Early Stage Syphilis Symptoms

Written on November 29, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• More About Syphilis
• Stages of Syphilis
• Early Stages of Syphilis Symptoms
• Treatment of Syphilis in the Early Stages
• Prevention of Syphilis Infection
• Online STD Consult and At-Home Lab Test With Everlywell
• Related Content

In the United States, infection rates of syphilis reached historic lows in 2000 and 2001.[1] However, rates of primary and secondary syphilis have increased nearly every year since then, increasing 28.6% from 2020 to 2021. Rates of syphilis were elevated in both males and females, all regions across the United States, and in every age group. Continue reading to learn more about syphilis and understand the early-stage syphilis symptoms.

More About Syphilis

Syphilis is a sexually transmitted disease (STD) caused by infection with a bacteria called Treponema pallidum.[2] Treponema pallidum is a spiral-shaped bacteria. The bacteria was identified by scientists as the causative agent of syphilis in 1905.[3] The first diagnostic test to detect syphilis infections was developed a year later. The bacteria is also considered to be slowly metabolizing, needing around 30 hours to multiply, and cannot be grown in the lab on artificial media.

Syphilis is a common STD, with f 176,700, and 53,767 new cases reported in 2021.[1] Syphilis is transmitted from one person to another by direct contact with a sore known as a chancre during vaginal, anal, or oral sex.[2] Chancres typically occur in, on, or around the penis, vagina, anus, rectum, and lips or mouth.

Appearance of the initial symptoms of syphilis takes an average of 21 days after infection, although it can range from 10 to 90 days.[2] The clinical manifestations of syphilis are very similar to many other diseases, and it is commonly referred to as “the great pretender” or “the great imitator and mimicker.”[2,3]

Stages of Syphilis

Syphilis infections usually follow a disease progression that can last weeks, months, or years.[2,4,5] The classification of syphilis has not changed for over 100 years and is described in terms of disease stages.[4] Early stages of syphilis include primary, secondary, and early-latent, while late stages are late-latent and tertiary.[4-6] Tertiary syphilis typically occurs many years after the initial infection and relates to the chronic, end-organ complications of the disease process.[4] Each stage of the disease has its own unique signs and symptoms.

Early Stages of Syphilis Symptoms

Primary, secondary, and early latent stages are all considered part of the early stages of syphilis.[2,4-6] Primary syphilis is the stage considered to be the initial exposure to the bacteria Treponema pallidum.[4] Secondary syphilis is the body-wide spread of the bacteria in the blood.[2] Syphilis is the most contagious during the primary and secondary stages.[2,3]

Primary Stage

Primary syphilis mainly presents as a single painless ulcer or chancre at the site of the infection but can also present with multiple painful sores and lesions.[2,6,7] Individuals with HIV and syphilis typically develop multiple chancres.[3] These chancres usually occur in areas of the body that make them hard to notice, such as the vagina or anus.[2] Symptoms appear about 10 to 90 days after exposure to the bacteria, with an average of 21 days.[2,6] The chancre usually lasts three to six weeks and will heal with or without treatment.[2] Without appropriate treatment of the syphilis infection, the disease will progress to the secondary stage.

Secondary Stage

In secondary syphilis, symptoms appear two weeks to six months after exposure.[2,6,7] Chancre can also be present during this stage. Symptoms of secondary syphilis include a rash that can appear when the primary chancre is healing or several weeks after the chancre heals.[2] The rash usually does not cause itching and may appear as red or reddish-brown spots on the palms of hands and bottoms of feet. Rashes may also appear on other parts of the body. Secondary syphilis rash can sometimes resemble rashes caused by other diseases and may be so faint that it can be hard to notice. Condyloma lata or large, raised, gray or white lesions may develop in warm, moist areas like the mouth, underarm, or groin region. Other symptoms are mucus lesions, fever, headaches, swollen lymph nodes, patchy hair loss, fatigue, and neurologic symptoms (such as eye redness or pain, meningitis, or changes to mental status or memory).[2,6]

Early Latent Stage

The latent stage of syphilis is when there are no visible signs or symptoms of the disease.[2,6] Without treatment, syphilis can remain in the body with no noticeable signs and symptoms of the infection. When the syphilis infection is latent and has occurred within the past 12 months, it is considered in the early-latent stage. The latent stage of syphilis itself can last for many years.

Treatment of Syphilis in the Early Stages

Once you are diagnosed with syphilis by your healthcare provider, you can receive treatment.[7] The recommended first-line treatment of early-stage syphilis by the Centers for Disease Control and Prevention (CDC) is benzathine penicillin G. Appropriate treatment will help to prevent syphilis from progressing, but it might not fix the damage that has already occurred.[2,7]

Prevention of Syphilis Infection

You can reduce your risk of getting a syphilis infection by practicing safe sex or avoiding sex altogether.[2] Another prevention strategy is to be in a long-term, mutually monogamous relationship with someone who does not have syphilis. Using condoms correctly every time you engage in sex can also help to prevent getting a syphilis infection. It’s important to consider that condoms offer protection only when the condom covers the infected area or site of potential exposure. Syphilis can still be transmitted if some lesions are not covered by a condom. Getting tested can also help you understand your status and get appropriate treatment.

Online STD Consult and At-Home Lab Test With Everlywell

With Everlywell, you have the option to make an on-demand STD appointment if you think you may have been exposed to a sexually transmitted disease or infection. You can connect with a healthcare provider in less than 2 hours. The virtual visit will include an up to 30-minute video call with a certified clinician where you can discuss your sexual health concerns and questions. During the virtual visit, your healthcare provider will also provide you with personalized recommendations and next steps based on your symptoms and exposure history. This may include additional STD testing or prescription medication, if applicable.

If you think you may have been exposed to syphilis and want to know your status, then you also have an option for an at-home syphilis lab test through Everlywell. This at-home lab test is used to detect the presence or absence of Immunoglobulin G (IgG) antibodies against the bacteria causing syphilis. This particular test cannot be used to differentiate between an active syphilis infection and a successfully treated syphilis infection. If your test results are abnormal, you will have the opportunity to connect with a healthcare provider at no additional cost to discuss your individual case.

Related Content

Understanding the Relationship Between Syphilis and Hair Loss

Can Syphilis Be Cured?

Gumma of Syphilis

Sendra Yang, PharmD, MBA received her Doctor of Pharmacy and Master of Business Administration degrees from Wingate University School of Pharmacy. She is a skilled medical information professional with experience in the pharmaceutical industry, pharmacy education, and clinical practice. She has also been a medical writer and editor for consumer health and medical content. Sendra is passionate about translating complex medical concepts into simple and easy-to-understand information.

References

1. National overview of STDs, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2021/overview.htm#Syphilis. May 16, 2023. Accessed November 14, 2023.
2. Detailed STD facts - syphilis. Centers for Disease Control and Prevention. https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm. April 11, 2023. Accessed November 14, 2023.
3. Tudor ME, Al Aboud AM, Leslie SW, et al. Syphilis.[Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK534780/.
4. French P. Syphilis. BMJ. 2007;334(7585):143-147. doi:10.1136/bmj.39085.518148.BE
5. Syphilis: NIH. Syphilis, NIH. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/syphilis. Accessed November 14, 2023.
6. O'Byrne P, MacPherson P. Syphilis. BMJ. 2019;365:l4159. doi:10.1136/bmj.l4159.
7. Syphilis - STI treatment guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/syphilis.htm. May 1, 2023. Accessed November 14, 2023.