Male Syphilis: Symptoms, Transmission, Testing & Treatment Explained by a Doctor

1. What Is Syphilis? Essential Background

Syphilis is a bacterial sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It is transmitted primarily through sexual contact, and because early-stage symptoms are often subtle, many people unknowingly let the infection progress and pass it on to others.

Trends in Syphilis Cases in Japan

According to figures published by Japan’s Ministry of Health, Labour and Welfare, the number of syphilis cases has risen sharply since the late 2010s. Once dismissed as a “disease of the past,” syphilis is staging a serious comeback in modern Japan. Cases are particularly concentrated among men in their 20s to 40s, with sexually active generations bearing the brunt of the trend.

Note: Syphilis can be fully cured with early treatment. However, if left untreated, it can cause serious damage to the heart, brain, and nervous system. If you have any reason to be concerned, we strongly recommend getting an STI test as soon as possible.

2. How Syphilis Is Transmitted

Primary Route: Sexual Contact

The main route of syphilis transmission is sexual contact (vaginal, oral, and anal sex). When you come into contact with an infected person’s lesions (oral mucosa, genitals, anus, etc.), Treponema pallidum can enter through tiny breaks in the mucous membrane or skin.

Key points to remember:

• Oral sex can transmit syphilis (kissing also carries some risk)
• Condoms alone cannot fully prevent transmission

Contact That Does NOT Transmit Syphilis

Syphilis is NOT transmitted through:

• Shared toilet seats, baths, or towels
• Sneezing, coughing, or respiratory droplets
• Sharing utensils or everyday casual contact

Mother-to-Child Transmission (Congenital Syphilis)

Syphilis can also be passed from a pregnant mother to her fetus, resulting in congenital syphilis. Because this can lead to miscarriage, stillbirth, premature birth, or congenital syphilis in the baby, syphilis testing during pregnancy is essential.

3. Syphilis Symptoms and Progression (Stages 1 to 4)

STEP 1

Primary Stage (3 weeks to 3 months after infection)

• A painless, firm sore or ulcer (chancre) appears at the site of infection (genitals, anus, mouth, etc.)
• Swollen lymph nodes in the groin
• Sores disappear on their own within a few weeks, leading many people to mistakenly believe they have recovered

STEP 2

Secondary Stage (3 months to 3 years after infection)

• A red rash (roseola) appears all over the body
• Rashes also appear on the palms and soles (easy to mistake for other skin conditions)
• Fever, fatigue, and swollen lymph nodes
• Symptoms again resolve on their own, but the infection continues to progress inside the body

STEP 3

Tertiary Stage (3 to 10 years after infection)

• Gummas (rubbery, tumor-like lesions) form in the skin, bones, and internal organs
• With modern access to appropriate treatment, progression to this stage is now rare

STEP 4

Quaternary Stage (10+ years after infection)

• Neurosyphilis: dementia, paralysis, sensory impairment
• Cardiovascular syphilis: aortitis, aortic aneurysm
• Life-threatening, severe complications

Important: “Symptoms disappearing does not mean you are cured.”
Syphilis symptoms fade naturally at each stage, but this does not mean the infection has resolved—the bacteria remain latent inside the body. Even if your symptoms have gone away, you must still get tested and treated.

4. The Recent Surge in Syphilis Cases and Its Causes

According to the National Epidemiological Surveillance of Infectious Diseases run by Japan’s Ministry of Health, Labour and Welfare, syphilis cases in Japan have surged since the 2010s, reaching tens of thousands of cases per year in recent years.

For more detailed epidemiological data, please refer to the following official sources.

• Ministry of Health, Labour and Welfare: Information on Sexually Transmitted Infections
• National Institute of Infectious Diseases: About Syphilis

Reasons behind the surge:

• Wider use of social media and dating apps, increasing the number of sexual partners
• Asymptomatic carriers unknowingly spreading the infection
• Low public awareness and knowledge of STIs
• Rising infection rates among the younger generation (20s to 30s)

5. How Syphilis Is Tested

Syphilis is mainly diagnosed through a blood test. Our clinic offers the following testing methods.

How to Get a Syphilis Test

STEP 1

Book your appointment online or by phone

STEP 2

Visit the clinic and complete a doctor’s consultation (symptoms, sexual history, etc.)

