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Syphilis Testing

Syphilis moves through stages: a painless sore, a distinctive rash, years of silence, and then, untreated, irreversible damage to the heart, brain, and eyes. A blood test detects it. Penicillin cures it. But treatment can only halt the disease, not undo what it has already done, so catching it early is what matters. With 209,253 U.S. cases in 2023, including 3,882 in newborns, syphilis is neither rare nor inevitable.

Find syphilis testing near you When can syphilis be detected?

Understanding syphilis

Testing for syphilis, in brief

Syphilis is usually symptomless and quick to cure, so testing is the only reliable way to know you have it. This page covers how syphilis testing works, what it costs, and where to get tested near you.

Full syphilis overview: symptoms, complications & treatment

Where to get tested

Find syphilis testing near you

Choose your test and enter your city: we'll take you straight to local syphilis testing: nearby clinics and labs, prices, hours and county rates.

Test from home

At-home STD testing in the U.S.

if you'd rather skip the trip, an at-home kit ships to the U.S., you collect the sample privately, and mail it back to a CLIA-certified lab. Results come online in days, with a clinician available if anything is positive. Same labs as a clinic, no waiting room, and you can read how accurate at-home STD tests are before you order.

Want a free option first? The CDC-supported TakeMeHome program mails free at-home HIV self-test kits, and, in many areas, free STI kits, to your door, with no insurance or payment needed. The paid kits below add broader panels and faster turnaround.

  • In-home collection

    Quest Diagnostics

    Quest Diagnostics

    $79 & up

    Panel:
    8-infection panel incl. chlamydia, gonorrhea, HIV, syphilis, hepatitis & herpes: single tests too
    Sample:
    Quest Mobile: a phlebotomist collects your sample at home
    Results:
    1–3 days, online: physician-reviewed
    • In-home sample collection
    • Nationwide Quest lab network
    • Physician-reviewed results
    • FSA/HSA eligible
    Order online Quest Diagnostics review

  • Best value: single tests

    Everlywell

    Everlywell

    $49 & up

    Panel:
    Chlamydia & gonorrhea, up to a 6-test panel adding HIV, syphilis, trichomoniasis & hep C
    Sample:
    Finger-prick + swab
    Results:
    Days, online
    • Telehealth visit if positive
    • CLIA-certified labs
    • HSA/FSA eligible
    • Subscription savings
    Order online Everlywell review

  • Best for simplicity & support

    LetsGetChecked

    LetsGetChecked

    $89 & up

    Panel:
    5–6 common STIs incl. chlamydia, gonorrhea, HIV, syphilis & trichomoniasis
    Sample:
    Finger-prick + urine/swab
    Results:
    2–5 days, online
    • 24/7 nurse support
    • Prescription for positives
    • CLIA-certified labs
    • Free shipping both ways
    Order online LetsGetChecked review

Every kit uses CLIA-certified labs. At-home testing is for screening; a reactive result should be confirmed and treated by a clinician. Prices and panels shown are illustrative and change often, confirm current details on the provider's site.

Symptoms

Do you need a syphilis test?

Syphilis is easy to miss at every stage. The primary sore is painless and heals on its own. The secondary rash can be subtle or confused with a drug reaction. The latent stage has no symptoms at all: yet the infection is still there, still doing damage, and still detectable only by a blood test. That's exactly why testing matters: you can have it, pass it on, and never feel a thing.

See every syphilis symptom — in women, men, rectal & throat

Disease progression

How does syphilis progress?

Syphilis progresses through distinct stages: each with different symptoms, contagiousness, and consequences. Catching it early means simpler treatment and better outcomes; the later stages are harder to manage and carry more serious risks.

