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Syphilis in Reno: Symptoms, Testing and Treatment

Updated · Sources are cited in the text

Syphilis in Reno: Symptoms, Testing and Treatment

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 has been known for centuries. It is also one of the more treatable infections in sexual health, as long as it is found. The hard part is that it can be quiet, and it can look like many other things.

This guide is a science-focused look at syphilis for people in Reno and Washoe County. It covers the organism, the stages, the rash, the blood tests, the medicine a clinician prescribes, the safety profile of that medicine, and what follow-up looks like. It also covers what the published numbers say about Nevada.

Anyone can get syphilis, whatever their gender, orientation or relationship status. It is passed through contact with a syphilis sore, usually during vaginal, anal or oral sex, and it can also pass from a pregnant person to a baby. The goal here is plain information, not worry.

Quick answers

  • Is syphilis curable? Yes. The CDC STI Treatment Guidelines (2021) say penicillin G is the preferred treatment at every stage, and a clinician decides the form and length based on the stage.
  • Can it be found with a test? Yes. Syphilis is found with blood tests, and sometimes with a swab from a sore, ordered by a clinician.
  • Can it cause symptoms? It can cause a sore, a rash and other signs. It can also cause none that a person notices for long stretches.
  • Where in Reno? Several clinics list syphilis testing. They are described below, and the sliding scale options are noted.

The science: what causes syphilis

Syphilis is caused by a bacterium called Treponema pallidum, subspecies pallidum. It is a spirochete, which means it is a thin, tightly coiled, corkscrew-shaped cell. It moves by spinning, and that motion helps it pass through the moist lining of the skin and mucous membranes.

This organism is unusual in a few ways. Research suggests that it has a small genome and depends heavily on its human host for nutrients. It also does not grow in routine laboratory culture. That is a key reason diagnosis relies on blood tests that look for the body's response, rather than on growing the bacterium in a dish.

Its outer surface has few exposed proteins. Researchers who study the organism have observed that this may help it avoid immune detection for long periods. That fits what clinicians see: the infection can move through stages over years, with quiet gaps in between.

The bacterium is fragile outside the body. The CDC says syphilis is not spread by toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing or eating utensils.

Syphilis symptoms by stage

The CDC describes syphilis in stages. The stages can overlap, and not everyone has every one. Only a clinician or a test can say whether symptoms or exposure mean syphilis.

Primary stage

The first sign is usually a sore called a chancre. It is typically firm, round and painless, which is why it is easy to miss. It can appear on the genitals, in the anus or rectum, or in or around the mouth, which are the places where the bacterium entered the body.

According to the CDC, the sore tends to appear about three weeks after exposure, though the range is wide. It heals on its own within a few weeks. Healing does not mean the infection is gone.

Secondary stage

Weeks to a few months after the first sore, the infection can show up in other parts of the body. The CDC lists a skin rash, mucous membrane sores, fever, sore throat, swollen lymph nodes, patchy hair loss, headaches, weight loss, muscle aches and tiredness. These signs can fade without treatment and come back.

Latent stage

In the latent stage there are no signs or symptoms. The infection is still present, and it can only be found with a blood test. The CDC divides this stage into early latent (within the past year) and late latent, because the treatment plan can differ.

Tertiary stage

Without treatment, a minority of people go on to tertiary syphilis. The CDC says this can appear years or even decades later and can affect the heart, blood vessels, brain and other organs. This stage is now uncommon where testing and treatment are available, which is one more reason finding the infection earlier matters.

Neurologic, eye and ear involvement

The CDC notes that syphilis can involve the nervous system, the eyes (ocular syphilis) or the ears (otosyphilis) at any stage. Changes in vision, hearing loss, severe headache or confusion are reasons to be seen promptly by a clinician, who can sort out the cause.

The syphilis rash, described plainly

The syphilis rash is the best-known sign of the secondary stage, and it is also one of the most confusing. Per the CDC, it can look like rough, reddish-brown or pink spots. They can show up on the trunk, on the palms of the hands and the soles of the feet, or anywhere on the body.

The rash is usually not itchy. It can be faint enough that it is overlooked. In other cases it resembles rashes from allergies, medicines, viral infections or skin conditions. Because of that overlap, the appearance of a rash on its own cannot tell anyone what is causing it.

