Syphilis has different stages, with symptoms that come and then disappear. Even if the symptoms go away, people with syphilis will still have the infection until they are treated. The sores caused by syphilis are usually painless, so they often go unnoticed or are dismissed as something else. For this reason, syphilis can be transmitted easily without people even realizing they have it. In fact, syphilis is called “the great imitator” because its signs and symptoms are so easy to confuse with other conditions. Recently, there has also been an increase in syphilis infections that lead to vision problem. Vision problems can occur at any stage of syphilis and are easy to confuse with other conditions.


The first or primary stage of syphilis involves the appearance of a small, painless sore, called a chancre, a few weeks after someone is infected. The chancre is located on the part of the body where syphilis entered. Usually, it is found on the penis, vagina, anus, or lips. It can also be found inside someone’s mouth or rectum. While most people have one sore, some have multiple sores. Someone with a syphilis sore is very likely to transmit the infection to others if their sex partners come in contact with the sore during this stage. The sores heal and go away in 3–6 weeks. However, if someone has not been treated, syphilis will move to a second stage. 

Secondary syphilis typically starts with the appearance of a non-itchy rash, often with brownish/reddish spots on the palms of the hand and the soles of the feet. This rash can appear on one or more areas of the body and can show up when the primary sore is healing or several weeks after the sore has healed. The rash can remain for 6–10 weeks. Other common symptoms include sores called mucous patches in moist parts of the body, such as the mouth, vagina, and anus. These mucous patches are highly infectious. People with secondary syphilis can have many other symptoms, including fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, fatigue, or vision issues. Like the first stage of syphilis, if someone does not receive treatment, the symptoms in secondary syphilis will go away, but the person will still have syphilis. 

Without treatment, syphilis moves to hidden or latent stages. Often, there are no signs or symptoms during the latent stages. Most people with untreated syphilis do not develop late stage syphilis. However, late stage syphilis is very serious when it does occur, usually 10–30 years after the infection began. Symptoms of late stage syphilis may include damage to internal organs, muscle impairment, paralysis, blindness, dementia and even death. 


It can be easy to confuse symptoms of syphilis with symptoms of other STIs, such as gonorrhea or herpes. Unlike gonorrhea, syphilis does not cause a burning sensation or discharge when you urinate. And unlike herpes sores, which can be very painful, syphilis sores tend to be painless and easy to dismiss as bumps or nicks.