What does the first sign of syphilis look like?
The first sign of syphilis is usually a chancre, a small, firm, round sore that is typically painless. It appears at the spot where the bacteria entered the body, generally 10 to 90 days after exposure, with an average of around three weeks (BASHH consensus).
In men, the chancre commonly appears on:
- The head or shaft of the penis
- The foreskin
- The scrotum, in less common cases
- The anus or rectum, particularly after receptive anal sex
- The lips, mouth, or throat, after oral sex
Because it does not hurt, many men either do not notice it or assume it is a minor graze or ingrown hair. If it is inside the anus or mouth, it may not be seen at all. The sore heals by itself within three to six weeks whether or not you have treatment, which creates a false sense that the problem has gone away. It has not; the infection is still there.
What happens if the chancre is missed?
If primary syphilis is not treated, it moves into a second stage, usually four to ten weeks after the chancre first appeared, and this stage is where the infection becomes more visible and more often mistaken for something else.
The secondary syphilis rash has a distinctive pattern:
- It commonly appears on the palms of the hands and soles of the feet, which is unusual for most rashes
- It can also spread across the trunk, arms, and legs
- It is typically red or reddish-brown and does not usually itch
Alongside the rash, secondary syphilis can cause flat, greyish growths in warm, moist areas such as the groin folds or around the anus (condylomata lata), white patches inside the mouth, sore throat, swollen lymph nodes, fever, and general tiredness. Like the chancre, these symptoms fade on their own after a few weeks to months, and that fading does not mean the infection has cleared.
What is the latent stage, and can syphilis stay hidden?
Yes. After the secondary symptoms settle, syphilis can enter a latent stage with no visible signs at all, while the bacteria remain in the body and the infection stays detectable on a blood test.
Latent syphilis is split into an early phase, within about two years of infection, and a late phase beyond that. A man can feel completely well throughout this stage. This is often when syphilis is finally picked up, usually because a blood test was done for another reason, such as a routine screening package or a new partner's request. Left untreated for years, a minority of people go on to develop late-stage complications affecting the heart, brain, or other organs, which is the main reason syphilis should never be dismissed as a passing rash.
Syphilis stages at a glance
The table below sets out the pattern most men experience, and what each stage is commonly confused with.
When is a syphilis blood test accurate?
Most infections show on a syphilis blood test by around 4 weeks after exposure, but a test taken early can still be negative. If your first test was negative and taken soon after the exposure, a repeat test at 12 weeks is usually advised. If you have a sore, do not wait for the blood test window: book so a clinician can look at it, because the blood test can be negative while a chancre is present.
An HIV test is worth booking alongside a syphilis test, since the two infections are frequently picked up together and share some of the same exposure risks.
Is syphilis serious, and is it curable?
Syphilis is curable with antibiotics, and the earlier it is treated, the simpler that treatment is. Early syphilis, covering the primary, secondary, and early latent stages, is generally treated with an antibiotic injection. At Sexual Health Clinic London the injection is given in-house, usually at a follow-up visit once your results are back rather than on the day of testing. Left untreated for years, syphilis can go on to damage the heart, brain, and other organs, which is why testing after a painless sore or an unexplained rash is worth doing rather than waiting for symptoms to settle on their own.
If you are diagnosed with syphilis, current and recent sexual partners need to be tested too, since they may be infected without knowing it. A clinician can advise on partner notification in a way that keeps your own information confidential.
Regular testing is recommended for men who have sex with men, given the higher rates of syphilis seen in this group. The early signs are easy to miss in women too, often because the sore is internal; our guide to syphilis symptoms in women covers the differences.
How testing works at our Harley Street clinic
A syphilis blood test at Sexual Health Clinic London is £85 plus a £50 blood draw (£135 total), with results in as little as 24 hours. The Bronze package for men, £250, includes syphilis testing alongside chlamydia, gonorrhoea, and HIV in a single visit.
If you need an answer faster, the FAST Screen Simple on our same-day screening service covers syphilis, HIV, chlamydia and gonorrhoea for £350, with results for all four in 6 hours. You can walk in seven days a week at 117A Harley Street. The visit is confidential, as with all of our private STI testing in London.
Book a syphilis test or a same-day screen at 117a Harley Street. Walk in seven days a week, or book online.
References
- NHS: Syphilis
- BASHH: UK national guidelines on the management of syphilis
- NICE CKS: Syphilis
- UKHSA: Sexually transmitted infections surveillance data
