Because syphilis mimics symptoms of other conditions, such as canker sores, herpes, and Lyme 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 this sexually transmitted infection (STI) as well as the signs and complications in children born with syphilis.
Primary Syphilis
Primary syphilis is the first stage that occurs soon after exposure to Treponema pallidum, the bacteria that cause the condition. The classic sign is a painless skin ulcer, called a chancre, that appears at the point of sexual contact, most often the cervix, 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 nodes nearest the chancre may also be swollen. This is a sign that the body is fighting the infection. Without treatment, a chancre will heal within three to six weeks.
Secondary Syphilis
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 from hives to pus-filled blisters—or be so faint that you can hardly see it. There may even be whitish, wart-like lesions, called condyloma lata, on moist parts of the body like the groin or armpits.
Another telltale sign is unexplained hair loss, referred to as syphilitic alopecia.
During this stage of infection, other symptoms may include:
FeverSore throatSwollen lymph nodesFatigueWeight lossHeadacheJoint painMuscle ache
The symptoms usually resolve without treatment within weeks or months. Studies have shown that 40% to 85% of women and 20% to 65% of men who have secondary syphilis do not recall having a chancre.
Latent Syphilis
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:
Early latent syphilis is the period within 12 months of the initial infection. As many as 1 in 4 people will experience a relapse of secondary syphilis during this stage. Late latent syphilis is when the infection occurred more than 12 months ago. This stage can last for years and even decades with no signs of disease.
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.
Tertiary Syphilis
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
Gummatous syphilis is a complication in which soft, tumor-like lesions (called gummas) form on the skin, bones, liver, heart, muscles, and other parts of the body. The gummas are caused by an inflammatory reaction and contain a mass of dead and swollen fiber-like tissues.
Gummas can grow to a considerable size, causing major damage to organs. It can also cause open sores on the skin and mouth that resemble tuberculosis.
Cardiovascular Syphilis
Cardiovascular syphilis is a complication that affects the heart and blood vessels. It causes severe inflammation of the aorta, the main vessel that carries blood from the heart, causing it to swell and weaken. This can result in an aortic aneurysm in which the aorta bulges to a point where it can spontaneously burst.
Neurosyphilis
Neurosyphilis affects the central nervous system. While some people will not have any symptoms of neurosyphilis, others may develop serious issues such as:
General paresis: Also known as paralytic dementia Meningitis: Inflammation of the membrane surrounding the brain and spinal cord Tabes dorsalis: Caused by the destruction of nerves in the spinal cord
Seizures, personality changes, hallucinations, dementia, and stroke are among the possible symptoms of neurosyphilis.
Complications in Newborns
Congenital syphilis is a serious condition in which a pregnant mother with syphilis passes the infection to her unborn baby.
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:
An enlarged liver or spleen Petechiae (purplish skin spots caused by ruptured blood vessels) Profuse nasal drip with highly infectious mucus discharge Jaundice (yellowing of the skin and eyes) Pneumonitis (lung inflammation) Seizures
By age 2, the child may start to develop physical deformities and other severe complications if not treated. This may include:
Blunted upper front teeth (known as Hutchinson’s teeth) The collapse of the nasal bone (referred to as saddle nose) A protruding jawbone and foreshortened upper jaw A protruding forehead (known as frontal bossing) Bowing of the shin bones (referred to as saber shins) Swollen knees Interstitial keratitis (loss of clearness of the cornea of the eye) Glaucoma (caused by damage to the optic nerve) Deafness Developmental delays
Summary
The signs and symptoms of syphilis vary by stage. Primary syphilis occurs soon after infection and usually causes one or more sores (called chancres) on the genitals, anus, rectum, or mouth.
This is followed by secondary syphilis, in which there is a rash on one or more parts of the body, followed by the latency stage, which can last for years with no symptoms.
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 an STI test whether you’ve ever had symptoms or not.
For some key populations, such as men who have sex with men (MSM) and people living with HIV, syphilis screening may be advised every three months rather than annually.
