How to Prevent Syphilis

Greater vigilance is needed as infection rates rise

Couple ready to Use Condom
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Syphilis is a sexually transmitted disease that had been on the decline for most of the 20th century with the discovery of a cure (penicillin) in 1943. Since the turn of the millennium, however, those rates have begun to reverse, largely in tandem with the rise of HIV.

Today, syphilis strikes more than 27,000 Americans each year and six million worldwide. Of these, more than 100,000 people die annually as a result of the disease, while as many as 1.6 million pregnancies are affected, causing miscarriage, stillbirth, and congenital syphilis in babies.

According to statistics from the Centers for Disease Control and Prevention (CDC), the rate of syphilis among women in the U.S.increased by 35.7 percent between 2015 and 2016 and rose in every age group and every ethnic/racial population.

As scary as these figures sound, the risk of syphilis can be greatly reduced by taking a few simple but consistent precautions.

Risk Factors

Syphilis is caused by bacterium Treponema pallidum which can pass through the mucosal tissues of the mouth, vagina, and anus and through microscopic breaks in the skin. It is primarily transmitted by oral, vaginal, or anal sex and during pregnancy from mother to child. Less commonly, syphilis can be spread through kissing.

A painless, ulcerative sore, known as a chancre, is often the first sign of infection. However, it can often be missed either because it is internalized or mistaken for a pimple, ingrown hair, or canker sore.

As a result, people may not even realize they've been infected and go on to infect others.

Even after symptoms have disappeared, a person can remain contagious for a significant period of time.

There are certain behaviors and characteristics that can increase a person's risk of infection or transmission.

Among them:

  • Inconsistent use or avoidance of condoms
  • Multiple sex partners, especially anonymous sex partners
  • Having other sexually transmitted diseases (STD), including HIV
  • Injecting drug use, who are at increased risk of STDs
  • Men who have sex with men (MSM), who account for nearly 60 percent of syphilis infections in the U.S.

By contrast, syphilis cannot be spread through toilet seats, casual contact, or the shared use of eating utensils or personal care items. With the exception of shared sex toys, perhaps, object to human transmission of syphilis is highly unlikely.

Prevention and Screening

Condoms remain the first-line defense against sexually transmitted diseases. While condoms are not infallible (especially if you don't use them consistently or correctly), they are the most reliable form of prevention short of abstinence.

Dental dams should also be considered for oral-vaginal sex (cunnilingus) or oral-anal sex (analingus, or "rimming"). Female condoms, largely ignored in the U.S., also have their place is woman's sexual self-determination. As a safeguard, condoms should also be used on shared toys.

Equally important is a reduction in the number of people you have sex with, particularly those who are anonymous or you meet on Grindr.

In the end, the more people you have sex with, the greater your odds will be of getting not only syphilis, gonorrhea, and chlamydia but diseases for which condoms are less effective like the human papillomavirus (HPV).

To protect yourself and others, consider getting an STD screen from your doctor or local clinic. In their 2016 guidelines, the U.S. Preventive Services Task Force recommends the following tests for at-risk individuals:

  • Chlamydia and gonorrhea for sexually active women 24 and under or older women at increased risk
  • Syphilis, hepatitis B, and HIV or for all pregnant women
  • HIV for all persons 15 to 65
  • Syphilis, HIV, and hepatitis B for all persons at increased risk

Sexually active men who have sex with men (MSM) who practice unprotected receptive anal sex may need routine screening as well any individual with multiple risk factors.

Preventing Congenital Syphilis

Congenital syphilis is a serious medical condition in which a pregnant mother with syphilis passes T. pallidum to her developing baby. The risk of transmission varies by the mother's stage of infection (primary, secondary, tertiary). Mothers with primary syphilis have a transmission risk of between 60 percent and 80 percent, while mothers with secondary through tertiary syphilis have a 20 percent risk.

To this end, the CDC recommends that all women be screened for syphilis at their first prenatal visit. Those considered to be at increased risk should be screened again at 28 weeks. Any positive result would be treated immediately with penicillin, the only antibiotic drug known to be effective in preventing congenital syphilis.

Your partner may also want to be tested, particularly if he has never done so. In this way, any STD can be identified and treated early. As a precaution, you and your partner should also consider using condoms during the pregnancy.

If you believe you have been exposed to syphilis or any other sexually transmitted disease, do not hesitate to ask your doctor for an STD screen. Doing so allows you to take the necessary precautions to protect yourself and your baby.

A Word From Verywell

Many people will avoid getting tested for STDs out of fear of facing a positive result. Others may have regrets or guilt about past behaviors or worry about how their partner or family will react.

If this is you, find a clinic that offers anonymous testing and speak with a counselor. They are trained in these issues and can either assist directly or refer you to providers who can help you access treatment, apply for financial assistance, and find family counseling services.

Don't let fear stop you from getting the testing and treatment you need. There is help if you ask.


Bowen, V.; Su, J.; Torrone, E. et al. "Increase in incidence of congenital syphilis - United States, 2012-2014". MMWR. 2015; 64(44):1241-5. DOI: 10.15585/mmwr.mm6444a3.

Braccio, S.; Sharland, M.; and Ladhani, S. "Prevention and treatment of mother-to-child transmission of syphilis." Curr Opin Infect Dis. 2016; 29(3):268-74. DOI: 10.1097/QCO.0000000000000270.

Centers for Disease Control and Prevention. "2016 Sexually Transmitted Diseases Surveillance: Syphilis." Atlanta, Georgia; updated September 26, 2017.

Lee, K.; Nyo-Metzger, Q.; Wolff, T. et al. "Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force." Amer Fam Phys. 2016; 94(11):907-915.

Workowski, B. and Bolan, G. "Sexually Transmitted Diseases Treatment Guidelines, 2015." MMWR. 2015 Aug 28;64(33):924.