What Are The Symptoms Of Syphilis?

February 26, 2024

Perhaps you’ve heard the reports of increasing syphilis numbers in the Charlotte, NC metro area. If so, you are wise to try and understand the disease better—how it spreads, what its symptoms are, and your own risk of contracting it.

North Carolina has seen syphilis cases double since 2018, and Mecklenburg County is experiencing the largest statewide increase in cases while the North Carolina Department of Health and Human Services struggles to fill its five Disease Intervention Specialist positions which track HIV and syphilis cases. Up to 40% of babies born to infected women die from the infection and in 2023 there were seven newborn syphilis deaths in North Carolina.

Syphilis is a sexually transmitted disease (STD) that spreads through sexual contact between two people. Most cases in the U.S. are diagnosed among men (or those assigned male at birth) who are gay, bisexual, and those who have sex with other men. The cause of infection is the bacteria Treponema pallidum which is transmitted from one person to another via vaginal, anal, or oral sex as the person comes into direct contact with a lesion. While quite rare, it is possible to contract syphilis from a kiss if the infected person has a lesion in their mouth.

Stages and Symptoms

There are four stages of syphilis, each with its own set of symptoms, though stages can overlap.


A person who has been infected with syphilis will often develop a single sore, or chancre, approximately 3-6 weeks after infection. The sore will appear where the bacteria enters the body through broken skin. The sore is often small, sometimes resembling a pimple. It won’t itch and will be firm, round, and painless. Due to its small size and unobtrusive nature, it can easily hide on a part of the body or between folds of skin where it is not visible. After several weeks, the sore will go away. At this stage, the infected person is very contagious but may be entirely unaware that they have contracted the bacterium and may unknowingly pass it to other intimate partners.


In this stage, one to six months after infection, the individual develops a skin rash that often appears on the trunk of the body and then spreads to the entire body. Like the initial sore, the rash will not itch. It is sometimes so faint that it is unnoticeable. The rash may develop a rough texture and be red to reddish brown. Sores may develop on the mouth, vagina, anus, or hands (palmar lesions) and feet (plantar lesions). It may come and go for up to two years. When it flares, it can last from two to six weeks. At this stage, the symptoms will go away without any medical treatment. It can be hard to distinguish a syphilis rash from other illnesses with similar presentations. In the secondary stage, the infected person remains highly contagious.

Other symptoms may include:

  • wart-like sores in the mouth or on the genitals
  • fever
  • swollen lymph glands
  • sore throat
  • patchy hair loss
  • headaches
  • weight loss
  • muscle aches
  • fatigue

Latent Stage

The latent stage, also referred to as the ‘hidden stage,’ occurs when the affected person exhibits no visible signs of infection. In this stage, the symptoms may never come back. The ‘early’ latent stage is when the initial syphilis infection occurs within the previous 12 months, while one can still pass it along to others. The ‘late’ latent stage is when the initial infection occurs more than 12 months in the past and may last for as long as 20 years. It is rare for a person to pass the disease along to another at this stage. Even though there may be no symptoms, syphilis remains in the body. Latent syphilis can only be diagnosed by antibody serological tests, though the tests cannot determine the disease stage.

Tertiary- ‘late syphilis’

Most who remain untreated for syphilis stay at the Latent stage, however, 30-40% develop Tertiary, or Late syphilis. Though this stage may not manifest for 10 to 30 years after infection, it can have profoundly serious health consequences that slowly emerge and can lead to death.

Multiple organ systems can be affected by Tertiary syphilis, including the:

  • Brain & nerves (neurosyphilis)
  • Eyes (ocular syphilis)
  • Ears (otosyphilis)
  • Spinal cord
  • Heart
  • Blood vessels
  • Liver
  • Bones
  • Joints

Multiple tests are required to confirm this stage of the disease.

Who might get syphilis?

Anyone sexually active can get syphilis, but your risk is higher if you:

  • Have unprotected sex, especially if you have/have had more than one partner
  • Are a man who has sex with men (MSM)
  • Have HIV
  • Have had sex with someone who’s tested positive for syphilis
  • Tested positive for another sexually transmitted infection (STI), such as chlamydia, gonorrhea or herpes

Syphilis and pregnancy

It is important to note that syphilis, called congenital syphilis, can be passed from mother to fetus through the placenta in utero or at the time of birth should the baby’s body touch a lesion. Congenital syphilis can cause harm to a fetus, including birth defects. Ten times more babies were born with syphilis in 2022 than in 2012. Of babies born to untreated, infected women, up to 40% die from the infection. Since the symptoms of syphilis can go unnoticed, any person who finds themselves pregnant should be tested as soon as possible to avoid significant injury to them or their fetus.

How to protect yourself and others

The best protections against contracting syphilis are to remain in a mutually monogamous sexual relationship, ask partners if they have been tested, and use condoms or dental dams properly during intimacy. Condoms or dental dams will not protect you from exposure to syphilis if a lesion remains uncovered despite their use. If at any point you test positive for syphilis, you should promptly notify every person you’ve been intimate with in the previous two years, so they can get tested.

The good news is that syphilis if discovered early enough, can be cured through the administration of a simple antibiotic without having caused any long-term harm. When you see your doctor, be honest with them regarding whether you have practiced safe sex or not. Remember, just because you may have been diagnosed and treated for syphilis in the past, that does not confer any immunity. You can get syphilis again at any time.

Visit AFC Urgent Care Statesville for all your testing needs. Our team is fully equipped to help you with your recovery.

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