Syphilis and MSM
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 Syphilis and MSM

 Syphilis and MSM

What is syphilis?

Syphilis is a bacterial sexually transmitted infection (STI).

Men who have sex with men (MSM) seen in the DSC Clinic have 25 times the average rate of syphilis.

How is syphilis passed?

• Syphilis is mainly passed on during sex, by direct skin or mucous membrane contact with a syphilis ulcer or rash.  It can also be passed on from someone without symptoms.
• Syphilis ulcers (called “chancres”) can occur anywhere on the body but often occur inside the mouth, anus or genitals. This means you can catch syphilis from any type of sex including oral sex, and non-penetrative sex.
• Syphilis can also be passed by blood transfusion or sharing injecting needles with an infected person (all blood donations are screened for syphilis in Singapore).

What are the signs and symptoms?

Signs and symptoms of syphilis vary according to the stage of infection. Many people do not have symptoms; this is called “latent” syphilis.

​Primary Secondary​ Latent​ Tertiary​
Painless sore on the genitals (and sometimes in the mouth)​ • Rash on palms and soles
• Swollen neck and armpit glands
• Growths on the genitals and anus
• Patchy hair loss
• Brain infection​
No symptoms but internal organs may continue to be affected by disease​ Permanent damage to organs (e.g. brain, nerves,  heart, and skin​


When do signs and symptoms appear?

​Primary Secondary​ Early Latent​ Late Latent​ Tertiary​
9 – 90 days after infection​ Few weeks to 6 months after infection (sometimes up to 2 years)​ <1 year after infection​ >1 year after infection​ 5 – 30 years after infection​

How is syphilis diagnosed?

• Syphilis is diagnosed with blood tests, usually at least 2 different types.
• Fluids from ulcers / sores may also be tested.

If you have been diagnosed with syphilis, you should be tested for other STIs, especially HIV.

Can syphilis be treated?

Yes, syphilis can be treated and cured.

• Penicillin injections
• Antibiotics are available for patients who are allergic to penicillin

It is important that sexual partners are also tested and treated to prevent infection developing in them, and to prevent you from catching syphilis again from that partner.

Early detection and treatment ensures complete cure and prevents complications. However, you can catch syphilis again if you have a new sexual exposure.

MSM should have an STI / HIV check-up at least once a year. Using condoms reduces the risk of catching syphilis but does not give 100% protection since the condom may not cover the infectious areas. Regular testing is important, even if you always practice safer sex.

Do I need to return for follow-up visits?

Syphilis is not infectious once it is treated adequately.

However, you must have regular follow-up blood tests for up to 2 years to confirm that the infection has been cured.

Even after cure, syphilis blood tests remain positive for life. This is called a “serological scar”. This is why it is always important to tell your future doctor you have had syphilis and been treated in the past.

What if I am HIV positive and infected with syphilis?

• Being HIV positive increases your chances of being infected with syphilis.
• Your syphilis infection may be more difficult to diagnose and treat, and the symptoms may be different.
• The complications of syphilis, particularly neurosyphilis (syphilis of the brain and nerves), can appear much earlier.
• Occasionally, treatment for syphilis may fail and another course of antibiotics and further tests are necessary.
• Syphilis can speed up progression of HIV by weakening your immune system and increasing your viral load. Higher viral load and having a chancre in early syphilis increases the risk of you passing HIV to someone else.
• Follow-up blood tests are even more important if you have HIV to ensure treatment has worked.
• Be aware of the risks of syphilis, use condoms, abstain from sex and get tested and treated quickly to avoid complications.

Practice safer sex


• Sex without exchange of body fluids (vaginal secretions or semen).
• Use condoms correctly and every time you have sex.
• Avoid drinking excessive amounts of alcohol or using recreational drugs before or during sex, as this may impair your judgment.



We have attempted to provide full, accurate and up to date information in this patient information leaflet, based on current medical evidence and opinion. However, information and advice may vary from different sources, and over time. If you have any further questions, see your doctor or healthcare provider.

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Last update on 23 Sep 2014
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