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Syphilis vs. Herpes: How to Tell the Difference

by | May 1, 2024 | Blog, Sexual Health, STD

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Despite many STDs being preventable or treatable, they continue to impose a considerable health and economic burden. STDs can lead to severe long-term consequences such as reproductive health issues, an elevated risk of certain cancers, and complications during pregnancy and childbirth.

Syphilis and herpes are often confused in their early stages due to some overlapping symptoms, primarily involving sores or lesions. Here’s how these symptoms can appear similar:


Sores or Lesions:

  • Herpes: Typically presents with painful blisters or ulcers that can appear on the genital area, rectum, or mouth. The sores are usually filled with fluid and can be quite painful.
  • Syphilis: In its primary stage, syphilis may cause a single sore (chancre) that is usually firm, round, and painless. It appears at the site where syphilis entered the body, often on the genitals, anus, or mouth.


Site of Sores:

Both infections can cause sores in and around the genital area, anus, and mouth, which can be mistaken for one another by patients or even healthcare providers without proper testing.

What Is Syphilis?

Syphilis is a serious bacterial infection caused by the bacterium Treponema pallidum.[1]

  • Primary syphilis: The first stage is characterized by the appearance of a single, painless sore (chancre) at the site of infection, typically on the genitals, rectum, or mouth.  This sore usually appears 3 to 4 weeks after initial exposure and can last for 3 to 6 weeks if left untreated.[2]
  • Secondary syphilis: If left untreated, the infection can progress to the secondary stage, which is marked by a skin rash, fever, swollen lymph nodes, and other flu-like symptoms. This stage can last for several weeks or even months.
  • Latent syphilis: After the secondary stage, the infection can enter a latent phase where there are no visible symptoms, but the bacteria remain in the body.  This stage can last for years, and if left untreated, the infection can progress to the final, most dangerous stage.
  • Tertiary syphilis: In the final stage, the infection can cause serious and potentially life-threatening complications, such as damage to the heart, brain, and other organs.  This stage can develop years or even decades after the initial infection.


Early detection and treatment of syphilis are crucial, as the infection can be cured with antibiotics if caught in the early stages.  Untreated syphilis can lead to severe health consequences, including neurological problems, blindness, and even death.


What Is Herpes?

Herpes is a viral infection caused by the herpes simplex virus (HSV), which exists in two main types: HSV-1 and HSV-2.[3] While both types can cause genital and oral herpes, there are some key differences between them:

  • HSV-1 is primarily associated with oral herpes, which manifests as cold sores or fever blisters around the mouth and lips.However, HSV-1 can also cause genital herpes, though this is less common.
  • HSV-2 is the main cause of genital herpes, which results in painful blisters and sores around the genitals, rectum, and surrounding areas.Genital herpes is typically spread through sexual contact.[4]

Both HSV-1 and HSV-2 are highly contagious and can be transmitted through direct contact with the infected areas, such as during oral, vaginal, or anal sex.The viruses can also be spread through contact with saliva or other bodily fluids, even in the absence of visible sores.


Syphilis vs. Herpes: Telling Them Apart





Symptoms Comparison


  • Incubation period: 3 to 4 weeks after initial exposure.
  • Primary stage: Single, painless sore (chancre) at the site of infection, typically on the genitals, rectum, or mouth.
  • Secondary stage: Skin rash, fever, swollen lymph nodes, and other flu-like symptoms.
  • Tertiary stage: Serious complications, such as damage to the heart, brain, and other organs.
  • Incubation period: 2 to 12 days after initial exposure.
  • HSV-1 (oral herpes): Cold sores or fever blisters around the mouth and lips.
  • HSV-2 (genital herpes): Painful blisters and sores around the genitals, rectum, and surrounding areas.
  • Both types can cause genital herpes, though HSV-2 is more common.




  • Blood tests: Serologic tests to detect antibodies produced by the body in response to the syphilis infection.
  • Direct tests: Samples from sores are examined under a microscope to detect the presence of the bacteria.


  • Viral culture: Collecting a sample from a sore to culture the virus and confirm the diagnosis.
  • Polymerase chain reaction (PCR) test: Detects the genetic material of the herpes virus for accurate diagnosis.


