Syphilis vs herpes: symptoms, causes & treatments

Syphilis and herpes are among the most well-known sexually transmitted infections (STIs) worldwide. Syphilis is caused by the bacterium Treponema pallidum, while herpes is caused by the herpes simplex virus (HSV). Syphilis progresses through four stages with varying symptoms, while herpes causes painful blisters and usually has recurring episodes of rashes.

This article explains the differences between syphilis and herpes so that you can better understand what these diseases are, how they present, how to distinguish between them, how they are transmitted, and what you can do to protect yourself. 

Table of contents

• Syphilis and herpes compared
• How can you tell whether it is syphilis or herpes?
• How long does it take for the first symptoms of syphilis and herpes to appear?
• How are syphilis and herpes transmitted?
• Can you be infected with both herpes and syphilis at the same time?
• How are syphilis and herpes diagnosed?
• How are syphilis and herpes treated?
• Are syphilis and herpes curable?
• How can syphilis and herpes be prevented?
• Summary

Syphilis and herpes compared

Syphilis and herpes are sexually transmitted infections (STIs). Syphilis is caused by the bacterium Treponema pallidum and progresses through four stages with different symptoms. Syphilis can be completely cured with antibiotics (CDC, 2024).

Herpes, on the other hand, is caused by the herpes simplex virus (HSV), either HSV-1 or HSV-2, and leads to recurring, painful blisters. Herpes requires antiviral therapy without a complete cure (WHO, 2024).

What are the differences between the symptoms of syphilis and herpes?

Syphilis begins with painless sores (chancres), followed by a rash; herpes causes painful blisters and ulcers, often accompanied by itching and burning. Syphilis develops systemic symptoms, while herpes typically remains locally confined. Both diseases can have recurring outbreaks, but they progress differently and lead to different complications.

Syphilis symptoms

• First signs: Small, firm, painless sores (chancres) at the site of infection. These sores often appear on the genitals, in the rectum, or in the mouth and heal on their own within a few weeks.

• Second phase of infection:

  • Rash (often non-itchy, on the torso, limbs, palms, and soles)

  • Wart-like sores in the mouth or genital area

  • Hair loss

  • Muscle pain

  • Fever

  • Sore throat

  • Fatigue, exhaustion

  • Weight loss

  • Swollen lymph nodes

• Latent stage: No symptoms

• Severe late complications of infection: Damage to the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

Sources: Mayo Clinic, 2024, Cleveland Clinic, 2022. 

Herpes symptoms

Blisters or open sores (ulcers) in or around the mouth or lips (oral herpes), on the genitals, or around the anus (genital herpes). These sores and blisters are usually painful. The blisters can burst, ooze, and crust over. During the initial infection, the following symptoms may occur:

• Fever

• Muscle aches

• Sore throat (oral herpes)

• Headaches

• Swollen lymph nodes near the site of infection

Source: Cleveland Clinic, 2024, WHO, 2024 

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How can you tell whether it is syphilis or herpes?

Distinguishing between syphilis and herpes can be difficult without medical assistance, as the symptoms may appear similar. However, there are some indicators that can help differentiate them:

Sources: Cleveland Clinic, 2022, Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz, 2024, Cleveland Clinic, 2024.

How long does it take for the first symptoms of syphilis and herpes to appear?

Syphilis symptoms typically appear about 21 days after infection. In herpes, symptoms usually occur within 6 to 8 days after exposure. Both infections have different incubation periods, which depend on individual factors such as the immune system and the virulence of the pathogen (WHO, 2024, Cleveland Clinic, 2024).

How are syphilis and herpes transmitted?

Both syphilis and herpes are usually transmitted through direct contact with infected bodily fluids or skin, particularly during oral, anal, or vaginal sex. Both infections can be transmitted even without visible symptoms. Herpes can also be spread through droplet and smear infections, for example, by sharing a glass (Deutsche Aidshilfe, n.d., Deutsche Aidshilfe, n.d.).

Can you be infected with both herpes and syphilis at the same time?

Yes, co-infection with both herpes and syphilis is possible, as both are transmitted through close sexual contact. Additionally, people infected with herpes have a higher risk of contracting other sexually transmitted diseases, as the skin barrier is compromised and pathogens can enter more easily. A co-infection increases the risk of more severe disease progression and requires targeted diagnosis and treatment of both infections (InformedHealth, 2006).

How are syphilis and herpes diagnosed?

Syphilis is diagnosed through blood tests, as well as by taking fluid or tissue from a syphilitic sore and examining it under a microscope (Cleveland Clinic, 2022).

The diagnosis of herpes depends on the type of infection. Herpes is usually detected through a blood test (for antibodies against HSV-1 or HSV-2) or by taking a swab from a sore, which is then analyzed in a lab (Cleveland Clinic, 2024).

How are syphilis and herpes treated?

Syphilis is treated with antibiotics (Penicillin G). In early stages, a single dose is sufficient, while in advanced stages, multiple doses over several weeks are required  (CDC, 2024).

Herpes can be treated short-term during an outbreak with antiviral medications to relieve symptoms. Depending on the type and severity of the infection, these medications are available as tablets, creams, infusions, or eye drops. Drugs such as acyclovir, valacyclovir, or famciclovir are often used for long-term treatment and prevention of frequent or severe outbreaks, especially in cases of genital herpes caused by HSV-2 (Cleveland Clinic, 2024).

Are syphilis and herpes curable?

Syphilis can be completely cured with antibiotics, but if left untreated, it can lead to severe long-term complications. Herpes, on the other hand, is not curable and remains in the body for life. It can be reactivated and cause recurring outbreaks. However, symptoms can be managed. With appropriate treatment, both infections can allow for a normal life expectancy (Cleveland Clinic, 2022, Cleveland Clinic, 2024).

How can syphilis and herpes be prevented?

Syphilis and herpes can be prevented through safer sex practices such as consistent condom use. Limiting the number of sexual partners, open communication, and regular testing also significantly reduce the risk of infection. These tips can help:

1. Use condoms and barrier methods.
2. Limit the number of sexual partners.
3. Open communication.
4. Use regular testing.

Summary

Syphilis and herpes are two widespread sexually transmitted infections. While syphilis is caused by the bacterium Treponema pallidum and can be cured with antibiotics, herpes is a viral infection (caused by the herpes simplex virus, HSV) that is not curable but can be controlled with antiviral medication. The symptoms of syphilis and herpes are similar but differ in their level of pain and appearance. If you have symptoms or suspect that you may have been infected, you should not hesitate to get tested to ensure prompt and effective treatment.