Table of ContentsView AllTable of ContentsPrimary SyphilisSecondary SyphilisLatent SyphilisTertiary SyphilisSymptoms in NewbornsFAQsNext in Syphilis GuideHow Syphilis Is Diagnosed
Table of ContentsView All
View All
Table of Contents
Primary Syphilis
Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
Symptoms in Newborns
FAQs
Next in Syphilis Guide
The signs and symptoms ofsyphilisvary based on the stage of the infection. There are four stages in all, each with distinct features. Some symptoms are “classic,” meaning clear signs of the disease, while others are non-specific and easily confused for other conditions.
Because syphilis mimics symptoms of other conditions, such ascanker sores,herpes, andLyme disease, it is often referred to as the “great imitator.” This accounts for why many cases are missed until the disease is advanced and symptoms turn severe.
This article lists the symptoms of each stage of thissexually transmitted infection (STI)as well as the signs and complications in children born with syphilis.
Verywell / Joshua Seong
Primary syphilis is the first stage that occurs soon after exposure toTreponema pallidum,the bacteria that cause the condition. The classic sign is a painless skin ulcer, called achancre, that appears at the point of sexual contact, most often thecervix,vagina,penis, anus, rectum, or mouth. This can show up 10 to 90 days after exposure, though the average is 21 days.
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 inside the rectum or vagina.
Lymph nodesnearest the chancre may also be swollen. This is a sign that the body is fighting the infection. Withouttreatment, a chancre will heal within three to six weeks.
Chancre SoresThe classic sign of primary syphilis is a skin ulcer, called a chancre, that typically appears on the genitals, anus, rectum, or mouth. Without treatment, the sore will heal in three to six weeks.
Chancre Sores
The classic sign of primary syphilis is a skin ulcer, called a chancre, that typically appears on the genitals, anus, rectum, or mouth. Without treatment, the sore will heal in three to six weeks.
How Syphilis Is Diagnosed
If left untreated, primary syphilis will progress to secondary syphilis. Symptoms most often appear within four to 10 weeks after the primary infection.
Secondary syphilis typically starts with a non-itchy rash on one or more parts of the body. This rash can start while the chancre is still healing or after it has healed. A classic sign is the appearance of red or reddish-brown spots on the palms of the hands and soles of the feet.
The rash on other parts of the body can vary in appearance—ranging fromhivesto pus-filled blisters—or be so faint that you can hardly see it. There may even be whitish, wart-like lesions, calledcondyloma lata, on moist parts of the body like the groin or armpits.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet New Zealand and © Dr. Richard Ashtonwww.dermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNet New Zealand and © Dr. Richard Ashtonwww.dermnetnz.org2023.
Another telltale sign is unexplained hair loss, referred to assyphilitic alopecia.
During this stage of infection, other symptoms may include:
The symptoms usually resolve without treatment within weeks or months.Studies have shown that 40% to 85% of people with vaginas and 20% to 65% of people with penises who have secondary syphilis do not recall having a chancre.
Secondary SyphilisSecondary syphilis typically starts with a rash on one or more parts of the body. The rash can vary from person to person, but a “classic” sign is the appearance of red to reddish-brown spots on both the palms of the hands and soles of the feet.
Secondary syphilis typically starts with a rash on one or more parts of the body. The rash can vary from person to person, but a “classic” sign is the appearance of red to reddish-brown spots on both the palms of the hands and soles of the feet.
Latent syphilis is the third stage of infection. This “hidden” stage is noted for having few or no signs or symptoms.
The latent stage is further divided into two sub-stages:
While syphilis can be passed to another person during the early latent stage, it is less likely to be passed during the late latent stage.
How Is Syphilis Transmitted?
Tertiary syphilis is the most serious stage, as it can affect multiple organs. It tends to start 10 to 30 years after you have been infected and can be fatal.Between 15% and 40% who don’t get treatment will develop tertiary syphilis.
