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.
A syphilis rash is one of the hallmark symptoms of secondary syphilis. It typically appears as reddish-brown, non-itchy spots on the trunk, arms, legs, palms of the hands, and soles of the feet. A rash on the palms and soles is particularly distinctive and strongly suggestive of syphilis, as few other conditions cause this pattern.
If you’ve noticed an unusual rash and are worried it could be syphilis, this guide covers what a syphilis rash looks like at each stage, how it differs from other rashes, and what to do next.
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What Does a Syphilis Rash Look Like?
Syphilis progresses through stages, and skin symptoms change at each one:
Primary syphilis (10-90 days after exposure)
The first sign is a single, painless sore called a chancre. It appears at the site where syphilis entered the body, often on the genitals, anus, lips, or inside the mouth. It’s firm, round, with raised edges, and typically 1-2cm across. It heals on its own within 3-6 weeks without treatment, but the infection progresses.
A chancre is not a rash. It’s a single sore. The rash comes later.
Secondary syphilis (weeks to months after the chancre heals)
This is when the classic syphilis rash appears. Characteristics:
- Colour: Reddish-brown, coppery, or dark red
- Texture: Usually flat or slightly raised. Not blistered or fluid-filled
- Itch: Usually not itchy (a key distinguishing feature)
- Location: Trunk, arms, legs. Critically: palms of hands and soles of feet
- Pattern: Widespread, roughly symmetrical
- Duration: Lasts weeks if untreated, then fades (but infection remains)
Other secondary syphilis symptoms can include:
- Sore throat
- Swollen lymph nodes
- Patchy hair loss
- Greyish-white mucous patches in the mouth or on the genitals (condylomata lata)
- Fatigue, fever, and weight loss
Why Palms and Soles Matter
Very few conditions cause a rash on the palms and soles simultaneously. If you have a rash in these locations alongside any other symptoms listed above, syphilis should be seriously considered. Other conditions that can affect palms and soles include hand-foot-and-mouth disease (usually children) and secondary allergic reactions, but these look and behave differently.
How a Syphilis Rash Differs from Other Rashes
| Feature | Syphilis Rash | Herpes | Psoriasis | Allergic Rash |
|---|---|---|---|---|
| Appearance | Flat/raised reddish-brown spots | Fluid-filled blisters | Thick, scaly patches | Red, raised, hive-like |
| Itchy? | Usually no | Burning/tingling | Yes | Yes |
| Painful? | No | Yes | Sometimes | No |
| Location | Widespread, including palms/soles | Localised clusters | Elbows, knees, scalp | Variable |
| Comes and goes? | Fades without treatment over weeks | Recurs in outbreaks | Chronic, flares | Resolves when trigger removed |
What Happens If the Rash Fades?
The secondary syphilis rash eventually fades on its own, even without treatment. This does NOT mean the infection has gone. Untreated syphilis progresses to latent syphilis (no symptoms, still infectious for a period) and eventually to tertiary syphilis, which can cause serious damage to the heart, brain, and nervous system years later.
If you had a rash that matches the description above and it’s now gone, you should still get tested. A blood test can detect syphilis antibodies even after symptoms have resolved.
How Syphilis Is Tested and Treated
Testing: A simple blood test checks for syphilis antibodies. It can be done at a sexual health clinic, by your GP, or with a home blood test kit. Testing is most reliable from 4-6 weeks after potential exposure.
Treatment: Syphilis is curable with a single penicillin injection at any stage. Early-stage syphilis requires one injection. Later stages may need three weekly injections. Treatment is free at NHS sexual health clinics.
Read more: What is syphilis? | The 4 stages of syphilis | How to identify syphilis blisters
Frequently Asked Questions
Can you have syphilis without a rash?
Yes. Not everyone develops a visible rash. The primary chancre can be internal (inside the vagina, rectum, or throat) and missed entirely. Some people skip noticeable secondary symptoms. The only reliable way to detect syphilis is a blood test.
Is a syphilis rash contagious?
Yes. Secondary syphilis is highly contagious. The rash and mucous patches contain active Treponema pallidum bacteria. Close physical contact (sexual and sometimes non-sexual) can transmit the infection during this stage.
How quickly does the rash appear after infection?
The secondary syphilis rash typically appears 6-12 weeks after the initial infection (2-8 weeks after the primary chancre heals). The timing varies. If you had a painless sore that healed and now have a widespread rash, get tested immediately.
Can syphilis rash be confused with HIV rash?
Both syphilis and acute HIV can cause a widespread, non-specific rash. The key difference: syphilis rash characteristically affects palms and soles, while HIV acute rash usually does not. Both should be tested for, as co-infection is common.
Related reading
- Cold Sores vs Syphilis Sores: How to Tell the Difference
- How to Identify Syphilis Sores (Chancres)
- Syphilis Symptoms by Stage
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
- Can You Catch Syphilis Without Having Sex?
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.
