Syphilis Symptoms in Women and Men

What syphilis symptoms look like

Syphilis moves in stages, and each stage’s signs go away on their own, which is exactly why it is missed. The first stage is a sore, called a chancre, at the place the bacteria entered: usually single, firm, round and painless, but sometimes small, tender, multiple, or hidden inside the vagina, rectum or mouth where it is never seen. It appears anywhere from ten days to three months after exposure and heals by itself in three to six weeks.

The second stage, weeks to a few months later, is a rash – often rough, reddish-brown spots on the palms of the hands and soles of the feet, but it can look like almost any rash and is usually not itchy – sometimes with fever, swollen glands, sore throat, patchy hair loss, headache, tiredness, or moist wart-like patches around the genitals or mouth. That, too, clears on its own. The infection then goes quiet, sometimes for years, while it is still there. Untreated, it can eventually damage the heart, brain, nerves, eyes and bones.

Why most people have no symptoms

Because the sore is painless and often hidden, and the rash is easily mistaken for something else, most people with syphilis never notice the early stages. The CDC reported more than 200,000 cases in 2023, and syphilis passed from mother to baby during pregnancy rose more than tenfold between 2012 and 2023, largely because infections in adults went undiagnosed. A test is the only way to know. Symptoms do not shorten the time an infection takes to show up on a test, and having none does not mean you are clear.

What else causes the same symptoms

A genital sore can be herpes, a cut, an ingrown hair, a reaction to a product or, rarely, other infections. A rash on the palms and soles is unusual and should always raise the question of syphilis, but rashes elsewhere have endless causes. Patchy hair loss, sore throat and swollen glands are not specific to anything. A sore should be examined and, if possible, tested directly while it is present; the blood test can be negative in the first weeks after a sore appears.

When to see a clinician rather than wait for a test

Some symptoms need a clinician, not just a lab. A sore, blister, ulcer or rash should be examined – and, where possible, swabbed – while it is there, because a blood or urine test cannot tell you what a sore is. Severe pelvic or lower-belly pain, pain or swelling in a testicle, a fever with pelvic pain, vision or hearing changes, a severe headache, or yellowing of the skin or eyes need prompt medical care. If you are pregnant, tell your prenatal provider about any symptom or exposure. And if you may have been exposed to HIV in the last 72 hours, go to an urgent care or emergency room today and ask about PEP, which can prevent infection only if it is started in time. Syphilis can affect the eyes, ears and nervous system at any stage, not only after years: vision changes, hearing loss, ringing in the ears, a severe headache or confusion with any of the signs above need prompt medical care. Syphilis screening is part of routine prenatal care – the CDC recommends it at the first prenatal visit and, for many, again in the third trimester and at delivery – and treatment in pregnancy prevents the infection passing to the baby.

How syphilis is tested, and what the test cannot tell you

Syphilis is diagnosed with a blood test for the antibodies your body makes against the bacteria; if the first screen is reactive, the laboratory runs a second, confirmatory test on the same sample. It is a quick blood draw, no exam. Antibodies take weeks to appear, so a negative result soon after an exposure, or while a sore is present, is not final and should be repeated. A positive result cannot tell you on its own how long you have had the infection or whether it was treated in the past; the physician reads the two test results together with your history. The timing is on our When to Get Tested page, or call (866) 872-1888. More about the test is on our syphilis testing page.

After a positive result

Syphilis is curable at every stage, and the damage of late syphilis is preventable by treating it early. A member of our care team calls you, explains the result, and arranges a consultation with a physician who sets up treatment: for early syphilis, one injection of long-acting penicillin, given in person; for infection that has been present longer than a year or of unknown duration, three weekly injections. Avoid sex until sores have healed and treatment is complete. Partners from the last several months need to be told and tested, and the CDC recommends follow-up blood tests at six and twelve months to confirm the treatment worked.