Syphilis Symptoms: All Four Stages Explained

Syphilis progresses through four stages: primary (painless sore at the infection site that heals in 3–6 weeks), secondary (characteristic rash on palms and soles plus flu-like illness), latent (no symptoms, infection persists), and tertiary (irreversible damage to heart, brain, and other organs). All four stages are curable with penicillin G — but damage from tertiary syphilis cannot be reversed. Testing window is 3–6 weeks after exposure. Same-day testing in Atlanta, Houston, Miami, Chicago, and Los Angeles.

Syphilis is called the great imitator for good reason: its symptoms mimic dozens of other conditions and change significantly across four distinct stages. Understanding which stage you might be in determines what to look for — and why testing is essential regardless of whether you have symptoms.

Stage 1: Primary Syphilis

The hallmark of primary syphilis is the chancre — a painless sore that appears at the site of infection 10 to 90 days after exposure (average 3 weeks). The chancre is firm, round, and painless. This is its most dangerous feature: because it doesn’t hurt, it’s easily missed or ignored.

Location: on the penis, scrotum, or inside the foreskin in men; on the cervix, vaginal walls, or labia in women (where it may be entirely invisible without examination); around the anus or inside the rectum for rectal transmission; in the mouth or throat for oral transmission. The chancre heals on its own within 3 to 6 weeks without treatment. This healing is not a sign of recovery — the bacteria have entered the bloodstream and the disease is progressing.

Stage 2: Secondary Syphilis

Secondary syphilis develops 2 to 10 weeks after the primary sore heals, as the infection becomes systemic. Symptoms include a rash — typically rough, reddish-brown spots on the palms of the hands and soles of the feet (the characteristic distribution); the rash may also appear on the trunk, face, and mucous membranes; flu-like symptoms including fever, fatigue, sore throat, swollen lymph nodes, headache, and muscle aches; sores in the mouth, vagina, or anus (mucous patches); hair loss in patches (moth-eaten alopecia); and wart-like growths in warm, moist areas (condylomata lata).

Secondary symptoms resolve without treatment, again creating a false sense of recovery. Without antibiotics, the infection enters the latent phase.

Stage 3: Latent Syphilis

Latent syphilis produces no symptoms. The infection is detectable only on blood tests. It can remain latent for years — sometimes a lifetime. Early latent syphilis (within 1 year of infection) carries transmission risk; late latent syphilis (over 1 year) is rarely transmissible sexually, but can still be transmitted from mother to baby in pregnancy.

Stage 4: Tertiary Syphilis

Without treatment, approximately 15 to 30% of people with latent syphilis progress to tertiary syphilis after years to decades. Tertiary syphilis is rare now with widespread testing, but its consequences are severe: neurosyphilis (meningitis, dementia, personality changes, vision and hearing loss), cardiovascular syphilis (aortic aneurysm, heart valve disease), and gummatous syphilis (granulomatous lesions in skin, bones, and organs). These manifestations are largely irreversible even with treatment.

Testing for Syphilis

Syphilis is diagnosed with a two-step blood test: a non-treponemal test (RPR or VDRL) as the initial screen, confirmed with a treponemal test (TPPA or FTA-ABS). The window period is 6 weeks minimum; confirm at 90 days if initial result is negative despite clinical suspicion. Active sores can also be swabbed for direct detection. For fast private syphilis testing, Health Test Express offers blood testing with results in 1 to 2 days.

When to Seek Urgent Care

• Painless sore on genitals, anus, or mouth: test within 24 hours — don’t wait for it to resolve on its own.

• Rash on palms or soles with flu-like illness: same-day evaluation for secondary syphilis.

• Eye symptoms (pain, redness, vision change) with known or suspected syphilis: emergency evaluation — ocular syphilis can cause permanent blindness within days.

• Neurological symptoms in someone with syphilis history: emergency evaluation for neurosyphilis.

• Pregnant and syphilis-positive: contact your OB same day — treatment timing determines foetal outcome.

Frequently Asked Questions

What does a syphilis sore look like?

A firm, round, painless sore at the infection site. It can be as small as a few millimetres. Because it doesn’t hurt, it’s often not noticed — particularly when located on the cervix, inside the foreskin, or in the rectum.

How long does each syphilis stage last?

Primary: 3 to 6 weeks. Secondary: 2 to 6 weeks. Latent: years to decades. Tertiary: develops years after latent stage without treatment.

Can syphilis be cured?

Yes — with penicillin G at every stage. Early-stage syphilis is cured with a single injection. Later-stage syphilis requires multiple doses. Damage from tertiary syphilis cannot be reversed, but progression is halted with treatment.

Can you have syphilis with no symptoms?

Yes. Latent syphilis has no symptoms by definition. The only way to know is a blood test. Annual syphilis screening is recommended for sexually active people with new or multiple partners, MSM, and pregnant women.

Related: Syphilis and Hair Loss · Syphilis and Heart Disease · Syphilis and Neurological Symptoms · Get tested today