Nucleic acid amplification test (NAAT)-preferred

Microscopy, culture, antigen detection, genetic probe methods

Signs and symptoms (can be asymptomatic)

Burning sensation when urinating

White, yellow, or green discharge from the penis

Painful or swollen testicles

Painful or burning sensation when urinating

Increased vaginal discharge

Bleeding

Nucleic acid amplification test (NAAT)*

Microscopy, culture, antigen detection, genetic probe methods

Signs and symptoms (can be asymptomatic)

1 or more chancres at site of exposure around 3 weeks after infection (range of 10-90 days)

Patient highly infectious

Chancres can heal on their own, even without treatment

Mucocutaneous lesions can occur as chancres fade around 6 weeks after infection (range of 3 weeks – 6 months)

Rashes may first appear of palms of hands or feet, then on other areas of the body

Patient may experience lymphadenopathy & constitutional symptoms as well as tongue lesions

Patient highly infectious, especially if there is direct contact with a moist lesion

Manifestations in skin, bones, and cardiovascular system

Patient is not infectious

Early

Patient has reactive nontreponemal and treponemal tests within 1 year of onset of infection but no symptoms

Patient potentially infectious

Late

Patient has reactive nontreponemal and treponemal tests ≥ 1 year of onset of infection but no symptoms

Patient is not infectious

May occur at any stage

Any patient with syphilis and neurologic, ophthalmologic, or audiologic symptoms need a neurological exam and CSF evaluation via a lumbar puncture

Nontreponemal tests (RPR, VDRL, TRUST) and

Treponemal tests (FTA-ABS, MHA-TP, TPPA, TP-EIA, CIA)

Examination of cerebrospinal fluid to definitively diagnose neurosyphilis