Secondary syphilis can also cause moist, wart-like patches in warm skin folds, and white patches inside the mouth. A clinician can look at these and order the right tests.

If you have a rash and are wondering about syphilis, a blood test and a clinical exam are the way to find out. Many Reno clinics listed below offer both. Visiting is also reasonable if the rash has already faded, since the infection can still be present.

Why the national rise matters

CDC surveillance reports show that syphilis cases in the United States have increased in recent years, including congenital syphilis, which is syphilis passed to a baby during pregnancy. The CDC describes this as a public health concern across many states, not one community.

Here is why that matters for an individual. When more infections are circulating, the chance that any one person is exposed goes up. Because syphilis often has no obvious symptoms, many infections are found only through screening. And in pregnancy, an untreated infection can cause serious harm, while the CDC notes that timely treatment can prevent it.

The USPSTF recommends that all pregnant people be screened for syphilis early in pregnancy. It also recommends screening for people who are not pregnant but have a higher chance of infection. A clinician can talk through what that means for any given person without assumptions.

Syphilis in Reno and Nevada: the published numbers

Local numbers are limited, and they come from different years and different definitions. They should be read separately rather than compared.

MeasureFigureSource and year
Washoe County, all non-congenital syphilis (all stages)45.8 per 100,000 (226 cases)CDC AtlasPlus data as compiled by Stacker, 2021
Nevada, primary and secondary syphilis28.4 per 100,000 (902 cases)CDC AtlasPlus data as compiled by Stacker, 2022
Nevada, primary and secondary syphilis by sex10.3 per 100,000 in women; 35.0 per 100,000 in menKFF, citing the CDC 2023 STI Surveillance Report
Nevada, congenital syphilis232.0 per 100,000 live births; ranked 45th among statesAmerica's Health Rankings, citing CDC AtlasPlus, 2023

A few cautions apply. The Washoe County number counts every stage except congenital syphilis, while the Nevada numbers count only primary and secondary syphilis, so they measure different things. The county figure is from 2021, and the Nevada figures are from 2022 and 2023. The Washoe County 2023 and 2024 rates were not available in the sources reviewed, so check with Northern Nevada Public Health for current local figures.

What the numbers do show is that syphilis is present in both Washoe County and the state, and that congenital syphilis is a documented concern in Nevada. That is the reason Nevada has a prenatal screening law, described below.

Blood tests: treponemal and non-treponemal

Because the bacterium cannot be grown routinely, the standard approach is to test blood for the body's response. The CDC STI Treatment Guidelines (2021) describe two families of blood tests. They answer different questions, and both are usually needed.

Non-treponemal tests

These include the RPR and VDRL tests. They detect substances the body produces in response to cell damage from the infection, rather than antibodies to the bacterium itself. If positive, the lab reports a number called a titer, such as 1:8 or 1:32.

The titer matters because it can be followed over time. A clinician compares the number before and after treatment. A falling titer is how follow-up shows that treatment is working.

Non-treponemal tests can sometimes read positive for reasons other than syphilis. That is called a biologic false positive, and it is one reason a second test type is used.

Treponemal tests

These tests look for antibodies made specifically against Treponema pallidum. Examples named by the CDC include the TP-PA, FTA-ABS, EIA and chemiluminescence immunoassay tests.

The CDC notes that treponemal tests usually stay reactive for life after infection, even after successful treatment. So a positive treponemal test on its own cannot show whether an infection is recent or was treated years ago. A clinician interprets it alongside the history and the other test.

Two testing orders

Labs can run these tests in two sequences. The traditional approach starts with a non-treponemal test and confirms with a treponemal one. The reverse approach starts with a treponemal test and then runs a non-treponemal test. If the first two disagree, a different treponemal test is usually used to break the tie. The lab and clinician decide which sequence applies.

Timing

Antibody-based tests need time after exposure to turn positive. The CDC does not give a single number that fits everyone, and the timing can vary. If a test is done soon after a possible exposure, a clinician may suggest repeating it later. A clinician can set that timing based on the exposure and any symptoms.

When there is an open sore, a clinician can sometimes also take a sample from it for direct testing. That is a separate option and not available everywhere.

Syphilis treatment: is syphilis curable?

