Syphilis develops in four stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don't always occur in the same order. You may be infected with syphilis and not notice any symptoms for years. If you have HIV infection at the same time, the symptoms of syphilis may be somewhat different than without HIV infection.
These signs may occur from 10 days to three months after exposure:
• A small, firm, painless sore (chancre, pronounced "SHANG-ker") on the part of your body where the bacteria entered, usually your genitals, rectum, tongue or lips. A single chancre is typical, but you may have multiple sores.
• Enlarged lymph nodes in your groin.
The sore will heal without treatment, but the syphilis infection remains. In some people, syphilis then moves to the secondary stage.
The signs and symptoms of secondary syphilis begin two to 10 weeks after the chancre appears and may include:
• Skin rash, often appearing as rough, red or reddish-brown, penny-sized sores, over any area of your body, including your palms and soles
• Fatigue and a vague feeling of discomfort
• Soreness and aching
• Swollen lymph glands
• Sore throat
• Wart-like sores in the mouth or genital area
These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.
If you aren't treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.
Tertiary or late syphilis
About 15 to 30 percent of people infected with syphilis who don't get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original infection.
Some of the signs and symptoms of late syphilis include:
• Jerky or uncoordinated muscle movements
• Gradual blindness
If you're pregnant, you may pass syphilis to your unborn baby. Blood containing the bacteria reaches the fetus through the placenta, the organ that nourishes the developing baby. This is known as congenital syphilis.
Most infants born with syphilis have no symptoms of the disease. Almost all develop symptoms by 3 months of age, though some children with congenital syphilis show no signs of the disease until after age 2.
Early signs and symptoms, which occur before the age of two, may include:
• "Snuffles" (runny nose)
• Skin sores
• Jaundice — yellow skin
• Infection of the umbilical cord
• Swollen liver and spleen
If not treated right away, the baby may experience serious problems, including:
• Tooth abnormalities
• Developmental delays
When to see a doctor
Visit your doctor if:
• You have a sore in your genital area, enlarged lymph nodes in your groin area, a widespread rash or any other symptoms that might indicate syphilis.
• Your sexual behaviors put you at risk for sexually transmitted diseases. You should be tested periodically for syphilis.
• You've been treated for another sexually transmitted disease, such as gonorrhea or HIV infection. You should be tested to make sure you don't also have syphilis.