Syphilis symptoms: how to recognise the signs

The tricky thing about syphilis symptoms is that they start mild and fade on their own. The first sign is usually a painless sore, and because it does not hurt, it is often overlooked. We calmly walk through the signs per phase, so you know what to look for.

Let's start with what matters most. Not everyone gets clear complaints, and the signs can vary a lot from person to person.

What are the first symptoms of syphilis?

The first symptom is usually a single sore at the spot where the bacteria entered, often around the genitals, anus or mouth. This is called a chancre. The sore is typically painless with firm edges, and fades on its own after a few weeks, while the infection stays.

A thorough overview in the Lancet describes this primary sore as the classic first sign, often missed because it does not hurt (PMID 27993382). Sometimes more than one sore appears, and sometimes there are swollen lymph nodes nearby.

Because the sore can sit in a hidden place, some people simply do not notice it. The sore going away does not mean you are cured.

Symptoms per stage of syphilis

Without treatment, syphilis can develop in four phases: primary, secondary, latent and tertiary. Each stage has different possible signs, and some phases pass with no symptoms at all. Below you see what you might notice per stage.

RIVM describes the same phases. What stands out is that the visible signs can come and go. Between the phases it can seem as if nothing is wrong, while the infection stays in the body.

What does the syphilis rash look like?

In the secondary stage a skin rash can appear that often does not itch and sometimes also sits on the palms and soles. That combination is striking, because many other rashes spare exactly those spots. A feverish feeling, sore throat and swollen glands can come with it.

An overview in Nature Reviews Disease Primers describes this secondary phase as a moment when the infection can show itself throughout the body (PMID 29022569). Yet these signs also fade on their own, which can again feel reassuring.

The rash sometimes resembles other skin conditions. So the picture alone proves nothing, and a test gives more clarity.

Can you have syphilis without symptoms?

Yes, you can. In the latent phase there are often no complaints at all, while the bacteria are still present. The infection can then only be shown with a blood test. That makes symptoms an unreliable gauge to rely on.

Research on the modern course of syphilis stresses that a large share of infections sits in a symptom-poor phase when people are tested (PMID 32101666). No complaints is therefore no proof that nothing is going on.

The signs of syphilis can also resemble those of other STIs. If in doubt, also read about early HIV symptoms and gonorrhoea symptoms, since the first signs can resemble one another.

When should you get checked for syphilis?

After a possible risk contact it is sensible to wait out the window period before testing, so the result is reliable. For syphilis a test is usually only reliable from around 6 weeks. If you have a sore, rash or other complaints, it can help to talk to a doctor sooner.

If you want to arrange it calmly and privately, you can do a syphilis test via a blood sample. How the stages, test and treatment connect is in our guide on syphilis: stages, signs and testing. And what the treatment involves is in syphilis treatment.

Feel free to discuss the timing with a doctor or the sexual-health clinic. They can help you further discreetly.

Sources

• Hook EW 3rd. Syphilis. Lancet. 2017. PMID 27993382.
• Peeling RW, et al. Syphilis. Nature Reviews Disease Primers. 2017. PMID 29022569.
• Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. NEJM. 2020. PMID 32101666.
• RIVM, Syphilis. Soa Aids Nederland, Syphilis.

Every blood test result we provide includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.