SYNTHETIC DEMONSTRATION — no real student or patient. Not a medical device.

Sexual health

Syphilis Symptoms by Stage: What to Look For and When to Get Tested

Syphilis is a curable bacterial infection that progresses through stages if untreated: a painless sore first, then a body rash, a silent latent phase, and finally serious organ damage. Symptoms often resolve on their own even as the bacteria remain, so testing is the only reliable way to know your status.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

What does primary syphilis look like?

The first sign is a chancre — a single, round, firm, and usually painless sore — at the site where the bacteria entered the body. This may be on the genitals, anus, lips, or mouth. It typically appears roughly 10 days to 3 months after exposure (often around 3 weeks) and heals on its own within 3 to 6 weeks.

The painlessness is the detail most people miss. Because the chancre is not painful and heals without treatment, many people do not know they were infected 1. The infection persists and advances even after the sore disappears.

What does secondary syphilis look like?

Several weeks after the chancre heals, secondary syphilis develops in most untreated people. Its hallmark is a rash with distinctive features 1:

  • Appears on the palms of the hands and soles of the feet — this specific location is a classic clinical clue
  • May also spread across the trunk, face, or entire body
  • Usually non-itchy (which helps distinguish it from many other rashes)
  • Appears rough, reddish-brown, or copper-colored

Other secondary-stage symptoms can include fever, fatigue, sore throat, headache, and swollen lymph nodes. Patchy hair loss and flat, moist wart-like growths called condyloma lata may appear in warm skin folds. As with the primary stage, secondary symptoms resolve on their own — but the bacteria remain 1.

What is latent syphilis?

After secondary symptoms resolve, syphilis enters a latent (hidden) phase with no symptoms at all. This can last for years. Latent syphilis is divided into early latent (within the first year) and late latent (after one year). The person feels completely well, but the bacteria remain in the body and can continue to cause damage.

A blood test is the only way to detect latent syphilis. This is one reason the CDC STI Treatment Guidelines emphasize routine blood-based screening for people at elevated risk, rather than relying on symptoms alone 2.

What is tertiary syphilis — and how serious is it?

Tertiary syphilis develops in a minority of people who go untreated for many years. It can affect the heart (cardiovascular syphilis, damaging the aorta), the nervous system (neurosyphilis, causing confusion, vision or hearing changes, or personality change), or form destructive lesions called gummas in various organs 12.

Neurosyphilis can actually occur at any stage of infection, not only the tertiary stage. It requires prompt diagnosis and intravenous treatment. All of these complications are preventable by treating syphilis early.

How is syphilis diagnosed, and what does testing involve?

Syphilis is diagnosed with a blood test — there is no urine test. Diagnosis involves two steps: a screening test (such as RPR or VDRL), and if positive, a confirmatory treponemal test 2. Because antibodies take time to develop, a single early negative result does not rule out infection. A clinician will typically recommend retesting at 6 weeks, 3 months, and sometimes 6 months after a potential exposure.

The USPSTF recommends syphilis screening for people at increased risk, including all pregnant people 3.

Treatment is with penicillin — highly effective especially in early stages. A clinician determines the right regimen based on the stage of infection. Congenital syphilis (passed to the baby during pregnancy) can cause stillbirth and severe newborn illness; prenatal screening and treatment are safe and protective 1.

Common questions

Can a syphilis sore be painless?

Yes — and this is what makes primary syphilis easy to miss. The chancre is typically painless, firm, and round. It heals on its own within 3 to 6 weeks, but the infection remains active and will progress if untreated.

Does a syphilis rash always appear on the palms and soles?

A rash on the palms and soles is the classic pattern of secondary syphilis, but the rash can also spread to the trunk or rest of the body. Not everyone develops the rash in this distribution. A blood test is needed to confirm syphilis regardless of the rash's location.

How long after exposure should I get tested for syphilis?

Syphilis antibodies typically become detectable about 3 to 6 weeks after exposure, with full confirmation usually requiring a test at 3 months. Testing too soon after a potential exposure may give a falsely negative result. A clinician can advise on the right timing based on your situation.

Is syphilis curable?

Yes. Syphilis is completely curable with antibiotics, especially penicillin, and is most easily treated in the early stages. Later stages require longer treatment courses. Organ damage from advanced untreated disease cannot always be reversed.

Can syphilis be passed to a baby during pregnancy?

Yes — this is called congenital syphilis. It can cause stillbirth, premature birth, or severe illness in the newborn. Routine prenatal screening at the first prenatal visit (and again later in pregnancy in higher-risk areas) is standard practice and important to protect both the pregnant person and the baby.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek care urgently

  • —A painless sore on the genitals, anus, or mouth — especially one that heals on its own — warrants testing as soon as possible
  • —A non-itchy rash on the palms and soles, especially with flu-like symptoms
  • —Neurological symptoms: headache, confusion, vision changes, hearing changes — these may indicate neurosyphilis and need urgent evaluation
  • —Syphilis in pregnancy: untreated syphilis can cause stillbirth and serious newborn illness — prenatal screening is essential

If you are experiencing sudden neurological symptoms — confusion, vision loss, severe headache, or weakness — go to the emergency room. Neurosyphilis is serious and requires urgent evaluation.

This article provides general health education and is not a diagnosis or treatment recommendation. If you think you may have syphilis or have had a possible exposure, please see a licensed clinician for testing and evaluation.

References

  1. 1.Centers for Disease Control and Prevention (2021). Syphilis — STI Treatment Guidelines 2021 (Web Chapter). CDC STI Treatment Guidelines. link ✓Primary chancre characteristics (painless, firm, self-healing); secondary syphilis rash on palms/soles, condyloma lata, flu-like symptoms; tertiary/cardiovascular syphilis; neurosyphilis at any stage; congenital syphilis consequences
  2. 2.Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports. doi:10.15585/mmwr.rr7004a1 ✓Two-step serological testing protocol (RPR/VDRL + confirmatory treponemal); latent syphilis classification; neurosyphilis at any stage; penicillin as preferred treatment; routine screening in at-risk populations
  3. 3.US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. (2021). Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. doi:10.1001/jama.2021.14081 ✓USPSTF context for STI screening in at-risk populations including pregnant people

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.