Yes, syphilis is curable. The CDC STI Treatment Guidelines (2021) name penicillin G as the preferred treatment for every stage. Penicillin is a prescription antibiotic given by a clinician, and the form and number of visits depend on the stage and on whether the nervous system or eyes are involved. The details are set by the clinician, not by a general article.

Early treatment can stop the infection from moving to later stages. The CDC is also clear on a limit: treatment can stop damage from getting worse, but it cannot reverse harm that has already happened. That is a clear reason to test early, and not a reason for fear.

After treatment, a person is not immune. Syphilis can be caught again. A past infection does not protect against a new one, and a new infection will need a new test and treatment.

Sexual partners matter too. The CDC advises that partners from the recent past be evaluated, because they may be infected and not know it. Clinics and health departments can help with this, and partner notification can be handled with privacy.

Safety profile and contraindications

Penicillin has been used for syphilis for many decades, and the CDC considers it the standard of care. Like any medicine, it has things to know about.

  • Penicillin allergy. Some people are allergic. The CDC recommends that anyone who says they have a penicillin allergy talk with their clinician, since many reported allergies turn out not to be true allergies on evaluation. Clinicians have options, and the choice depends on the stage.
  • Pregnancy. The CDC says penicillin is the only recommended treatment for syphilis in pregnancy. For a pregnant person with a true penicillin allergy, the CDC guidelines describe a process of allergy testing and desensitization under medical care, so that penicillin can still be used.
  • The Jarisch-Herxheimer reaction. Within about a day after starting treatment, some people get fever, chills, headache or muscle aches. The CDC describes this as a reaction to the bacteria breaking down. It is usually short-lived. People should ask the clinician what to expect and when to call.
  • HIV. The CDC guidelines address syphilis in people living with HIV, who may need closer follow-up. Syphilis testing and HIV testing are often offered together.

No one should try to treat syphilis with leftover antibiotics, antibiotics from another person, or products bought without a prescription. Using the wrong medicine can hide symptoms while the infection continues. Treatment should come from a clinician after a diagnosis.

Follow-up blood tests after treatment

Treatment is not the end of the process. The CDC guidelines describe follow-up blood tests to confirm the treatment worked. For primary and secondary syphilis, the guidelines call for clinical and non-treponemal test follow-up at set intervals, such as 6 and 12 months. For later stages, the schedule is different. People living with HIV, and pregnant people, may be checked more often.

The point of follow-up is to watch the titer. A clinician looks for a drop of fourfold or more, which is two dilutions, such as 1:32 falling to 1:8. Many people see their titer fall to a low level or become negative over time. Some people have a low titer that stays positive for a long time even after successful treatment, which the CDC calls the serofast state. A clinician can explain what that means for any one person.

If the titer does not fall as expected, a clinician may look for a new infection, re-treatment, or further evaluation. Keeping follow-up appointments is the way that gets caught.

Syphilis during pregnancy

Nevada law addresses this directly. According to NRS 442.010 on the Nevada Legislature site, a syphilis test is to be offered at the first prenatal visit, or as soon as practicable, and again in the third trimester. The third-trimester test falls between the 27th and 36th week of pregnancy, or as soon after as practicable. Testing at delivery applies in certain situations, such as no prenatal care or a stillbirth after 20 weeks. A pregnant person who objects is not tested, and the refusal is documented. (The statute has been updated recently, so check the Nevada Legislature website or ask a prenatal provider for the current wording.)

The CDC says congenital syphilis is preventable. Treatment with penicillin in pregnancy, given early enough, can prevent passing the infection to the baby. This is the reason both the USPSTF and Nevada ask for screening in pregnancy.

Prevention, including doxy-PEP

Condoms and dental dams lower the chance of syphilis when they cover the sore, though syphilis can spread through skin contact in areas a condom does not cover. Regular testing is another tool, particularly for people with new or multiple partners.

In 2024 the CDC issued guidance on doxycycline post-exposure prophylaxis, often called doxy-PEP. The CDC recommends that clinicians discuss it with gay and bisexual men and transgender women who have had a bacterial STI in the past 12 months. Observational and trial data cited by the CDC suggest it lowers the chance of syphilis, chlamydia and gonorrhea in that group. It is a prescription decision made with a clinician, and it does not replace testing. Northern Nevada Public Health is listed by the CDC NPIN directory as offering doxy-PEP, and the clinic can say who it is for and how it fits.

