What Are the Symptoms & Signs of Syphilis?

Syphilis is a sexually transmitted infection (STI) that can cause serious health complications if not treated properly. In this article, we will explain the symptoms of syphilis that warrant a visit to the doctor if you notice them.

When Do Syphilis Symptoms Appear?

The initial symptoms of syphilis do not immediately appear on the person after bacterial infection. They typically take several weeks to manifest, with an average incubation period of around 21 days, or 3 weeks. However, the time frame for symptoms to appear can range from 10 - 90 days. Additionally, a person can be infected with syphilis bacteria without any symptoms for several years.

What Are the Symptoms of Syphilis?

Syphilis progresses through several stages, with symptoms varying depending on the stage reached. The symptoms do not always occur in a specific order, as the stages can overlap. The infection is typically contagious during the first two stages, where the patient exhibits clear symptoms. Here are the symptoms and signs of syphilis according to its stage:

• Primary Syphilis

Primary syphilis typically begins 10 - 90 days after infection with the bacteria, averaging around 3 weeks. The main symptom is the appearance of one or more painless sores, often found on or around the mouth, anus, penis, vagina, or cervix. These sores are round, may discharge pus, and usually heal on their own within 2 to 6 weeks.

Patients might not notice these sores because they are painless and may appear in hidden areas like the rectum or cervix. The only other symptom could be swollen and enlarged lymph nodes. This stage is highly contagious.

• Secondary Syphilis

This stage starts about 7 - 10 weeks after the initial infection. The primary symptom is a rash that can appear on the palms of the hands, soles of the feet, chest, or back. The rash consists of rough, red, or reddish-brown spots that are non-itchy and non-painful, sometimes so faint they are hard to notice. Other symptoms include:

• Hair loss.
• Sore throat.
• Headache.
• Fatigue.
• Fever.
• Swollen lymph nodes in the armpits and groin.
• Weight loss.
• Joint and muscle pain.

Symptoms of secondary syphilis may disappear with or without treatment, but without treatment, the disease can progress to the latent stage.

• Latent Syphilis

The third stage is latent or hidden syphilis, where the symptoms of the first and second stages disappear, and there are no noticeable symptoms. 

This stage can last for several years. Without treatment, the patient may remain in this stage or progress to the final stage, causing severe complications.

• Tertiary Syphilis

Approximately 30-40% of untreated syphilis patients will develop tertiary syphilis, also known as late-stage syphilis. 

This stage can damage any part of the body, including the heart, brain, spinal cord, eyes, bones, liver, and blood vessels, potentially leading to blindness, hearing loss, memory loss, stroke, meningitis, dementia, impotence, paralysis, heart disease, and other life-threatening complications. 

These complications usually occur many years after the initial infection and neglecting treatment.

How is syphilis diagnosed?

Diagnosing syphilis typically involves a combination of blood tests and a physical examination. The doctor may request a syphilis test to look for antibodies to the bacteria in the blood, along with a comprehensive physical examination. If there are sores present, the doctor may also take a sample from them to determine whether the syphilis bacteria are present or not.

In cases where there is suspicion of neurosyphilis and blood tests are positive, the doctor may request a cerebrospinal fluid test.

The primary test for diagnosing syphilis is usually done on Blazma and doesn't require prior preparation, such as the Venereal Disease Research Laboratory (VDRL) test or the Syphilis (RPR) test.

When should you get tested for syphilis? 

It's essential to get tested for syphilis if you or your partner show signs and symptoms of the disease, which typically appear after two to three weeks of infection or later. Additionally, testing for syphilis is necessary if your partner has recently been diagnosed with syphilis, or in the following cases:

• Engaging in multiple sexual partners.
• Having unprotected sex.
• Being infected with the human immunodeficiency virus (HIV).
• Having other sexually transmitted diseases, such as gonorrhea.