How to Identify & Treat Syphilis Sores

Syphilis is a sexually transmitted infection (STI). It is an infection caused by the bacterium Treponema pallidum (T. pallidum). Syphilis cases have steadily climbed since the lowest reported number of new cases in 2000, which accounted for nearly 134,000 new cases that year.

Syphilis is typically transmitted via direct contact with a sore called a chancre. Chancres are usually located in the vagina, anus, genitals, rectum, lips, or mouth. Without treatment, syphilis can progress through different stages, causing significant health problems. Untreated, you can remain contagious and infect other people.

Woman touching her mouth

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Early Signs of Syphilis

Once syphilis is contracted, syphilis symptoms tend to appear within 21 days. However, the range of when symptoms start to appear can be as short as 10 days and as long as 90 days.

Often referred to as the "great pretender" due to appearing similar to many other diseases, syphilis tends to go through four stages. The first stage is as follows:

  • Primary: During the primary stage, the syphilitic sores, known as chancres, develop. The sores are often painless and tend to develop on the genitals, mouth, or inside the vagina or anus. The chancres usually heal within three to six weeks.

It can take weeks, months, or years to progress through all four stages. The secondary stage, latent stage, and tertiary stage will be discussed further down.

What Do Syphilis Sores Look Like?

Syphilis sores are part of the primary stage of a syphilis infection. The chancre is usually firm, round, and located in the area where T. pallidum, entered the body.

The chancre is usually small in size and painless. It often goes unnoticed. It is possible to have multiple chancres, but it is not uncommon for only one chancre to be present.

Where Are Syphilis Sores Located?

Syphilis sores, or chancres, are located where T. pallidum entered the body. Syphilis is mostly transmitted via direct person-to-person contact with the chancre. Sexual activity is the primary method of the direct contact, so chancres typically are located in the mouth, throat, vagina, or anus.

How Long Do Syphilis Sores Last?

Syphilis sores usually appear within 21 days of initial infection. Symptom onset can occur as soon as 10 days or as late as 90 days, though. The chancre or chancres usually last for three to six weeks. Even when a chancre is not present, you can still be contagious and spread the syphilis to others.

Diagnosing Syphilis

Syphilis is detected by an antibody blood test. A healthcare professional will use a small needle and insert it into a vein in the arm. Once inserted, a blood sample is withdrawn and sent to a laboratory for multiple antibody testing.

The blood is tested for several antibodies specific to syphilis. Even after successful treatment, a person previously infected with syphilis can still have detectable antibody levels in the blood. This is why several types of antibody testing are completed to determine if it is a prior infection or new infection.


Treatment is based on your age and the stage of syphilis, as follows:

  • For adolescents and adults in primary, secondary, or early latent syphilis: One dose of benzathine penicillin G (an antibiotic) is administered in the muscle.
  • For adolescents and adults with late latent syphilis or latent syphilis of unknown duration: One dose of benzathine penicillin G is administered in the muscle once a week for 3 weeks.
  • For adults and adolescents with neurosyphilis, ocular syphilis, or otosyphilis: One dose of aqueous crystalline penicillin G is administered through a vein, either every four hours or continuously, over a 10–14 day period of time.
  • Options for people allergic to penicillin, people who are pregnant, and newborns with congenital syphilis: Treatment options vary and should be considered with careful collaboration with a health care professional.

Later Stages of Syphilis

The stages of syphilis after the initial infection and primary stage include:

  • Secondary: Symptoms associated with the secondary stage include a rash, sores in moist areas (such as the mouth, genitals, or anus), fever, fatigue, sore throat, weakness, hair and weight loss, and swollen lymph nodes.
  • Latent: In this stage, all of the symptoms from the secondary stage end, often resulting in the latent, or hidden, stage. You can stay in the latent stage for years. Sometimes people infected with syphilis experience the secondary stage two or more times and then go back to the latent stage for a period of time.
  • Tertiary: In the tertiary, or destructive phase, of syphilis, you will develop gummas, which are sores that grow deep and eat away at the area where they develop, such as the skin, lungs, liver, or bone. You can also develop cardiovascular syphilis, which attacks the heart and blood vessels, or neurosyphilis, which attacks the nerves, spinal cord, and brain. Ultimately, without treatment, syphilis becomes so damaging to the body that it can cause death.


Syphilis is a bacterial infection that is spread by direct contact and is usually transmitted through sexual activity. Once the syphilis bacterium enters the body, you can expect symptoms to appear within 10 to 90 days, most often appearing around day 21.

The primary stage begins with a painless syphilis sore, known as a chancre, at the entry point of the syphilis bacterium and is most often located in the mouth, throat, vagina, or anus. Syphilis will progress through secondary, latent and tertiary stages if not treated.

Finish your entire prescription antibiotic. Even if you do not show symptoms, you remain contagious and can still spread syphilis. Syphilis is diagnosed through a blood test and is treated mostly with penicillin, a type of antibiotic. Even in the tertiary stage, treatment can stop disease progression, although it might not repair damage already done.

A Word From Verywell 

Being told you have a sexually transmitted infection, particularly syphilis, can be overwhelming and create much anxiety. Collaborating with your healthcare provider to ensure early diagnosis and treatment, however, can halt disease progression and restore your health.

Protecting yourself from exposure to sexually transmitted diseases by using condoms can be a proactive method to prevent transmission, but it is important to follow your health care professional's advice on any additional protective methods.

Frequently Asked Questions

  • When do syphilis sores appear?

    Syphilis is contracted by direct person-to-person contact. From the time of direct contact, it typically takes about 21 days for syphilis sores, or chancres, to appear. Some people infected with syphilis can show symptoms as early as 10 days after infection, while others might not show symptoms until around 90 days.

  • Do syphilis sores hurt to touch?

    Syphilis sores (chancres) are often painless. Chancres are usually firm and round and located at the point where the syphilis bacterium entered the body. Syphilis chancres are usually located in the mouth, throat, vagina, or anus.

  • How long do syphilis sores last?

    Chancres, associated with the primary stage of syphilis, often last from 3 to 6 weeks after the initial appearance. Some people infected with syphilis might only have one chancre, while others might have several. Even after the chancre resolves, the person infected with syphilis remains contagious.

3 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.
  1. Centers for Disease Control and Prevention. Syphilis. Updated April 12, 2022.

  2. American Academy of Dermatology. Syphilis. Updated September 11, 2018.

  3. National Institute of Allergy and Infectious Diseases. Syphilis. Updated May 2022.

By Pamela Assid, DNP, RN
Pamela Assid, DNP, RN, is a board-certified nursing specialist with over 25 years of expertise in emergency, pediatric, and leadership roles.