  1. 1

    Primary

    10–90 days after exposure (average 21 days) Contagious

    The first sign of syphilis is a single, firm, painless ulcer called a chancre at the site where T. pallidum entered the body: most often the genitals, anus, lips or throat. It has a clean, hard, raised edge, a clean base, and causes no pain, which is why it goes unnoticed so easily. The sore disappears on its own in 3–6 weeks even without treatment, giving a false sense that the problem has resolved. It has not, the bacteria have disseminated through the bloodstream and the infection is progressing to the secondary stage.

    • Single (occasionally multiple) firm, round, painless ulcer at the infection site
    • Swollen, rubbery lymph nodes near the sore (groin nodes for genital chancres)
    • No fever, no systemic illness in most cases
  2. 2

    Secondary

    2–12 weeks after the primary chancre heals Contagious

    Treponema pallidum has now spread through the bloodstream and seeded tissues throughout the body. The hallmark is a rough, non-itchy rash that often appears on the palms of the hands and soles of the feet, a distinctive pattern that should prompt immediate testing. Condylomata lata, flat, moist, highly contagious gray-white patches, appear in warm skin folds. A flu-like illness with fever, swollen lymph nodes, sore throat and deep fatigue accompanies the skin findings. Secondary symptoms resolve on their own in weeks to months without treatment, after which the infection enters the latent phase. Many people who have had syphilis can date their infection from this stage if they recognized the rash.

    • Non-itchy rash on trunk, palms and soles, may be faint or easily confused with other rashes
    • Condylomata lata: flat, moist, gray-white patches in skin folds, highly infectious
    • Fever, generalized lymph node swelling, sore throat, fatigue, headache, myalgias
    • Patchy, moth-eaten hair loss on the scalp and eyebrows
    • Mucous patches: painless flat sores inside the mouth, vagina or anus
  3. 3

    Latent

    After secondary resolves; can persist for years to decades Not contagious

    Latent syphilis has no symptoms, the only evidence of infection is a positive blood test. It is divided into early latent (less than one year since the original infection, based on history, prior negative tests or documented exposure) and late latent (more than one year or unknown duration). During early latent, sexual transmission to partners is still possible and secondary relapse can occur. During late latent, sexual transmission is extremely rare, but the bacteria are not gone, they remain dormant in tissues. Without treatment, 25–30% of people with latent syphilis will eventually develop tertiary disease. Latent syphilis in a pregnant person, at any duration, can still infect the fetus.

    • None, by definition this stage is completely asymptomatic
    • Positive blood tests (both treponemal and nontreponemal) are the only finding
  4. 4

    Tertiary

    Years to decades after initial infection; in ~25–30% of untreated cases Not contagious

    Tertiary syphilis represents the body's inflammatory response to persistent T. pallidum infection and is defined by three overlapping manifestations. Gummatous syphilis produces soft, tumor-like granulomas (gummas) in the skin, bone, liver and other organs; locally destructive, they can erode bone and perforate the hard palate. Cardiovascular syphilis causes inflammation of the aortic wall (aortitis), most dangerously in the ascending aorta, leading to aortic aneurysm and aortic valve regurgitation, complications that can be lethal even decades after the original infection. The third manifestation is neurosyphilis, detailed separately below. All tertiary manifestations are now rare in countries with accessible testing and treatment, but they are a reminder of what syphilis does when it goes unchecked.

    • Gummas: firm, rubbery, slow-growing lesions on skin, bone or internal organs
    • Chest pain, shortness of breath, aortic regurgitation murmur (cardiovascular syphilis)
    • Progressive neurological and psychiatric symptoms (neurosyphilis)
  5. 5

    Neurosyphilis & Ocular Syphilis

    Can occur at any stage, early or late Not contagious

    Treponema pallidum can invade the central nervous system early in infection, meningeal involvement may begin during the secondary stage. Early neurosyphilis presents as aseptic meningitis: severe headache, stiff neck, fever, cranial nerve palsies. Late neurosyphilis, which develops after years of untreated infection, produces two classic syndromes: general paresis (progressive dementia, personality change, psychosis) and tabes dorsalis (degeneration of the posterior spinal cord causing loss of position sense, lightning pains and an unsteady, wide-based gait). Ocular syphilis, uveitis, retinitis, optic neuritis, can cause permanent vision loss and may be the sole presenting finding. Otic syphilis causes sensorineural hearing loss. These complications require urgent evaluation with cerebrospinal fluid analysis and IV penicillin.

