10 Key Syphilis Symptoms You Should Never Ignore

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. This bacterial infection has been a significant public health concern for centuries and continues to affect millions of people worldwide. What makes syphilis particularly challenging is that it progresses through distinct stages, each presenting different symptoms that can sometimes be subtle or easily mistaken for other conditions.

Understanding the symptoms of syphilis is crucial because early detection and treatment can prevent serious complications. If left untreated, syphilis can lead to severe damage to the heart, brain, nerves, and other organs. The infection can also be passed from a pregnant person to their baby, causing congenital syphilis. This comprehensive guide will walk you through the ten most important symptoms of syphilis, helping you recognize the warning signs at every stage of the infection.

1. Painless Sore or Chancre (Primary Stage)

The first and most recognizable symptom of syphilis is the appearance of a painless sore called a chancre. This syphilis sore typically appears at the site where the bacteria entered the body, which is usually on or around the genitals, anus, rectum, or mouth.

The syphilis chancre has several distinctive characteristics:

• Appearance: The sore is typically round, firm, and painless with well-defined borders
• Size: Usually small, ranging from a few millimeters to about one centimeter in diameter
• Number: Most people develop only one chancre, though multiple sores can occur
• Timing: The chancre appears approximately 3 weeks after infection, though it can range from 10 to 90 days
• Duration: The sore heals on its own within 3 to 6 weeks, even without treatment

Because the chancre is painless and may appear in areas that are not easily visible, many people miss this early stage syphilis symptom entirely. In women, the chancre may develop inside the vagina, making it particularly difficult to detect. In men, it commonly appears on the penis. However, the absence of pain does not mean the absence of infection—the bacteria remain active in the body even after the chancre heals.

2. Swollen Lymph Nodes (Primary Stage)

Accompanying the chancre during the primary stage of syphilis is the enlargement of nearby lymph nodes. The lymphatic system is part of the body’s immune response, and swollen lymph nodes indicate that your body is fighting an infection.

Key features of lymph node swelling in syphilis include:

• Location: The lymph nodes closest to the chancre typically swell—inguinal (groin) nodes are most commonly affected when the chancre is on the genitals
• Characteristics: The nodes feel firm and rubbery but are usually painless
• Bilateral: Swelling may occur on one or both sides
• Duration: The swelling persists throughout the primary stage and may continue into the secondary stage

Unlike lymph node swelling from other infections, syphilis-related lymphadenopathy is typically painless and not accompanied by warmth or redness of the overlying skin. This symptom is often overlooked because it doesn’t cause discomfort.

3. Widespread Skin Rash (Secondary Stage)

One of the most characteristic symptoms of secondary syphilis is a distinctive skin rash that can appear anywhere on the body. The syphilis rash typically develops as the primary stage chancre is healing or shortly after it disappears, usually 2 to 8 weeks after the initial infection.

The syphilis rash has several identifying features:

• Appearance: Rough, red, or reddish-brown spots that don’t itch
• Distribution: Often appears on the palms of the hands and soles of the feet—a distinctive feature that helps differentiate it from other rashes
• Extent: Can cover the entire body or appear in patches
• Texture: May be rough or scaly
• Subtlety: The faint syphilis rash can be very subtle and may not be easily noticeable, especially on darker skin tones

The rash is caused by the syphilis bacteria spreading throughout the bloodstream and affecting multiple organs. Unlike many other rashes, the syphilis rash is typically not itchy, which can make it less noticeable. The rash will eventually clear on its own, even without treatment, but this does not mean the infection has gone away.

4. Mucous Membrane Lesions (Secondary Stage)

During the secondary stage of syphilis, mucous membrane lesions can develop in the mouth, throat, cervix, or anus. These lesions are highly contagious and represent one of the ways syphilis can be transmitted even when no obvious genital sores are present.

Characteristics of mucous membrane lesions include:

• Appearance: White or gray patches on mucous membranes, sometimes called “mucous patches”
• Texture: Moist and slightly raised
• Common locations: Inside the mouth, on the tongue, lips, throat, vagina, cervix, or around the anus
• Symptoms: Usually painless but may cause mild discomfort, especially when eating or swallowing
• Infectivity: These lesions are teeming with bacteria and are highly contagious

Oral lesions may be mistaken for canker sores or other common mouth problems, which is why many people don’t recognize them as syphilis symptoms. These patches are particularly important to recognize because they make transmission possible through kissing or oral sex.

