STI guide
Syphilis: symptoms, testing and what a result means
Curable, rising again in South Africa, and built to be missed: the first sore is painless and it heals on its own whether or not anything has been done about it.
Basically
- A syphilis blood test starts at R87, with results in 2 to 3 working days. No doctor's referral needed.
- The first sore is painless and heals by itself. That is what syphilis does. It is not a sign the infection has gone.
- Most PCR panels do not include syphilis. It is in the penile 17-target panel, the Extra Large and both oral panels only. Otherwise add the R524 blood test.
- Test from 3 to 6 weeks after exposure. Antibodies take time to appear.
- Blood cannot be done at home. A syphilis blood test needs a branch visit.
- It is completely curable with antibiotics, especially early. Late-stage damage cannot be undone.
- Epicentre does not treat it. A reactive result goes to a doctor, who confirms the stage and treats.
What syphilis is
Syphilis is caused by the bacterium Treponema pallidum. It is completely curable with antibiotics, it is rising again in South Africa and elsewhere, and it is the STI with the most misleading natural history: it produces symptoms, then stops, then produces different symptoms years later.
That pattern is why it was once called the great imitator, and why the useful advice is simple. If you have had a possible exposure, test. Do not wait for the symptom to come back, because it is supposed to go away.
The stages, and why the silence is the dangerous part
- Primary, roughly 3 weeks after exposure. A single firm, round, painless sore, called a chancre, at the site the bacterium entered. Because it does not hurt, it is frequently missed entirely, especially when it is internal. It heals by itself in 3 to 6 weeks whether or not anything is done about it.
- Secondary, weeks to months later. A rash that often includes the palms and the soles, along with fever, sore throat, swollen glands, patchy hair loss and a general unwellness. This also resolves on its own.
- Latent. No symptoms at all, for years. The infection is still present and still doing damage.
- Tertiary, in a minority of untreated cases, years or decades later: damage to the heart, blood vessels, brain and nerves. At this stage treatment stops further damage but cannot undo what is done.
Neurological and eye involvement can happen at any stage, not only the last one.
How syphilis is tested at Epicentre
Mostly by blood. Syphilis testing is antibody testing: it looks for your body's response to the bacterium rather than the bacterium itself, which is what makes it detectable long after the first sore has healed.
| Test | What it covers | Price |
|---|---|---|
| Syphilis (RPR/VDRL) | Blood. The standard screening test and the cheapest single option. Results in 2 to 3 working days. | R87 |
| TPHA (syphilis antibody) | Blood. An alternative or confirmatory antibody test. Results in 2 to 3 working days. | R142 |
| Combined HIV, syphilis and hepatitis B add-on | Blood. All three at once, and the usual companion to a PCR panel. Results in 2 to 3 working days. | R524 |
| Sexual Health Express | Blood. Syphilis, HIV, hepatitis B, herpes type 2 and a chlamydia antibody. Results in 2 to 5 working days. | R1,078 |
This is worth getting right, because it is easy to assume a big panel covers everything. Treponema pallidum is included in the 17-target penile panel, the 34-target Extra Large and both oral panels. It is not in the Small, the Medium or the 17-target vaginal panel. If you are taking one of those and want syphilis covered, add the R524 blood test.
| Test | What it covers | Price |
|---|---|---|
| Large Sexual Health, penile swab | 17 targets for anyone with a penis. Includes Treponema pallidum, plus chancroid and candida. | R1,925 |
| Extra Large Sexual HealthMost complete | 34 targets, our most thorough screen. Includes Treponema pallidum. Not sex specific. | R3,305 |
| Essential Oral Sexual Health | 9 targets from a throat swab, including Treponema pallidum. | R1,580 |
| Comprehensive Oral Sexual Health | 16 targets from a throat swab: the oral 9 plus respiratory organisms. | R1,925 |
When to test after exposure
Antibodies take time to appear. A blood test is generally reliable from around 3 to 6 weeks after exposure, and a test taken in the first days afterwards can be negative while the infection is establishing.
If you have a painless sore right now, do not wait for it to heal and do not wait for the antibody window. See a doctor as well as testing.
Syphilis in pregnancy can pass to the baby and cause serious harm, and it is one of the reasons syphilis screening is part of routine antenatal care in South Africa. It is also entirely preventable with treatment. If you are pregnant and have any reason to test, do it now rather than later, and tell your doctor.
