Syphilis often goes unrecognized in its early stages because the symptoms are painless and disappear on their own — only to return years later in more dangerous forms. Knowing the stages is what gets people tested and treated in time.

Syphilis Symptoms by Stage — What to Look For at Each Stage

Syphilis is a bacterial sexually transmitted infection that progresses through four distinct stages if untreated. The reason it is so important to understand the stages is that the early symptoms — the ones where treatment is easiest and most effective — are often painless and disappear without intervention. People assume the problem went away. The bacterium does not.

Here is what each stage actually looks like, when to test, and what treatment involves.

Primary syphilis — the chancre

The first sign of syphilis is a single (occasionally multiple) painless sore called a chancre at the site where the bacterium entered the body. This is usually:

Penis, scrotum, anus, vulva, vaginal walls — the most common sites
Mouth or throat — from oral sex
Anal canal or rectum — sometimes hidden inside

The chancre appears 10 to 90 days after exposure (average around 3 weeks). It looks like:

A firm, round, painless ulcer (sometimes mistaken for an ingrown hair or "cold sore")
1-2 cm across, with clean edges
Painless to touch — this is what makes it easy to miss
Sometimes accompanied by swollen lymph nodes in the groin

The chancre heals on its own in 3 to 6 weeks without treatment. This is the dangerous part: people assume the problem resolved itself. It didn't. The bacterium has just gone latent and will reappear as secondary syphilis weeks to months later.

Testing at the primary stage: Standard syphilis blood tests (RPR/VDRL) may not yet be positive — they take 1-3 weeks after symptoms to convert. Direct testing from the chancre (darkfield microscopy or PCR) can confirm immediately if your clinic offers it.

Treatment: A single intramuscular injection of benzathine penicillin G 2.4 million units cures primary syphilis completely.

Secondary syphilis — the rash phase

If primary syphilis is not treated, 4 to 10 weeks after the chancre heals, the secondary stage begins. This is when the bacterium has spread through the bloodstream throughout the body. Symptoms include:

The classic rash

Non-itchy, copper-colored rash, often on the palms of the hands and soles of the feet — this is highly specific to syphilis
Can also appear on the trunk, arms, legs
Sometimes flat (macular), sometimes raised (papular)

Mucous patches

Painless white or grayish patches in the mouth, throat, or genitals

Condyloma lata

Wart-like lesions in warm, moist areas (groin, anus, under breasts)
Highly infectious — anyone in contact can acquire syphilis

Systemic symptoms

Fever, fatigue, weight loss
Sore throat
Muscle aches
Hair loss (patchy, often eyebrows or scalp — "moth-eaten alopecia")
Headaches

These symptoms also resolve without treatment, usually within 3 to 12 weeks. The bacterium then enters the latent stage.

Testing at secondary stage: Standard blood tests are very reliable here — both treponemal (TP-PA or FTA-ABS) and non-treponemal (RPR or VDRL) tests will be positive.

Treatment: Same as primary — single dose of benzathine penicillin G 2.4 million units IM. Completely curative.

Latent syphilis — no symptoms

The bacterium is still in the body but is not producing visible symptoms. Latent syphilis is divided into:

Early latent: less than 1 year since infection
Late latent: more than 1 year since infection (or unknown duration)

There are no outward symptoms during the latent stage. The only way to know is through blood testing.

This phase can last years to decades. About 25% of untreated latent syphilis will progress to tertiary syphilis; the rest may remain latent for life or eventually clear on their own.

Testing during latent stage: Blood tests detect it readily. RPR titer (a number that reflects current activity) helps determine early vs late latent. Lumbar puncture may be done if neurosyphilis is suspected.

Treatment:

Early latent: Single dose of benzathine penicillin G 2.4 million units IM
Late latent or unknown duration: Three weekly doses of benzathine penicillin G 2.4 million units IM

Tertiary syphilis — the dangerous end stage

Develops in roughly 25-40% of untreated cases, anywhere from 3 to 30 years after the original infection. Tertiary syphilis has three main forms:

Gummatous syphilis

Soft, granulomatous lesions called gummas form in the skin, bones, liver, and other organs. Less common today because antibiotics have caught most infections earlier.

Cardiovascular syphilis

Damage to the heart and aorta, typically appearing 10-30 years after infection. Can cause aortic aneurysm, aortic regurgitation, and is potentially fatal.

Neurosyphilis

Invasion of the central nervous system. Can occur at ANY stage (not just late) but is more common in late untreated disease. Symptoms include:

Headaches, meningitis-like symptoms (early)
Hearing loss, vision changes (ocular syphilis)
Dementia, personality changes
Difficulty walking, tabes dorsalis (loss of coordination)
Stroke

Tertiary syphilis is still treatable with penicillin, but damage already done to the heart, brain, or eyes is not reversible.

A common pattern: HIV co-infection

HIV and syphilis are co-traveling epidemics. People with syphilis are more likely to acquire HIV (the sores create entry points). People with HIV who get syphilis often progress faster through the stages and have higher rates of neurosyphilis.

If you are testing for syphilis, get an HIV test at the same visit.

Congenital syphilis — passed from parent to baby

Pregnant people with untreated syphilis can transmit the bacterium to the fetus, causing miscarriage, stillbirth, or severe lifelong complications in the baby. Congenital syphilis is at a 30-year high in the United States — and it is entirely preventable with one round of penicillin during pregnancy.

This is the strongest argument for prenatal syphilis screening — every pregnancy, regardless of risk profile.

When to get tested

Test if any of the following:

A new sex partner since your last test
A partner has been diagnosed with syphilis
You notice a painless sore at any genital, oral, or anal site
You develop an unexplained rash, especially on palms and soles
You are pregnant — at first visit, and again at 28 weeks if higher risk
You have HIV — every 3-6 months
You are MSM with multiple partners — every 3-6 months

Standard syphilis testing is two blood tests run in sequence: a non-treponemal screen (RPR or VDRL), then a treponemal confirmatory (TP-PA or FTA-ABS). Results back in days. Free at most public-health clinics. Available via at-home kits.

The bottom line

Syphilis is curable at every stage with penicillin. The challenge is recognizing it — early symptoms are painless, disappear on their own, and can be easily mistaken for other things. Knowing the four-stage pattern, knowing what a chancre and a palm-and-sole rash look like, and getting tested when there is any concern is the entire ball game.

If you have ever had a painless genital sore that disappeared, a rash on your palms and soles, or any of the systemic symptoms described above, get tested. The test is simple, the cure is one or three injections, and the alternative — letting it progress untreated — has real consequences.

For more on syphilis — neurosyphilis, treatment options, congenital syphilis, and current epidemiology — see our complete syphilis pillar guide.