Signs and Symptoms of Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the bacteria, Treponema pallidum. You can get the infection from skin-to-skin contact during vaginal, anal, and oral sex with a person with syphilis.

When syphilis is left untreated, the infection can progress through a series of stages: primary, secondary, latent, and tertiary. Each stage of infection causes different symptoms of syphilis. As the bacteria spread throughout your body, the infection can affect several organs—that's why knowing the symptoms and receiving treatment early are so important.

Common Symptoms

Syphilis symptoms develop in stages: primary, secondary, latent, and tertiary. Your symptoms tend to worsen at each stage, progressively affecting different parts of the body as the infection spreads. At any stage, however, syphilis can spread to the:

• Brain and nervous system (neurosyphilis)
• Eyes (ocular syphilis)
• Ears (otosyphilis) 

Primary Stage Symptoms

Generally, symptoms of primary syphilis show up about 10 to 90 days after having sex with someone with a syphilis infection. During this time, you may notice swollen lymph nodes and one or more sores on your:

• Penis
• Vagina
• Anus or rectum
• Lips or inside the mouth

Sores can form at the site of infection, where the first bacteria entered the body. This sore is called a chancre. Chancre sores are usually (but not always) firm and round. They are also painless, so it may be difficult for you to notice at first.

It's important to note that syphilis is very contagious at the primary stage. If you have vaginal, anal, or oral sex during this time, you can easily transmit the infection to your sexual partners.

Keep in mind: chancre sores heal and go away after three to six weeks, regardless of whether you have received treatment. It's important to still receive treatment for syphilis, even after the chancre sores go away. If you don’t receive treatment, the syphilis infection will move into the secondary stage.

Secondary Stage Symptoms

Untreated primary stage syphilis moves into the secondary stage about two to eight weeks after your first chancre sore has healed. At this stage, you may experience a wide variety of symptoms in your body such as:

• Red or reddish-brown rashes on the palms of your hands and the bottoms of your feet
• More chancre sores on your genitals, inside the mouth, throat, or anus
• Sore throat
• Fever
• Weight loss
• Fatigue and weakness
• Patchy hair loss on your scalp, beard, or eyebrows
• Swollen lymph nodes

Like the primary stage, secondary stage syphilis is highly contagious. Rashes and chancre sores contain large amounts of T. pallidum bacteria, making it easy to transmit the infection to your sexual partners.

Similar to primary stage symptoms, secondary stage symptoms will go away on their own even if you don't receive treatment. However, not receiving treatment significantly raises your risk of moving on to the latent or tertiary stages of syphilis.

Latent Stage Symptoms

Without treatment, syphilis can exist in your body for months or a few years without visible symptoms. This is known as the latent or inactive stage. This stage is further divided into:

• Early-latent stage: Initial infection happened within the last 12 months
• Late-latent stage: Initial infection happened more than 12 months ago

It's important for your healthcare provider to know if you are experiencing symptoms during early or late latent stage syphilis. While active symptoms of syphilis are not present during this stage, your provider can order a blood test that can still detect the infection. This helps your provider determine which treatment is best for you and if the infection is transmissible to sexual partners.

Tertiary Stage Symptoms

Thanks to syphilis awareness and screening efforts, most people do not develop tertiary or late stage syphilis. However. symptoms may go unnoticed or may not be present at certain stages, as seen in the latent stage. As a result, tertiary stage syphilis is still possible.

Getting to the tertiary stage of syphilis usually takes many years. However, some people can get to this stage within a year of their initial syphilis infection. Tertiary stage syphilis is severe and damages different organs through:

• Gummas: Deep sores that can eat away at the area where the sores develop, such as the skin, lungs, liver, or bone
• Cardiovascular syphilis: Bacteria spreads to and attacks your heart and blood vessels
• Neurosyphilis: The infection spreads to and damages your nerves, spinal cord, and brain

Unfortunately, syphilis-related damage to the organs can be fatal at the tertiary stage. However, treatment can still stop the infection from worsening. But treatment cannot undo the damage that syphilis has already caused. It's also important to note that syphilis is not contagious during this stage.

When to See a Healthcare Provider

If you notice symptoms of syphilis or recently had sex with a partner who tested positive for the infection, it's good practice to see your healthcare provider to get tested. Talk to your healthcare provider about syphilis testing if you are sexually active and:

• Your sexual partner has symptoms of or tested positive for syphilis or any other STI
• You have unprotected sex
• You have tested positive for another STI

Starting treatment as soon as possible helps prevent or delay the damage that syphilis causes.

A Quick Review

Syphilis is a sexually transmitted infection that you can get through skin-to-skin contact during oral, vaginal, and anal sex. Symptoms of syphilis change as the infection progresses over four stages: primary, secondary, latent, and tertiary.

Common symptoms include chancre sores where the bacteria entered the body–typically occurring on your genitals, mouth, throat, or anus. Without treatment, syphilis can spread to your nerves, brain, spinal cord, heart, and blood vessels. 

If you believe you have syphilis symptoms or may have been exposed to the infection, it's important to get tested and start treatment as soon as you can. Early treatment stops syphilis progression and prevents long-term damage to your body.