When should I get a syphilis test?

Adults without symptoms should be screened for syphilis only if they are at an increased risk of infection or of transmitting the infection to others. Factors that increase a person’s risk of contracting syphilis and indicate the need for annual screening include:

• Being male and under age 29
• Involvement in commercial sex work
• Living in an area with high syphilis infection rates

Other groups also benefit from regular screening at certain intervals. These groups include:

• Pregnant people at the first prenatal visit, at 28 weeks, and again at delivery if high risk.
• Men and anyone with a penis who is sexually active and has sex with another person with a penis should be tested annually. More regular testing may be recommended if they have additional risk factors.
• Transgender and gender-diverse people should be screened annually depending on sexual behaviors and risk of exposure.
• People diagnosed with HIV may be screened at their first HIV evaluation, then one or more times each year depending on their behaviors and local infection rates.

Anyone with symptoms should receive diagnostic testing. Without treatment, syphilis infection progresses through three stages: primary syphilis, secondary syphilis, and tertiary syphilis. These three stages are separated by periods in which no symptoms are present. In any stage of syphilis, the infection can spread to the brain and nervous system, called neurosyphilis. Syphilis can also spread to the eye, called ocular syphilis, or to the ears, called otosyphilis.

The signs and symptoms of syphilis vary based on the stage of infection: