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    • Syphilis Information for Providers

    For general information, see our Sexually Transmitted Infections (STIs) page. 

    Syphilis spike in Pierce County

    A sharp increase in syphilis cases peaked in 2022, but cases are still much higher than they were before 2021.

    Syphilis stage 2017 2018 2019 2020 2021 2022 2023 2024*
    Primary/ secondary cases636692111241359286155

    The number of babies born with syphilis continues to rise at an alarming rate.

    Syphilis stage 2017 2018 2019 2020 2021 2022 2023 2024*
    Congenital cases00< 5< 514141422

    *2024 counts are preliminary.

    Test people 45 or younger who 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 people:

    • 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.

    Report suspected or confirmed cases within 3 days.

    Fax an STI report form and an optional positive syphilis or HIV test supplemental patient info form to (253) 649-1389.

    For more information, see our Report Notifiable Conditions page. 

    Diagnosis and treatment are complex.

    Treat patients who:

    • 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

    Print this image.

    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.

    References

    For clinicians

    For patients