How significant is the resurgence?
Syphilis diagnoses in England reached their highest level in 80 years in 2023, according to UKHSA data. Over 9,000 cases were diagnosed, a figure that represents a dramatic rise from the relatively low rates seen through much of the late twentieth century. Similar trends have been observed across Europe, North America, and Australia. This is not a new infection — syphilis has existed for centuries — but control measures that once kept rates low appear to have become less effective.
Which populations are most affected?
The increase has been most pronounced among gay, bisexual, and other men who have sex with men (GBMSM), who account for the majority of cases. However, there have also been significant increases among heterosexual men and women, and a concerning rise in congenital syphilis (passed from mother to baby during pregnancy) in some areas. Age groups most affected include those in their 20s and 30s, though cases span all adult age groups.
What does early syphilis look like?
Primary syphilis presents as a single, painless sore (chancre) at the site of infection — typically the genitals, anus, or mouth — which appears 2–3 weeks after exposure and heals on its own within a few weeks. Because it is painless and may be hidden, it is frequently missed. Secondary syphilis follows 4–10 weeks later, with a widespread rash (often on the palms and soles), flu-like symptoms, and sometimes mouth ulcers or genital warts. Without treatment, the infection enters a latent phase that can last years before progressing to late-stage syphilis.
Treatment
Syphilis remains curable with antibiotics. For early-stage syphilis (primary, secondary, and early latent), a single injection of benzathine penicillin G is the gold-standard treatment. Later stages may require multiple doses. For people with penicillin allergy, doxycycline is an alternative. Treatment is free at NHS sexual health clinics. After treatment, follow-up blood tests are needed to confirm the infection has cleared, as titers can take months to decline.