How is syphilis treated?

Written by Zhai Yu Juan
Dermatology Department
Updated on June 13, 2025
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Syphilis is a sexually transmitted disease caused by the infection of Treponema pallidum. The main transmission routes include sexual contact, mother-to-child transmission, close personal contact, and blood transmission. Once diagnosed with syphilis, formal treatment should be administered under the guidance of local doctors, with penicillin generally being the first choice for treatment. Both the patient and their sexual partners need to undergo thorough examination and treatment. Additionally, regular follow-up examinations are necessary after treatment, typically under the guidance of local doctors, with continuous follow-up for three years to ensure effective treatment of syphilis.

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Written by Huang Ling Juan
Dermatology
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What are the initial symptoms of syphilis?

The initial symptoms of syphilis typically refer to the symptoms of primary and secondary syphilis. The symptoms of primary syphilis mainly include a chancre, usually a single superficial ulcer located at the genital area with a clear border, scant discharge, no pain, and no tenderness. Serological tests would show a positive result for Treponema pallidum. Some patients may also experience local lymph node enlargement. In secondary syphilis, patients often develop papules, macules, and vesicles on the skin, and symmetrical copper-red macules appear on the hands and feet. For the treatment of syphilis infection, penicillin is primarily chosen. If there is an allergy to penicillin, macrolide antibiotics can be used as an alternative. It is crucial to treat syphilis promptly after infection.

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Written by Zhu Zhu
Dermatology
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Does tertiary syphilis have titers?

If one is suffering from stage three syphilis, syphilis titers will be present. However, syphilis titers do not always correlate directly with the severity of the condition. It is possible for the titers in stage one and two syphilis to be higher than in stage three. It's often the case that stage three syphilis represents the late stages of the disease, and the titers might decrease as the disease progresses into these later stages. Examples include titers such as 1:8 or 1:4, although some patients might exhibit titers of 1:16.

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Written by Zhu Zhu
Dermatology
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Can third stage syphilis be detected?

Third-stage syphilis can be detected. Syphilis is divided into primary, secondary, and tertiary stages, with the severity progressively increasing from the primary to tertiary stage, making tertiary syphilis a relatively advanced and serious condition. It can be detected by measuring the titers in serum, although the titers in tertiary syphilis may be lower than in the primary and secondary stages, and may sometimes present as negative. However, through the symptoms of tertiary syphilis, particularly some complications affecting the skin, cardiovascular system, bones, joints, and other organs, combined with the titer levels, it can definitely be detected.

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Is cervical lymphadenopathy related to syphilis?

Enlargement of cervical lymph nodes is somewhat related to syphilis. Although cervical lymph node enlargement is not necessarily solely caused by syphilis, if syphilis progresses to its secondary or tertiary stages, it tends to cause lymph node enlargement, and severe cases may even lead to ulceration. This happens because after a syphilis infection, immune responses in the lymph cells are triggered by the Treponema pallidum, leading to the enlargement of cervical lymph nodes, and also possibly the lymph nodes under the arms and in the groin area. In such cases, it is advised to seek timely medical attention, complete the necessary immunological testing, and ensure an accurate diagnosis of syphilis. If cervical lymph node enlargement occurs, prolonged treatment with penicillin should be administered, as it effectively controls the Treponema pallidum and can help reduce the severity of the lymph node enlargement.

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Written by Zhu Zhu
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How long does it take to cure third-stage syphilis?

Third-stage syphilis is the most severe stage of the disease. It generally damages the nervous system and cardiovascular system of the human body, thus having a significant impact. There is no definite timeline for the cure of third-stage syphilis. The treatment of third-stage syphilis primarily involves controlling the condition with medication; there is still no specific method that can completely cure it thoroughly. Therefore, it is necessary to take medication for a long period. Currently, for treating third-stage syphilis, procaine penicillin is generally chosen for patients. In fact, procaine penicillin mainly helps effectively control the syphilis spirochete.