This page is general health information, not medical advice. It cannot tell you whether you have an infection. A clinician can, and the testing options on this site are a good place to start.

Syphilis is a bacterial infection that is easy to miss and very treatable. Many people never notice the first signs. Others see a rash and do not connect it to a sexually transmitted infection.

This guide explains how syphilis works, what the stages look like, how blood tests are read, and why the answer to "is syphilis curable" is yes. It also covers what Pittsburgh and Pennsylvania numbers show and where free or low-cost testing is available in Allegheny County.

Only a clinician or a test can tell anyone whether they have syphilis. This article is a map, not a diagnosis.

What causes syphilis: the organism behind it

Syphilis is caused by a bacterium called Treponema pallidum. It is a thin, spiral-shaped organism known as a spirochete. The CDC describes syphilis as a bacterial infection, which is why it responds to antibiotics prescribed by a clinician.

This bacterium does not grow in routine laboratory cultures. That is a key reason diagnosis depends mostly on blood tests that look for the body's response, rather than on growing the germ from a sample. Research suggests this is also why test results need to be read carefully alongside symptoms and history.

According to the CDC, syphilis spreads through direct contact with a syphilis sore during vaginal, anal or oral sex. Sores can be on or inside the genitals, anus, rectum or mouth, and they are not always seen. A pregnant person can also pass syphilis to a baby during pregnancy. The CDC notes that it is not spread through toilet seats, doorknobs, shared dishes or hot tubs.

Anyone of any gender or orientation who is sexually active can get syphilis. Risk depends on contact with the bacterium, not on who a person is.

Syphilis symptoms by stage

The CDC STI Treatment Guidelines (2021) describe syphilis in stages. The stages can overlap, and some people move through them with few or no signs. That is why testing matters more than waiting for symptoms.

Primary syphilis

The first sign is usually a sore called a chancre. The CDC says it is typically firm, round and painless. It appears where the bacterium entered the body, often about three weeks after exposure, though the timing varies.

Because it does not hurt and may be inside the vagina, rectum or mouth, many people do not notice it. Without treatment, it heals by itself in a few weeks. Healing does not mean the infection is gone.

Secondary syphilis

Secondary syphilis often shows up as a skin rash. The CDC says other signs can include fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches and tiredness. These signs can be mild and may come and go.

Latent syphilis

In the latent stage there are no signs or symptoms. The infection is still present. The CDC says a blood test is the only way to find it at this point.

Tertiary syphilis

The CDC describes tertiary syphilis as a late stage that can affect the heart, blood vessels, brain and other organs. It develops in a minority of people who were not treated, and usually years after the first infection. It is rare in people who receive treatment earlier.

Nervous system, eye and ear involvement

The CDC notes that syphilis can reach the nervous system, the eyes or the ears at any stage. Signs can include a severe headache, vision changes, hearing changes or dizziness. Anyone with these symptoms should contact a clinician promptly and mention any possible STI exposure.

What the syphilis rash can look like

The syphilis rash is one of the best-known signs, but it is easy to mistake for something else. The CDC says the rash of secondary syphilis often appears as rough, red or reddish-brown spots. It may show up on the palms of the hands and the soles of the feet. It can also appear on the chest, back or elsewhere, and it can be so faint that it goes unnoticed.

The CDC also notes that this rash usually does not itch. Some people develop moist, wart-like patches in warm skin folds, or patches inside the mouth.

Many other conditions cause rashes, including allergies, viral infections and eczema. A rash alone cannot tell anyone whether they have syphilis. A clinician can look at it and order the right blood test. If a rash appears after a possible exposure, that is a good reason to get tested.

Why the national rise in syphilis matters

CDC surveillance reports show that syphilis cases in the United States have risen over more than two decades. The CDC has also reported steep increases in congenital syphilis, which is syphilis passed to a baby during pregnancy, in recent years.

This matters for a simple reason. Syphilis can go unnoticed, so more cases in a community means more chances for it to spread before anyone knows. It also means more pregnancies where screening is important.

The encouraging side is that the tools are well known. Testing is available, and treatment from a clinician works. The challenge is getting people connected to both.

Syphilis in Pittsburgh and Pennsylvania: what the data show

Local numbers help show why testing in Allegheny County is worthwhile. All figures below come from the sources named.

The Allegheny County Health Department (ACHD) reports 191 cases of early syphilis in Allegheny County in 2024, a rate of 15.5 per 100,000 people. ACHD lists this as early syphilis, not primary and secondary syphilis alone.
ACHD's preliminary 2025 figures list 109 early syphilis cases in the county. ACHD treats these as the most recent county figures.
The CDC's STI Surveillance report for 2023 lists Pennsylvania's primary and secondary syphilis rate at 9.1 per 100,000, or 1,179 cases, ranking 39th among states.