STEP 3

Blood draw (RPR and TPHA blood tests)

STEP 4

Results explanation; if positive, treatment begins (penicillin prescription)

Note: About the window period (when tests cannot yet detect infection)
Immediately after exposure, a test may not return a positive result (this is the window period). We recommend getting tested 3 to 4 weeks after the suspected exposure.

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6. Syphilis Treatment

Penicillin Antibiotics Are the First-Line Treatment

Syphilis is treated with penicillin-class antibiotics. When caught early (primary or secondary stage), proper treatment can achieve a complete cure.

Details of treatment options

• Primary and secondary stage (early syphilis): a 4-week oral course of amoxicillin (an oral penicillin), or a single intramuscular injection of long-acting penicillin (benzathine benzylpenicillin)
• Tertiary stage and neurosyphilis: intravenous benzylpenicillin (hospitalization may be required)

Post-Treatment Considerations

Key points:

• Periodic blood tests are required to confirm cure (typically at 1, 3, and 6 months after treatment)
• Your partner must also be tested and treated at the same time
• Avoid sexual contact during treatment
• For patients with a penicillin allergy, alternatives such as doxycycline are used

7. How to Prevent Syphilis

Proper Use of Condoms

Condoms significantly reduce the risk of syphilis transmission, but they cannot prevent it completely. This is because lesions on areas not covered by the condom can still transmit the infection.

Regular STI Testing

You should consider regular syphilis testing if you:

• Have had sexual contact with a new partner
• Have sexual contact with multiple or anonymous partners
• Have a partner who has been diagnosed with an STI
• Notice any unusual symptoms in your mouth or genitals

8. Frequently Asked Questions (FAQ)

Q. What are the early symptoms of syphilis?
A. Between 3 weeks and 3 months after infection, a painless, firm sore or ulcer (chancre) appears at the site of infection (genitals, mouth, etc.). Swollen lymph nodes may also occur. The symptoms eventually disappear on their own, but this is not the same as being cured.

Q. How long is the syphilis incubation period?
A. On average, it takes about 3 weeks from infection to the first symptoms (with a range of 10 days to 3 months). There are also asymptomatic periods, and many people unknowingly pass the infection on to others without realizing they have it.

Q. Can syphilis be transmitted through oral sex?
A. Yes. Oral sex is one of the main routes of syphilis transmission. If there are sores in the mouth, syphilis can potentially be transmitted through kissing as well.

Q. Can you have syphilis without any symptoms?
A. Yes. Syphilis often progresses without noticeable symptoms, and it is not uncommon for cases to be identified only through blood testing in people who feel completely fine. Regular testing is essential if you have any reason for concern.

Q. Where can I get tested for syphilis?
A. At our clinic (Men’s Care Clinic), we offer blood-based syphilis testing. Appointments are required, and same-day results are sometimes available. We also offer online consultations.

Q. Can syphilis be fully cured?
A. Yes. Early-stage syphilis (primary and secondary) can be fully cured with penicillin-class antibiotics. However, follow-up blood tests after treatment are required to confirm the cure.

Q. How much does syphilis treatment cost?
A. Under Japan’s health insurance system, the consultation fee, testing fee, and prescription fee typically total from a few thousand yen up to around 10,000 yen. Costs vary depending on the initial consultation fee and the specific tests required. Please ask during your counseling session for full details.

Q. What is the relationship between syphilis and HIV?
A. Syphilis lesions increase the risk of HIV transmission. If you are diagnosed with syphilis, it is recommended that you also be tested for HIV. Our clinic also offers combined STI testing.

9. Summary

Key takeaways from this article

• Syphilis is a bacterial STI that is fully curable with early detection and treatment
• Symptoms going away on their own does not mean you are cured—always get tested and treated
• Oral sex is one of the routes of transmission
• The first-line treatment is penicillin-class antibiotics
• Regular STI testing is essential, even without symptoms
• After diagnosis, your partner must also be tested and treated at the same time
• Our clinic offers blood-based syphilis testing and treatment

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Medical supervision: Men’s Care Clinic Doctor

Specialist in urology and sexually transmitted infections. This article is based on the latest medical evidence and on information from Japan’s Ministry of Health, Labour and Welfare and the National Institute of Infectious Diseases.