11 Signs and Symptoms of Syphilis
Syphilis is a stealthy infection that can remain in your body for years without obvious symptoms. You could have this serious condition without realizing it. You may unknowingly transmit it to others, thinking you have naturally recovered from an infection.
This sexually transmitted infection progresses through four distinct stages and is more common than many people assume. If left untreated, syphilis can cause severe damage to critical organs, including the brain and heart.
3–6 Weeks After Infection (Primary Stage)
The first signs of syphilis usually appear 3 to 6 weeks after infection, but their disappearance does not mean the infection has cleared. Without treatment, the infection remains in the body and progresses to the next stage.
Painless Sores
A chancre is a small, round sore that develops at the site where the bacteria has entered your body. It is usually firm, round, and painless, with a smooth border and a clean base.
These sores most commonly appear on the genitals, anus, rectum, lips, or inside the mouth, depending on the point of infection. Because the chancre does not cause pain, many people do not realize they have syphilis.
In some cases, multiple sores may develop in the same area, although a single sore is more common. The infection is highly contagious, and direct contact with the sore can cause it to spread.
Swollen Lumps
As your immune system responds to the bacterial infection, the lymph nodes near the site of infection are likely to become swollen. These swollen lumps develop under the skin, most commonly in the groin and under the jaw or neck area, but can develop near other affected areas.
Although swollen lymph nodes do not usually cause pain, they may feel slightly tender when gently pressed. The swelling typically appears around the same time as the chancre and may persist for several weeks.
Weeks to Months After Infection (Secondary Stage)
In the secondary stage of syphilis, noticeable symptoms affecting the entire body appear 2–12 weeks after the initial sore heals. These symptoms are often nonspecific, leading individuals to overlook them and clinicians to potentially miss the diagnosis.
Skin Rash
A distinct rash appears at this stage, featuring rough, reddish-brown lesions. These may be small and round or form larger, irregular patches. The rash often develops on the palms and soles but can spread to the trunk, arms, legs, and other areas.
A key characteristic is that it does not usually itch, which sets it apart from common skin conditions. This rash can sometimes be faint and easily overlooked, especially in people with darker skin tones since there is no discomfort.
Flu-Like Symptoms
One of the most common signs is a low-grade fever (99–101°F), which may cause you to feel warm or slightly flushed. Many people also feel very tired, even after getting enough rest.
Muscle aches and joint pain can cause soreness or stiffness, similar to what you might feel during a mild viral infection. A sore throat may develop, leading to mild pain, discomfort, or scratchiness when swallowing.
Headaches are also common, contributing to the flu-like nature of this stage. Additionally, some individuals may experience night sweats, which can further exacerbate discomfort.
These symptoms may come and go over time, mimicking other common illnesses and making syphilis more challenging to recognize without proper testing.
Hair Loss Spots
You might notice patches of hair falling out from your scalp, eyebrows, or beard. These patches appear scattered or look like random thinned-out areas rather than complete bald spots.
However, this symptom is not observed in all cases, and the intensity of hair loss varies from person to person. Since hair loss occurs gradually, you might not recognize it right away.
Some people only realize the change when they see more hair on their pillow, in the shower, or when brushing their hair. In most cases, hair begins to regrow once the infection is treated.
Patches in the Mouth or Genitals
You may develop mucous patches—painless, grayish-white sores that appear on the moist and thin surfaces of your mouth, tongue, throat, genitals, or anus.
These highly infectious lesions can cluster together as the bacterial infection spreads, causing swelling or inflammation, and may persist or reappear throughout this stage.
They are sometimes mistaken for other oral conditions, such as candidiasis (oral thrush), and may go unnoticed, increasing the risk of syphilis transmission through sexual or oral contact.
Genital Wart-Like Growths
Condyloma lata are highly contagious, wart-like growths that develop in warm, moist areas of the body. They can grow large or cluster together and typically appear as soft, flat, or slightly raised patches with a wet or velvety texture.
Due to their appearance, they are sometimes mistaken for genital warts caused by HPV. These growths may cause mild irritation, discomfort, or a slight odor, especially in areas where skin rubs together. However, they usually disappear once syphilis is treated.
Inactive Stage
The latent stage of syphilis starts after the initial symptoms disappear. During this phase, the bacteria remain in your body, but no visible signs are present. Sometimes, rashes or mouth sores may briefly return before the infection becomes completely inactive.
This stage is divided into two phases: early latent syphilis (within the first year), when the infection may still spread to others, and late latent syphilis (after one year), when the risk of transmission is much lower.
The infection can remain hidden for years without causing symptoms, but it may unpredictably progress to the tertiary stage, where severe and irreversible complications can develop.
Tertiary Stage- Complications
Untreated syphilis can lead to tertiary-stage complications years or decades after the initial infection, causing damage to various organs and body systems. Symptoms vary based on the affected areas and can be severe, life-threatening, and challenging to treat.
Heart-Related Symptoms
One of the most noticeable symptoms is chest pain, often described as pressure, tightness, or a squeezing sensation. The pain may occur during activity or at rest and radiate to the neck, jaw, shoulders, or left arm.
