Main Symptoms of Syphilis Infection

The first symptom of syphilis is a wound that neither bleeds nor hurts and appears after direct contact with another person's syphilis wound. This wound may take 3 to 12 weeks to appear and releases a clear liquid when rubbed.

This wound tends to disappear on its own without any treatment, but this doesn’t mean that the disease has healed; in fact, it is going on to the second stage.

Syphilis can appear in four different ways: primary, secondary, tertiary and congenital, which occurs when a pregnant woman who has syphilis doesn’t follow the treatment and passes the disease on to the baby. Each form of syphilis has its own characteristics:

Fotos da Sífilis
Fotos da Sífilis

1. Primary syphilis

Primary syphilis is the early stage of the disease, which appears about 3 weeks after infection. This stage is characterized by the appearance of hard lumps, small red lesions in the genital organs that end up disappearing after 4 or 5 weeks without leaving scars.

In men, these wounds usually appear around the foreskin, while in women they appear on the small lips, or labia minora, and vaginal wall. This wound can also appear in the anus and mouth, and on the tongue, breasts and fingers. Swollen lymph nodes may also appear in the groin or near the affected area during this stage.

2. Secondary syphilis

After the disappearance of the hard lesions, which is a period of inactivity that can last from six to eight weeks, the disease will become active once more. This time, the disease will affect the skin and internal organs, as the bacteria spreads throughout the body.

The new lesions are characterized as pinkish spots or small brownish-colored lumps that appear on the skin, mouth, nose, palms and soles, and sometimes there may be intense peeling of the skin. Other possible symptoms are:

  • Red spots on the skin, in the mouth, on the nose, the palms and the soles;
  • Peeling of the skin;
  • Swollen lymph nodes throughout the body, but mainly in your genital area;
  • Headaches;
  • Muscle pain;
  • Sore throat;
  • Malaise;
  • Mild fever, usually below 38 ° C;
  • Lack of appetite;
  • Weight loss.

This phase continues during the first two years of the disease, and appears as outbreaks that regress spontaneously, but which are longer-lasting.

3. Tertiary syphilis

Tertiary syphilis occurs in people who haven’t been able to spontaneously fight against the disease in its secondary stage or haven’t had the appropriate treatment. In this stage, syphilis is characterized by:

  • Greater lesions on the skin, mouth and nose;
  • Problems in internal organs: heart, nerves, bones, muscles, liver and blood vessels;
  • Constant headaches;
  • Frequent nausea and vomiting;
  • Neck stiffness, with difficulty in moving the head;
  • Convulsions;
  • Hearing loss;
  • Vertigo, insomnia and stroke;
  • Exaggerated reflexes and dilated pupils;
  • Delusions, hallucinations, decreased recent memory, and difficulty with orientation and doing simple mathematical calculations, as well as in speaking when there is general paresis.

These symptoms usually appear 10 to 30 years after the initial infection, and when the individual isn’t treated, so to avoid complications in other organs of the body, treatment should be done soon after the onset of the first syphilis symptoms.

Symptoms of congenital syphilis

Congenital syphilis is when the baby is infected with syphilis during pregnancy, and this happens when the woman has syphilis and doesn’t treat it.

Syphilis during pregnancy can cause miscarriage, malformations or death of the baby at birth. In live babies, symptoms may appear between the first weeks of life and up to more than 2 years after birth, and include:

  • Pale red or pinkish round spots on the skin, including the palms and soles;
  • Easy irritability;
  • Loss of appetite and energy to play;
  • Pneumonia;
  • Anaemia
  • Problems with the bones and teeth;
  • Loss of hearing;
  • Mental disability.

Treatment for congenital syphilis is usually done with 2 injections of penicillin for 10 days or 2 injections of penicillin for 14 days, depending on the child’s age.

Is syphilis curable?

Syphilis is curable and can be easily treated with penicillin injections, but its treatment should be started as soon as possible to prevent serious complications in other organs such as the brain, heart and eyes, for example.

How to diagnose syphilis

To confirm that it is a syphilis, the doctor must check the person's intimate area and confirm whether the person has had sexual contact without a condom. If there is no wound in the genital area or other parts of the body, the doctor may request a test called VDRL that identifies Treponema pallidum in the body.

This test is usually done every trimester for all pregnant women because syphilis is a serious illness that the mother can pass on to the baby, but is easily cured with antibiotics prescribed by the doctor.

Get to know a little more about syphilis in this interview (please enable subtitles in the video options):

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  • BARER, Michael R.. Medical Microbiology: A guide to microbial infections - pathogenesis, immunity, laboratory investigation and control. 19 ed. Elsevier, 2018. 317-322.
  • RADOLF, Justin D. et al. Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nat Rev Microbiol. Vol 14. 12 ed; 744-759, 2017
  • WORLD HEALTH ORGANIZATION. WHO Guidelines for the treatment of Treponema pallidum (syphilis). 2016. Available on: <>. Access in 10 Apr 2019
  • MINISTÉRIO DA SAÚDE. Sífilis: Estratégias para diagnóstico no Brasil. 2010. Available on: <>. Access in 10 Apr 2019
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