    • Severe headache, neck stiffness, photophobia (meningeal)
    • Cranial nerve palsies (facial weakness, hearing loss, diplopia)
    • Eye pain, redness, blurred vision, floaters, vision loss (ocular)
    • Personality and psychiatric changes, progressive memory loss (general paresis)
    • Lightning-bolt leg pains, loss of position sense, wide-based gait (tabes dorsalis)
    • Hearing loss, tinnitus, vertigo (otic syphilis)
  6. 6

    Congenital Syphilis

    Transmitted in utero; early congenital = birth to 2 years; late congenital = after 2 years Not contagious

    Congenital syphilis occurs when T. pallidum crosses the placenta from an infected pregnant person to the fetus. Transmission can happen at any stage of pregnancy but is most efficient with untreated primary or secondary maternal syphilis. Early congenital syphilis, the form present at birth or appearing in the first two years, causes nasal discharge ("snuffles"), a desquamating skin rash, hepatosplenomegaly, severe hemolytic anemia, jaundice and diffuse bone abnormalities visible on X-ray. Late congenital syphilis, emerging after age two, produces the classic Hutchinson triad: notched "peg" incisors, interstitial keratitis (corneal scarring causing blindness) and sensorineural hearing loss. Saddle-nose deformity, saber shins and Clutton joints (knee swelling) are additional late stigmata. In 2023, 3,882 newborns in the U.S. were diagnosed with congenital syphilis, contributing to 279 stillbirths and neonatal deaths. Every case is preventable: a blood test at the first prenatal visit, repeated testing at 28 weeks and delivery in high-prevalence areas, and penicillin treatment stops transmission.

    • Nasal discharge ("snuffles"), maculopapular rash, desquamation (early)
    • Hepatosplenomegaly, jaundice, severe anemia (early)
    • Bone pain and radiographic periostitis (early)
    • Hutchinson teeth: small, widely spaced, notched permanent incisors (late)
    • Interstitial keratitis: corneal inflammation leading to blindness (late)
    • Sensorineural hearing loss, saber shins, saddle-nose deformity (late)

How testing works

How a syphilis test works

Testing for syphilis is simple and painless — you pee in a cup or do a quick swab, and a lab checks the sample for the infection. Below: your options, what each costs, and how soon you can test after a possible exposure.

Your syphilis testing window

After a possible exposure, a syphilis test becomes reliable around 3–6 weeks later.

Exposure Day 0 Earliest reliable Day 21 Conclusive Day 42

Before day 21 a test can miss it · from day 21 it's reliable · re-test after day 42 if you tested early.

After treatment

After treatment, follow-up RPR or VDRL titers (not treponemal tests) confirm cure at 6, 12 and 24 months, a fourfold decline in titer is the standard benchmark for successful treatment. Treponemal tests typically remain reactive for life even after successful treatment and cannot be used to monitor cure.

Non-treponemal test (RPR / VDRL) Standard screen
Sample
Blood draw or finger-prick
Results
1–3 days

The standard initial screening test. Results include a titer (e.g., 1:16) that reflects disease activity and is used to monitor treatment response, a fourfold drop (e.g., 1:16 → 1:4) confirms successful treatment. Can produce biological false positives in pregnancy, autoimmune conditions (especially lupus), acute viral infections and IV drug use.

Treponemal test (TPPA / FTA-ABS / EIA) Confirmatory
Sample
Blood draw
Results
1–3 days

Confirms a positive non-treponemal screen by detecting antibodies specific to T. pallidum. The TPPA (Treponema pallidum particle agglutination assay) and FTA-ABS are confirmatory; EIA (enzyme immunoassay) is often automated and used for high-volume screening in the reverse-sequence algorithm. Remain positive for life after cure, cannot be used to judge treatment success or re-infection.