5. Flu-Like Symptoms (Secondary Stage)

Secondary syphilis often presents with general, non-specific symptoms that resemble the flu or other common viral infections. These systemic symptoms occur because the bacteria have spread throughout the body via the bloodstream.

Common flu-like symptoms of syphilis include:

• Fever: Usually low-grade, ranging from 100°F to 101°F (37.8°C to 38.3°C)
• Fatigue: Persistent tiredness and lack of energy
• Sore throat: Mild to moderate throat discomfort
• Headaches: Varying in intensity and frequency
• Muscle aches: General body aches similar to those experienced with the flu
• Malaise: Overall feeling of being unwell

Because these symptoms are so similar to common illnesses, they are often dismissed or attributed to other causes. Many people with secondary syphilis don’t realize they have a sexually transmitted infection because the symptoms seem unrelated to sexual health. This is particularly true when these symptoms appear without the characteristic rash or when the primary chancre went unnoticed.

6. Hair Loss and Patchy Baldness (Secondary Stage)

An unusual but distinctive symptom of secondary syphilis is hair loss, which can occur in a characteristic pattern. This symptom is sometimes called “moth-eaten” alopecia because of its distinctive appearance.

Features of syphilitic hair loss include:

• Pattern: Patchy hair loss creating a “moth-eaten” appearance on the scalp
• Distribution: Can affect the scalp, eyebrows, eyelashes, or beard area
• Extent: Usually not complete baldness, but rather irregular patches of thinning
• Reversibility: Hair loss is typically temporary and will regrow after treatment
• Timing: Usually occurs several months after the initial infection

This type of hair loss is quite distinctive because it creates irregular, patchy areas rather than the uniform thinning seen in other conditions. However, it’s often overlooked or attributed to stress or other causes. The hair loss occurs because the immune system’s response to the infection affects hair follicles.

7. Condyloma Lata (Secondary Stage)

Condyloma lata are large, raised, gray or white lesions that appear in warm, moist areas of the body during secondary syphilis. These are different from the initial chancre and are highly infectious.

Characteristics of condyloma lata include:

• Appearance: Broad, flat-topped, moist, warty growths
• Color: Usually gray or whitish
• Location: Develop in areas where skin touches skin—around the genitals, anus, armpits, or under the breasts
• Texture: Smooth or slightly rough surface that weeps fluid
• Size: Can vary from small bumps to larger patches several centimeters across
• Infectivity: Extremely contagious as they contain large numbers of bacteria

Condyloma lata are sometimes confused with genital warts (condyloma acuminata) caused by HPV, but they have distinct differences. Syphilitic lesions tend to be flatter, broader, and more moist than HPV warts. These lesions are one of the most contagious manifestations of syphilis and can transmit the infection through direct contact.

8. Neurological Symptoms (Late Stage)

If syphilis remains untreated for years, it can progress to the late or tertiary stage, affecting the nervous system in a condition called neurosyphilis. While this can actually occur at any stage, it’s most common in late-stage disease.

Neurological symptoms of untreated syphilis include:

• Severe headaches: Persistent and often intense
• Difficulty coordinating movements: Problems with balance and gait
• Paralysis: Weakness or inability to move certain body parts
• Numbness: Loss of sensation in the extremities
• Dementia: Cognitive decline, memory problems, and personality changes
• Vision problems: Blurred vision or blindness
• Stroke-like symptoms: Sudden weakness or speech difficulties
• Mental health changes: Depression, irritability, or psychosis

Neurosyphilis represents severe disease and indicates that the bacteria have invaded the central nervous system. These symptoms develop gradually over years and can cause permanent damage if not treated promptly. The neurological damage from late-stage syphilis was once a leading cause of institutionalization before effective antibiotics were available.

9. Cardiovascular Symptoms (Late Stage)

Another serious complication of untreated syphilis is cardiovascular syphilis, which affects the heart and blood vessels. This typically occurs 10 to 30 years after the initial infection if left untreated.

