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What is Syphilis? Early Symptoms and Warning Signs

  • Writer: Dr Joseph Nightingale
    Dr Joseph Nightingale
  • 2 days ago
  • 6 min read

Updated: 11 hours ago

A couple holding hands in the sun

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Most infections are asymptomatic or unrecognised. However, if it is not treated, it can lead to serious or potentially life-threatening problems. 


In the UK, cases of syphilis have increased in recent years. Between 2013 and 2019, infectious syphilis cases increased by 140%; by 2023, the number of cases rose further to almost 10,000 infectious cases. 


The earlier that syphilis is detected, the better. While the initial infection is most recognisable, long-term, it can cause major damage to the heart and brain.


What is Syphilis?


Syphilis is an infection caused by the bacterium Treponema pallidum. It is primarily spread through sexual contact. Initially, the disease begins with a painless sore on the genitals, rectum, or mouth. 


Once this initial infection subsides, the bacteria can remain in the body for many years without symptoms. Later on, the infection can reactivate, causing damage to the heart, brain, and other organs. In some cases, it is life-threatening. 


How Syphilis Affects the Body


Primary syphilis begins when a chancre develops, typically around 3 weeks after exposure, although it can occur anywhere from 10 to 90 days later. The infection can then subside for a while. Secondary syphilis is characterised by a skin rash, usually on the palms or soles, and a sore throat. 


The infection then becomes latent or hidden. However, the bacteria remain in the body. Without treatment, an estimated 14-40% of people may eventually develop tertiary syphilis, as the bacteria begin to damage organs and tissues throughout the body.


Patients may experience nerve and brain damage, heart and organ complications, or vision and hearing loss.


Symptoms of Syphilis


Symptoms vary depending on the stage of infection. Some people have no symptoms at all, especially during the latent stage.


Stages of Syphilis

The four stages of syphilis are:

  • primary

  • secondary

  • latent

  • tertiary


Early (Primary) Syphilis

The most common sign of early syphilis is a skin lesion called a chancre. It occurs within 3 to 4 weeks and is highly infectious.


Common symptoms include:

  • One or more painless sores (chancres)

  • Swollen lymph nodes

  • Mild flu-like symptoms

  • Fatigue


Secondary Syphilis

Secondary syphilis occurs if the infection is left untreated. 


Common symptoms include:

  • A rash on the palms of the hands or soles of the feet

  • Sore throat

  • Fever

  • Swollen lymph nodes

  • Patchy hair loss

  • Fatigue and muscle aches


Late (Tertiary) Syphilis

Late syphilis appears years after the initial infection.


Potential symptoms include:

  • Vision or hearing loss

  • Numbness or weakness

  • Memory problems

  • Heart and blood vessel damage

  • Difficulty with balance or coordination


Syphilis Symptoms in Men


  • Painless sore on the penis, anus, or mouth

  • Swollen lymph nodes

  • Rash, often on the palms or soles

  • Fever and fatigue

  • Patchy hair loss


Syphilis Symptoms in Women 


  • Painless sore on the vulva, vagina, anus, or mouth

  • Swollen lymph nodes

  • Rash, often on the palms or soles

  • Fever and fatigue

  • Patchy hair loss


How Long Does It Take for Syphilis Symptoms to Show?


The timeline of symptoms for syphilis can vary significantly between individuals. Most people develop primary syphilis within 9 to 90 days after exposure. However, because chancres are painless, many people don’t notice the initial infection. Chancres heal within 3-6 weeks.


Secondary syphilis arises ~6 to 12 weeks after the primary chancre appears. Symptoms can go away without treatment. Like the chancre, the lesions are a non-itchy rash, but are harder to miss. 


Following secondary syphilis, the infection enters the latent phase. The latent phase is extremely variable and can last anywhere from 1 to 30+ years. The infection will then become tertiary, causing widespread systemic symptoms. 


How Do You Get Syphilis


Syphilis is primarily thought of as a sexually transmitted infection (STI). However, any direct contact with sores or rashes can transmit the infection. Most commonly, this occurs during vaginal, anal, or oral sex. Spread via casual contact is extremely rare.


