Syphilis (sifilis) and STI testing in Malaysia: symptoms, tests, treatment and where to get checked
Syphilis (sifilis, sometimes called raja singa) is a bacterial infection spread mainly through sex. It is easy to cure with antibiotics, but its early signs are easy to miss, and untreated it can damage the brain, eyes, heart and an unborn baby. Malaysia recorded more than 4,600 new syphilis cases in 2022. Here is what to look out for, and how to get tested.
Key points
- Syphilis usually starts with a firm, painless sore where the infection entered, which heals by itself within 3 to 6 weeks even without treatment.
- Weeks later, a non-itchy rash can appear, often on the palms and soles, with fever and swollen glands. Then the infection can stay hidden for years.
- It is diagnosed with blood tests and cured with penicillin injections. One type of test can stay positive for life even after cure.
- Gonorrhoea and chlamydia often cause no symptoms, especially in women, but can cause infertility. They are found with a urine test or swab.
- You can get a confidential STI test at government health clinics and private GP clinics. Partners need testing and treatment too.
Syphilis and STIs in Malaysia
In 2022, Malaysia recorded 4,669 new cases of syphilis and 1,819 of gonorrhoea, according to figures given to Parliament by the Health Minister. About 1 in 15 syphilis cases and more than 1 in 5 gonorrhoea cases were in people under 21. Both are notifiable diseases under the Prevention and Control of Infectious Diseases Act 1988, so doctors must report cases to the Ministry of Health, which keeps them confidential.
Malaysia screens almost all pregnant women for syphilis and HIV. In October 2026 it kept its World Health Organization validation for eliminating mother-to-child transmission of both infections, which it first achieved in 2018, the first country in the Western Pacific to do so.
Syphilis symptoms by stage
Symptoms usually start about 3 weeks after infection, but can take anywhere from 10 days to 3 months.
| Stage | What happens |
|---|---|
| Primary | A firm, round, usually painless sore (chancre) on the penis, vagina, anus or mouth. It is easy to miss and heals by itself in 3 to 6 weeks, but the infection remains. |
| Secondary | A few weeks to months later: a rash that usually doesn’t itch, often on the palms of the hands and soles of the feet, with fever, tiredness, swollen glands, sore throat or patchy hair loss. It also clears without treatment. |
| Latent | No symptoms, sometimes for many years. Many people stay in this stage for life, but can still pass syphilis to a baby during pregnancy. |
| Tertiary | 10 to 30 years later in some untreated people: damage to the heart, brain, nerves and other organs. |
At any stage, syphilis can spread to the brain and nerves (neurosyphilis), the eyes or the ears. Get help urgently for sudden changes in vision or hearing, a severe headache, confusion or weakness.
Syphilis is most infectious in the first two stages, through direct contact with the sore or rash during vaginal, anal or oral sex.
Syphilis tests and what they mean
Syphilis is diagnosed with a blood test. Two kinds are used together:
- Treponemal tests (such as TPHA, TPPA or an EIA test) detect antibodies to the syphilis bacterium. Once positive, they usually stay positive for life, even after successful treatment. A positive result on its own can mean a past, treated infection.
- Non-treponemal tests (VDRL or RPR) measure how active the infection is. The level falls after treatment, so doctors use it to check that treatment has worked.
Rapid tests using a finger-prick of blood give a result within minutes, so treatment can sometimes start on the same visit.
Timing: antibodies may not show up until a few weeks after infection. If you test soon after a risk and the result is negative, the doctor may ask you to repeat it later. If you have a sore, the doctor may also test the sore itself.
Anyone with syphilis should also be tested for HIV, as the two often go together. See our guide to HIV testing, PrEP and treatment.
Syphilis treatment
Under the Ministry of Health’s antibiotic guideline:
- Early syphilis (infected within about the past 2 years) is treated with a single injection of benzathine penicillin.
- Late or latent syphilis of unknown duration needs one injection a week for 3 weeks.
- People allergic to penicillin can take doxycycline tablets for 2 to 4 weeks, except in pregnancy, when penicillin is needed.
- Neurosyphilis is treated in hospital with penicillin through a drip.
Some people get a fever, headache and aches within a day of the first injection, as the bacteria die. This settles within a day and isn’t an allergy.
After treatment:
- Don’t have sex until you and your partner have finished treatment and the sore or rash has gone. The NHS advises waiting 2 weeks after treatment ends.
- Go back for repeat blood tests, usually at 6 and 12 months, to make sure the infection has cleared.
- Recent sexual partners need testing and treatment, even if they feel well. The clinic can help you tell them.
- Treatment doesn’t make you immune. You can catch syphilis again.