Your result, and what happens next
You get one report, emailed to you and to nobody else. It is the YourGenes patient report: colour coded, in plain language, with a line for every organism on your panel saying whether it was detected. There is no second document, and no separate practitioner version. This report is what your doctor reads too.
If syphilis is detected, Epicentre does not treat it. We are a diagnostic laboratory. We collect samples, run tests and report results. We do not diagnose, prescribe medication or provide treatment, anywhere, including on WhatsApp. You have two equally good routes from here:
- Your own doctor, clinic or pharmacy clinic. Take the report. It names the organism, which is exactly what they need.
- An independent doctor we work with, who consults online or in person on sexual health results. She prescribes on her own responsibility, not as an Epicentre service.
This is the part people skip. If one of you is treated and the other is not, the infection comes straight back at the next exposure. Your partner should be tested, whatever your result says about you.
Syphilis treatment is straightforward and highly effective, particularly in the early stages. A reactive antibody result usually needs a confirmatory test and a clinical assessment to work out which stage you are at, and both of those are a doctor's job.
Where to test
Cape Town
24 Lower Main Road, Observatory, 7925
Monday to Friday, 08:30 to 16:00
Durban
2 Knelsby Avenue, Hillcrest, 3650
Monday to Friday, 08:30 to 16:00
Johannesburg
02 7th Avenue, Parktown North
Monday to Friday, 08:30 to 16:00
Walk in during those hours, no appointment and no doctor's referral. All three branches are closed on South African public holidays. If you would rather not come in, a home kit is couriered to you in discreet packaging and a free courier collects the sample.
You do not need a reason to get tested
No doctor's referral, no appointment, no awkward conversation first. Results are emailed to you and to nobody else.
Common questions
How much does a syphilis test cost in South Africa?
The single RPR/VDRL blood test is R87, and the TPHA antibody test is R142. The combined HIV, syphilis and hepatitis B add-on is R524, which is what most people order alongside a PCR panel. The blood-based Sexual Health Express is R1,078 and includes syphilis with four other tests.
Is syphilis included in the PCR sexual health packages?
Only in some. Treponema pallidum is in the 17-target penile panel, the 34-target Extra Large and both oral panels. It is not in the Small, the Medium or the 17-target vaginal panel. If you are taking one of those, add the R524 blood test, which covers HIV and hepatitis B as well.
How soon after exposure can I test for syphilis?
From around 3 to 6 weeks. Syphilis testing looks for antibodies, and antibodies take time to develop, so a test in the first few days after an exposure can be negative while the infection is establishing.
How long do syphilis results take?
2 to 3 working days for the blood antibody tests. The Sexual Health Express takes 2 to 5 working days.
Can I test for syphilis at home?
No. Syphilis testing is a blood test, and blood cannot be collected from a home kit. It has to be done at a branch. The PCR panels that include syphilis do work as home kits, but those are the penile, Extra Large and oral panels only.
The sore went away on its own. Am I fine?
No, and this is the single most important thing to understand about syphilis. The first sore is painless and heals by itself in 3 to 6 weeks whether or not the infection has been treated. Disappearance is what it does, not evidence that it has gone. If you had a sore, test.
Is syphilis curable?
Yes, with antibiotics, and it is highly treatable especially when caught early. What treatment cannot do is reverse damage already done at a late stage. Epicentre does not prescribe or treat; you take the result to a doctor.
Does syphilis affect pregnancy?
Yes. It can pass to the baby and cause serious harm, which is why it is part of routine antenatal screening in South Africa. It is also preventable with treatment, so if you are pregnant and have any reason to test, test now.
Should my partner get tested?
Yes. Your partner should be tested, whatever your result. Syphilis can be present for years without symptoms.
Why people trust us with this
Ready to test
No appointment and no doctor's referral. Walk into any of our three branches, or have a kit couriered to you in discreet packaging.
Not ready yet
That is normal, and there is no rush. Take the prices away with you, or ask us something without booking anything.
Other infections in this guide
Important. Epicentre Walk-In Labs is a diagnostic laboratory operated by Epicentre Aids Risk Management (Pty) Ltd. We collect samples, run tests and report results. We do not diagnose conditions, prescribe medication or provide treatment, and nothing on this page is medical advice. Results are released to the person tested. If you have symptoms that worry you, or think you may need urgent care after an exposure, see a doctor or clinic without waiting for a test result.
