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Syphilis symptoms and stages

The information provided herein does not constitute an expert or medical advice, nor intended to replace such advice.

Sexual Health



Written by Dr. Andrea Pintoon August 17th, 2021

You’ve probably heard about a sexually transmitted disease (STD) called syphilis at some point. But did you know that syphilis symptoms can be categorized into four distinct stages? Learning more about the symptoms and stages of syphilis can help you recognize this condition.

Keep reading to learn more about syphilis symptoms and stages.

What is syphilis?

Syphilis is a sexually transmitted infection (STI) that can be transmitted during oral, vaginal, or anal sex. This condition can also pass from a mother to her baby during pregnancy or childbirth. Although it’s an STI, syphilis can eventually affect practically any system in the human body.

According to the Cleveland Clinic, if left untreated, syphilis can lead to complications that include:

  • Blindness
  • Heart disease
  • Mental health problems
  • Damage to the nervous system

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However, these complications don’t happen overnight after someone contracts syphilis. In fact, the development of the late-stage complications of the disease typically occur after someone has been infected for many years without receiving treatment.

Despite the development of antibiotics and modern testing techniques, syphilis remains a relatively common STI — particularly in the developing world. The Pan American Health Organization (PAHO) estimates that nearly 6 million new cases of syphilis are diagnosed around the world each year. Most cases of syphilis affect teens and adults aged 14 to 49 years old, and it affects all genders equally.

Let’s review each stage of syphilis, its timeline, and the symptoms that a patient may experience during each stage.

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Symptoms of syphilis by stage

Primary syphilis

According to the Mayo Clinic, the first symptoms of syphilis typically appear approximately 3 weeks after infection. This lesion is also known as a chancre, and it’s usually completely painless.

Most patients with syphilis only develop a single chancre, but it’s possible to develop multiple chancres. The chancre appears on the area where the bacteria came into contact with your body, and it’s most commonly seen on the genitals or around the mouth. Sometimes, a syphilitic chancre can be hidden inside the vagina or rectum, or under the foreskin.

In most cases, a syphilis sore or chancre is small, round, and firm; it can also look wet inside. Patients can also notice swollen lymph nodes near the affected area. These sores usually heal on their own anywhere from 3 to 10 weeks after they initially appear.

Secondary syphilis

The secondary stage of syphilis starts 4 to 8 weeks after the chancre goes away. According to the British Medical Journal (BMJ), this happens because the bacteria Treponema pallidum enters the bloodstream and causes a generalized, systemic infection.

Secondary syphilis is characterized by a reddish, bumpy skin rash. This rash typically appears on the trunk at first, but it can quickly spread through the entire body, including the scalp, the palms of the hands, and the soles of the feet. In most cases, this rash doesn’t itch and it goes away on its own without leaving scars. In some cases, the “bumps” can become ulcerated. 

According to the University of Michigan, secondary syphilis can be accompanied by other symptoms, including:

  • Swollen lymph nodes
  • Mouth and/or genital ulcers
  • Fever
  • Fatigue
  • Sore throat
  • Weight loss
  • Patchy hair loss
  • Headaches
  • Irritability

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Latent syphilis

If left untreated, syphilis will then enter a latent stage. During this period, a person can remain completely asymptomatic for many years; however, they could still pass the disease to their partners. According to the CDC, “early latent syphilis” is the timeframe where infection occurred in the past 12 months, while “late latent syphilis” refers to the period where the infection occurred more than 12 months ago.

Some patients can experience a relapse during this stage and experience symptoms of secondary syphilis again. Latent or hidden syphilis can last anywhere from 1 to 20 years.

Tertiary syphilis

Tertiary syphilis is the most serious stage of the disease, and it can affect multiple organs at once. This stage can be fatal if left untreated — but thanks to antibiotics, it’s extremely rare for patients to reach tertiary syphilis.

Tertiary syphilis can lead to severe health problems. According to StatPearls, these complications can include:

  • Cardiovascular syphilis
    • Aortic aneurysm
    • Aortic valvulopathy
  • Neurosyphilis
    • Meningitis
    • Stroke
    • Seizures
    • Dementia
  • Gummatous syphilis
    • Infiltration and failure of any organ

Can syphilis be treated?

The good news is that most cases of syphilis can be treated quite easily with a single round or shot of penicillin. In some cases, a doctor will prescribe several rounds of penicillin to fully cure the infection.

Patients who are allergic to penicillin can receive treatment using alternative antibiotics, or they could undergo penicillin desensitization so they can receive this treatment.

If you’re receiving treatment for syphilis, you should abstain from sex until your sores are completely healed or until your doctor prescribes.  After treatment, you should still continue to practice safe sex; after all, it’s possible to get syphilis or other STDs again. It’s also important to get regular STD testing so you can detect any latent or asymptomatic infections.

You can learn more about syphilis and STD testing through these STDWatch articles:

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Dr. Andrea Pinto Lopez

Dr. Andrea Pinto Lopez

Dec 11, 2022

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