Cardiovascular symptoms include:

• Aortic aneurysm: Weakening and bulging of the aorta, the body’s main artery
• Aortic regurgitation: Leaking of the aortic valve causing heart failure symptoms
• Chest pain: Discomfort or pressure in the chest
• Shortness of breath: Difficulty breathing, especially during physical activity
• Heart palpitations: Irregular or rapid heartbeat
• Fatigue: Extreme tiredness due to reduced heart function

Cardiovascular syphilis is rare in the modern era because most cases are diagnosed and treated before reaching this stage. However, it remains a serious complication that can be life-threatening. The damage to the cardiovascular system occurs slowly as the syphilis bacteria damage the walls of blood vessels over many years.

10. Gummas (Late Stage)

Gummas are soft, tumor-like growths that can develop during late-stage syphilis. They represent localized areas of chronic inflammation and tissue destruction caused by the body’s immune response to the bacteria.

Characteristics of gummas include:

• Appearance: Soft, rubber-like nodules or tumors
• Location: Can appear almost anywhere in the body—skin, bones, liver, brain, heart, or other organs
• Size: Range from small nodules to large masses several centimeters in diameter
• Skin gummas: May break down and form ulcers that are slow to heal
• Bone gummas: Cause pain and can lead to bone destruction
• Organ damage: Gummas in internal organs can cause serious dysfunction

Gummas typically develop 3 to 15 years after the initial infection in people who have never been treated. While they can be disfiguring and damaging, they are now rare in developed countries due to earlier detection and treatment. When gummas do occur, they can cause significant tissue damage and may require both antibiotic treatment and sometimes surgical intervention.

Main Causes of Syphilis

Syphilis is caused by a single bacterial agent and is transmitted through specific routes. Understanding these causes is essential for prevention.

Bacterial Agent:

Syphilis is caused exclusively by the bacterium Treponema pallidum, a spiral-shaped bacterium (spirochete) that cannot survive outside the human body for long periods.

Transmission Routes:

• Sexual contact: The primary mode of transmission is through direct contact with a syphilis sore during vaginal, anal, or oral sex. This is responsible for the vast majority of cases.
• Congenital transmission: Pregnant individuals with syphilis can pass the infection to their baby during pregnancy or childbirth, causing congenital syphilis.
• Blood transmission: Rarely, syphilis can be transmitted through blood transfusions, though modern blood screening has made this extremely uncommon.
• Direct contact with lesions: Contact with open sores or rashes on an infected person can transmit the bacteria, even through kissing if oral lesions are present.

Risk Factors:

• Having unprotected sex with multiple partners
• Men who have sex with men (statistically higher rates)
• Having HIV infection, which increases susceptibility
• Previous history of syphilis or other STIs
• Using drugs or alcohol, which may lead to risky sexual behavior
• Being in a sexual relationship with someone who has syphilis

It’s important to note that syphilis cannot be transmitted through casual contact such as sharing utensils, doorknobs, swimming pools, hot tubs, bathtubs, or toilet seats. The bacteria require direct contact with infected lesions or bodily fluids to spread.

Prevention Strategies

Preventing syphilis requires a combination of safe practices, regular testing, and awareness. Here are the most effective prevention strategies:

Safe Sexual Practices:

• Use condoms correctly and consistently: Latex condoms significantly reduce the risk of transmission during vaginal, anal, and oral sex, though they don’t provide complete protection if sores are in areas not covered by the condom
• Dental dams: Use dental dams during oral-vaginal or oral-anal contact
• Abstinence: The only completely effective way to prevent sexual transmission is to abstain from sexual contact
• Mutual monogamy: Being in a long-term mutually monogamous relationship with a partner who has been tested and is uninfected

Regular Testing:

• Routine screening: Get tested regularly if you are sexually active, especially if you have multiple partners
• Partner testing: Ensure sexual partners are tested for STIs
• Prenatal screening: All pregnant women should be tested for syphilis during pregnancy
• High-risk groups: Those at higher risk should be tested at least annually or more frequently

Communication and Awareness:

• Talk with partners: Have open conversations about sexual health and STI testing with partners before sexual activity
• Notification: If diagnosed with syphilis, inform all recent sexual partners so they can be tested and treated
• Recognize symptoms: Be aware of the symptoms and seek medical attention if you notice any signs of infection

Other Prevention Measures:

• Limit number of partners: Reducing the number of sexual partners decreases risk
• Avoid alcohol and drugs: These can impair judgment and lead to risky sexual behavior
• Immediate medical attention: Seek prompt testing and treatment if you suspect exposure
• Complete treatment: If you or a partner is diagnosed, complete the full course of treatment and avoid sexual contact until cleared by a healthcare provider

Remember that early detection through regular screening is one of the most effective prevention strategies, as it allows for treatment before the disease progresses or is transmitted to others.

Frequently Asked Questions

What is syphilis and how serious is it?

Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum. While it can be easily cured with antibiotics in the early stages, untreated syphilis can lead to serious complications affecting the heart, brain, and other organs, potentially causing permanent damage or death.

What are the early signs of syphilis in men?

Early stage syphilis symptoms in men typically include a painless sore (chancre) on the penis, anus, or mouth, along with swollen lymph nodes in the groin. The chancre appears about 3 weeks after infection and heals on its own, even without treatment, but the infection remains active.

What do syphilis symptoms look like in women?

Syphilis symptoms in females include a painless chancre that may appear on the vulva, vagina, cervix, anus, or mouth—often going unnoticed if internal. Secondary symptoms include a rash (particularly on palms and soles), flu-like symptoms, hair loss, and mucous membrane lesions. Many women miss early symptoms because the chancre may be hidden inside the vagina.

How can I tell if I have a syphilis rash?

A syphilis rash typically appears as rough, red, or reddish-brown spots that don’t itch. The distinctive feature is that it often appears on the palms of the hands and soles of the feet—locations uncommon for most other rashes. The rash may be faint and subtle, particularly on darker skin tones, and can appear anywhere on the body.

What are the stages of syphilis?

Syphilis progresses through four stages: Primary (characterized by a painless chancre sore), Secondary (rash, flu-like symptoms, mucous patches), Latent (no visible symptoms but bacteria remain), and Tertiary or Late (serious complications affecting organs, nervous system, and cardiovascular system). Each stage has distinct symptoms.

Can syphilis go away on its own without treatment?

No, syphilis cannot cure itself. While symptoms may disappear on their own (like the primary chancre healing), the bacteria remain active in your body and the infection progresses. Without proper antibiotic treatment, syphilis will advance through stages and can eventually cause serious, irreversible damage to organs and tissues.

How soon do syphilis symptoms appear?

The first symptom of syphilis—the chancre sore—typically appears about 3 weeks after infection, though it can range from 10 to 90 days. Secondary symptoms usually develop 2 to 8 weeks after the chancre appears. Some people may not notice symptoms at all, which is why regular testing is important if you’re sexually active.

Is the syphilis sore always visible?

No, the syphilis chancre may not always be visible. It can develop inside the vagina, on the cervix, in the rectum, or inside the mouth—areas that are difficult to see without examination. This is one reason why syphilis often goes undiagnosed in the primary stage. The sore is also painless, making it easy to miss.

Can you have syphilis without symptoms?

Yes, many people with syphilis have no noticeable symptoms, especially during the latent stage which can last for years. Even in the primary and secondary stages, symptoms may be mild or mistaken for other conditions. This is why syphilis is sometimes called “the great imitator” and why regular STI screening is crucial for sexually active individuals.

When should I see a doctor about possible syphilis?

You should see a healthcare provider immediately if you notice any unusual sores on your genitals, anus, or mouth; develop an unexplained rash (especially on palms or soles); have had unprotected sex with someone who may have syphilis; or if a sexual partner informs you they have tested positive. Don’t wait for symptoms to worsen—early treatment is most effective.

References:

• Centers for Disease Control and Prevention (CDC) – Syphilis Facts
• World Health Organization (WHO) – Sexually Transmitted Infections
• Mayo Clinic – Syphilis Symptoms and Causes
• National Health Service (NHS) – Syphilis
• Planned Parenthood – Syphilis Information