This page is general health information, not medical advice. It cannot tell you whether you have an infection. A clinician can, and the testing options on this site are a good place to start.

Syphilis is a bacterial infection that spreads through sexual contact. It is treatable, and it is curable with the right care from a clinician. It can also go unnoticed for a long time, because its early signs are easy to miss and often fade without treatment.

This guide covers how syphilis behaves in the body, what the stages look like, how blood tests work, and what treatment and follow-up involve. It also covers what the numbers look like in Travis County and Texas, and where Austin residents can get tested for free or at low cost. It is written for every gender and orientation, and it describes what researchers and clinicians have observed rather than what any one person should assume about themselves.

What syphilis is, and what the tests look for

Syphilis is caused by a spiral-shaped bacterium called Treponema pallidum. The CDC STI Treatment Guidelines (2021) describe it as passing from person to person through direct contact with a syphilis sore, usually during vaginal, anal or oral sex. It can also pass from a pregnant person to a baby.

The ingredient list for this topic is short. There is one organism, and the body responds to it in two ways that blood tests can detect.

Antibodies aimed at the bacterium itself. These are the targets of treponemal tests.
Antibodies to material released from damaged cells. These are the targets of non-treponemal tests. The level tends to rise with active infection and fall after treatment.

That difference explains why a clinician usually orders more than one kind of test. It also explains why follow-up blood work matters after treatment. Both are covered below.

The stages of syphilis, one at a time

The CDC describes syphilis in stages. They can overlap, and some people move through them with few noticeable signs. Symptoms alone cannot confirm or rule out syphilis. A test ordered by a clinician is what answers that question.

Primary stage

The CDC says the first sign is usually a sore, called a chancre, at the spot where the bacterium entered the body. The CDC gives the time from exposure to the first sore as 10 to 90 days, with an average of about 21 days.

The sore is typically firm, round and painless. Because it does not hurt, and because it can be inside the mouth, vagina or rectum, many people never see it. Without treatment it usually heals on its own in a few weeks. Healing does not mean the infection is gone.

Secondary stage and the syphilis rash

The CDC describes the secondary stage as the one most people recognize, because the syphilis rash is its best-known sign. The rash can show up while the first sore is healing or after it has healed.

Clinicians describe the syphilis rash this way:

It often looks rough, reddish-brown or pink, and spotted.
It commonly appears on the trunk, and on the palms of the hands and the soles of the feet.
It usually does not itch, though it can in some people.
It can be faint enough to mistake for another skin condition.

The CDC also lists other secondary-stage signs: fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, muscle aches, weight loss and tiredness. Moist, wart-like patches can appear in warm areas such as the groin. These signs also fit many other conditions, which is one reason a blood test is more reliable than looking at a rash. Rash and sore symptoms often clear up without treatment, but the infection stays in the body.

Latent stage

In the latent stage there are no visible signs, but the bacterium is still in the body. The CDC separates early latent syphilis (infection within the past year) from late latent syphilis (longer than a year, or of unknown duration). A blood test is the only way latent syphilis is found. A clinician uses the history and past test results to decide which kind it is, and that affects the treatment plan.

Tertiary stage

The CDC says that in a minority of people who are not treated, syphilis can progress to the tertiary stage, often years or decades later. It can affect the heart, blood vessels, skin, bones and nervous system. This stage is the main reason public health agencies encourage testing and treatment in the early stages.

Neurosyphilis, ocular syphilis and otosyphilis

The CDC notes that the bacterium can reach the nervous system, eyes or ears at any stage. Possible signs include a severe headache, changes in vision, hearing loss, ringing in the ears, dizziness, or changes in thinking and balance. Anyone with these symptoms should be seen promptly by a clinician, who can decide what testing is needed. The CDC lists these as complications that call for urgent medical evaluation.

Why the national rise matters

The CDC's surveillance reports have documented a sustained rise in syphilis across the United States over the past decade. The increase has reached every region and has included more people of every gender, along with more babies born with congenital syphilis.

This matters for a few practical reasons:

Higher community prevalence means a higher chance of encountering an infection. This is true even for people with few partners.
Early syphilis is easy to miss. A painless sore or a faint rash may pass without anyone noticing.
Untreated syphilis can affect pregnancy. The CDC reports that it can cause serious harm to a baby, which is why prenatal screening is standard.
Syphilis sores can make HIV easier to acquire or pass on, according to the CDC. Testing for both together is common practice.

