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Syphilis Nursing Guide

Overview: Syphilis

This content is intended as a Quick Reference for Syphilis and will cover an overview and nursing considerations utilizing the nursing process.

Syphilis Etiology and Epidemiology

Syphilis, a bacterial infection, is usually caused by sexual contact. It starts as a painless sore (located on the mouth, rectum, or genitals) and then spreads via mucous membrane or skin contact with these sores.

The bacteria can remain dormant for decades after initial infection, then become active again. A single injection of penicillin can sometimes cure early syphilis.

The first sign of primary syphilis is a small sore, called a chancre. It usually develops 3 weeks after exposure and heals in 3 to 6 weeks. The patient could also have swollen lymph nodes.

Secondary syphilis usually begins within 6 months of initial exposure. It can last several weeks to months. Symptoms may include:

  • Fever
  • Fatigue
  • Hair loss
  • Rash
  • Sore throat
  • Sores on moist areas
    • Inside the mouth
    • In the throat or anus
    • On the genitals
  • Swollen lymph nodes
  • Weakness
  • Weight loss

Syphilis that enters the brain and nervous system is called neurosyphilis. Symptoms can include:

  • Headaches
  • Hearing loss
  • Neck stiffness
  • Problems with your reflexes
  • Paralysis

Approximately 15 to 30% of people with untreated syphilis can get late or tertiary syphilis (Mayo Clinic, 2019). This can occur many years after original infection and signs include damage to:

  • Blood vessels
  • Bones and joints
  • Brain
  • Eyes
  • Heart
  • Liver
  • Nerves

Complications of syphilis can cause damage throughout the body. This includes:

  • Gummas
    • Bumps or tumors that can develop on bones, skin, liver, or any other organ
  • Neurological problems
    • Bladder incontinence
    • Dementia
    • Headache
    • Hearing loss
    • Loss of temperature and pain sensations
    • Meningitis
    • Sexual dysfunction (men)
    • Stroke
    • Visual problems, including blindness
  • Cardiovascular problems
    • Aneurysm
    • Inflammation of the aorta
  • HIV
  • Pregnancy and childbirth complications

Risk factors for syphilis include:

  • Having sex with multiple partners
  • HIV
  • Men having sex with men
  • Unprotected sex

Syphilis Diagnosis

A blood test can determine if syphilis is present.

A second blood test may be done to confirm diagnosis.


Treatment depends on the stage of syphilis:

  • Early stage
    • One shot of penicillin
  • Late stage
    • Three shots of penicillin
  • Syphilis affecting nervous system
    • Penicillin through an intravenous infusion once a week for two weeks

Affected individuals should be advised to abstain from sex for 1 week after symptoms are gone. Their sexual partner(s) will also need treatment.

Syphilis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with syphilis are listed below.


  • History
    • Anorexia
    • Arthralgias
    • Brittle or pitted nails
    • Fever
    • Hair loss
    • Headache
    • Intellect changes
    • Malaise
    • Nausea and vomiting
    • Personality changes
    • Pharyngitis
    • Rash
    • Sensorium changes
    • Speech abnormalities
    • Stiff neck
  • Physical Examination
    • Alopecia
    • Broad grayish plaques (condylomata lata)
      • May be found in warm, moist, intertriginous areas
    • Chancres
      • Smooth ulcers smooth without exudate and with raised, firm borders
      • Primary chancres heal within 3 to 6 weeks
    • Eyes with Argyll Robertson (AR) pupils
    • Hyperactive reflexes
    • Mucocutaneous lesions
      • Discrete, macular, pink­to­red lesions that are 3 mm to 10 mm in diameter
      • May spread to entire body
      • Do not ulcerate
    • Mucous patches
      • Superficial, silver-gray erosions occurring on mucous membranes
    • Painless papule at inoculation site

Syphilis Nursing Diagnosis/Risk For

  • Altered nutrition, less than body requirements
  • Anxiety
  • Disturbed body image
  • Disturbed sexual pattern
  • Impaired skin integrity
  • Pain
  • Risk for infection
  • Risk for injury


  • Administer medications, as ordered
  • Administer pain medications and nonpharmacological pain relief measures
  • Encourage patient to express feelings and communicate
  • Explain the diagnosis, treatment, and side effects
  • Give patient emotional support
  • Follow infection and safety precautions
  • Initiate comfort measures
  • Insert and maintain IV, per protocol and order
  • Maintain calm environment
  • Monitor the following:
    • Adverse reactions or complications
    • Lab results
    • Treatment response
    • Vital signs

Expected Outcomes

  • Decrease anxiety and pain
  • Maintain normal body weight and image
  • Maintain normal skin integrity
  • Prevent injury and infection

Individual/Caregiver Education

  • Avoid all sexual contact until individual and partner(s) finish full treatment.
  • Avoid pregnancy until treatment is completed and lab results return to normal.
  • Follow-up visits for lab tests should be scheduled at 3-, 6- and 12-month intervals after treatment.
  • Individuals with HIV or those treated with a nonpenicillin regimen should be followed for life yearly after initial first-year follow-up.
  • Know diagnosis and treatment plan.
  • Know medications and potential side effects.
  • Individuals with neurosyphilis need cerebrospinal fluid testing and serologic testing every 6 months for at least 3 years.
  • Call if any complications or adverse effects arise.
  • Follow up with provider, as directed.
  • Resume normal, as tolerated.
  • Maintain well-balanced nutrition, as tolerated.
  • Avoid illicit drugs and high-risk sexual behaviors.
  • Healthcare workers should use universal precautions.
  • IV drug users should never share needles and should only use clean needles.
  • Follow safe sex practices.
  • Call provider or return to medical center if adverse reactions or complications occur.

Pharmacology of Drugs for Sexually Transmitted Infections: Syphilis and Gonorrhea CE Course

1.0 Contact Hour

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The content was created by Kelly LaMonica, DNP, RNC-OB, C-EFM. Kelly LaMonica received her Associate’s Degree and RN from Muhlenberg School of Nursing in New Jersey 20 years ago. She began her career in Labor and Delivery 16 years ago. She earned her BSN and MSN from the University of Phoenix and her DNP from Grand Canyon University. She is certified in Inpatient Obstetrics (C-OB) and Electronic Fetal Monitoring (EFM). She is a neonatal resuscitation (NRP) Instructor. She has been a clinical leader for the past 11 years at Penn Medicine Princeton. She is also a Clinical Instructor at Rutgers University and Chamberlain School of Nursing.



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