What Are the Early Signs of Syphilis?

Syphilis is a highly contagious sexually transmitted infection (STI) caused by bacteria. The infection goes through four stages, and symptoms vary by stage. In most cases, the first sign of syphilis is the development of sores in the affected area.

This article discusses the signs and symptoms of syphilis infection and how it is diagnosed and treated.

female doctor talking with female patient

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First Signs of Syphilis

Symptoms of syphilis are present during the first two stages of infection, known as the primary and secondary stages. Some symptoms can also develop during the final stage, which is known as the tertiary stage, but this happens long after a person first becomes infected.

Primary Syphilis

The primary stage of syphilis occurs between 10 and 90 days after you contract the infection. During the time before the primary stage, known as the incubation period, symptoms are not present.

When the primary stage begins, one or multiple sores, known as chancres, will develop. These sores will appear in the affected area, usually the genitals, and feel firm or are rubbery to the touch. Syphilis sores are typically painless and roughly 0.5–2 centimeters in diameter. In some cases, lymph nodes near the sores will become enlarged.

The primary stage lasts anywhere from four to 10 weeks, during which time a sore will develop and then heal.

Talking to Your Partner About a Syphilis Diagnosis

If you notice early signs of syphilis and get diagnosed, it’s important to speak to your sexual partners. Gently inform them that you have an STI and are receiving treatment. Give them space to air out how they are feeling, their concerns, and any other worries they may have. Reassure them that syphilis is curable.

Secondary Syphilis

Following the primary stage and after the sores have almost or completely healed, a person will enter the secondary stage of a syphilis infection.

The most notable sign of secondary syphilis is a rash that develops on the palms of the hands and the soles of the feet. The rash will appear flat and red, with areas of raised bumps.

Symptoms that can occur during this stage include:

  • Fever
  • Fatigue
  • Weight loss
  • Hair loss
  • Swollen lymph nodes
  • Muscle aches and pains
  • Wartlike lesions in the affected areas
  • Neurological involvement, also known as neurosyphilis

What Is Neurological Involvement in Syphilis?

Neurological involvement, or neurosyphilis, is marked by symptoms affecting the central nervous system. Although symptoms are not always present in the secondary stage, they can include:

  • Swelling and inflammation of the brain and spinal cord
  • Reduced blood flow to the brain
  • Blood clots
  • Tissue death
  • Hearing loss
  • Ringing in the ears (tinnitus)
  • Inflammation of various parts of the eye

Later Stages of Syphilis 

The later stages of syphilis include the latent and tertiary stages. The symptoms and duration of these stages can vary significantly.

Latent Syphilis

The latent stage of syphilis can occur between three and 12 weeks after the secondary stage. During this time, symptoms disappear completely.

In some people, signs of infection can recur during latency. This typically happens within the first two years of the latent period. The latent period can go on for years.

Tertiary Syphilis

The tertiary stage typically occurs roughly 15–30 years after entering the latency stage.

The signs and symptoms of this late-stage syphilis involve other organ systems within the body. Tertiary syphilis is divided into three categories depending on what part of the body is affected and what signs occur. The categories include:

  • Gummatous: Lesions, known as gummas, begin to develop on the skin and bones. 
  • Cardiovascular: Syphilis that affects the heart tends to cause aortic valve enlargement, which is enlargement of a heart valve that controls blood flow into your aorta, the body's main artery. This can lead to aortic regurgitation, which occurs when the valve doesn’t shut, causing blood to flow back in the wrong direction. 
  • Neurological: The neurological problems that can arise during the tertiary stage are similar to those mentioned previously. Symptoms will vary depending on what part of the brain or spinal cord is affected.

Neurological Complications of Syphilis

Other neurological problems can occur when a person is in the final stage of the disease and has yet to be treated. These effects, which usually are not reversible, include:

When to See a Healthcare Provider

Since syphilis is highly treatable, the best time to see a healthcare provider is before or as soon as you notice any symptoms. This is because proper screening processes for people who are sexually active or at greater risk of contracting syphilis can prevent the disease. Screenings can also catch the first signs early so that treatment can begin quickly.