While syphilis can still be treated during the tertiary stage, any damage caused to the heart, kidneys, and other major organs may be permanent and can lead to end-stage organ failure.
There are three major complications of tertiary syphilis:
Gummatous Syphilis
Gummas can grow to a considerable size, causing major damage to organs. It can also cause open sores on the skin and mouth that resembletuberculosis.
Cardiovascular Syphilis
Cardiovascular syphilis is a complication that affects the heart and blood vessels. It causes severe inflammation of theaorta, the main vessel that carries blood from the heart, causing it to swell and weaken. This can result in anaortic aneurysmin which the aorta bulges to a point where it can spontaneously burst.
Neurosyphilis
Neurosyphilisaffects thecentral nervous system. While some people will not have any symptoms of neurosyphilis, others may develop serious issues such as:
Seizures, personality changes, hallucinations,dementia, and stroke are among the possible symptoms of neurosyphilis.
Tertiary SyphilisTertiary syphilis is the most advanced stage of the disease and one that can affect the heart, skin, bones, brain, and other organ systems. While the infection can still be treated, any damage to major organs may be permanent and lead to organ failure and death.
Tertiary syphilis is the most advanced stage of the disease and one that can affect the heart, skin, bones, brain, and other organ systems. While the infection can still be treated, any damage to major organs may be permanent and lead to organ failure and death.
Complications in Newborns
Congenital syphilis is a serious condition in which a pregnant person with syphilis passes the infection to the developing fetus.
As many as two-thirds of babies born with syphilis will not have symptoms during the first two years of life. Of those who do, symptoms may include:
By age 2, the child may start to develop physical deformities and other severe complications if not treated. This may include:
Syphilis in ChildrenMost children with congenital syphilis will not have symptoms for the first two years of life. After age 2, the child may start to develop physical deformities, impaired vision and hearing, and developmental delays if not treated.
Syphilis in Children
Most children with congenital syphilis will not have symptoms for the first two years of life. After age 2, the child may start to develop physical deformities, impaired vision and hearing, and developmental delays if not treated.
How Syphilis Is Treated
Summary
The most advanced stage is tertiary syphilis, which can affect multiple organs, including the skin, heart, brain, bones, and liver. While syphilis can still be treated at this stage, there is an increased risk of permanent organ damage and organ failure.
Children born with congenital syphilis may not have any symptoms at first but then start to develop physical deformities, impaired hearing and vision, and developmental delays if not treated.
A Word From Verywell
Because syphilis symptoms can be missed, you need to take action if there is a chance you may have been infected. If you have ever been at risk of exposure—either because of condomless sex or having multiple sex partners—you should consider getting anSTI testwhether you’ve ever had symptoms or not.
For some key populations, such asmen who have sex with men (MSM)andpeople living with HIV, syphilis screening may be advised every three months rather than annually.
