Stages of syphilis: Timeline explained

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The first stage of syphilis is the primary stage. People start this stage 10–90 days after they first contract syphilis.

They also most commonly do so about 3 weeks after sexual activity without a condom or other barrier method with someone who has syphilis. This includes vaginal, anal, or oral sex. People can get syphilis if they come into contact with an ulcer on a person’s:

• penis
• vagina
• anus
• inside of the mouth

People can also contract syphilis by using a needle that a person with syphilis has previously used.

A person who is pregnant can pass syphilis to their unborn child. It may cause serious birth defects or stillbirth. However, treating syphilis can prevent it from being passed onto the unborn child.

During this stage, syphilis can also be highly contagious.

The symptoms of the primary stage of syphilis include one or more firm and painless open sores, known as chancres. Other symptoms include swollen lymph nodes — small lumps of tissue throughout a person’s body.

The open sores typically appear at the location where syphilis entered the body. People may not notice them, as they are often painless. They usually last for 3–6 weeks before they go away, with or without treatment.

Learn more about syphilis.

Without treatment, syphilis may progress to the secondary stage. This stage usually develops 2–8 weeks after chancres disappear. People with the secondary stage of syphilis may have:

• rough, red, or brown skin rashes that usually do not itch on the:
  • palms of their hands
  • bottoms of their feet
• sores in their:
  • mouth
  • genitals
  • anus

The first symptom is usually a rash on one or more areas of the body. It may develop as sores clear or several weeks after they heal.

Other symptoms can include:

• fatigue
• fever
• hair loss
• headaches
• muscle aches
• rashes
• sore throat
• swollen lymph glands
• weakness
• weight loss

These symptoms will typically go away with or without treatment.

Learn more about secondary syphilis.

Without treatment, primary or secondary syphilis can develop into the latent stage. People may develop this stage in 1 year or less, known as early latent syphilis, or 1 year or more, known as late latent syphilis.

This stage of syphilis often has no symptoms. However, healthcare professionals can use tests to detect it.

Without treatment, people may have latent syphilis for several years or the rest of their lives. It can then develop into the next stage of syphilis, known as the tertiary, or late, stage.

In some cases, latent syphilis relapses into secondary syphilis. This can happen more than once.

Syphilis is still contagious during the latent stage.

Most people with untreated syphilis do not develop tertiary syphilis. If they do, they may develop it months or up to 10–30 years after contracting the infection. Tertiary syphilis can cause several complications and conditions that may damage a person’s:

• heart and blood vessels — cardiovascular syphilis
• brain, spine, and nervous system — neurosyphilis
• other organs

This damage can result in severe or fatal complications, such as:

• damage to the aorta
• stroke
• seizures
• organ destruction and failure
• aphasia
• hemiplegia
• tabes dorsalis, which is slow damage to nerve cells and fibers that carry information to the brain

Healthcare professionals can use tests to diagnose tertiary syphilis.

Learn about RPR testing for syphilis.

Healthcare professionals typically use antibiotics to treat syphilis. A person’s treatment, dosage, and how long they need it depends on the stage of their syphilis. They also generally require follow-up appointments for testing to check they no longer have the condition.

Treatments for syphilis can take from 2–3 weeks depending on which stage it is in. People should not have sex for at least 1 week after treatment and until all their symptoms have cleared.

Healthcare professionals normally use injected or intravenous (IV) penicillin to treat syphilis. They may use different antibiotics if a person is allergic to penicillin.

Correct antibiotic treatments can cure the condition. However, they cannot cure the damage that syphilis causes. People with complications from syphilis may require separate treatments.

Without treatment, syphilis can spread during any stage to the:

• brain and nervous system
• eyes
• ears

These conditions can cause a person to have severe physical and mental health complications. Syphilis treatments are also essential for a person who is pregnant. Treatments may prevent birth defects and fatal complications for a person’s unborn child.

Some frequently asked questions about syphilis include:

How long does it take for syphilis to get bad?

People can develop several significant secondary symptoms of syphilis within 2–8 weeks of their sores healing. However, they may also develop many severe syphilis complications many years after contracting the infection.

Can you tell how long you have had syphilis?

People with different stages of syphilis can have different or no symptoms as it progresses over time. Healthcare professionals may be able to use some medical tests to estimate how long a person has had syphilis. However, these may only indicate if a person has had syphilis, not for how long.

Syphilis is a contagious bacterial STI. People can contract it through sexual activity without a condom or other barrier method, or through using needles that other people with syphilis have used. A person with syphilis can also pass it to their unborn child.

The infection passes through four stages – primary, secondary, latent, and tertiary. People have different symptoms and signs at each stage. Some stages may not have any symptoms or signs and can last for years.

Without treatment, syphilis can cause several symptoms. It may also eventually cause severe or fatal complications. It can also be transmitted to other people, even if a person has no symptoms.

However, healthcare professionals can typically diagnose and treat syphilis using tests and medication.