warm, moist areas (condylomata lata)

These symptoms can be mistaken for many other illnesses, which is another reason syphilis gets missed.

Latent Syphilis

After secondary syphilis, symptoms disappear and the infection enters a hidden (latent) phase. Early latent is within the first year; late latent can be years with no symptoms at all — but the infection is still there and transmissible.

Late / Tertiary Syphilis (Years later, if untreated)

• Serious damage to the heart, blood vessels, brain, and nervous system
• Neurological problems (neurosyphilis): confusion, headaches, paralysis, vision and hearing loss
• Soft, destructive tissue growths called gummas

Late-stage syphilis is rare today because most people are diagnosed and treated before it gets this far. But it underlines why testing and early treatment matters.

Testing & Diagnosis

Syphilis is diagnosed with a blood test. Your GP, GUM (genitourinary medicine) clinic, or sexual health clinic can organise this. If you have a visible sore, a swab of the sore may also be taken.

In Ireland, testing is available at:

• Your GP — can request a syphilis blood test (STI screen)
• HSE Sexual Health Clinics — free and confidential across Ireland
• Brook Ireland (Dublin) — free sexual health services for under-25s
• GUIDE Clinic, St. James's Hospital, Dublin — specialist GUM clinic
• Dean Clinic, Cork — sexual health services in Cork
• Private sexual health clinics — same-day appointments, nationwide

If you think you may have syphilis, don't wait for symptoms to get worse or disappear. Book a test — it's a simple blood draw and the result is usually back within a few days.

Who should be testing regularly? If you're sexually active with new or multiple partners, or MSM, a syphilis blood test should be part of your routine STI screen — at least once a year, or every 3–6 months if you have higher risk exposure.

Treatment

The good news is that syphilis responds very well to antibiotics — it is one of the most treatable STIs. Treatment depends on the stage:

• Primary and secondary syphilis: A single injection of benzylpenicillin (penicillin G) is usually curative. An oral antibiotic course (doxycycline or azithromycin) may be used if you have a penicillin allergy.
• Latent syphilis: Longer course — usually three weekly penicillin injections.
• Neurosyphilis: Intravenous penicillin in hospital for 10–14 days.

After treatment, you'll have follow-up blood tests to confirm the infection has cleared — typically at 3, 6, and 12 months. Avoid sex (including oral sex) until treatment is fully complete and you've been given the all-clear.

Treatment does not give you immunity. You can get syphilis again after being cured, so ongoing prevention and regular testing remain important.

Why Syphilis Is On the Rise in Ireland

HSE data shows a consistent upward trend in syphilis diagnoses in Ireland over recent years. This is a European and global trend, not unique to Ireland. Factors include changes in sexual behaviour, reduced condom use, and gaps in testing coverage.

This doesn't mean you should panic — it means it's worth including syphilis in your routine sexual health checks. A simple blood test once a year can catch it early when it's easiest to treat.

If you've had unprotected sex with a new partner recently, or if you've noticed any unusual sores that came and went, getting a full STI screen including syphilis is a smart move.

Partner Notification

If you test positive for syphilis, it's important that recent partners are notified so they can get tested too. Your clinic can help with this — either by giving you information to share yourself, or through a confidential contact tracing service where they notify partners without using your name.

Partner notification isn't about blame. It's about making sure everyone gets the treatment they might need.

Prevention

• Use condoms for vaginal, anal, and oral sex — though note that condoms only protect areas they cover, so skin-to-skin contact with sores elsewhere can still transmit syphilis
• Dental dams for oral-vaginal and oral-anal contact
• Regular STI screening — include syphilis in your annual or 3–6 monthly test if you're at higher risk
• Discuss STI status with new partners before sex
• Avoid sex during treatment until cleared by your clinic
• Avoid contact with active sores — even non-sexual skin contact with a primary chancre can transmit syphilis

If you're pregnant, syphilis testing is included as part of routine antenatal bloods in Ireland. Congenital syphilis (passed from mother to baby) is rare but serious and entirely preventable with treatment during pregnancy.

Support & Resources

• HSE Sexual Health: sexualwellbeing.ie — clinic finder, info on testing and treatment
• Brook Ireland: brook.ie — free services for under-25s in Dublin
• GUIDE Clinic: St. James's Hospital Dublin — specialist GUM clinic, walk-in and appointment
• Man2Man.ie: Sexual health resources for MSM in Ireland
• HIV Ireland: hivireland.ie — sexual health advice and HIV support
• GP: Your own doctor can test and treat syphilis — all consultations are confidential