These figures use different definitions and different years, so they are not a direct comparison. They do show that syphilis is a regular part of the public health picture in the region. ACHD's page on sexually transmitted infections also gives local numbers for chlamydia, gonorrhea and HIV, and it is worth a look for the full picture.

How syphilis testing works

Most syphilis testing is a blood test. A clinic may draw blood from a vein, or in some settings use a finger-stick for a rapid test. Allies for Health + Wellbeing says its rapid syphilis tests give results in about 20 minutes.

The CDC STI Treatment Guidelines (2021) explain that syphilis is usually diagnosed with two kinds of blood tests used together.

Non-treponemal tests

These tests look for substances the body makes in response to damage caused by the infection. The CDC lists the RPR and VDRL as common examples. A positive result usually comes with a number, called a titer, that shows the strength of the reaction.

The titer is useful because it can be followed over time. The CDC says a falling titer after treatment is a sign that treatment is working.

Treponemal tests

These tests look for antibodies made specifically against the syphilis bacterium. The CDC says these tests often stay positive for life, even after successful treatment. A clinician will not read a positive treponemal test alone as proof of a new infection.

Why two tests are used

Either test can occasionally give a result that does not match the true situation. Using both helps a clinician interpret the pattern. Some laboratories start with the treponemal test and some start with the non-treponemal test. The CDC says both approaches are accepted.

Your clinician can explain what your specific results mean, including whether past treatment, pregnancy or another condition could be affecting them. If a sore is present, a clinician may also collect a sample from it for additional testing.

Timing of a test after a possible exposure

A test taken very soon after exposure may not show an infection yet. The CDC guidance is that a clinician decides when to test and when to repeat. If you are unsure about timing, ask the clinic. Testing now and again later is a common and reasonable plan.

Who is screened

The U.S. Preventive Services Task Force (USPSTF) recommends syphilis screening for adolescents and adults who are at increased risk, and for all pregnant people. The CDC adds that people who have sex with partners who may have syphilis, people with HIV, and people taking HIV PrEP are among those clinicians often screen regularly. A clinician can help decide how often screening makes sense for you.

Is syphilis curable? Treatment from a clinician

Yes. The CDC states that syphilis can be cured with the right antibiotic prescribed by a clinician. For all stages, the CDC STI Treatment Guidelines (2021) identify penicillin as the preferred treatment. The form and length of treatment depend on the stage, and a clinician decides this for each person.

Syphilis treatment is a medical decision. Please do not use leftover antibiotics or try to treat it without a clinician, because the wrong medicine or the wrong course can leave the infection in place.

Treatment stops the infection. The CDC notes that it cannot undo damage that has already happened, which is one more reason earlier testing helps. Having syphilis once also does not protect a person from getting it again, so repeat testing can be part of ongoing care.

Safety profile and contraindications

This section covers the questions to bring to a clinician. It is not a substitute for one.

Penicillin allergy. The CDC says a reported allergy should be discussed. Clinicians may evaluate the allergy, since many reported allergies do not hold up on review. Alternatives exist for some people, but the CDC says penicillin is the only recommended treatment during pregnancy, so people who are pregnant and allergic may be referred for allergy evaluation.
A reaction in the first day. The CDC describes a short-term reaction called the Jarisch-Herxheimer reaction. It can include fever, chills, headache and muscle aches, usually within the first 24 hours after treatment. A clinician can explain what to expect and when to call.
HIV. People with HIV are screened for syphilis and can be treated. A clinician may adjust follow-up.
Nervous system, eye or ear symptoms. These need prompt evaluation because they can require different care.
Sex during treatment. The CDC advises avoiding sex until treatment is complete and any sores have healed, and until partners have been evaluated and treated if needed.

Follow-up blood tests after treatment

Follow-up is part of syphilis care. The CDC STI Treatment Guidelines (2021) recommend repeat non-treponemal blood tests after treatment to confirm the titer is falling. The timing depends on the stage and on factors like HIV status, so a clinician sets the schedule.

If the titer does not fall as expected, the clinician may look into possible reinfection or the need for more evaluation. Keeping follow-up appointments is the best way to be sure treatment worked.

Pregnancy and congenital syphilis

Syphilis in pregnancy can cause serious harm to a baby, and the CDC says treatment during pregnancy can prevent it. Pennsylvania has a rule here. Under 28 Pa. Code 27.89, a physician examining a pregnant person is directed to offer a syphilis test at the first examination. The Pennsylvania Department of Health also recommends additional testing in the third trimester and at delivery. On the page reviewed, the department presented the third-trimester and delivery testing as recommendations, not requirements.

Anyone who is pregnant or planning a pregnancy can ask their prenatal clinician about syphilis testing at each stage.

Prevention and partners

The CDC says condoms can lower the risk of syphilis when they cover the sore, but sores can be in places a condom does not cover. Regular screening is an important layer of protection.

