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.

The main symptom of primary syphilis is a painless sore (chancre) at the site that had contact with an infected partner. Common infection sites include the vagina, penis, scrotum, 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. Nevertheless, the disease can still be transmitted. From the chancre, bacteria spread rapidly into the system. Chancres usually heal within a few weeks with no treatment. Enlarged lymph nodes in the groin may also be present.

The secondary stage of the disease has numerous symptoms and can affect many body areas. They may appear as the initial chancre is fading or several weeks later. Symptoms of secondary syphilis include:

• Rash. Occurs throughout the trunk and extremities. The rash may appear as coin-sized lesions that do not itch, a rash with pustules (pus-filled sores), or an itchy rash. 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 wart-like 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.

Signs and symptoms of tertiary syphilis depend on the body system involved. This latest stage of syphilis may affect any or all of these areas of the body:

• 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 dementia (loss of mental functioning). Sometimes neurosyphilis symptoms can appear as part of secondary syphilis, especially in people with HIV or AIDS. Neurosyphilis is the most common sign of tertiary syphilis and is the most difficult to treat.
  
  
• Skin, bones and liver. Soft ulcers and lesions (gumma) found inside or outside the body. These are more common among patients with HIV infection.
  
  
• 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.

Infants born with congenital syphilis may have symptoms at birth, but many develop them between two weeks and three months after birth. Signs and symptoms of congenital syphilis may include:

• Skin ulcers
  
  
• Rashes
  
  
• Fever
  
  
• Weakened crying
  
  
• Swollen liver or spleen
  
  
• Jaundice (yellowing of the skin, whites of the eyes, nail beds and/or mucous membranes)
  
  
• Anemia (a lack of red blood cells and/or the iron-rich molecule in red blood cells [hemoglobin] that carries oxygen throughout the body and gives blood its red color)
  
  
• Deformity of the bridge of the nose (saddle nose)

Symptoms in infants are usually detected during well-child visits (routine medical examinations). However, when congenital syphilis is left untreated, complications during childhood can occur. These may include abnormally shaped teeth, vision loss, deafness and other complications associated with congenital syphilis.