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  • Syphilis Information for Providers

    For general information, see our Sexually Transmitted Diseases (STDs) page. 

    Syphilis is rapidly increasing in Pierce County. 

    Cases quadrupled from 2016 (58 cases) to 2021 (243 cases).

    Congenital syphilis cases increased from 2 in 2020 to 14 in 2021.

    Report suspected or confirmed cases within 3 days.

    Fax an STD report form to (253) 649-1389. For more information, see our provider page. 

    Test people 45 or younger that have sex. 

    Syphilis is increasing in all groups, especially in heterosexual people. 

    Pregnant people with syphilis can pass it to their baby.

    Outcomes include:

    • Stillbirth.
    • Low birth weight.
    • Permanent neurologic and physical damage.

    As syphilis cases in heterosexual people increase, cases of congenital syphilis are rapidly increasing.

    Test pregnant women:

    • The first time they see any provider, as RCW 70.24.090 requires.
    • At around 28 weeks gestation, and again at delivery or stillbirth/termination.

    Diagnosis and treatment are complex.

    Treat patients that:

    • Present with syphilis symptoms.
    • Report exposure within the last 3 months, regardless of test results.
      • If a patient tests negative and refuses treatment, test again in 1 and 3 months.

    Exposed patients may test negative during the incubation period (up to 3 months). Treat recently exposed patients regardless of test results.

    It’s easy to misdiagnose early symptoms.

    See Evaluating Patients for Syphilis for diagnosis help and reference images.

    Stages of Syphilis

    Click for printable PDF.

    Diagram shows stages of syphilis.

    Primary syphilis

    Painless sores on body parts used for sex.

    • Highly infectious.
    • Often misdiagnosed (can look like an ingrown hair).
    • Can appear within days or months of exposure.
    • Resolve without treatment.

    Secondary syphilis

    Typically last a few weeks and resolve without treatment.

    Non-infectious symptoms:

    • Rashes anywhere on body.
    • Patchy hair loss (can include eyebrows).
    • Swollen lymph nodes.

    Infectious symptoms:

    • Mucous patches on mucous membranes like mouth, vagina and anus.
    • Wart-like lesions on anus, vagina or penis.

    Latent syphilis

    Early Non-Primary Non-Secondary:

    • Asymptomatic.
    • Less than 1 year after exposure.

    Unknown duration or date:

    • Asymptomatic.
    • More than 1 year after exposure or infection date unknown.

    We recommend the reverse testing algorithm.

    No FDA-approved PCR tests exist for syphilis. Treponemal and non-treponemal serology testing are both used to increase sensitivity and specificity. These tests can be used with traditional and reverse algorithms. We recommend the reverse testing algorithm. It’s what Washington Public Health Lab uses.

    Download a PDF of this reverse testing algorithm flowchart.

    Decision-tree diagram of syphilis reverse testing algorithm.


    For clinicians

    For patients