Syphilis progresses through distinct stages, each with different symptoms, and it can take anywhere from weeks to decades to move through them. The first sign is typically a painless sore that appears 3 to 6 weeks after exposure. Because that sore heals on its own, many people assume the infection is gone. It isn’t. Without treatment, syphilis advances through secondary, latent, and potentially tertiary stages, causing progressively more serious damage.
Primary Stage: The Painless Sore
The earliest symptom is a firm, round sore called a chancre (pronounced “shanker”). It shows up at the spot where the bacteria entered your body, most commonly on the genitals, anus, rectum, or lips and mouth. You might get one sore or several. What makes it easy to miss is that it usually doesn’t hurt. If it’s inside the vagina, rectum, or mouth, you may never see it at all.
The sore typically lasts 3 to 6 weeks and heals completely on its own whether or not you get treated. This is what makes the primary stage deceptive: the visible symptom disappears, but the infection remains active in your body and continues progressing.
Secondary Stage: Rash and Flu-Like Symptoms
The secondary stage can begin while the primary sore is still healing or several weeks after it’s gone. The hallmark is a rash that often appears on the palms of the hands and the soles of the feet, known as palmar and plantar lesions. This is unusual because most rashes don’t show up in those locations, which can be a telltale sign. The rash may also spread to other parts of the body and can look rough, red, or reddish-brown.
Along with the rash, secondary syphilis causes a range of systemic symptoms that can feel like a bad case of the flu:
- Fever
- Sore throat
- Muscle aches
- Fatigue and weight loss
- Swollen lymph nodes
- Patchy hair loss
- Wartlike sores in the mouth or genital area
These symptoms will also resolve on their own, reinforcing the false sense that the infection has cleared. Without treatment, it simply moves underground into the latent stage.
Latent Stage: No Symptoms at All
Latent syphilis is the stage that has no visible symptoms. You feel fine, look fine, and have no sores or rash. The only way to detect it is through a blood test. This stage can last for years, even decades. Early latent syphilis refers to the first year after infection, while late latent syphilis describes anything beyond that. During the early latent period, the secondary symptoms can sometimes flare up again briefly, but in late latency, the infection is essentially silent.
This is why screening matters so much. Without testing, you’d have no reason to suspect you were infected. The CDC recommends at least annual syphilis testing for sexually active men who have sex with men, with testing every 3 to 6 months for those at higher risk. All pregnant women should be tested at their first prenatal visit, with repeat testing at 28 weeks and at delivery for those with additional risk factors. Anyone with HIV should be screened at their first evaluation and at least annually after that.
Tertiary Stage: Organ Damage
If syphilis still hasn’t been treated, tertiary disease can develop 10 to 30 years after the initial infection. Only a subset of untreated people progress to this point, but the consequences are severe. Tertiary syphilis can produce rubbery masses of inflamed tissue called gummas that form in the skin, bones, liver, or other organs. Cardiovascular syphilis damages the heart and blood vessels, particularly the aorta. Psychiatric symptoms like memory loss and personality changes can also emerge.
Tertiary syphilis is now rare in countries with accessible healthcare, but it still occurs. The damage it causes is often irreversible, even after the infection itself is treated.
Symptoms Affecting the Brain, Eyes, and Ears
Syphilis can attack the nervous system, eyes, and ears at any stage of infection, not just the late stages. These complications are serious enough that they’re classified separately.
Neurosyphilis affects the brain and spinal cord. Early on, it can cause meningitis, stroke, altered mental status, and problems with cranial nerves (the nerves controlling facial movement, swallowing, and similar functions). Late neurosyphilis, which develops over decades, can cause difficulty walking and coordinating movements, along with progressive mental decline.
Ocular syphilis can involve nearly any structure of the eye, but inflammation inside the eye is the most common form. Symptoms include blurred or decreased vision, eye pain, redness, and sensitivity to light. It can lead to permanent blindness if not caught and treated quickly.
Otosyphilis targets the inner ear and balance system. It typically causes hearing loss, ringing in the ears, or vertigo. The hearing loss can come on suddenly, affect one or both ears, and worsen rapidly. Like the eye complications, it can become permanent.
Congenital Syphilis in Newborns
When a pregnant person has untreated syphilis, the infection can pass to the baby during pregnancy or delivery. Congenital syphilis can cause deformed bones, severe anemia, an enlarged liver and spleen, jaundice, skin rashes, meningitis, and brain and nerve damage including blindness or deafness. Some infected babies show no symptoms at birth but develop them later, and untreated congenital syphilis can be fatal. Children who survive may face developmental delays and seizures.
Congenital syphilis cases have been rising sharply in recent years, which is why repeat screening during pregnancy is now recommended for anyone with risk factors.
Why Syphilis Is Easy to Miss
The pattern of syphilis is uniquely deceptive. Each visible stage resolves on its own, creating the impression that the problem has passed. The primary sore heals. The secondary rash fades. Then the infection goes completely silent for years. By the time serious damage appears, it may be irreversible. A simple blood test can detect syphilis at any stage, and treatment in the earlier stages is straightforward and highly effective. The challenge is recognizing that you need to get tested, especially when symptoms have already disappeared or were never noticed in the first place.