For example, with syphilis, the initial sign is often a painless bump. Many people won't notice the bump, but a healthcare provider could detect this at a screening and have it tested.

If you do notice any small bumps or other signs of infection, have them checked promptly so you can get get you started on treatment.

Who Is at Risk for Syphilis?

Anyone who is sexually active is at risk for contracting syphilis. However, some may be more susceptible than others. People who have a higher incidence of syphilis include:

  • Men who engage in sexual activities with other men
  • People who are HIV (human immunodeficiency virus) positive
  • People taking HIV prevention medication
  • People who have syphilis-positive partners
  • People who have multiple sexual partners
  • People who have condomless sex

Diagnosis

To diagnose syphilis, healthcare providers will check for any visual signs of the infection and collect a health history. They will also have to conduct a blood test or, in some cases, a spinal test.

The tests used to diagnose syphilis include:

  • Rapid plasma regains (RPRs): This test looks for special proteins in the blood (antibodies) that are created in response to syphilis infection.
  • Venereal disease research laboratory (VDLR): This test also looks for antibodies but can be done using blood or spinal fluid.

If either of these tests comes back positive for syphilis antibodies, more blood tests will be needed to confirm the diagnosis. In some cases, a lab test that specifically looks for syphilis bacteria may be conducted, but they are often used sparingly because they require the use of a specialized lab.

Treatment

Treatment for syphilis is simple and involves taking antibiotics. The sooner you start treatment, the shorter your course of antibiotics will be.

If you have had the infection for less than two years, a penicillin injection can be given once. If you cannot take penicillin, you will take other antibiotics for 10–14 days.

In the event that an infection has gone on for longer than two years, three penicillin injections will be given spread out over the course of three weeks, or oral antibiotics will need to be taken for a period of 28 days.

Why It's Important to Get Treated Early

Since syphilis is curable, getting treated early can help reduce the risk of permanent damage or long-term health issues because of the infection.

Summary

There are four stages of syphilis, and symptoms are unique to each stage. Symptoms include rashes, fever, and fatigue. The first sign of syphilis is one or more small, painless bumps in the affected area. While these usually occur in the genital or anal area, they also can develop in the mouth.

The latency stage will show no symptoms and could last for years. Therefore, it’s important to pay attention to the early signs and get prompt treatment in order to avoid any complications. Testing usually involves a simple blood test, and treatment includes a course of antibiotics.

A Word From Verywell 

Though syphilis is an unpleasant infection, it is curable. But if left untreated, it can lead to irreparable damage to several different organ systems within the body. As a result, it's important to pay attention to the early signs to make sure it's addressed as quickly as possible. Diagnosis and treatment are simple and can protect your health.

Frequently Asked Questions

  • How long does it take to show signs of syphilis?

    The time from initial infection and showing signs can vary significantly. According to research, signs can show up as early as 10 days after the initial infection. However, it can also take as long as three months for any signs to appear.

  • Can syphilis cure itself?

    No. Syphilis will not cure itself. The infection, which goes through stages, requires treatment. One stage is called latency. In it, you will not have symptoms and not be as infectious as when you had an active infection. However, after latency, there is a fourth and final stage that can cause severe health consequences.

  • What are the four stages of syphilis?

    The four stages of syphilis are primary, secondary, latency, and tertiary. Most symptoms appear in the first two stages. The third stage, latency, is marked by a period of no symptoms. The fourth, and final, stage is the worst stage and is marked by severe health issues.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Kamath M, Rizvi M, O'Nions J, Brook G. A complex neurological presentation of syphilis. BMJ Case Rep. 2013;2013:bcr2013200309. doi:10.1136/bcr-2013-200309

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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.