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The symptoms of syphilis can be very sneaky. Some people have none at all, while others experience symptoms that change over time.
Because syphilis symptoms can mimic everything from a drug reaction to an inflammatory disease, it’s notoriously tricky to diagnose. Syphilis symptoms may disappear without treatment, but the infection can resurface years later, affecting the heart, central nervous system, and other organs. Late-stage syphilis can even be deadly.
Luckily, there is a simple and effective antibiotic treatment for it. Even if you don’t show signs, syphilis is still contagious. Let’s take a look at common signs of syphilis and how to get treatment.
Common syphilis symptoms
The first sign of syphilis is usually a single sore known as a chancre (pronounced shane-ker) that appears on the genitals, mouth, or anus. A chancre can show up anywhere from a few days to several months following infection (Nyatsanza, 2016).
Chancres typically heal in 3-6 weeks on their own without treatment. However, it’s still critical to get properly treated for syphilis—even if you show no symptoms at all. Left untreated, the initial sore goes away, but the infection is still alive and well (Tudor, 2021).
If you don’t get treatment for syphilis, it progresses to the secondary phase. This stage can be hard to pinpoint due to the variety of symptoms. Some people don’t show any signs of infection at all.
- A mild rash on the palms of the hands or soles of the feet
- A rash on your chest, arms, back, or shoulders
- Moist grey or white lesions on your genitals, mouth, or anus
- Flu-like symptoms (fever, headache, sore throat, swollen lymph nodes)
- Muscle pain
- Hair loss
- Weight loss
Some people experience no symptoms at all. That’s why it’s essential to get checked regularly, especially if you’re in sexual contact with multiple partners (Nyatsanza, 2016; Clement, 2014).
You typically see signs of secondary syphilis about 2-8 weeks after any initial sores heal. Just like primary syphilis, these second-stage symptoms usually go away without treatment, but the infection is active and contagious (Tudor, 2021).
Late-stage or tertiary syphilis
Not all cases of untreated syphilis progress to tertiary or late-stage syphilis. But if it does, much more than your skin is affected.
Syphilis can remain dormant for decades before progressing and causing severe organ damage (Stock, 2017). The whole body is impacted, including organ systems needed for daily function. Tertiary syphilis also causes problems with the heart, liver, and brain. Neurological issues from the infection can also trigger fatal events like a stroke or seizure (Tudor, 2021).
Other signs of late-stage syphilis include:
- A rash on the chest, back, limbs, palms, and soles of the feet
- Lesions on the genitals, mouth, or anus
- Flu-like symptoms including fever, muscle pain, and swollen lymph nodes
Treatment options for syphilis
If you think you might have syphilis, the first thing to do is get tested. Testing is as simple as a blood test, and treatment can be as simple as a single shot of antibiotics.
Luckily, syphilis treatment is fairly straightforward. One shot of penicillin in the butt or thigh is the most common cure for it (Clement, 2014). If you’re allergic to penicillin, there are other antibiotics you can take. This route is a bit longer, as it requires you to take a daily antibiotic pill over 2-4 weeks.
For advanced syphilis affecting the heart, central nervous system, and organs, treatment includes a weekly antibiotic shot for three weeks. Another option is getting antibiotics intravenously every day for up to two weeks (Peeling, 2017).
Syphilis and pregnancy
If you have syphilis and are pregnant, the infection can be passed to your baby.
Having untreated syphilis while pregnant can lead to severe problems, including a miscarriage or stillbirth (Cooper, 2018; Tsai, 2019). A baby born with syphilis may have facial or bone deformities. Two-thirds of children born with syphilis are asymptomatic, however, symptoms can surface later on in life (Tudor, 2021; Mattei, 2012).
You can prevent passing syphilis on to your baby with the same shot of antibiotics (Workowski, 2015). Following treatment, a healthcare provider will likely do another blood test to confirm the infection is gone (Tudor, 2021).
It’s possible to get re-infected, so continue using condoms if you’re having sex. Let any partners in the past year know you’ve been diagnosed and treated so they can seek care as well. Treatment will also reduce the risk of contracting syphilis again in the future.
The bottom line: if you notice any symptoms of syphilis or you’ve had sex with someone who may have syphilis, see a medical professional right away to get tested.
- Clement, M. E., Okeke, N. L., & Hicks, C. B. (2014). Treatment of syphilis: a systematic review. JAMA, 312(18), 1905–1917. doi: 10.1001/jama.2014.13259. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690208/
- Cooper, J. M., & Sánchez, P. J. (2018). Congenital syphilis. Seminars in Perinatology, 42(3), 176–184. doi: 10.1053/j.semperi.2018.02.005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29627075/
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- Nyatsanza, F., & Tipple, C. (2016). Syphilis: presentations in general medicine. Clinical Medicine, 16(2), 184–188. doi: 10.7861/clinmedicine.16-2-184. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4952975/
- Peeling, R. W., Mabey, D., Kamb, M. L., Chen, X. S., Radolf, J. D., & Benzaken, A. S. (2017). Syphilis. Nature Reviews Disease Primers, 3, 17073. doi: 10.1038/nrdp.2017.73. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809176/
- Stock, I. (2017). Syphilis – an update. Syphilis Der vergessene Affe unter den Infektionskrankheiten. Medizinische Monatsschrift fur Pharmazeuten, 40(3), 113–119. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29952481/
- Tsai, S., Sun, M. Y., Kuller, J. A., Rhee, E. H. J., & Dotters-Katz., S. (2019). Syphilis in Pregnancy. Obstetrical & Gynecological Survey, 74(9):557-564. doi: 10.1097/OGX.0000000000000713. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31830301/
- Tudor, M. E., Al Aboud, A. M., Gossman, W. G. (2021). Syphilis. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK534780/
- Workowski, K. A., Bolan, G. A., & Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report, 64(RR-03), 1–137. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885289/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.