Quality indicators: how to read information and results

Instead of sourcing a product, the practical question with syphilis is where good information and good testing come from. A few markers are worth looking for:

  • The source is named. Good information says where its numbers come from, such as the CDC, the USPSTF or a health department, and gives the year.
  • The test comes with a clinician. A syphilis result is easier to interpret when a clinician can review it with your history, order the second test if needed, and arrange treatment on the spot.
  • Both test types are explained. A good visit explains whether the lab runs the traditional or reverse sequence, and what the titer means.
  • Follow-up is planned. Look for a plan for repeat blood tests, not a one-time result.
  • Costs are stated honestly. A clinic should be able to tell you about sliding scale fees, insurance and Medicaid before you are seen.

Where to get tested for syphilis in Reno

These clinics list syphilis testing through the CDC GetTested directory or the CDC NPIN directory. Hours were often not published there, so call before going. For a fuller look at costs and options, see the guide to STD testing in Reno, including where to go and what it costs.

  • Northern Nevada Public Health Sexual Health Clinic, 1001 E Ninth St, Bldg B, Reno, NV 89512. Phone 775-328-2470. The CDC NPIN lists on-site chlamydia, gonorrhea and syphilis testing, plus HIV testing, PrEP, PEP and doxy-PEP. CDC GetTested lists a free STI test and a free HIV test, plus a sliding scale, with eligibility to confirm by phone. The listings list it as walk-in. Hours were not published, so call first.
  • Nevada Health Centers, Willow Street Health Center, 790 Willow St, Reno, NV 89502. Main line 800-787-2568. CDC NPIN lists syphilis testing, STI treatment and a sliding scale, and notes that appointments are recommended and walk-ins are welcome. Listed hours are Monday to Friday, 8:00 AM to 5:00 PM, closed for lunch from 12:00 to 1:00 PM.
  • Northern Nevada HOPES, 5th Street Clinic, 580 W 5th St, Reno, NV 89503. Phone 775-786-4673. CDC GetTested lists syphilis testing, a sliding scale, and appointments required. The clinic's website lists hours of Monday to Thursday 8am to 7pm and Friday 8am to 5pm, but does not say which clinic those hours apply to, so confirm when you call.
  • Community Health Alliance, North Valleys Health Center, 280 Vista Knoll Pkwy, Suite 107, Reno, NV 89506, and the Nell J Redfield Health Center, 3915 Neil Rd, Reno, NV 89502. Phone 775-329-6300 for both. CDC GetTested lists syphilis testing and a sliding scale, and appointments are required. Hours were not published.
  • Planned Parenthood Mar Monte, Reno Health Center, 8025 S Virginia St, Reno, NV 89511. Phone 775-688-5555. CDC GetTested lists syphilis testing, accepts insurance and Medicaid, and requires appointments. The listing does not publish a price, so ask about eligibility and cost when you call.

You can also look up other clinics through the CDC GetTested directory. Free and low-cost options exist, and no clinic needs you to explain your reasons for coming in.

Nevada law notes

  • Minors. According to NRS 129.060 on the Nevada Legislature website, a minor may give express consent to examination and treatment for sexually transmitted diseases by a health officer, licensed physician, physician assistant, registered nurse or clinic. The statute also covers prevention services. Ask the clinic about its own policy.
  • Reporting. Under NRS 441A.150, health care providers and laboratories report certain communicable diseases to the health authority. That is public health surveillance, and it is how the case counts above come to exist.

Frequently asked questions

Is syphilis curable?

Yes. The CDC STI Treatment Guidelines (2021) name penicillin G as the preferred medicine at every stage. A clinician prescribes it and chooses the form based on the stage.

Does the syphilis rash always appear?

No. The CDC says the rash is a common sign of the secondary stage, but it can be faint, and some people never notice one. A blood test is the way to find out.

Does a positive test mean a new infection?

Not necessarily. Treponemal tests often stay positive for life after an infection, even after treatment. A clinician reads the result with the history and a non-treponemal titer.

How often should I be tested?

It depends on pregnancy, partners and other factors. The USPSTF and CDC give recommendations for specific groups, and a clinician can apply them to your situation.

Sources