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Syphilis Diagnosis
How is syphilis diagnosed?
Your doctor will do a physical exam and will ask you about your symptoms and your sexual history. Your doctor may ask you questions such as:
- Do you think you have been exposed to any sexually transmitted infections (STIs)?
- What are your symptoms?
- Do you have sores in your genital area or anywhere else on your body?
- Do you or your partner engage in sexual behaviors that put you at risk? For example, do you have sex without a condom or have more than one sex partner?
- Have you had an STI in the past?
The physical exam may include:
- A careful examination of the skin and mouth to look for any rash or other abnormalities.
- For women, a pelvic exam to look for signs of syphilis. During the pelvic exam, your doctor will look for abnormal sores in your vagina or on your vulva, labia, rectal area, and inner thighs. These sores occur during the primary stage of syphilis.
- For men, a genital exam to look for signs of syphilis.
- For newborns, an exam of both the newborn and the mother for symptoms. The evaluation for congenital syphilis starts with a review of the mother's health and testing the mother for syphilis.
The diagnosis of syphilis is usually confirmed with one of several blood tests. This is especially true if you don't have sores. If you have sores, a doctor may look at the fluid from one of the sores with a microscope to look for syphilis bacteria. (This is called a dark-field examination.)
To diagnose the primary and secondary stages of syphilis, the doctor may do a lumbar puncture (spinal tap) in some cases.
More testing should be done to look for other sexually transmitted infections, such as:
- Chlamydia.
- Gonorrhea.
- Human immunodeficiency virus (HIV). People who have syphilis have a greater chance of being exposed to HIV.
The diagnosis of syphilis can be complicated or can take a long time. That's because its symptoms are very similar to those of many other diseases and sometimes aren't recognized. Syphilis has historically been called "the great imitator."