Signs and Symptoms

Know Signs and Symptoms of Syphilis

How quickly do symptoms appear after infection? 

The average time from exposure and the start of the first symptom is 21 days. However, this can range from 10 to 90 days. 

What are the symptoms of syphilis? 

There are four stages of syphilis. Each stage has different signs and symptoms that can look like other health conditions. Syphilis has been called “the great imitator” because of this. Testing for syphilis is the only sure way to diagnose this disease. 

Primary Stage 

During this first stage of syphilis you may notice one or more sores (called chancre). The sore is the location where syphilis enters your body. These sores usually occur in or around the penis, vagina, anus, rectum, lips or inside of the mouth. The sore(s) are painless, round and usually (but not always) firm to the touch. Because the sore is painless, you may not notice it.  The sores last 3 to 6 weeks and heal without treatment. Even after the sore goes away, you must receive treatment to stop your infection from moving to the next (secondary) stage. 

What does the primary (first) stage of syphilis look like in the primary stage? 

(click below to see images of primary stage syphilis sores)

Primary stage syphilis sore (chancre) on the surface of a tongue

Primary stage syphilis sore (chancre) on glans (head) of the penis

Primary stage syphilis sore (chancre) inside the vaginal opening 

Secondary Stage 

During this stage you may have skin rashes on one or more areas of your body. The rash can be on the palms of your hands and soles of your feet and look rough, red or reddish-brown. The rash can show up while your primary sore is healing or several weeks after it has healed. 

The rash usually won’t itch and it can be so faint that it’s hard to notice. 

You may also have other symptoms: 

  • fever 
  • swollen lymph glands 
  • sore throat 
  • patchy hair loss 
  • headaches 
  • weight loss 
  • muscle aches 
  • fatigue (feeling very tired) 

The symptoms from the secondary stage go away without treatment, but if you don’t receive the right treatment your syphilis infection will move to the next stage and can cause serious health problems. 

What does the secondary stage of syphilis look like in the secondary stage? 

(click below to see images of secondary stage syphilis sores)

Lesions of secondary syphilis

Secondary stage syphilis sores (lesions) on the palms of the hands. Referred to as "palmar lesions”

Secondary stage syphilis sores (lesions) on the bottoms of the feet. Referred to as “plantar lesions”

Secondary syphilis rash on the back

Latent Stage 

You will not have visible signs or symptoms during this stage. However, without treatment syphilis can stay in your body for years.  Syphilis can be cured with proper treatment during this stage. 

Tertiary Stage 

Many people with untreated syphilis don’t progress to the tertiary stage. However, when tertiary syphilis does happen, it is very serious and can affect many organs and systems. This stage starts 10-30 years after your infection began. It damages your internal organs and can cause death. Your healthcare provider can diagnose tertiary syphilis with the help of many tests. 

Neurosyphilis, Ocular Syphilis, and Otosyphilis 

If syphilis is not treated soon after infection it can spread to: 

  • the brain and nervous system (neurosyphilis) 
  • the eye (ocular syphilis), or  
  • the ear (otosyphilis). 

This can happen during any of the stages above. 

Signs and symptoms of neurosyphilis can include: 

  • severe headache 
  • muscle weakness and/or trouble with muscle movements 
  • changes to your mental state (trouble focusing, confusion, personality changes) 
  • dementia (problems with memory, thinking, and/or decision making) 

Signs and symptoms of ocular syphilis can include: 

  • eye pain and/or redness 
  • changes in your vision or even blindness. 

Signs and symptoms of otosyphilis may include: 

  • hearing loss 
  • ringing, buzzing, roaring, or hissing in the ears (“tinnitus”) 
  • dizziness or vertigo (feeling like you or your surroundings are moving or spinning)