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Last updated: Jun 12, 2021
3 min read

What does a syphilis rash look like?

yael coopermandanielle oaks

Medically Reviewed by Yael Cooperman, MD

Written by Danielle Oaks

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Syphilis is a sexually transmitted infection that can be challenging to identify as it mimics multiple conditions. 

Most frequently, the first sign is a single sore on the genitals, anus, or mouth. If left untreated, syphilis can progress to the second stage, which is characterized by a widespread rash. Pale round spots on the palms of the hands, soles of the feet, back, arms, and chest are a telltale sign of secondary syphilis.

This rash looks different from person-to-person—another reason why syphilis is difficult to detect. One in five people with a syphilis rash might not notice it at all. For others, the rash is very obvious or mistaken for another skin condition (WHO, 2016; Peeling, 2017; Clement, 2014). 

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What does a syphilis rash look like?

If syphilis goes untreated, it can progress to the rash stage. This rash can show up while you have a sore (also called a chancre) or after the chancre has healed. 

For the most part, a syphilis rash appears as pale, red spots on your chest, back, arms, legs, palms, and soles of your feet. The patches are symmetrical and tend to be non-itchy. The infection spreads through contact with the rash or sores, making the secondary stage of syphilis very contagious.

Typically, the rash goes away by itself within three to 12 weeks. You’ll likely have no symptoms for awhile, but the infection isn’t truly gone until it’s been treated (WHO, 2016; Nyatsanza, 2016). 

Conditions commonly confused with syphilis 

A syphilis rash can be mistaken for other conditions. Depending on your symptoms, syphilis can look similar to: 

  • An allergic reaction
  • Skin irritation from something you came in contact with (contact dermatitis)
  • Skin conditions like eczema or erythema multiforme (a rash with spots that resemble a bullseye)
  • A viral rash called pityriasis rosea 
  • A rash from a tick-borne illness called Rocky Mountain spotted fever

While any of these could cause a rash, it’s best to find out for sure since syphilis spreads so easily. A simple blood test is all it takes to test for a syphilis infection (Hook, 2017; Peeling, 2017).   

Other secondary syphilis symptoms

In addition to a rash, you may or may not notice these signs of secondary syphilis: 

  • White or grey lesions on the genitals or mouth
  • Fever
  • Muscle pain
  • Sore throat
  • Swollen lymph nodes
  • Hair loss

Treatment for syphilis rash

To get rid of the rash, you need to treat the underlying infection first.

Fortunately, all that’s required is antibiotics in the form of a penicillin shot to the leg or butt. More advanced cases might require longer treatment courses. 

After treatment, a healthcare provider may do an additional blood test to ensure the infection is gone. Keep in mind that you can catch syphilis again if exposed to it. 

If you think you might have syphilis, the most important thing is to get tested. If you test positive, it’s a good idea to inform any sexual partners you’ve had so they can get treatment, too. Without proper treatment, syphilis can have severe (and even deadly) consequences like damage to the heart, nervous system, and other organs (Tudor, 2021). 

Wondering if you have syphilis might be scary, but getting tested is easy, and antibiotic treatment is simple and effective.

References

  1. 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/
  2. Hook, E. W. (2017). Syphilis. Lancet, 389(10078), 1550–1557. doi: 10.1016/S0140-6736(16)32411-4. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32411-4/fulltext.
  3. Mattei, P. L., Beachkofsky, T. M., Gilson, R. T., & Wisco, O. J. (2012). Syphilis: a reemerging infection. American Family Physician, 86(5), 433-40. Retrieved from https://www.aafp.org/pubs/afp/issues/2012/0901/p433.html
  4. 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/
  5. 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/
  6. Tudor, M. E., Al Aboud, A. M., & Gossman, W. G. (2021). Syphilis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534780/
  7. World Health Organization (WHO). (2016). WHO Guidelines for the Treatment of Treponema pallidum (syphilis). Retrieved from http://apps.who.int/iris/bitstream/handle/10665/249572/9789241549806-eng.pdf