12 April 23

Ending HIV

What is the difference between syphilis and gonorrhoea?

Did you know that syphilis and gonorrhoea are two of the most common Sexually Transmitted Infections (STIs) among guys who have sex with guys? While they share some similarities, they are two different and unique STIs.

It’s good to know how syphilis or gonorrhoea differ so you know what to look out for, and in case you have a suspected infection, you know what to do and expect.

Similarities between syphilis and gonorrhoea

Before we examine some of the differences, let’s cover their similarities.

Syphilis and gonorrhoea are bacterial infections

Both STIs are caused by bacteria — although the types of bacteria differ. Bacterium Treponema Pallidum causes syphilis, and Neisseria Gonorrhoeae Bacterium causes gonorrhoea.

Syphilis and gonorrhoea can be prevented by condoms

Syphilis and gonorrhoea transmission can both be minimised through the wearing of condoms, as they reduce skin-to-skin contact and help to stop bodily fluids from the anus, mouth, penis or front hole from being shared.

Syphilis and gonorrhoea are both curable STIs

While the treatment for syphilis and gonorrhoea differs, the good news is that they are both curable STIs. But once cured, it is possible to be reinfected, which is why taking safe sex precautions and testing is crucial.

Differences between syphilis and gonorrhoea

There are several differences between syphilis and gonorrhoea when it comes to transmission, symptoms and treatment.

Modes of transmission

Syphilis and gonorrhoea are both transmitted by sex; however, their modes of transmission are different. Syphilis transmission most commonly occurs by skin-to-skin contact with sores (known as “chancres”), usually found on your genitals, arse, mouth, lips or skin.

Gonorrhoea is primarily transmitted during sex by infected fluids such as semen, precum and front hole fluids.

Symptoms of syphilis and gonorrhoea

Syphilis and gonorrhoea have different symptoms, which can help identify them.

 Symptoms of syphilis occur in stages and include:

• A visible sore, called a “chancre”, forms during the primary stage of syphilis, usually around three weeks after infection. These are generally firm, round and painless, appearing in the anus, on the penis, front hole, balls, or sometimes on or around the mouth.
• Rashes on the palms of the hands, soles of the feet, or other body parts can appear during the secondary stage. You might also get some cold or flu-like symptoms.
• In the latent stage, it’s likely no symptoms will be experienced at all, and this stage can last indefinitely if left untreated. If syphilis is left untreated for a long time, it can cause serious health issues, affecting your heart, brain, nerves and bones. This is very rare nowadays with access to testing and treatment.

Symptoms of gonorrhoea appear differently and do not include any visible sores/chancres. Here is what you can expect if you do get symptoms:

• Swelling or pain in or near the scrotum
• Itchiness and pain during bowel movements
• Discharge or bleeding from your rectum
• An unusual discharge from the urethra (penis or front hole)
• Pain or burning when urinating
• Swelling or redness near the tip of your penis

It’s also possible to get gonorrhoea in your eyes, in which case the symptoms are usually pain and discharge from your eyes.

You do not need to experience all these symptoms to have a gonorrhoea infection, and if you suspect you may have it, the only way to know is to get tested!

Testing for syphilis and gonorrhoea

Syphilis is usually tested via a blood sample but can be tested by swabbing any visible ulcers/sores.

Gonorrhoea is generally tested by taking a urine sample, throat swab, and anal swab.

Treatment of syphilis and gonorrhoea

Treatment for syphilis and gonorrhoea can differ depending on your circumstances and will be directed by your doctor.

Generally, syphilis is treated with one or two penicillin injections (usually in the buttocks).

Gonorrhoea is usually treated with a course of antibiotics such as azithromycin.

Currently, there is a trial for a gonorrhoea vaccine called GoGoVax. Find out more about the trial here.

Can you have syphilis and gonorrhoea at the same time?

Yes, it’s possible to have syphilis and gonorrhoea simultaneously. When you have multiple STIs, this is known as co-infection. Your doctor or healthcare professional will advise what treatment plan is best based on your circumstances.

Get tested regularly and know your status

If you’re a guy who has sex with guys and you’re sexually active, you should test for HIV and other STIs every three months. If you ever need a reminder, sign up for our remind me service, which sends you an SMS text or email when you are next due for a test.

Not sure where to get tested? Loads of sexual health clinics across NSW offer confidential STI testing and treatment.  Find your closest sexual health clinic or testing site here.