Conditions
Syphilis: symptoms, testing and where to get treated
Syphilis is a sexually transmitted infection that the right antibiotic cures, but it often goes unnoticed because the sore does not hurt and heals on its own. In a discreet video visit, the doctor evaluates you and gives you a lab order for the blood test. If it is positive, she explains the result and tells you where to go for treatment, which according to the CDC is an injection.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Sudden changes in your vision, or hearing loss
- Confusion, weakness on one side of the body, or a severe headache with a stiff neck
- Sexual assault: go to the emergency room or call 911
- Possible HIV exposure in the last 72 hours: go to the ER to be evaluated for preventive treatment (PEP)
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At a glance
Syphilis
Common symptoms
- A sore, usually painless, on the genitals, anus or mouth
- A rash on the palms of the hands and soles of the feet
- Fever, swollen glands and tiredness
- Other names
- Treponema pallidum infection
- Usual test
- Nontreponemal (RPR or VDRL) and treponemal blood tests, by lab order
- Treatment
- Antibiotic; the recommended one is a penicillin injection given in person
- Possible complication
- Damage to the eyes, ears, brain and other organs; congenital syphilis in the baby
On this page(11)
What is syphilis?
Syphilis is a bacterial infection passed on through direct contact with a syphilis sore during vaginal, anal or oral sex. It can also pass from a pregnant woman to her baby.
According to the CDC, the right antibiotic cures syphilis, but having had it does not protect you: you can get it again. Untreated, it can stay quiet in the body for years and, 10 to 30 years later, damage the heart, brain and other organs.
Syphilis symptoms by stage
Primary. A sore, usually painless, appears where the bacteria entered: the genitals, anus, lips or mouth. It lasts 3 to 6 weeks and heals on its own, with or without treatment. The sore going away does not mean the infection has.
Secondary. A rash appears on one or more parts of the body, often on the palms of the hands and soles of the feet, and usually does not itch. It can come with fever, swollen glands and tiredness.
Latent. There are no symptoms, but the infection is still there and only a blood test finds it.
Tertiary. Years later, it can affect many organs. Also, according to the CDC, syphilis can reach the eyes, ears or nervous system at any stage.
How we care for syphilis by video
You see Dr. Diana Nieves Castro, MD, a Puerto Rico–licensed general practice physician with several years of emergency-department experience. No judgment, in English or Spanish. Join from a private place; visits are not recorded.
The doctor asks about your symptoms, your recent partners and whether you could be pregnant, and gives you a lab order for a lab near you. According to the CDC, a diagnosis needs two blood tests: a nontreponemal test (RPR or VDRL) and a treponemal test. One alone is not enough. The CDC also recommends an HIV test for everyone with syphilis.
If we need to see a sore or rash in an intimate area, it is done only through the secure visit link. Do not send photos by email or text message.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get tested and get a plan.
Take the order to the lab; the doctor reviews your result with you and tells you the next step.
Price
A doctor visit costs US$79, with no membership, and includes the lab order. You pay the lab for the tests. Reviewing the result is a US$49 follow-up visit. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. See all prices.
Video visit
Doctor visit
US$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the visit can’t take place
Syphilis treatment: an injection given in person
According to the CDC’s 2021 STI Treatment Guidelines, the recommended treatment for primary and secondary syphilis is a single injection of benzathine penicillin G into the muscle. That injection is given in person. If your test is positive, the doctor explains the result and tells you where to go to get it.
The Puerto Rico Department of Health runs Centers for the Prevention and Treatment of Communicable Diseases (CPTET) in its eight regions, and an HIV and STI line: (787) 765-1010. If you are allergic to penicillin, say so in the visit: the doctor goes over the options in the guidelines with you.
The CDC recommends repeating the blood tests 6 and 12 months after treatment to confirm it worked. You can do that review with us in a follow-up visit.
Your partner
According to the CDC, the sex partners of someone with early syphilis (primary, secondary or early latent) from the 90 days before the diagnosis should be treated even if their test is negative. Partners from before that need testing.
For telling partners, the CDC counts back: 3 months plus how long symptoms lasted for primary syphilis, 6 months plus how long symptoms lasted for secondary, and 1 year for early latent. Each partner needs their own evaluation with a doctor. The doctor helps you plan how to tell them.
Syphilis in pregnancy
If you are pregnant and have syphilis or a positive result, you need your OB-GYN right away. According to the CDC, untreated syphilis in pregnancy can lead to a low-birth-weight baby, stillbirth, or a baby born with syphilis who may have cataracts, deafness or seizures. The CDC recommends syphilis testing at the first prenatal visit. A syphilis test is also part of the Puerto Rico health certificate.
If you are under 21
If you are under 21, a parent or legal guardian must sign the consent, stay on camera for the whole visit and show photo ID.
When to go to the ER
For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.
- Sudden changes in your vision, or hearing loss
- Confusion, weakness on one side of the body, or a severe headache with a stiff neck
- Sexual assault
- Possible HIV exposure in the last 72 hours, to be evaluated for preventive treatment (PEP)
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Can syphilis be cured?
How do I get a syphilis test?
If the sore went away, is the syphilis gone?
Does my partner need treatment?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (6)
- CDC: About Syphilis (opens in a new tab) (accessed 2026-10-02)
- CDC: Syphilis, STI Treatment Guidelines 2021 (management of sex partners, diagnosis) (opens in a new tab) (accessed 2026-10-02)
- CDC: Primary and Secondary Syphilis, STI Treatment Guidelines 2021 (opens in a new tab) (accessed 2026-10-02)
- CDC: Neurosyphilis, Ocular Syphilis and Otosyphilis, STI Treatment Guidelines 2021 (opens in a new tab) (accessed 2026-10-02)
- Puerto Rico Department of Health: Ryan White Program, HIV (CPTET and HIV/STI line) (opens in a new tab) (accessed 2026-10-02)
- CDC: preventing HIV with PEP (opens in a new tab) (accessed 2026-10-02)
