Syphilis produces the same stages in men and women, but where the first sore lands differs. Men usually get a visible, painless chancre on the penis; women's chancres often sit inside the vagina or on the cervix, where they go unseen and heal on their own. Both then risk a body rash, then silent years.
| Item | Reported cases (babies) |
|---|---|
| 2020 | 2,163 |
| 2021 | 2,881 |
| 2022 | 3,769 |
| 2023 | 3,882 |
The common symptoms of syphilis (the same in both sexes)
Syphilis is caused by the bacterium Treponema pallidum, and it moves through distinct stages whether you're a man or a woman CDC. The biology of each stage is identical between the sexes. What changes is whether you can see the early signs.
The primary chancre
The first sign is a chancre: one or more painless, firm, round sores that appear right where the bacteria entered the body — the penis, vagina, anus, rectum, lips, or mouth. Because it doesn't hurt, it's easy to ignore. It lasts a few weeks and heals on its own with or without treatment. The sore disappearing feels like recovery, but the infection is still spreading inward (E2).
The secondary rash and flu-like illness
Weeks after the chancre fades, the secondary stage can bring a rough red or reddish-brown rash, classically on the palms and soles but often on the trunk too. Many people also get mucous-membrane lesions (sores in the mouth or genitals), fever, swollen lymph nodes, sore throat, patchy hair loss, headache, weight loss, muscle aches, and fatigue. These look like a hundred other illnesses, so syphilis is called "the great imitator."
The silent latent stage
After secondary symptoms clear, syphilis can go quiet for years. There are no symptoms in the latent stage, but the bacteria are still present and still detectable on a blood test. Clinicians split this into early latent (acquired within the preceding year, shown by recent seroconversion, a fourfold titer rise, or recent primary/secondary signs) and late or unknown-duration latent. The split determines how long the treatment course runs CDC Tx Guidelines.
Absorb this point: symptoms going away does not mean you're cured. Per CDC, the symptoms resolve whether or not you get treatment, and without the right antibiotics the infection advances to the latent and possibly tertiary stages.
Why women's symptoms are missed more often than men's
In men, the primary chancre typically forms on the shaft, glans, or foreskin of the penis — out in the open, where it's hard to overlook even though it doesn't hurt. In women, the chancre frequently develops inside the vagina or on the cervix. There's no pain to prompt a look, the sore is physically out of view, and it heals on its own. Many women never know they had a primary infection at all and only learn of it during the secondary rash or through a routine blood test.
A man may seek care when he sees a penile sore. A woman is more likely to present later, after the chancre is gone, sometimes during the latent stage or in pregnancy. That delay matters enormously for congenital syphilis, which is why universal screening in pregnancy exists.
Throat and rectal symptoms in both sexes
Syphilis sores form wherever the bacteria enter, so oral and anal sex can produce a chancre on the lips, in the mouth or throat, or in the anus and rectum. An anal or rectal chancre is painless and easily mistaken for a hemorrhoid or fissure; a throat chancre or secondary mucous lesions can pass as a sore throat. These sites are commonly missed in both men and women because no one thinks to look there.
How soon do syphilis symptoms appear?
The primary chancre usually shows up about three weeks after exposure, though the incubation period ranges from 10 to 90 days. Secondary symptoms follow weeks later, after the chancre heals. Untreated, the disease can stay latent for years; tertiary syphilis classically appears 10 to 30 years after infection in untreated cases, but that is not a guaranteed symptom-free window, because some serious manifestations can strike far earlier.
What syphilis is mistaken for
At every stage, syphilis copies other conditions. The painless chancre is mistaken for an ingrown hair, a friction sore, a hemorrhoid, or another STI's lesion. The secondary rash gets blamed on a drug reaction, pityriasis, or a viral illness, and the fatigue and aches on the flu. The sores in particular are confused with herpes and HPV — if you're trying to tell them apart, see syphilis vs herpes vs hpv sores compared. The tiebreaker is pain: classic herpes sores are painful and clustered, while a syphilis chancre is single, firm, and painless.
Complications and emergency signs
Left untreated, syphilis does lasting damage. Tertiary syphilis can attack the heart and blood vessels (cardiovascular syphilis) and form destructive masses called gummas in tissue and organs, and it can be fatal StatPearls. But two complications are emergencies that can happen at any stage, not just late:
- Ocular syphilis — infection of the eye that can cause new vision changes, blurring, eye pain, or vision loss, and can lead to blindness if untreated.
- Neurosyphilis — invasion of the brain and nervous system, causing headache, confusion, difficulty coordinating movement, numbness, or paralysis.
New vision or neurological symptoms in anyone with syphilis are a medical emergency; get evaluated the same day CDC. Two more risks deserve a flag: syphilis roughly doubles the chance of catching HIV, and in pregnancy it harms the baby in a large share of untreated cases — stillbirth, prematurity, newborn death, or congenital infection. Congenital syphilis (passed from parent to baby, causing stillbirth, death, or lifelong disability) has surged in recent years, and screening rules tightened in response.
Who should get screened for syphilis
The U.S. Preventive Services Task Force gives syphilis screening its strongest endorsement, Grade A, for two groups. All pregnant persons should be screened early and universally, regardless of risk; if that didn't happen early, they should be screened at the first opportunity, even at delivery USPSTF. Among nonpregnant adolescents and adults, the 2022 recommendation is to screen anyone at increased risk USPSTF, 2022, including:
- Men who have sex with men.
- People living with HIV or who have another STI.
- Anyone with a history of incarceration or sex work.
- People in communities where syphilis is common.
Rates are far from even across the country, with several states running multiple times the national average. If you've had a new or untreated partner, don't wait for a sore — get tested.
How syphilis is confirmed
Diagnosis is a simple blood draw, but it takes two tests — a screening test plus a confirmatory one — because no single test is enough on its own (E1) [[mmwr-syph-lab-2024|CDC, 2024]]. Early after exposure a test can read negative before antibodies develop, so timing matters; if your risk was recent, learn when to test after exposure and plan to retest. For the full how-to, see the syphilis test guide.
The blood test does one thing symptoms can't: confirm a cure. After treatment, clinicians track antibody titers, and a fourfold drop over the following months means the treatment worked. Feeling better is not proof. The cure itself is penicillin: Penicillin G given by injection is the preferred drug for every stage, and there's no oral substitute that reliably works. Dosing and the Jarisch-Herxheimer reaction (a brief flu-like response as bacteria die off, not an allergy) are covered in the syphilis treatment guide.
When to see a clinician
See a clinician if you notice any painless sore on the genitals, anus, or mouth; an unexplained rash, especially on the palms or soles; or flu-like symptoms after a possible exposure. Get care urgently for any vision change or neurological symptom. Get screened in pregnancy and if you fall into a higher-risk group, even with no symptoms, because the silent latent stage is when syphilis hides while still being curable.