None of this is a reason for alarm. It is a reason to treat a syphilis test as routine health maintenance, the way many people treat a cholesterol check. The CDC recommends syphilis screening on a schedule that depends on a person's circumstances, and the USPSTF recommends screening for people at increased risk and for all pregnant people. A clinician can help work out what applies to you.

Syphilis numbers in Austin and Texas

Local numbers help show what is happening in the community. Travis County figures come from the Texas Department of State Health Services (DSHS) Texas STD Surveillance Report, 2022 Annual Report. To compare like with like, the table below sets them beside the DSHS figures for Texas as a whole in the same year.

Measure (2022, DSHS)	Travis County	Texas
Primary and secondary syphilis, cases	418	4,655
Primary and secondary syphilis, rate per 100,000 people	31.5	15.5
Syphilis at all stages, cases	1,470	25,991
Syphilis at all stages, rate per 100,000 people	Not published in the report's tables	86.6

In 2022, the DSHS report shows Travis County's rate of primary and secondary syphilis at about twice the statewide rate. The report did not publish a county rate for syphilis at all stages, so no comparison is made for that row.

The CDC's Sexually Transmitted Infections Surveillance 2023 state ranking tables report 930 congenital syphilis cases in Texas, a rate of 238.6 per 100,000 live births. Congenital syphilis is syphilis passed to a baby during pregnancy, and it is one of the main reasons prenatal testing exists.

Numbers describe populations, not individuals. A county rate says nothing about whether any one person has syphilis. Only a test can answer that.

How syphilis blood tests work

The CDC STI Treatment Guidelines (2021) explain that diagnosis generally relies on two kinds of blood tests used together. A swab of a sore can also be examined in some settings, but blood tests are the usual route.

Non-treponemal tests

These include tests commonly called RPR and VDRL. They detect antibodies to material released from damaged cells, not to the bacterium directly.

Results are often reported as a ratio, such as a number that describes how far the sample could be diluted and still react.
The level generally rises with active infection and falls after successful treatment, so these tests are used to follow response over time.
The CDC notes they can occasionally react in people who do not have syphilis, for example because of pregnancy, some autoimmune conditions or other infections. That is why a second type of test is used to confirm.

Treponemal tests

These detect antibodies aimed at the bacterium itself. Several laboratory formats exist, including enzyme immunoassays and particle-agglutination tests.

The CDC says they generally stay reactive for life after a past infection, even after successful treatment.
Because of that, they are good at confirming exposure at some point but not good at measuring whether an infection is new or has been treated.

Why two tests

Laboratories follow one of two orders: a non-treponemal test first, then a treponemal test to confirm, or the reverse. Either way, a result is read from both tests together, alongside any symptoms and testing history. If you are given a result that seems to contradict a past one, ask the clinician to explain how the two tests relate. This is common and usually has a straightforward explanation.

On timing: antibodies take time to develop after an exposure, so a test taken very soon after a possible exposure may be repeated later. The CDC is the source for these timing questions, and a clinician can explain how the guidance applies to your situation.

Is syphilis curable?

Yes. The CDC states that syphilis can be cured with the right antibiotic from a clinician. Penicillin is the preferred treatment recommended in the CDC STI Treatment Guidelines (2021) for all stages. Which form and how long it is given depend on the stage, and the clinician decides this. This guide does not list doses or schedules, because those are set case by case.

Some points the CDC emphasizes about treatment:

Treatment stops the infection from progressing. It does not reverse damage that has already happened, which is another reason earlier detection helps.
Syphilis does not leave lasting immunity. Someone who has been treated can be infected again, so testing remains useful afterward.
Treatment is not something to start on your own. Leftover or borrowed antibiotics are not a substitute for care from a clinician.