Gonorrhoea and chlamydia
These are the other common bacterial STIs. Both are often silent, especially in women.
| Gonorrhoea (kencing nanah) | Chlamydia | |
|---|---|---|
| Typical symptoms | Pus-like discharge from the penis and burning when passing urine in men. Most women have no symptoms, or unusual discharge. | Often none. Sometimes discharge, burning when passing urine, bleeding after sex or pain in the testicles. |
| Test | Urine test for men, or a swab, which women can often take themselves | Urine test or swab |
| Treatment | An antibiotic injection (ceftriaxone) | A course of antibiotic tablets |
- Untreated, both can cause pelvic inflammatory disease, ectopic pregnancy and infertility, and can be passed to a baby at birth.
- Throat and rectal infections are common and usually cause no symptoms, so tell the doctor what kind of sex you have had, so they can test the right places.
- Gonorrhoea is becoming resistant to antibiotics, including in Southeast Asia. Don’t take leftover antibiotics or buy them without a prescription: see a doctor and go back for a test of cure if advised.
Where to get a confidential STI test in Malaysia
- Government health clinics (Klinik Kesihatan): outpatient fees for Malaysians are very low. Many clinics test for syphilis and HIV, and some offer free HIV PrEP.
- Private GP clinics: you can usually be seen quickly, including in the evening. Ask for an “STI screen” and say which infections you want tested.
- Community and NGO clinics offer testing and support in some cities, and HIV self-test kits are sold at pharmacies.
Confidentiality: doctors must keep your medical information confidential. Notifying the Ministry of Health is for public health and isn’t shared with your employer or family.
Who should test, and when:
- anyone with symptoms such as a sore, rash, discharge or burning
- after condomless sex with a new or casual partner
- if a partner has an STI
- at least yearly if you have several partners, and every 3 to 6 months for men who have sex with men at higher risk
- in pregnancy, at the first antenatal visit, which is routine in Malaysia
Prevention
- Use condoms every time, for vaginal, anal and oral sex. They greatly reduce, but don’t remove, the risk of syphilis, as sores can be on skin a condom doesn’t cover.
- Test regularly if you have new or several partners, and encourage partners to test.
- HIV PrEP prevents HIV but not other STIs, so regular STI testing is part of PrEP care.
- In May 2026 the World Health Organization recommended doxy-PEP, a dose of doxycycline after sex, for some men who have sex with men and transgender women at high risk. It isn’t part of Ministry of Health policy in Malaysia, so discuss it with a doctor rather than self-medicating.
- The hepatitis B and HPV vaccines protect against two other sexually transmitted infections. See our guides to hepatitis B and the HPV vaccine.
Where to get an STI test
GP clinics can test for syphilis, HIV, gonorrhoea and chlamydia, and treat most infections on the spot. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open late and at weekends if you’d rather not take time off work.
Browse the clinic directoryFrequently asked questions
What are the first signs of syphilis?
Usually a firm, painless sore on the genitals, anus or mouth about 3 weeks after infection. It heals on its own, but the infection remains and needs treatment.
What does a syphilis rash look like?
A rash that usually doesn’t itch, often on the palms and soles, sometimes with fever, swollen glands and patchy hair loss. It appears weeks to months after the sore.
Can syphilis be cured?
Yes. Penicillin injections cure syphilis. Damage already done in late syphilis may not reverse, which is why early testing matters.
What does a positive TPHA test mean?
It shows you have had syphilis at some point. It usually stays positive for life, even after cure, so doctors use it together with a VDRL or RPR test to tell whether the infection is active.
Where can I get an STI test in Malaysia?
At government health clinics, private GP clinics and some community clinics. Testing is confidential.
What are the symptoms of gonorrhoea (kencing nanah)?
Men often have pus-like discharge and burning when passing urine. Most women have no symptoms. It is diagnosed with a urine test or swab.
Can I have chlamydia without symptoms?
Yes, most people with chlamydia have no symptoms. Untreated, it can cause infertility, so test after condomless sex with a new partner.
Do I need to tell my partner?
Yes. Recent partners need testing and treatment, or you can be reinfected. The clinic can help you tell them.
Sources
- CodeBlue — Youths below 21 comprised 22% of gonorrhoea cases in 2022 in Malaysia (Jun 2023)
- The Star — Malaysia retains WHO validation for eliminating mother-to-child HIV, syphilis transmission (19 Oct 2026)
- Ministry of Health Malaysia — National Antimicrobial Guideline: sexually transmitted infections
- World Health Organization — Syphilis fact sheet (May 2025)
- US CDC — About syphilis (Jan 2025)
- US CDC — Laboratory recommendations for syphilis testing (MMWR, Feb 2024)
- NHS — Syphilis (reviewed Mar 2026)
- World Health Organization — Gonorrhoea fact sheet (Oct 2025)
- World Health Organization — Chlamydia fact sheet (Nov 2025)
- World Health Organization — First recommendation on doxycycline post-exposure prophylaxis (28 May 2026)