Reverse-sequence screening (EIA → RPR) Lab algorithm
Sample
Blood draw
Results
1–3 days

Many hospital and commercial labs now perform treponemal EIA first (automated, high-throughput), then reflex to RPR only if positive. A positive EIA with negative RPR is a common result in someone cured years ago: it means past infection, not active disease. This pattern requires careful clinical interpretation and sometimes a second treponemal test (TPPA) to resolve.

Darkfield microscopy / PCR of sore Early detection
Sample
Swab of fluid from an active chancre
Results
Same day (darkfield) to 1–3 days (PCR)

Detects the spirochete directly in primary syphilis before antibody tests turn positive. Darkfield requires a trained microscopist and viable organisms and is rarely available outside specialized STI clinics. PCR of sore fluid is increasingly preferred where available and is more sensitive. Either test confirms primary syphilis even during the antibody window period.

Cerebrospinal fluid analysis (for neurosyphilis) Neurosyphilis only
Sample
Lumbar puncture (CSF)
Results
1–3 days

Required to diagnose or rule out neurosyphilis in patients with neurological or ocular symptoms, HIV and syphilis coinfection, or treatment failure. Key findings: CSF-VDRL (specific but insensitive), elevated white cell count (> 5 cells/μL), elevated protein. A positive CSF-VDRL in the right clinical context confirms neurosyphilis.

What a syphilis test costs

Where What it costs
Private lab (self-pay)~$24–$80 self-pay for a syphilis blood test at a private lab; at-home kits and bundled STI panels run approximately $45–$150
Free / sliding-scale clinicFree or sliding-scale at health departments, Title X family planning clinics and federally qualified health centers (FQHCs), and prenatal syphilis screening is routine standard of care
With insuranceCovered with no out-of-pocket cost for recommended screening (including all pregnant people) under most ACA-compliant plans, under USPSTF Grade B recommendation

Compare STD testing costs across every option.

Screening guidance

Who should get tested for syphilis?

Because syphilis is often silent, the CDC and U.S. Preventive Services Task Force recommend routine screening for the groups most likely to have it, not just people with symptoms.

  1. 1

    Gay and bisexual men (MSM)

    MSM account for roughly 36–47% of all P&S syphilis cases. The CDC recommends testing at minimum once a year and every 3–6 months with new or multiple partners, active drug use, or HIV-positive status. Syphilis rates among MSM are more than 100 times the rate in heterosexual men.

  2. 2

    Everyone who is pregnant

    Screen at the first prenatal visit, period. Retest at 28 weeks and again at delivery in high-prevalence areas or with any ongoing risk. Untreated maternal syphilis during pregnancy is the direct cause of congenital syphilis, which reached 3,882 cases in 2023. Treatment with penicillin during pregnancy prevents virtually all cases.

  3. 3

    People with HIV or on PrEP

    Test at every PrEP follow-up visit (every 3 months) and at least annually with HIV. People with HIV are at higher risk of acquiring syphilis and, if coinfected, at significantly higher risk of neurosyphilis and ocular complications. An open syphilis sore also makes HIV easier to transmit and acquire.

  4. 4

    Anyone with a new sore, rash or known exposure

    A painless genital, anal or mouth ulcer, or an unexplained non-itchy rash covering the palms and soles, warrants same-day testing. If a partner or recent contact tests positive for any stage of syphilis, get tested immediately regardless of symptoms.

  5. 5

    People with multiple or anonymous partners

    Routine annual screening catches the silent latent stage, which has no symptoms at all. You cannot tell by looking at someone, or by how you feel, whether syphilis is present.

  6. 6

    People experiencing homelessness, incarceration or substance use

    Intersecting structural vulnerabilities drive disproportionately high rates in these populations. Opportunistic screening at shelter intake, jails and harm-reduction programs catches the infection in people who may not otherwise access testing.

