Syphilis Lesions: Everything You Need to Know

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Syphilis is a sexually transmitted infection (STI) that causes lesions (abnormal areas of tissue) to develop in the affected area. In the case of syphilis, these lesions appear as sores or chancres. The STI has four stages and will present differently at each stage.

This article discusses the lesions at each stage of a syphilis infection.

A serious healthcare provider asks older adult about their symptoms.

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Types of Syphilis Lesions at Each Stage

Throughout a syphilis infection, the STI will go through various stages if left untreated. At each stage, lesions or sores may develop. The way they look varies depending on the stage.

Primary Stage

The primary stage of syphilis is the first stage of infection. During this stage, a single firm and usually painless sore will develop in the area where the syphilis bacteria entered the body.

The sore will be less than 2 centimeters in diameter. In some cases, the sore will ooze fluid containing more of the syphilis bacteria. Sores usually last three to six weeks and heal on their own. However, treatment is still needed to prevent it from moving to the secondary stage.

People may notice the sore roughly 10 to 90 days after they contracted the bacteria. The most common timeline for being exposed to the bacteria and developing the sore is three weeks.

Secondary Stage

If left untreated, syphilis will advance to the secondary stage. This typically occurs roughly two weeks to six months after they were first exposed to the bacteria. In some cases, the secondary stage will develop eight weeks after the first sore occurs or while the sore is still healing.

The lesions that develop during the secondary stage are small, open, and can sometimes mimic warts. While the primary sore is localized to the spot where the infection entered the body, secondary syphilis lesions often develop in the mouth, nose, and other mucous membranes, including the vagina and anus. These sores are called condylomata lata.

A rash will usually also develop during this stage. The rash will often appear reddish-brown, usually doesn't itch, and may have skin sores smaller than 2 centimeters. The sores that develop with the rash could be flat or raised and are typically solid to the touch.

This rash tends to pop up on the soles of the feet and palms of the hands. That said, it can appear anywhere on the body.

Other Symptoms of Secondary Syphilis

During the secondary stage of syphilis, other symptoms may appear along with the sores, such as:

  • Alopecia
  • Fever
  • Headaches
  • A feeling of general unwellness
  • Neck stiffness
  • Weight loss
  • Swollen lymph nodes
  • Muscle aches
  • Fatigue
  • Sore throat
  • Irritability
  • Paralysis
  • Pain or redness of the eyes
  • Memory changes 

Tertiary Stage

The tertiary stage is considered late-stage syphilis and occurs in people who left the infection untreated. This stage can come on anywhere from one to 46 years after a person first contracts the bacteria and is considered the most harmful stage of syphilis.

Tertiary syphilis sores are much larger than those found in the first two stages and can form inside the body and on the skin. They are called gummata. At first, these sores look like superficial nodules or ulcers. However, over time, they develop into masses that resemble tumors.

These masses occur when the immune system cannot get rid of the syphilis bacteria, and clumps of cells begin to form. When the tissue that makes up these lesions dies, it is called necrotic.

Types of Tertiary Syphilis

There are three types of tertiary syphilis: gummatous, cardiovascular, and neurological. The one that develops with sores is called gummatous. Cardiovascular syphilis affects the heart and cardiovascular system, and neurological syphilis affects the brain and nervous system. Neurological syphilis is often considered the most detrimental because it can cause irreversible damage to the brain.  

Latent Phases

Latent phases refer to periods of time when the infection is inactive within the body, meaning that there are no symptoms present.

Typically, the latent phase can last anywhere from one to 20 years after the secondary stage. The latent period may not present with any symptoms, but a person can still transmit the infection to others.

The tertiary stage is most likely to follow the latent phase.

Other Types of Syphilis

Other types of syphilis like neurosyphilis and ocular syphilis can occur at any stage. Neurosyphilis is when a syphilis infection spreads to the brain and spinal cord, and ocular syphilis is when a syphilis infection spreads to the eyes.

Diagnosing Syphilis

Diagnosing syphilis requires a blood test. This is because, while the physical symptoms can be examined, they can sometimes mimic other health disorders.

Often times during the primary stage, a negative result will come back from a blood test in people with the symptoms of syphilis. When this does occur, it is advised that tests be retaken in two to four weeks.

Other Conditions With Similar Symptoms

Syphilis is notoriously difficult to diagnose because it can mimic other types of diseases. Some conditions or health issues that have similar lesions as syphilis include genital herpes and chancroids.

These conditions are easily mistaken during the primary stage. During the secondary stage, the infection can mimic:

Similar Conditions to Tertiary Syphilis

Cognitive symptoms such as memory loss are common in neurosyphilis. Because of this, other neurological disorders such as dementia or stroke could be suspected. This is especially true for people who are unaware they have this STI.

Treatment

Since bacteria cause syphilis, the first-line treatment is antibiotics—specifically penicillin. Other antibiotics such as doxycycline and ceftriaxone can be used in people that have an allergy to penicillin.

The duration of antibiotic treatment and how a person has to take them varies depending on which stage they are in. For primary, secondary, and early latent disease, treatments include:  

  • One single-dose penicillin injection into a muscle
  • Oral Doxycycline is taken twice a day for two weeks
  • Ceftriaxone, as determined in consultation with specialists

For late-latent disease, the treatments required are stronger and more lengthy. They are:

  • Three separate penicillin injections are given once per week for three weeks
  • Oral doxycycline is taken twice a day for 28 days
  • Ceftriaxone is taken once per day for 10 days, either as a muscle injection or through an intravenous needle directly into the bloodstream.

Who Should be Tested for Syphilis

People that should get tested for syphilis include:

  • People who have just become pregnant
  • Men who have sex with other men
  • People who have condomless oral, anal, or vaginal sex with multiple partners
  • People who have engaged in sexual activity with a person who has a known case of syphilis

Summary

Syphilis is an STI that presents with various types of lesions and symptoms depending on the stage. The infection typically goes through four stages, with the first displaying a single sore in the area where bacteria entered the body and the second showing multiple sores on various body parts.

The latent stages mark a period of infection inactivity, so a person in this stage will not develop any symptoms or sores. However, larger sores that look like ulcers can form inside the body and on the skin if the infection progresses to the tertiary stage. People who suspect syphilis should get tested because it is highly treatable with antibiotics and can mimic other conditions.

A Word From Verywell 

Getting a syphilis diagnosis can be scary, especially when you know the risks involved in an untreated case. The good thing is that once you get diagnosed, you can treat the infection and rid it from your body, eliminating the chances it will develop into a more serious disease. If you're at increased risk for syphilis, get tested even if you don't have symptoms.

Paying attention to any sores, even if they are small and painless, is the best way to catch the STI early and get treated for it promptly.

Frequently Asked Questions

  • Can syphilis lesions be painful?

    The initial symptom of primary syphilis is one single lesion. These initial lesions are painless, which is why many people overlook the sore. As the infection progresses into the secondary stage, other painless sores also develop. While pain is possible, it is not a common trait of syphilis lesions.

  • What is the classic skin lesion of primary syphilis?

    The skin lesion found in primary syphilis is small, painless, and develops in the area the bacteria entered the body. Also referred to as a chancre or ulcer, this small lesion is often missed because it doesn’t present with any soreness. The sore will also be firm to the touch and can ooze fluid.

  • Can you get syphilis on your face?

    The most common areas of the body where you can get syphilis include the genitals and the anal region. That is because the infection is spread through sexual activity. However, in some rare instances, lesions can develop on the face, most notably, the tongue.

11 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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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.