Symptoms of Syphilis

The signs and symptoms of syphilis are related to the stage of the infection. The first involves a painless sore on the genitals, rectum, or mouth. After that heals, the second stage will begin and usually produce a rash. After a long period with no symptoms (stage three), the fourth stage can suddenly develop, causing extensive damage to the brain, nerves, eyes, or heart.

The symptoms of syphilis are often mimic those of other conditions like psoriasis, hemorrhoids, and canker sores. It is for this reason that syphilis is often referred to as the "great imitator." It is also why syphilis infection is often missed and left untreated.

syphilis symptoms
Illustration by Joshua Seong. © Verywell, 2018. 

Primary Syphilis (Stage 1)

Primary syphilis is the first stage of infection. It will typically start with the appearance of an ulcer called a chancre between 10 to 90 days after the initial exposure; the average is 21 days. The sore will develop at the point of contact, most commonly on the cervix, vagina, penis, anus, rectum, or mouth.

There may be one or more lesions ranging in size from an eighth of an inch to an inch or more. Because the sores are painless, they can be missed if they are located internally.

Sometimes swollen lymph nodes can develop near the site of the infection. These are small glands that, among other things, contain white blood cells that help fight infection called lymphocytes.

Without treatment, a chancre will heal in three to six weeks.

Secondary Syphilis (Stage 2)

If left untreated, a primary infection will progress to secondary syphilis. Symptoms typically appear within two to eight weeks of the appearance of the chancre.

During this stage, a person may experience general symptoms of illness such as:

  • Fever
  • Sore throat
  • Fatigue
  • Weight loss
  • Headache
  • Muscle ache

They may also experience symptoms that may be a bit more telling:

  • Unexplained hair loss (syphilitic alopecia)
  • Cracked lesions on the corner of the mouth (fissure cheilitis)
  • Generalized swelling of the lymph nodes
  • Widespread, non-itchy rash on the palms and soles of the feet, the trunk, or the limbs

The appearance of a syphilis rash can vary dramatically. The lesions may be flat or raised, scaly or hive-like, or they can manifest with pus-filled blisters. Regardless, the lesions are highly contagious and can readily pass the disease to others.

Rarely, secondary syphilis affects the liver, kidneys, bones, and central nervous system and may produce associated symptoms and complications.

The symptoms of secondary syphilis typically resolve without treatment within weeks or months.

Latent Syphilis (Stage 3)

Latent syphilis is the third, so-called "hidden" stage of infection. It is marked by the relative absence of symptoms and positive blood tests.

This stage is further divided into two stages:

  • Early latent syphilis is the period within a year of the initial infection. Secondary symptoms can sometimes relapse during the early latent phase.
  • Late latent syphilis is the period a year after the initial infection. It can last for years and even decades with no signs of disease.

While the infection can be passed during the early latent stage, that is less likely during the late latent stage.

Syphilis and HIV

The progression of syphilis may be accelerated when HIV is also contracted at the time of infection—what's known as a co-infection. An open chancre sore provides HIV an easy route into the body. And having HIV and syphilis together increases the risk of late-stage complications, even during the early stages of infection.

Tertiary Syphilis (Stage 4)

Tertiary syphilis is the most serious stage of this infection and it is characterized by three major complications: 

  • Gummatous syphilis causes the formation of soft, tumor-like lesions called gummas. These noncancerous lesions can cause large ulcerative sores on the skin and mouth, and erode tissues of the heart, liver, muscles, bones, and other vital organs. Symptoms typically develop between three and 10 years after a person is first infected.
  • Cardiovascular syphilis can cause severe inflammation of the aorta and swelling and weakening of the aortic wall (aortic aneurysm). It generally occurs 10 to 30 years after the initial infection.
  • Neurosyphilis affects the central nervous system and usually develops within four to 25 years after the initial infection. While some people will not develop symptoms, others may experience severe issues such as meningitis (inflammation of the membrane surrounding the brain and spinal cord) or tabes dorsalis (a condition characterized by nerve pain, loss of motor skills, visual impairment, deafness, and incontinence). Seizures, personality changes, hallucinations, dementia, and stroke can also occur.

While syphilis infection can still be treated during the tertiary stage, any damage caused to the heart, kidneys, and other organs may be permanent and can lead to end-stage organ failure. Treatment is determined by the type and extent of the damage.

Complications in Newborns

Congenital syphilis is a serious condition in which a pregnant mother with syphilis passes T. pallidum—that bacteria that causes the infection—to her developing baby.

Untreated syphilis during pregnancy can sometimes lead to miscarriage or stillbirth.

Of the babies born with syphilis, as many as two-thirds will not have symptoms during the first couple of years of life.

If left untreated, the symptoms may include:

  • Liver and spleen enlargement
  • Purplish skin spots caused by ruptured capillaries (petechiae)
  • Profuse nasal drip with highly infectious mucus discharge (known as syphilitic "snuffles")
  • Neurosyphilis
  • Lung inflammation
  • Yellowing of the skin and eyes (jaundice)
  • Seizures

By age 2, the child may have characteristic facial or physical deformities and significant sensory impairment, including:

  • Blunted upper front teeth (known as Hutchinson's teeth)
  • A collapse of the bony part of the nose (saddle nose)
  • A protruding jawbone and foreshortened upper jaw
  • A protruding frontal bone of the skull (frontal bossing)
  • Swollen knees
  • Bowing of the shin bones (saber shins)
  • Inflammation and scarring of the cornea, the clear cover over the front of the eye (interstitial keratitis)
  • Glaucoma, a disease that damage's the optic nerve and can cause bliness
  • Deafness
  • Developmental delays

Related death in these children is most often caused by bleeding (hemorrhage) in the lung.

When to See a Doctor

Because syphilis symptoms can be missed or misdiagnosed, you need to take action if there's a chance you may have been infected.

If you are or have ever been at risk of sexual exposure—either because of unprotected sex, having multiple partners, or being HIV-positive—you need to consider getting an STD screening test whether you have had symptoms or not.

The resolution of symptoms should never be considered a sign that an infection has cleared or never was. Get tested. Tests are easy and can usually return results within a couple of business days.

Frequently Asked Questions

Is syphilis curable?

Yes, syphilis can be treated and cured with antibiotics. However, associated damage to some parts of your body, such as your kidneys, may not be reversible.

In which stage is syphilis contagious and not contagious?

Syphilis is known to be contagious during the primary, secondary, and early part of the latent stages. It is less contagious during the latter part of the latent stage or when in relapse. Still, it's best to get treated and avoid sexual activity until you are given clearance by your doctor.

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Article 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. Michigan Medicine. Stages of syphilis. Updated February 26, 2020.

  3. Hook E. SyphilisThe Lancet. 2017;389(10078):1550-1557. doi:10.1016/s0140-6736(16)32411-4

  4. Morris SR. Syphilis. Merck Manual Professional Version. Updated July 2019.

  5. Murali MV, Nirmala C, Rao JV. Symptomatic early congenital syphilis: A common but forgotten disease. Case Rep Pediatr. 2012;2012:934634. doi:10.1155/2012/934634

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