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Syphilis testing by state & city

Jump to local syphilis testing, clinics and labs, prices and county rates, in your state or a popular city, or explore another test.

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Living with syphilis

Questions to ask your provider about syphilis

Syphilis is treatable and nothing to be ashamed of. The most useful next step after a positive result (or before a first test) is a direct conversation with a clinician. Here are the questions that matter most:

  • Is my syphilis test result definitive, or do I need a confirmatory test?
  • What treatment options are available to me, and how long until I'm no longer contagious?
  • Should I notify my recent partners, and can your office help me do that confidentially?
  • How soon can I re-test to confirm the infection has cleared?
  • Are there other STIs I should test for at the same visit?
  • Can this affect my fertility, pregnancy, or long-term health if left untreated?

Good to Know

Syphilis testing FAQs

Common questions about syphilis and syphilis testing, answered.

How long after exposure should I test for syphilis?

Blood tests for syphilis, both RPR and treponemal tests, become detectable 1–4 weeks after the chancre appears, which is roughly 3–6 weeks after the sexual exposure that caused it. For the most reliable negative result, test at least 6 weeks after a potential exposure. If you test earlier and get a negative result but you have a sore, know you were exposed, or have symptoms of secondary syphilis, retest at 6 weeks and again at 3 months. A single early negative is not a green light. If you have an active sore, a clinician can swab it for direct testing even before the blood test turns positive.

What is the difference between an RPR and a TPPA test?

RPR (Rapid Plasma Reagin) is a non-treponemal test that detects antibodies produced during syphilis infection but not specifically targeted at Treponema pallidum. It is fast, inexpensive and quantitative, the titer (e.g., 1:32) reflects disease activity and falls with successful treatment, making it ideal for monitoring cure. TPPA (Treponema pallidum Particle Agglutination Assay) is a treponemal test that detects antibodies specifically targeting T. pallidum proteins. It is more specific, far fewer false positives, but it remains reactive for life even after successful treatment, so it cannot be used to assess whether treatment worked. In practice: RPR screens and monitors; TPPA confirms and diagnoses. Most labs now use a reverse-sequence algorithm: automated treponemal EIA first, then RPR if positive.

Why did my syphilis test come back positive if I was treated years ago?

This is one of the most common points of confusion about syphilis testing. Treponemal tests, TPPA, FTA-ABS, EIA, remain reactive for life after successful treatment. They detect antibodies specific to Treponema pallidum that the immune system produces and retains permanently, even after the bacteria are gone. A positive treponemal test in someone who was previously treated and cured does not indicate active infection or treatment failure. The test you need to distinguish past-cured infection from active infection is the RPR (or VDRL): after successful treatment, the RPR titer falls and eventually becomes non-reactive (or stays at a low, stable level called a "serofast" state). If your RPR is negative or at a stable low titer and you have no symptoms, you are almost certainly cured. If the RPR is rising, that indicates active infection requiring treatment.

Do I need to tell past partners if I test positive?

Yes: and this matters clinically, not just ethically. Partners who were exposed during your infectious period need to be tested and potentially treated, since they may have syphilis without knowing it and may be passing it on or developing complications. For primary syphilis, notify partners from the 3 months before your symptom onset; for secondary syphilis, 6 months; for early latent, 1 year. You can tell partners yourself, or your local health department's disease intervention specialist (DIS) can notify partners confidentially without revealing your name. Many areas also have online partner notification services. Avoiding sex with current partners until treatment is complete and the chancre has healed prevents re-infection.

Medically Reviewed · Updated

Reviewed by Mark Riegel, MD · Sexual Health Physician · Chief Medical Reviewer

Physician focused on sexual health, STI testing, treatment and prevention, and EasySTD's chief medical reviewer. Owns the condition guides and is the clinical backstop for any page without a more specific specialist. Our editorial guidelines →

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