Mother-to-foetus transmission is another possibility. Globally, there were 700,000 maternal syphilis cases in 2022, leading to 390,000 adverse pregnancy outcomes (including stillbirths, neonatal deaths, preterm births, and infected infants). 


Syphilis can also rarely be transmitted through sharing needles contaminated with infected blood.


Can You Get Syphilis from Kissing?


Syphilis can rarely be caught by kissing or touching an active sore. However, this is much less common than via sexual intercourse.


How Syphilis is Tested


Syphilis can be tested for with an at-home test. If you receive a positive result, you’ll need to go to a healthcare professional to confirm the diagnosis.


You may receive the following tests:


  • Blood. Blood tests can confirm syphilis-specific antibodies. Health Klinix offers syphilis testing either alone or as part of STI screening. The advantage of a blood test is that it can confirm a current or past infection, if there’s no sore present.

  • Fluid from a sore. A swab may be taken from a sore and analysed for evidence of the bacteria, particularly during the early stages of infection.

  • Fluid from the spinal cord. If your doctor suspects syphilis is affecting your nervous system, fluid can be removed from the spinal cord via a lumbar puncture and sent for testing. 


At-home syphilis tests are a convenient way to check for infection, particularly if you've recently had unprotected sex or are concerned about symptoms. However, any positive result should be confirmed by a healthcare professional. 


Health Klinix offers confidential syphilis testing, either as a standalone test or as part of a broader STI screen.


Syphilis Treatment


Syphilis is relatively simple to treat once diagnosed. The infection responds well to penicillin at all stages. If you’re allergic to penicillin, your healthcare professional can find another effective antibiotic. 


In the earlier stages, a single shot of penicillin is enough to eliminate the infection. However, if you’ve had syphilis longer than a year, an additional dose may be needed. Because of the dangers of long-term syphilis, it is critical to receive early treatment. If you suspect you have syphilis, getting tested and treated can eliminate the risk. 


Is Syphilis Curable?


Yes. Syphilis is completely curable during the early stages with a simple penicillin injection. During late-stage syphilis, the infection can cause permanent damage to the eyes, heart, brain, and other organs. Even if the syphilis infection is cured, these symptoms will persist and cannot be reversed. 


How to Prevent Syphilis


As with any sexually transmitted infection, syphilis can be prevented by practicing safe sex. Using a condom during intercourse will minimise the risk. 


It’s also recommended that you get screened for STIs, such as chlamydia, especially if a previous partner received a confirmed diagnosis. If you receive a positive diagnosis, partner notification is essential to stop further transmission.


Get Tested


If you're experiencing symptoms of syphilis book an STI test as soon as possible. At Health Klinix we offer discreet and confidential STI testing in a private clinic. Book now and get clear results for your peace of mind.



Frequently Asked Questions About Syphilis


What should I do if my partner tests positive for syphilis?

If your partner tests positive, it’s also sensible to take a syphilis test. You can book an affordable blood test with Health Klinix and get a confirmed diagnosis. 


What are the long-term health complications of untreated syphilis?

If left untreated, syphilis can cause permanent damage to several organs. Potential outcomes include blindness, loss of hearing, memory loss, neurological disorders, heart disease, and damage to soft tissue and bone. 

These outcomes may not be reversible with treatment. 


Can you have syphilis without having any symptoms?

Yes. Latent stage syphilis is characterised by a complete absence of symptoms. Even primary syphilis can go unnoticed as the sore is painless. 


How to tell the difference between syphilis and herpes?

Syphilis usually causes a single painless sore (chancre), while herpes typically causes multiple painful blisters or ulcers. However, symptoms can vary, so testing is the only reliable way to confirm the cause.


Is there a vaccine for syphilis?

No. There is currently no vaccine available to prevent syphilis. The best ways to reduce your risk are practising safer sex, getting tested regularly, and ensuring sexual partners are tested and treated if necessary.


References


Written by:


Dr Joseph Nightingale, MBBS, MSc


Approved by:


Consultant in Infectious Diseases and Travel Medicine

MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP

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