Potential Complications



  • Neurological complications: Untreated syphilis can lead to serious neurological problems, including dementia and stroke.
  • Cardiovascular complications: Syphilis can damage the heart and blood vessels, leading to life-threatening conditions.


  • Recurrent outbreaks: Herpes can cause recurrent outbreaks of painful sores, affecting quality of life.
  • Increased risk of other infections: Herpes infection can increase susceptibility to other sexually transmitted infections. 


Treatment Options


Syphilis Treatment:

  • Antibiotics: Syphilis can be effectively treated with antibiotics, such as penicillin, which can cure the infection if administered in the early stages.
  • Penicillin injections: Depending on the stage of syphilis, treatment may involve a single dose or multiple doses of penicillin injections.[5]
  • Follow-up testing: Regular monitoring and follow-up testing are essential to ensure the infection has been successfully treated.


Herpes Management:

  • Antiviral medications: While there is no cure for herpes, antiviral medications like acyclovir, valacyclovir, and famciclovir can help manage symptoms, reduce outbreaks, and shorten the duration of outbreaks.[6]
  • Topical treatments: Creams or ointments may be prescribed to alleviate discomfort and promote healing of sores during outbreaks.
  • Lifestyle modifications: Maintaining good hygiene, avoiding triggers that may induce outbreaks, and managing stress can help reduce the frequency and severity of herpes outbreaks.


Preventive Measures and Managing Recurrences

  • Safe Sex Practices: Practicing safe sex, including the use of condoms, can help reduce the risk of infections that may lead to Bartholin’s cysts. Maintaining good sexual hygiene is essential for overall vaginal health.[7]
  • Hygiene: Maintaining proper hygiene in the genital area, including regular cleansing with mild soap and water, can help prevent infections and blockages in the Bartholin’s glands.


Recurrences and Long-Term Management 

  • Recurrence Expectations: Understanding that Bartholin’s cysts may recur is important. Individuals should be aware of the signs and symptoms of recurrence and seek medical advice promptly if they suspect a new cyst or abscess.
  • Long-Term Management: Developing a long-term management plan with healthcare providers can help individuals navigate potential recurrences effectively. This may involve regular check-ups, monitoring symptoms, and adjusting treatment strategies as needed to prevent complications.

When to See a Doctor

It is crucial for individuals to be aware of the symptoms of syphilis and herpes and seek prompt medical attention if they suspect they may have been exposed to or are experiencing these infections.


Recognizing Symptoms and Seeking Medical Help

If you notice any of the following symptoms, it is important to schedule an appointment with a healthcare provider as soon as possible:



  • A single, painless sore (chancre) on the genitals, rectum, or mouth.
  • A skin rash, fever, and swollen lymph nodes.



  • Painful blisters or sores around the genitals, rectum, or mouth.
  • Recurring outbreaks of these sores.
  1. Radolf JD, Deka RK, Anand A, Šmajs D, Norgard MV, X. Frank Yang. Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nature reviews Microbiology. 2016;14(12):744-759. doi:
  2. Dourmishev LA, Dourmishev AL. Syphilis: Uncommon presentations in adults. Clinics in dermatology. 2005;23(6):555-564. doi:
  3. World. Herpes simplex virus. Published April 5, 2023. Accessed April 28, 2024.
  4. Bernstein DI, Bellamy AR, Hook EW, et al. Epidemiology, Clinical Presentation, and Antibody Response to Primary Infection With Herpes Simplex Virus Type 1 and Type 2 in Young Women. Clinical infectious diseases/Clinical infectious diseases (Online University of Chicago Press). 2012;56(3):344-351. doi:
  5. Pao D, Goh BT, Bingham JS. Management Issues in Syphilis. Drugs. 2002;62(10):1447-1461. doi:
  6. Nikkels AF, Piérard GE. Oral Antivirals Revisited in the Treatment of Herpes Zoster. American journal of clinical dermatology. 2002;3(9):591-598. doi:
  7. Krishnan R, Stuart PM. Developments in Vaccination for Herpes Simplex Virus. Frontiers in microbiology. 2021;12. doi:


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