In 2024, the CDC issued guidance on doxycycline taken after sex (doxy-PEP). It is recommended for gay, bisexual and other men who have sex with men, and for transgender women, who have had a bacterial STI in the past year. Research suggests it can reduce the chance of syphilis, chlamydia and gonorrhea. It is a prescription decision with a clinician, who can talk through benefits and side effects. ACHD lists doxy-PEP among the services at its Sexual Health Clinic.

If a test is positive, the clinic can help with telling partners. Pennsylvania law also lets a clinician prescribe or furnish antibiotics for STIs for a partner without examining them first (35 P.S. 603, per CDC's summary of expedited partner therapy). Which infections that covers is not listed in the sources reviewed, so ask your clinician whether it applies to syphilis.

Privacy, age and reporting

Pennsylvania's Act of Feb. 13, 1970 (35 P.S. 10103) says any minor may consent to medical and health services to determine the presence of or to treat venereal disease. The consent of no other person is necessary. ACHD's Sexual Health Clinic says it sees anyone 13 and older without parental consent.

Under 28 Pa. Code 27.21a, syphilis at all stages is reportable to the health department within 5 work days after identification. This is routine public health reporting that helps the county track and respond to infections.

Where to get tested for syphilis in Pittsburgh

Several Pittsburgh options are free or lower cost. The full list, with details on costs and what to expect, is on our guide to STD testing in Pittsburgh. Here is a summary from the clinics' own published information. Hours and services can change, so call first.

Allegheny County Health Department Sexual Health Clinic

Downtown: 425 First Avenue, Fourth Floor (entrance on Cherry Way), Pittsburgh, PA 15219.
McKeesport: 339 Fifth Avenue, McKeesport, PA 15132.
Phone: 412-578-8081.
Cost: ACHD lists the services as free. Walk-ins are accepted, and appointments get priority.
Hours: ACHD lists Downtown as Monday, Tuesday, Wednesday and Friday 9:00 am to 3:45 pm, and Thursday 11:30 am to 6:15 pm, with a lunch closure. McKeesport is listed as Monday to Friday 9:00 am to 3:45 pm, closed 12 to 1 pm. Another ACHD page shows different Downtown hours, so call to confirm.
Good to know: Photo ID is not required to be seen but is required to receive results, according to ACHD.

ACHD also lists free at-home kits for gonorrhea, chlamydia, syphilis and HIV on its Sexual Health Clinic page, ordered through lumba.health/achd. Check that page for who is eligible, since the age limit was not confirmed in the sources reviewed.

Allies for Health + Wellbeing

Allies offers free walk-in testing at 211 North Whitfield Street, Suite 500, Pittsburgh, PA 15206, on Sundays from 9 to 11:15 am and 1 to 4:15 pm. It lists other weekly walk-in sites around the city. Its page noted a cancelled Sunday session, so confirm before you go. Call 412-345-7456. Allies says it accepts many insurance plans and offers financial assistance, but it does not publish prices.

Central Outreach Wellness Center

Central Outreach is an LGBTQ-focused community health center at 127 Anderson Street, Suite 101, Pittsburgh, PA 15212. It offers sliding-scale options for people with or without insurance. The center's phone is (412) 322-4151. Its hours are published on its website, and the CDC directory lists a slightly different Friday schedule, so confirm.

Planned Parenthood of Western Pennsylvania

The Pittsburgh health center is at 933 Liberty Ave, Pittsburgh, PA 15222, phone (412) 434-8971. The CDC GetTested directory lists syphilis testing, a sliding scale and an appointment requirement. Hours were not listed, so call the center.

University Family Medicine UPMC

This Squirrel Hill office is at 5608 Wilkin Ave, Suite 100, Pittsburgh, PA 15217, phone (412) 422-8762. The CDC directory lists syphilis testing and an appointment requirement. Cost was not published there, so ask the office about insurance and fees.

For more options, the CDC's GetTested directory lets you look up testing sites by ZIP code.

Signs of a trustworthy testing source

Syphilis is a condition where quality of care matters. Research and CDC guidance suggest a few markers worth looking for:

Blood tests are processed by a laboratory and interpreted by a clinician, not just handed over without explanation.
The site can connect you to treatment and follow-up testing, or can refer you to one that does.
Staff explain results in plain language, including what a positive treponemal test means after past treatment.
Privacy is explained, including what the health department receives.
The clinic is listed by the health department or in the CDC directory.

Questions to bring to an appointment

Which blood tests will be run, and how will results be shared?
When should I test again after a possible exposure?
If treatment is needed, what should I expect, and how do I handle a penicillin allergy?
When are my follow-up blood tests?
How can my partners be tested or treated?
Should I also be tested for HIV, chlamydia, gonorrhea or hepatitis C?

Syphilis is common enough to have a well-worn path: test, treat if needed, follow up. Choosing a free or low-cost clinic in Pittsburgh is a simple first step, and the staff have heard these questions many times.

Syphilis in Pittsburgh: Symptoms, Testing and Treatment