Some people also experience nausea, sweating, or a sense of impending doom. You may feel a rapid, slow, or irregular heartbeat, sometimes described as a fluttering sensation or brief pauses between beats.
This can be accompanied by palpitations, dizziness, or lightheadedness, especially during physical exertion, prolonged activity, or when standing up too quickly.
Syphilis damages the heart muscle and blood vessels, which makes it harder for the heart to pump blood efficiently and may lead to heart failure.
You may experience swelling in your legs, ankles, or feet due to fluid buildup. Severe cases can cause a chronic cough, bluish skin (cyanosis), or difficulty breathing when lying down, indicating worsening heart function.
Affected Brain Function
Untreated syphilis can cause progressive memory loss- making it difficult to remember recent events, conversations, or important dates. Confusion and impaired thinking can make daily tasks difficult, while poor judgment may lead to risky behaviors.
As the condition worsens, you may struggle to find the right words, recognize familiar faces, or follow simple instructions as the brain function is affected.
Personality and mood changes often occur even in the absence of triggers, with family members noticing your frustrations and irritability before you do.
Movement and coordination gradually decline, leading to clumsiness and shaky hands. As nerve damage worsens, muscle weakness may develop and progress to partial or complete paralysis, often affecting one side of the body and making daily tasks increasingly difficult.
Eye Symptoms
In the tertiary stage of syphilis, the infection can spread to your eyes (ocular syphilis), which leads to progressive vision problems in one or both eyes.
Early symptoms may include blurry or unfocused vision, making activities like reading or driving difficult. As the condition progresses, objects may appear distorted or doubled, and you may experience visual disturbances like floating spots or flashes of light.
Eye discomfort can range from mild to severe, ranging from aching, burning, or sharp pain when the eye moves. Without treatment, syphilis-related inflammation can lead to permanent vision loss.
These changes can occur gradually or suddenly as the infection damages the optic nerve and retina, leading to irreversible blindness.
Effects on Skin & Bones
Syphilis can severely affect the skin, bones, and deep tissues, causing gummas—large, painless sores that form on the skin or inside the body.
These swollen, rubbery lesions may appear as bumps or ulcers, commonly on the face, scalp, trunk, or legs. If they break open, they can leak fluid or form deep wounds, often leaving permanent scars once healed.
Internal gumma may develop in the oral cavity on the tongue and palate and in internal organs like the liver, stomach, or brain, impairing function without noticeable symptoms until serious complications arise.
Some people may develop lumps or thickened areas on the bones, which may feel warm or swollen due to inflammation. If left untreated, bone damage can progress to fractures or deformities, affecting mobility and skeletal structure.
Mother-to-Baby Syphilis Transmission
Syphilis can be transmitted from a pregnant mother to her unborn baby through the placenta, potentially causing severe health problems. The infection can spread at any stage of pregnancy and may lead to serious complications if left untreated.
Severe Rash and Blistering Lesions
Babies born with congenital syphilis often develop a distinctive rash within the first few weeks of life. The rash usually manifests on the palms of hands and soles of feet before spreading across the body.
The affected skin may develop red or copper-colored spots that gradually enlarge and become raised. In some cases, these lesions fill with fluid and eventually rupture, resulting in open sores or ulcerations that are highly contagious and vulnerable to infection.
In some cases, wart-like growths (known as condylomata lata) may develop, with these lesions thickening, cracking, or ulcerating, which increases the risk of secondary infections. If left untreated, they may contribute to extensive skin damage and potential scarring.
Bone Deformities and Swollen Joints
Congenital syphilis can severely affect your baby’s bone development, leading to swollen joints and structural abnormalities. One of the earliest signs is swelling around the long bones of the arms and legs, which can cause pain and difficulty with movement.
Your baby might cry when held or when their limbs are touched due to bone inflammation. X-rays might show characteristic changes in the bones, including areas that appear moth-eaten or have abnormal growth patterns.
In some cases, babies with congenital syphilis develop bowed legs, abnormally curved shin bones, or other skeletal deformities that can persist if left untreated, affecting the baby’s ability to crawl, stand, or walk as they grow.
Enlarged Liver and Spleen
In infants with congenital syphilis, the liver and spleen may become swollen as the body responds to the infection. This swelling can cause the belly to appear enlarged, which may be noticeable during diaper changes or bath time.
These symptoms can interfere with feeding, leading to fussiness and difficulty in nursing. Liver dysfunction may cause jaundice, leading to a yellowing of the skin and eyes due to waste buildup in the body.
Severe liver damage can lead to dark-colored urine and pale stools. Additionally, bruising or small red or purple spots (petechiae) on the skin may appear if the enlarged spleen affects blood cell production, signaling further complications from congenital syphilis.
Stillbirth or Developmental Delays
Without treatment during pregnancy, syphilis can lead to serious health risks for the baby, such as stillbirth or dangerous infections at birth.
The infection can damage vital organs before birth, heightening the risk of premature delivery, low birth weight, or early infant death.
Babies who survive congenital syphilis may experience developmental delays, affecting their physical, cognitive, and neurological growth.
You might notice that your baby takes longer to reach milestones, such as sitting, crawling, or walking. Some infants develop hearing loss or vision problems due to nerve damage.
