The signs and symptoms of syphilis vary depending on the stage of the disease. Symptoms may go unnoticed, especially for primary syphilis, or may be attributed to other causes.

Primary syphilis. The main symptom of primary syphilis is a painless sore (chancre) at the site that had contact with an infected partner. Common infection sites in women include the vagina, cervix, vulva or anal area. Chancres are flat or slightly raised and do not itch. The chancre may not be noticed or may be in a location the person cannot see such as the cervix. Nevertheless, the disease can still be transmitted. From the chancre, bacteria spread rapidly in the system. Chancres usually heal within a few weeks with no treatment. Enlarged lymph nodes in the groin may also be present.

Secondary syphilis. This stage of the disease has numerous symptoms. They may appear as the initial chancre is fading or several weeks later. Symptoms include:

• Rash. Occurs throughout the trunk and extremities. The rash may appear as coin-sized lesions that do not itch. A rash on the palms of the hands and soles of the feet is characteristic of syphilis. In some cases, the rash is very faint or is similar to rashes caused by other infections. As a result, it may not be noticed. Because of the bacteria level in these lesions, any physical contact (sexual or nonsexual) with a broken sore can transmit the disease.
  
  
• Condyloma lata. Gray or white wartlike mucous patches that form in skin folds or moist areas inside or outside the body, such as under the breast, in the groin or in the armpits.
  
  
• Patchy hair loss on the head and other parts of the body.
  
  
• Swollen lymph nodes and sore throat.
  
  
• Fever.
  
  
• Headache and muscle aches.
  
  
• Fatigue.
  
  
• Weight loss.
  

Other less common symptoms of secondary syphilis include gastrointestinal upset, hepatitis or kidney disease. Many of the symptoms during this stage of syphilis are common to other diseases as well. The symptoms will disappear with or without treatment.

Tertiary syphilis. Signs and symptoms of this late stage of the disease depend on the body system involved. They may affect any or all of these areas:

• Skin, bones and liver. Soft ulcers and lesions (gumma) found inside or outside the body. These are more common among patients with HIV infection.
  
  
• Central nervous system (neurosyphilis). Syphilis may affect many parts of the nervous system, including the meninges, brain, spinal cord, eyes or ears. Symptoms may include uncoordinated muscle movement, meningitis, incontinence, numbness, paralysis, blindness, deafness, and personality changes such as paranoia, mood swings and eventually loss of mental functioning (dementia). Sometimes neurosyphilis symptoms can appear as part of secondary syphilis. Neurosyphilis is the most common form of the tertiary stage and is the most difficult to treat.
  
  
• Cardiovascular system. Inflammation affects the aorta, the body’s largest artery that transports blood from the heart. There may also be problems with the aortic valve, which opens between the heart and aorta.