Syphilis Stages Explorer
Primary Syphilis
3 weeks after exposure
Secondary Syphilis
2-8 weeks after primary
Latent Syphilis
Weeks to years
Tertiary Syphilis
Years (often >3)
Syphilis Timeline Progression
Stage Details
Select a stage above to learn more about its characteristics, symptoms, and treatment.
Important Notes
- Early stages (primary and secondary) are highly treatable with a single dose of penicillin
- Latent syphilis shows no symptoms but still requires treatment to prevent damage
- Tertiary syphilis can cause irreversible damage to vital organs
- Congenital syphilis can be prevented with early prenatal screening
Quick Summary / Key Takeaways
- Syphilis moves through syphilis stages that each have distinct signs and timeframes.
- Early stages (primary and secondary) are usually easy to treat with a single dose of penicillin.
- Latent syphilis shows no symptoms but still requires treatment to prevent damage later on.
- Tertiary syphilis can affect the heart, brain, and bones and may need longer antibiotic courses.
- Pregnant people can pass the infection to their baby, causing congenital syphilis, which is preventable with early screening.
What Is Syphilis?
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease has a reputation for being called “the great imitator” because its symptoms can mimic many other conditions. If left untreated, the infection follows a predictable path of worsening health problems, which is why understanding each stage matters.
How Syphilis Progresses: The Stages
After infection, the bacteria travel through the bloodstream and settle in different tissues. Over weeks to years, the disease unfolds in several phases, each with its own clinical picture. Knowing the timeline helps you recognize warning signs early and seek treatment before irreversible damage occurs.
Primary Syphilis
Primary syphilis appears about three weeks after exposure. The hallmark is a single, painless sore called a chancre, usually on the genital area, anus, or mouth. The sore heals on its own in 3‑6 weeks, but the bacteria remain alive underneath.
- Typical location: genitals, rectum, lips.
- Size: 0.5-2cm, firm and round.
- Accompanying signs: mild swollen lymph nodes nearby.
Because the chancre feels harmless, many people ignore it, allowing the infection to slip into the next stage.
Secondary Syphilis
Secondary syphilis kicks in 2-8 weeks after the chancre resolves. This phase is marked by a widespread rash that can involve the palms and soles-something few other STIs do. Other symptoms include fever, sore throat, hair loss, and muscle aches.
- Rash pattern: copper‑colored spots, often non‑itchy.
- Systemic signs: low‑grade fever, malaise.
- Mucous‑membrane lesions: moist patches on the mouth or genitals.
These manifestations usually disappear within a few weeks, yet the infection silently moves forward.
Latent Syphilis
Latent syphilis is the silent middle ground. After secondary symptoms fade, the disease enters a period with no visible signs. Doctors split it into early latent (within the first year) and late latent (beyond a year). Blood tests stay positive, but patients feel fine.
- Early latent: still contagious; risk of progressing to tertiary disease.
- Late latent: no longer infectious, but organ damage can still develop.
Without treatment, about one‑third of people will eventually move to the final stage.
Tertiary Syphilis
Tertiary syphilis can surface years-sometimes decades-after the initial infection. It attacks internal organs and may cause:
- Cardiovascular problems (aortitis, aneurysm).
- Neurological damage (general paresis, tabes dorsalis).
- Destructive skin or bone lesions called gummas.
At this point, the damage is often irreversible, emphasizing why early detection matters.
Congenital Syphilis
Congenital syphilis occurs when a pregnant person transmits the bacteria to the fetus. Babies can be born with rash, fever, organ enlargement, or even stillbirth. The good news: routine prenatal screening and prompt penicillin treatment can prevent almost all cases.
Diagnosis and Testing
Doctors rely on blood tests to confirm infection. The most common are:
- Rapid plasma reagin (RPR) - a non‑treponemal test that measures antibodies produced in response to the infection.
- Venereal Disease Research Laboratory (VDRL) - another screening test with similar purpose.
- Confirmatory treponemal tests (FTA‑ABS, TP‑PA) that detect antibodies specific to Treponema pallidum.
Positive screening followed by a confirmatory test gives a definitive diagnosis. Testing is recommended for anyone with risk factors or unexplained symptoms.
Treatment Overview
Penicillin remains the gold‑standard therapy for all syphilis stages. The regimen varies:
- Primary, secondary, or early latent: a single intramuscular dose of benzathine penicillin G (2.4million units).
- Late latent or tertiary without neurosyphilis: three weekly doses of the same amount.
- Neurosyphilis or pregnant patients: intravenous aqueous crystalline penicillin for 10‑14 days.
For those allergic to penicillin, doxycycline or ceftriaxone may be alternatives, but they are less studied in pregnancy.
Prevention Tips
- Use condoms consistently; while they don’t eliminate risk completely, they drastically reduce it.
- Get tested regularly if you have multiple partners or engage in high‑risk activities.
- Pregnant individuals should undergo syphilis screening at the first prenatal visit and again in the third trimester if at risk.
- Inform sexual partners if you test positive so they can seek testing and treatment.
- Avoid sharing needles or other equipment that could introduce blood into the body.
Comparison of Syphilis Stages
| Stage | Typical Time After Infection | Main Symptoms | Contagious? | Standard Treatment |
|---|---|---|---|---|
| Primary | ~3 weeks | Single painless chancre | Yes | Single 2.4MU penicillin dose |
| Secondary | 2-8 weeks after primary | Rash (palms/soles), fever, mucous‑membrane lesions | Yes | Single 2.4MU penicillin dose |
| Latent | Weeks to years | No visible signs | Early latent: Yes; Late latent: No | Three weekly 2.4MU doses (late) |
| Tertiary | Years (often >3) | Cardiovascular, neurological, or gummatous lesions | No | Three weekly 2.4MU doses or IV penicillin for neurosyphilis |
Common Misconceptions
1. “If the sore goes away, the infection is cured.” - The chancre heals on its own, but the bacteria remain and can spread.
2. “You can’t get syphilis from oral sex.” - The bacteria can infect the mouth or throat; oral lesions are possible.
3. “Antibiotics other than penicillin work just as well.” - Penicillin is the only drug proven to reliably clear the infection in all stages, especially in pregnancy.
Frequently Asked Questions
Can syphilis be cured without treatment?
No. The bacteria never go away on their own. Even if symptoms disappear, the infection persists and can cause serious damage later.
How long does it take for a test to become positive after exposure?
Screening tests like RPR or VDRL are usually positive 1-3 weeks after infection, but a confirmatory treponemal test can detect antibodies a bit later.
Is syphilis a lifetime infection if left untreated?
Yes. Without antibiotics, the disease progresses through its stages and can lead to irreversible organ damage, but it remains present for life.
Can I still have sex after a single dose of penicillin?
It’s safest to abstain for at least 7 days after treatment and until a follow‑up test shows a drop in antibody levels. This reduces the chance of passing the infection.
What should pregnant people do to avoid congenital syphilis?
Get screened early in pregnancy, repeat testing in the third trimester if at risk, and receive the recommended penicillin regimen immediately if positive.
Naresh Sehgal
October 8, 2025 AT 14:30Listen up-if you brush off that painless sore thinking it’ll vanish on its own, you’re just inviting the later stages to crash the party. Get tested, get treated, and stop the bacteria from marching toward the heart and brain.