Safety profile and contraindications

Penicillin has a long track record, and it is the standard treatment. A few safety points from the CDC guidance:

Penicillin allergy. People who report an allergy should tell the clinician. The CDC notes that many reported penicillin allergies do not hold up on evaluation, and clinicians can sort this out. Other options exist for some stages in non-pregnant people.
Pregnancy. The CDC says penicillin is the only recommended treatment for syphilis in pregnancy. A pregnant person with a penicillin allergy is typically referred for allergy evaluation and, if needed, a supervised process to allow penicillin to be given.
Jarisch-Herxheimer reaction. The CDC describes a short-lived reaction some people have within the first day after treatment, with fever, chills, headache and muscle aches. It is a known response and clinicians can advise on managing it.
Neurologic, eye or ear symptoms. The CDC says these call for additional evaluation, which can change the treatment plan.

Tell the clinician about all allergies, medications and pregnancy status. These affect which treatment is chosen.

Follow-up blood tests after treatment

Treatment is not the last step. The CDC recommends repeat non-treponemal blood tests after treatment to confirm that levels are falling as expected. The clinician sets the timing, which depends on the stage and on factors such as HIV status and pregnancy. In general the CDC calls for repeat checks over the months that follow.

The CDC explains that a sustained drop in the non-treponemal level suggests treatment is working. If levels do not fall as expected, or if symptoms return, the clinician can decide whether further evaluation or retreatment is needed. Treponemal tests are not used for follow-up, since they usually stay reactive.

The CDC also advises that sexual partners be tested and, where appropriate, treated, so the infection does not pass back and forth. Texas allows a form of this called expedited partner therapy. According to the CDC's page on the legal status of EPT in Texas, rules from the Texas Medical Board allow a physician to prescribe for the partner of an established patient without a prior relationship with that partner, and pharmacists may dispense those prescriptions. Ask the treating clinician whether this applies to you.

Doxy-PEP and syphilis

In 2024 the CDC issued guidance on doxycycline taken after sex (doxy-PEP) to lower the chance of certain bacterial STIs. The CDC's recommendation covers gay, bisexual and other men who have sex with men, and transgender women, who have had a bacterial STI in the past year. Research suggests it lowers the chance of syphilis, chlamydia and gonorrhea in that group.

Doxy-PEP does not replace testing. It is prescribed by a clinician, who also decides whether it fits a person's situation. In Austin, CommUnityCare lists DoxyPEP among its IDEALhealth Program services. Kind Clinic states that it is not offered as a standalone service or appointment, and that you must be receiving ongoing care at Kind Clinic.

Pregnancy, minors and reporting under Texas law

Prenatal screening

Texas Health and Safety Code Section 81.090, as summarized by the Texas DSHS, calls for syphilis and HIV testing at the first prenatal visit and again in the third trimester. The statute puts the third-trimester test at no earlier than the 28th week. If there is no third-trimester result on record, testing is done at delivery. A pregnant person may decline the HIV tests but not the syphilis tests. This routine testing exists because the CDC reports that syphilis treated early in pregnancy can prevent congenital syphilis.

Minors

Texas Family Code Section 32.003 lets a minor of any age consent to diagnosis and treatment of a reportable infectious disease, and this covers reportable STIs and HIV. Parental consent is not necessary. The statute also allows a physician to tell a parent or guardian about the treatment, so a teen should not assume a provider will never do so. A teen who is concerned can ask the clinic about its practices before the visit.

Reporting

Syphilis is a notifiable condition in Texas, according to the DSHS Texas Notifiable Conditions list for 2026. Primary and secondary syphilis must be reported within one work day. Syphilis at other stages, including congenital syphilis, must be reported within one week. Reports go to public health authorities, who use them to track trends and help connect people with care and partner notification.

What research suggests

A few observations from the published guidance and surveillance work, framed as what research suggests rather than as settled claims about any one person:

Research suggests early treatment lowers the chance of the later complications the CDC describes for the tertiary stage.
Surveillance data suggest syphilis often goes undetected in its early stages, since the first sore is painless and the rash can look like other skin conditions.
Studies summarized by the CDC suggest syphilis sores are linked to a higher chance of HIV acquisition and transmission, which is why HIV testing is often offered alongside syphilis testing.
Clinical trial results summarized in the CDC's 2024 doxy-PEP guidance suggest that doxycycline taken after sex reduced bacterial STI infections, including syphilis, among the groups studied.
The CDC's guidance notes that co-infection is common, which is one reason a clinician may suggest testing for several infections at once. If you are reading about related infections, the guide to chlamydia symptoms, testing and treatment in Austin covers another common bacterial STI that is also curable.

