Syphilis Symptoms

Syphilis usually presents as a sore on the genitals; the sore develops, on average, 3 weeks after a person is infected. The sore (called a chancre) heals in 3 – 6 weeks even if a person doesn’t get treatment. If left untreated, syphilis can progress, causing serious health problems.

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What is Syphilis?

Medically reviewed by Amy Cyr, MD
Reviewed on October 11, 2019

Syphilis is a sexually transmitted disease (STD), caused by the bacterium Treponema pallidum. In recent years, the rate of infection has been increasing, especially among men who have sex with men.

Untreated syphilis can cause severe health problems in men and women, even years after they were infected. Routine screening is recommended for people at high risk of syphilis exposure, including men who have sex with men and people with HIV.

How is Syphilis Prevented?

Syphilis is commonly spread through sexual activity, including vaginal, oral, and anal sex. Because many people don’t have symptoms, it is important to practice safer sex with partners. This can involve the use of condoms and dental dams, limiting the number of sexual partners, being in a mutually monogamous relationship, or even abstaining from sex altogether. 

If you were treated for syphilis, make sure your partners are, too. If they are not, they can re-infect you.  t is also important to abstain from sexual activity until your treatment is done and all the syphilitic sores are gone.

If you are aware that your partner has syphilis, avoid sexual contact with them until they are finished with their treatment and their sores are completely gone. You should be tested and treated, too. Even if you were exposed to syphilis more than 90 days ago, you should be tested and may need to be treated.

What do Syphilis Symptoms Look Like?

Syphilis symptoms depend on the disease stage, and many of the symptoms are easy to mistake for other diseases. Syphilis symptoms can come and go, and some people show no symptoms at all or not until many years later. This is one of the reasons syphilis is so common: People aren’t aware they are carrying the bacteria but can spread it from one sexual partner to the next.

Primary Stage Syphilis Symptoms

The first symptom of syphilis is usually the development of a sore (called a chancre). Chancres are round and painless and usually develop several weeks after a person is infected. Infected people may have one or more chancres. Chancres are contagious and contact with them can spread syphilis.

Chancres can develop in a variety of areas on the body, but usually appear on the genitals, including the vagina, vulva, penis, scrotum, and anus. They can also appear around the mouth. Because they are not painful and can develop in hidden places, they may be difficult to notice.

Chancres tend to last 3 – 6 weeks, going away on their own, even without treatment. The infection remains, though, and without treatment the infection will get worse and people enter the secondary stage of infection.

Secondary Stage Syphilis Symptoms

The secondary stage of syphilis develops as the chancre is healing or weeks later. The main symptom is a rash. This rash can be located on any part of the body, including the palms of the hands and the soles of the feet. These rashes can be difficult to see and will not itch. It may be accompanied by wart-like spots on the genitals or around the mouth.  

In the secondary stage of syphilis, people may also develop flu-like symptoms, including fever, fatigue, sore throat, muscle aches, headaches, swollen glands, weight loss, and hair loss. Like the chancre, these symptoms will resolve over a period of weeks to months, even without treatment, but the infection is still there. People with syphilis are very contagious during this stage.  

Latent Stage Syphilis Symptoms

Although primary and secondary stage syphilis symptoms will resolve on their own, the infection remains latent, or hidden in the body. The infection may persist for months and even years without causing any symptoms. The infection is not contagious during the latent stage.

Tertiary or Late Stage Syphilis Symptoms

Some people with latent syphilis will progress to the tertiary (late) stage, often many years later.  Tertiary syphilis can damage the nervous system, heart, joints, liver, blood vessels, eyes, and may even cause death.

What Can I Expect When I Get Tested for Syphilis?

Getting tested for syphilis is easy. All that is required is a blood sample, which will be used to look for the antibodies (made by the immune system) associated with a syphilis infection. Finding syphilis antibodies can indicate that the body has been fighting such an infection.

If your test shows that you are infected with syphilis, you should also be tested for HIV. Having syphilis sores makes it easier for HIV to enter the body.

What Can I Expect From Syphilis Treatment?

A single injection of the antibiotic penicillin is the standard treatment for primary and secondary syphilis. After receiving the antibiotic, some people develop a flu-like reaction, with fever, chills, aches, and headache. This typically goes away within a day. People with latent syphilis who have been infected for less than a year also receive a single injection of penicillin; people with latent syphilis for more than a year require more doses of penicillin. Tertiary syphilis treatment also includes antibiotics but the specific treatment depends on what complications a person has. You should be re-tested for syphilis 6 – 12 months after treatment, to make sure the infection is gone.

You should avoid sexual contact if you suspect or are known to have syphilis.  Do not resume sexual activity until your treatment is complete and any chancres or rashes have resolved.

It is also important to notify your sexual partners if you suspect you have syphilis or if you have been diagnosed with it. Any sexual partners you had in the past 90 days should be tested and treated. Partners with whom you had sexual activity more than 90 days ago also need to be tested. In some states, partners can be treated without being tested or seen by a provider.

How Will Syphilis Affect My Pregnancy?

Syphilis can be spread from a mother to her baby during pregnancy or delivery, causing miscarriage, stillbirth, and death of the infant even after delivery. It is recommended that all pregnant women be tested for syphilis. If you do get treated during your pregnancy, your doctor will want to retest you to make sure the infection is gone.

Sources: ACOG.orgCDCCDC-2Mayo ClinicACOG.org-2

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