Syphilis - Exams and Tests
Diagnosis of syphilis includes a medical history and a physical exam. Your doctor may ask you questions such as:
Do you think you have been exposed to any sexually transmitted infections (STIs)?
- What are your symptoms?
- Do you have sores in your genital area or anywhere else on your body?
- Do you or your partner engage in high-risk sexual behaviors?
- Have you had an STI in the past?
The physical exam may include:
- A careful examination of the skin and mouth to look for any rash or other abnormalities.
- For women, a
pelvic exam to look for signs of syphilis.
During the pelvic exam, your doctor will look for abnormal sores
in the vagina or on the vulva, labia, rectal area, and inner thighs. These
sores occur during the primary stage of syphilis.
- For men, a
genital exam to look for signs of
- For newborns, an examination of both the newborn and the mother for symptoms. The evaluation for congenital
syphilis begins with a review of the mother's health and testing the mother for
The diagnosis of syphilis
is usually confirmed with one of several
blood tests. This is especially true if no sores are
present. If sores are present, a doctor may look at the fluid from
one of the sores with a microscope to see whether syphilis bacteria are present
In the diagnosis of the
primary and secondary stages of syphilis,
lumbar puncture (spinal tap) is needed in some cases.
A lumbar puncture may be done in adults:
- If there is evidence of
tertiary syphilis (such as
iritis) or if
neurosyphilis is suspected.
- If penicillin
or another recommended antibiotic cannot be used for treatment in latent
syphilis. If the appropriate antibiotic cannot be used, it is important to
find out whether fluid from the spinal column and brain (cerebrospinal fluid) is infected, because specific
treatment methods are needed to effectively treat infected cerebrospinal
- Infected with
HIV. Some experts recommend lumbar puncture in all
HIV-infected people who have syphilis.
- To check whether a person is
cured of neurosyphilis.
In newborns and children, a lumbar puncture may be done
- There are signs of congenital
- The child's mother had syphilis and she was not treated,
was not treated adequately, or was treated after the 20th week of
- The child's mother was treated with an
antibiotic other than penicillin.
Additional testing should be done to find out if
other sexually transmitted infections are present, especially:
The diagnosis of syphilis can be delayed or complicated
because its symptoms are very similar to those of many
other diseases and are sometimes not recognized.
Syphilis has historically been called "the great imitator."