Syphilis in South Africa: Stages, Testing & Treatment | Epicentre
🦠 Treponema pallidum · Bacterial STI

Syphilis: "The Great Imitator" That Progresses in Stages

Called "The Great Imitator" because its symptoms mimic dozens of other conditions. Syphilis is curable at every stage with treatment from your doctor, but late-stage damage to the heart, brain, and nerves can be permanent. Resurgent in South Africa and critical to detect in pregnancy.

✓ Curable at every stage ⚠ Resurgent in South Africa 🩸 RPR blood test from R1,076 🏥 No referral needed
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30%
of genital ulcers in SA
are caused by syphilis
🩺
Medically Reviewed
Dr. Samantha Naidoo
MB ChB, FCP (SA) · Medical Director, Epicentre Laboratories
Published: 2 August 2025 · Last reviewed: 1 March 2026
Key facts

How common is syphilis in South Africa?

30.2%
of SA genital ulcers are syphilis
NICD Surveillance
10-60%
transmission risk per encounter
Wilson & Wilson, 2019
4 stages
of disease progression
Primary, Secondary, Latent, Tertiary
✓
Curable at every stage
Treatment from your doctor
⚠
Critical to test in pregnancy
Congenital syphilis is preventable
1,800+
syphilis tests at Epicentre in 2025
Across JHB, CPT & DBN labs
The 4 stages

What are the stages of syphilis?

Syphilis is unique among STIs because it progresses through distinct stages, each with different symptoms. Without treatment, it escalates. With treatment from your doctor, it is curable at every stage.

Stage 1: Primary
The Painless Sore
3-90 days after exposure (average 21 days)
A single, firm, round, painless sore (chancre) appears where the bacteria entered the body: genitals, rectum, lips, or throat. It heals on its own in 3-6 weeks, even without treatment. The painlessness is what makes it dangerous. Many people never notice it.
Stage 2: Secondary
The Rash That Doesn't Itch
4-10 weeks after the chancre
A non-itchy rash appears on the palms of the hands and soles of the feet (almost unique to syphilis). Other symptoms: fever, swollen lymph nodes, sore throat, patchy hair loss, weight loss, muscle aches. Symptoms come and go for up to 2 years.
Stage 3: Latent
The Silent Phase
Months to decades
Zero symptoms. The bacteria remain in the body. You can still transmit syphilis during early latent phase (first 1-2 years). Late latent syphilis is not sexually transmissible but can still pass from mother to baby. Only a blood test can detect this stage.
Stage 4: Tertiary
Organ Damage
10-30 years after initial infection (if untreated)
Occurs in about 15-30% of untreated cases. Causes serious, potentially fatal damage: neurosyphilis (brain and nerve damage), cardiovascular syphilis (heart and blood vessels), gummatous lesions (destructive tissue masses), blindness, deafness. Damage at this stage may be permanent even after treatment.
Treatment at any stage cures the infection. But damage already caused by tertiary syphilis cannot always be reversed. This is why early detection through blood testing matters so much.
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Pregnancy warning

Why is syphilis testing critical during pregnancy?

Untreated syphilis in pregnancy is one of the most preventable causes of stillbirth and neonatal death in South Africa.

Congenital syphilis occurs when syphilis passes from mother to baby during pregnancy or birth. It can cause stillbirth, premature birth, low birth weight, and serious birth defects including bone deformities, anaemia, and organ damage. All of this is preventable with a simple blood test in the first trimester.
SA Department of Health guidelines recommend syphilis testing at the first antenatal visit, again at 32 weeks, and at delivery. Syphilis is fully curable during pregnancy with treatment from your doctor, and treatment prevents transmission to the baby.
"
"Congenital syphilis is a tragedy because it is entirely preventable. A blood test costs R1,076 and takes minutes. Treatment during pregnancy cures the mother and protects the baby. There is no reason for a single case of congenital syphilis to occur in 2026."
Dr. Samantha Naidoo, MB ChB, FCP (SA), Medical Director, Epicentre
Without treatment

What happens if syphilis goes untreated?

Syphilis is sometimes called "the slow burn." It can take decades to cause its worst damage, and the latent stage gives a false sense of security.

