Syphilis Symptoms: All Four Stages Explained

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 — fever, fatigue, sore throat, swollen lymph nodes, headache, muscle aches; sores in the mouth, vagina, or anus (mucous patches); hair loss in patches (moth-eaten alopecia); 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); 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.

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. 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.

Related: STD rash guide · False positive STD test · Syphilis in pregnancy · Get tested today

This article is for informational purposes only and does not constitute medical advice.