Quality indicators when choosing where to test

Not every testing option offers the same range of services. A few markers of a well-run testing setup, based on CDC practice:

A clinician is available to explain results and discuss treatment. This matters most if a result is reactive.
The clinic can order confirmatory testing, meaning both test types described above.
Treatment and follow-up are available on site or through a clear referral.
The clinic is open about what it tests for. Syphilis is not always part of a basic panel, so ask.
The costs are stated clearly, or the clinic tells you plainly how to find out.

For a side-by-side look at cost and what each Austin option offers, see the guide to STD testing in Austin: where to get tested and what it costs.

Where to get tested for syphilis in Austin

These are the options published by the clinics themselves. Hours, fees and walk-in rules can change. Austin Public Health notes on its website that content updates may be delayed, so confirm details by phone before you go. The full list of Austin testing locations is on our home page.

Austin Public Health Sexual Health Clinic (RBJ Health Center), 15 Waller Street, Austin, TX 78702. The clinic page says: "The fee for testing and treatment is only $30." Its standard tests are HIV, syphilis, gonorrhea and chlamydia. Hours listed are Monday to Friday, 8 a.m. to 12 p.m. and 1 to 5 p.m. To book, schedule online or call 512-972-5430.
Kind Clinic, Austin Koenig, 101 W Koenig Lane, Ste 100, Austin, TX 78751. Kind Clinic states that it offers walk-in testing for gonorrhea, syphilis, chlamydia, HIV and hepatitis C at this location. The phone is 833-937-5463. Kind Clinic says patients with health insurance must use it for lab work, and that its Kind Patient Assistance Program can help people who are uninsured or cannot afford lab costs. Walk-in testing hours differ from regular hours, and the clinic is closed on observed holidays and the first Friday of every month. Walk-in STI testing is not offered at its South Austin location.
CommUnityCare IDEALhealth Program (Hancock Health Center), 1000 E. 41st St., Suite 700, Austin, TX 78751. It lists STI and HIV testing and prevention. CommUnityCare states that its sliding fee scale is determined through a meeting with a Financial Eligibility Specialist. Phone: 512-978-9015. Walk-in policy is not stated on the program page, so call first.
ASHwell Sexual Health + Wellness, 3100 Red River St, Suite 3, Austin, TX 78705. ASHwell states that its services are always free, though there may be costs for medication. Treatment is for ASHwell patients. It does not accept walk-ins. Call (512) 900-3116.
Vivent Health, 104 E. Highland Mall Blvd, Suite 100, Austin, TX 78752. Vivent states that its HIV testing is free and confidential. A CDC listing also names free STI tests at this site, so ask whether syphilis testing is included when you call (512) 458-2437 for walk-in hours or an appointment.
University Health Services STI Testing Clinic (UT Austin), Student Services Building, 100 West Dean Keeton Street, Room 1.400. It serves UT Austin students. Test options include chlamydia, gonorrhea, HIV and syphilis, with drop-in visits for people without symptoms. People with symptoms need a provider appointment. Phone: 512-471-4955. The page does not list a price, so ask the clinic.

Testing from home

The Texas DSHS runs Test for Texas, which offers free mail-order self-testing for HIV, syphilis, gonorrhea and chlamydia at testfortexas.org. Any reactive or unclear result should be followed up with a clinician, because a clinician can order the confirmatory tests described above and discuss treatment.

Find more options

The CDC runs a national locator at gettested.cdc.gov where you can enter a ZIP code to find nearby STI testing sites.

Common questions

Does a syphilis rash always appear?

No. The CDC describes the rash as a feature of the secondary stage, but it can be faint or missed, and not everyone has one. A blood test is the way to learn more.

Can syphilis go away on its own?

Early signs such as the first sore and the rash often fade without treatment, according to the CDC. The infection itself stays in the body until a clinician treats it.

Is syphilis curable if it has been there for years?

The CDC states that antibiotics from a clinician can cure syphilis at every stage. Treatment prevents further harm, but it cannot undo damage that has already occurred, so a clinician will discuss what is right for the stage involved.

What happens if a test is reactive?

The clinician will usually order the second type of test to confirm, review your symptoms and history, and discuss treatment and follow-up. Partners may also need to be notified, and the clinic or health department can help with that.

Syphilis in Austin: Symptoms, Testing and Treatment