1
Weeks 3-12: Primary sore heals on its own
The chancre disappears without treatment. Many people assume they are fine. The bacteria are still in the body and spreading.
2
Months 1-24: Secondary symptoms come and go
Rash, fever, sore throat, hair loss. These also resolve without treatment. The disappearance of symptoms does not mean the infection is gone.
3
Years 2+: Latent phase (no symptoms at all)
The bacteria lie dormant. No symptoms. You feel healthy. But the infection is still present and detectable by blood test. Early latent is still transmissible sexually; late latent is not.
4
Years 10-30: Tertiary syphilis (15-30% of untreated cases)
Neurosyphilis: confusion, headaches, vision loss, paralysis. Cardiovascular syphilis: aortic aneurysm, heart failure. Gummas: destructive tissue masses. This stage can be fatal. Damage may be permanent even after treatment.
5
At any time: HIV risk multiplied
Syphilitic sores create entry points for HIV. Having syphilis makes you 2-5 times more likely to contract HIV. Testing and treating syphilis is also an HIV prevention strategy.
Get tested

Where can I test for syphilis in South Africa without a referral?

Syphilis is detected by an RPR blood test. Testing window: 3-6 weeks after exposure. Ideal window: 6-12 weeks. Epicentre includes syphilis in the Express STI Package.

Express STI Screening (includes syphilis)

R1,076🎓 R968

5-in-1 blood panel: Syphilis RPR + HIV + chlamydia Ab + hepatitis B + herpes IgM. 24hr urgent results available.

4× R269/mo with Payflex
🎓 10% student👴 10% pensioner
Learn More →Book

Medium PCR (9 pathogens)

R1,508🎓 R1,357

PCR panel for chlamydia, gonorrhoea, herpes, mycoplasma, ureaplasma, trichomoniasis. Add syphilis RPR on request.

4× R377/mo with Payflex
🎓 10% student👴 10% pensioner
Learn More →Book

XL Sexual Health (35 targets)

R3,305🎓 R2,975

The most extensive panel. Includes syphilis (Treponema pallidum PCR) alongside 34 other pathogens. Full ecosystem analysis.

4× R827/mo with Payflex
🎓 10% student👴 10% pensioner
Learn More →Book

Syphilis RPR is included in the Express STI Package. Syphilis PCR (Treponema pallidum) is included in XL packages. View all packages →

FAQ

Syphilis: Your Questions Answered

Can you have syphilis without symptoms?

Yes. The primary sore is painless and often hidden (inside the vagina, rectum, or throat). The latent stage has zero symptoms but remains detectable by blood test. Only testing can confirm or rule out syphilis.

How soon after exposure can I test?

RPR: 3-6 weeks. The ideal window is 6-12 weeks. Epicentre's Express STI Package includes syphilis RPR with results in 2-5 days (24hr urgent available).

Is syphilis curable?

Yes, at every stage. Treatment from your doctor cures the infection. However, damage from tertiary syphilis (heart, brain, nerves) may be permanent. Early detection prevents this entirely.

Why is the rash on the palms and soles significant?

A non-itchy rash on the palms and soles of the feet is almost unique to secondary syphilis. Most skin conditions do not affect these areas. If you notice this pattern, get tested immediately.

Is syphilis dangerous in pregnancy?

Extremely. Untreated syphilis causes stillbirth, premature birth, and congenital syphilis. Testing in the first trimester is recommended by SA Department of Health guidelines. Syphilis is fully curable during pregnancy.

Does syphilis increase HIV risk?

Yes, 2-5 times higher. Syphilitic sores create entry points for HIV. Testing and treating syphilis is also an HIV prevention strategy. Read our HIV guide →

How much does syphilis testing cost?

Express STI (includes syphilis RPR): R1,076. XL Sexual Health (includes syphilis PCR): R3,305. Students 10% off. Payflex 4× interest-free. View all packages →

STI guide

Other infections in this guide

🦠 Chlamydia 🦠 Gonorrhoea 🧬 Genital Herpes 🧬 HIV / AIDS 🧬 HPV 🔬 Trichomoniasis 🦠 Mycoplasma genitalium 🦠 Mycoplasma hominis 🦠 Ureaplasma 🧬 Viral Hepatitis 🦠 Male Urethritis 🦠 Chancroid
📚 Interactive STI Guide 🔬 All Packages & Pricing 📦 Home Test Kits 🎓 Student Discount

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