Frequently Asked Questions
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.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Syphilis - CDC fact sheet (detailed).Klausner JD.The great imitator revealed: syphilis.Top Antivir Med.2019;27(2):71–74.Michigan Medicine.Stages of syphilis.Tudor ME, Al Aboud AM, Gossman W.Syphilis. In:StatPearls [Internet].Hook E.Syphilis.Lancet. 2017;389(10078):1550-1557. doi:10.1016/s0140-6736(16)32411-4Mullooly C, Higgins SP.Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy.Int J STD AIDS. 2010;21(8):537–545. doi:10.1258/ijsa.2010.010243O’Byrne P, MacPherson P.Syphilis.BMJ. 2019;28:365:l4159. doi:10.1136/bmj.l4159Peeling RW, Mabey D, Lamb ML, Chen XS, Radolf JD, Benzaken AS.Syphilis.Nat Rev Dis Primers. 2017;3:17073. doi:10.1038/nrdp.2017.73MedlinePlus.Gumma.Murali MV, Nirmala C, Rao JV.Symptomatic early congenital syphilis: a common but forgotten disease.Case Rep Pediatr. 2012;2012:934634. doi:10.1155/2012/934634U.S. Preventive Services Task Force.Final recommendation statement: syphilis infection in nonpregnant adults and adolescents: screening.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Syphilis - CDC fact sheet (detailed).Klausner JD.The great imitator revealed: syphilis.Top Antivir Med.2019;27(2):71–74.Michigan Medicine.Stages of syphilis.Tudor ME, Al Aboud AM, Gossman W.Syphilis. In:StatPearls [Internet].Hook E.Syphilis.Lancet. 2017;389(10078):1550-1557. doi:10.1016/s0140-6736(16)32411-4Mullooly C, Higgins SP.Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy.Int J STD AIDS. 2010;21(8):537–545. doi:10.1258/ijsa.2010.010243O’Byrne P, MacPherson P.Syphilis.BMJ. 2019;28:365:l4159. doi:10.1136/bmj.l4159Peeling RW, Mabey D, Lamb ML, Chen XS, Radolf JD, Benzaken AS.Syphilis.Nat Rev Dis Primers. 2017;3:17073. doi:10.1038/nrdp.2017.73MedlinePlus.Gumma.Murali MV, Nirmala C, Rao JV.Symptomatic early congenital syphilis: a common but forgotten disease.Case Rep Pediatr. 2012;2012:934634. doi:10.1155/2012/934634U.S. Preventive Services Task Force.Final recommendation statement: syphilis infection in nonpregnant adults and adolescents: screening.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Syphilis - CDC fact sheet (detailed).Klausner JD.The great imitator revealed: syphilis.Top Antivir Med.2019;27(2):71–74.Michigan Medicine.Stages of syphilis.Tudor ME, Al Aboud AM, Gossman W.Syphilis. In:StatPearls [Internet].Hook E.Syphilis.Lancet. 2017;389(10078):1550-1557. doi:10.1016/s0140-6736(16)32411-4Mullooly C, Higgins SP.Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy.Int J STD AIDS. 2010;21(8):537–545. doi:10.1258/ijsa.2010.010243O’Byrne P, MacPherson P.Syphilis.BMJ. 2019;28:365:l4159. doi:10.1136/bmj.l4159Peeling RW, Mabey D, Lamb ML, Chen XS, Radolf JD, Benzaken AS.Syphilis.Nat Rev Dis Primers. 2017;3:17073. doi:10.1038/nrdp.2017.73MedlinePlus.Gumma.Murali MV, Nirmala C, Rao JV.Symptomatic early congenital syphilis: a common but forgotten disease.Case Rep Pediatr. 2012;2012:934634. doi:10.1155/2012/934634U.S. Preventive Services Task Force.Final recommendation statement: syphilis infection in nonpregnant adults and adolescents: screening.
Centers for Disease Control and Prevention.Syphilis - CDC fact sheet (detailed).
Klausner JD.The great imitator revealed: syphilis.Top Antivir Med.2019;27(2):71–74.
Michigan Medicine.Stages of syphilis.
Tudor ME, Al Aboud AM, Gossman W.Syphilis. In:StatPearls [Internet].
Hook E.Syphilis.Lancet. 2017;389(10078):1550-1557. doi:10.1016/s0140-6736(16)32411-4
Mullooly C, Higgins SP.Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy.Int J STD AIDS. 2010;21(8):537–545. doi:10.1258/ijsa.2010.010243
O’Byrne P, MacPherson P.Syphilis.BMJ. 2019;28:365:l4159. doi:10.1136/bmj.l4159
Peeling RW, Mabey D, Lamb ML, Chen XS, Radolf JD, Benzaken AS.Syphilis.Nat Rev Dis Primers. 2017;3:17073. doi:10.1038/nrdp.2017.73
MedlinePlus.Gumma.
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
U.S. Preventive Services Task Force.Final recommendation statement: syphilis infection in nonpregnant adults and adolescents: screening.
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