References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Syphilis is a bacterial STI that progresses through distinct stages if left untreated. Each stage has different symptoms and health implications, and treatment becomes more complex as the infection advances. Understanding the stages helps explain why early diagnosis and treatment are so important — and why syphilis is sometimes called “the great imitator” because of its varied presentations.
Here’s a clear guide to each stage.
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The Four Stages
| Stage | Timing | Main Features |
|---|---|---|
| Primary | 10-90 days after infection | Painless sore (chancre) at site of infection |
| Secondary | Weeks to months after chancre | Rash, flu-like symptoms, widespread inflammation |
| Latent | Months to years | No symptoms, but infection still present |
| Tertiary | Years to decades later | Serious damage to heart, brain, other organs |
Stage 1: Primary Syphilis
The first sign is usually a chancre — a single painless, firm ulcer at the site where bacteria entered the body. Features:
- Appears 10-90 days after infection (average 3 weeks)
- Painless, so easy to miss
- Usually on genitals, anus, mouth or lips
- Heals on its own in 3-6 weeks even without treatment
- Swollen nearby lymph nodes often present
The infection is highly transmissible during this stage.
Stage 2: Secondary Syphilis
Weeks to months after the chancre heals, untreated syphilis enters the secondary stage. This is when it spreads throughout the body. Symptoms can include:
- Body rash, often on palms and soles (distinctive)
- Mucous patches in the mouth or genitals
- Fever, fatigue and body aches
- Swollen lymph nodes
- Headache
- Patchy hair loss
- Wart-like growths called condylomata lata
Symptoms can come and go, leading to missed diagnosis. This stage is also highly infectious.
Stage 3: Latent Syphilis
After secondary symptoms resolve, the infection enters a latent (hidden) stage with no symptoms. There are two phases:
- Early latent — first year of latency; still infectious
- Late latent — more than a year; less infectious but still present
Many people with untreated syphilis stay in latent stage for years or even for life without progressing further. But some do progress.
Stage 4: Tertiary Syphilis
Years or decades after initial infection, a minority of untreated people develop tertiary syphilis, which can affect:
- Cardiovascular — aortic aneurysm, heart valve problems
- Neurological (neurosyphilis) — stroke, dementia, paralysis, personality changes
- Gummatous — large soft growths on skin, bone or organs
Tertiary syphilis can be serious and life-threatening. Neurosyphilis can occur at any stage, not just in tertiary disease.
Diagnosis
Syphilis is diagnosed with a blood test for antibodies. Active infection can be confirmed with a swab from a chancre during primary stage. Testing is routine in antenatal care, sexual health clinics and among people at risk.
Treatment
- Primary and secondary: Single injection of benzathine penicillin
- Early latent: Single injection
- Late latent or unknown duration: Three weekly injections
- Neurosyphilis: Intravenous penicillin, usually in hospital
- Alternative antibiotics for penicillin allergy
Earlier treatment is easier and more straightforward. Late treatment may not reverse tissue damage already done.
Read more: What is syphilis? | Identifying syphilis sores | Cold sores vs syphilis
Frequently Asked Questions
Can syphilis be cured at any stage?
Early stages are cured easily with antibiotics. Late stages can be treated but pre-existing damage may not reverse.
Is syphilis still common?
Rates have been rising in the UK in recent years, particularly among men who have sex with men. Regular testing and awareness matter.
Can I have syphilis without any symptoms?
Yes. Latent syphilis causes no symptoms but can progress years later. Blood testing is the only way to detect it.
Related reading
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
- Can You Catch Syphilis Without Having Sex?
- Cold Sores vs Syphilis Sores: How to Tell the Difference
- How to Identify Syphilis Sores (Chancres)
- Lab Test for Syphilis and Herpes
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
