Symptoms · stages · what it looks like · Australia-wide
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A Specialist GP arranges your test over a quick phone call — they review your symptoms and risk, then send your pathology referral by SMS. Syphilis is easily missed early, so testing after any risk is worthwhile.
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Syphilis is a sexually transmitted infection caused by a bacterium. It spreads through direct contact with a syphilis sore during vaginal, anal or oral sex, and it can also pass from a pregnant person to their baby. After decades of being rare, syphilis is rising sharply in Australia and many other countries — including among women and heterosexual people, not only the groups historically most affected.
The most important thing to understand about syphilis is that it comes in stages, and its signs typically appear, then disappear on their own — even though the infection is still there. This is why it’s nicknamed the great imitator and why it’s so often missed. The good news is that syphilis is completely curable, especially when treated early, and a simple blood test detects it.
What Syphilis Looks Like, and Its Stages
What syphilis looks like depends entirely on its stage, and in the early stages the signs are easy to overlook or mistake for something harmless.
The first sign (primary syphilis) is usually a single sore, called a chancre. It’s typically firm, round and painless, and appears where the infection entered the body — the genitals, anus, or mouth and lips. Because it doesn’t hurt and can be hidden internally, it’s frequently missed. It heals on its own within a few weeks, whether or not you’re treated — but the infection remains.
The next stage (secondary syphilis) often brings the syphilis rash. Classically, it’s a rough, red or reddish-brown rash that can appear on the palms of the hands and soles of the feet — an unusual location that’s a useful clue — and it’s usually not itchy. There may also be flat wart-like patches in moist areas, sores in the mouth, patchy hair loss, swollen glands, fever and feeling generally unwell.
The critical point about how syphilis looks: the sore and the rash both go away by themselves, which people understandably take as a sign of recovery. It isn’t. The infection continues silently and can cause serious harm years later. Any painless genital sore, or an unexplained rash on the palms or soles, is worth a syphilis test.
The stages of syphilis
Syphilis progresses through distinct stages if it isn’t treated. Understanding these stages explains why testing matters even when you feel completely well.
Stage
When
What happens
Primary
~3 weeks after exposure (range 10–90 days)
A single painless sore (chancre) at the site of infection; heals on its own.
Secondary
Weeks to a few months later
Rash (often palms and soles), mucous patches, hair loss, fever, swollen glands; also resolves on its own.
Latent
After symptoms resolve
No symptoms at all — detectable only by a blood test. Can last for years.
Tertiary
Years later, if untreated
Serious damage to the heart, brain, nerves and other organs.
Syphilis can also affect the nervous system (neurosyphilis) or the eyes at any stage, which is one reason it’s never something to leave untreated. The earlier it’s found, the simpler the treatment and the more complete the recovery.
Syphilis in Men, Women and Pregnancy
Syphilis in men
In men, the primary sore usually appears on the penis, but it can also be around the anus or in the mouth, depending on the type of sex involved — and sores at the anus or inside the mouth are easily missed. Because the chancre is painless and heals by itself, many men don’t realise they’ve had it. Rates have risen substantially, particularly among men who have sex with men, though heterosexual men are increasingly affected too. A painless sore anywhere in the genital or anal area, or an unexplained rash, should prompt a syphilis test.
Syphilis in women
Syphilis in women can be even harder to spot, because the primary sore often forms internally — on the cervix or inside the vagina — where it can’t be seen or felt. This means many women pass through the primary stage without any awareness of it. Rates of syphilis in women of reproductive age have climbed steeply in recent years, which matters enormously, because syphilis in pregnancy can be passed to the baby with devastating consequences. Any woman who is sexually active benefits from including syphilis in routine STI screening, and testing is especially important before and during pregnancy.
Syphilis in pregnancy
Syphilis in pregnancy is serious but preventable. If a pregnant person has untreated syphilis, it can pass to the baby — called congenital syphilis — and can cause miscarriage, stillbirth, newborn death, or lifelong disability. This is why syphilis testing is a routine part of antenatal care. The reassuring part: it’s treatable in pregnancy, and treating it protects the baby. Testing early and, where needed, being retested later in pregnancy prevents almost all cases of congenital syphilis. If you’re pregnant or planning to be, make sure syphilis testing is part of your care.
Syphilis Testing
Testing for syphilis is simple. The main test is a blood test, which looks for the body’s response to the infection and can detect syphilis at any stage, including the silent latent stage when there are no symptoms at all. If you have a visible sore, a swab of it can also be tested directly. Either way, the sample goes to a laboratory and results are usually available within a few days. Syphilis is included in most standard STI screens alongside chlamydia, gonorrhoea and HIV, so a routine screen will usually cover it.
When should you get tested?
Consider a syphilis test if you have any possible symptom — a painless sore, or an unexplained rash on the palms or soles — if a partner has been diagnosed, if you’re pregnant, or simply as part of routine STI screening if you’re sexually active. Because so much of syphilis is silent, testing when you feel completely well is the main way it gets caught.
Timing matters. After exposure, it can take a few weeks — sometimes up to around three months — for a syphilis blood test to become reliably positive. If you’ve had a recent risk and test negative, a clinician may recommend testing again after this window. If you have a sore now, get tested now regardless.
How testing works with Clinic365
A Specialist GP arranges your test over a quick phone call, reviews your symptoms and exposure, and sends your pathology referral by SMS. You then walk into any pathology lab Australia-wide — no appointment needed — and results come back by SMS, usually in 2-3 days. If syphilis is found, the Specialist GP calls you to arrange treatment and follow-up. You can also screen for other infections at the same time with the full STI test.
Treatment, Follow-up and Why It Matters
Syphilis is curable, and treatment is straightforward and highly effective. The standard treatment is an antibiotic injection. How many doses you need depends on the stage: early syphilis usually needs a single injection, while later or long-standing infection needs a longer course. For people with an allergy to the standard injection, alternatives are available, and in pregnancy the standard injection is used — with a desensitisation process if needed — because it’s the only treatment reliably effective for the baby. Treatment cures the infection and stops it progressing, but it can’t reverse damage already done in the late stages, which is exactly why testing and treating early is so important.
Some people feel flu-like for a few hours after their first treatment — fever, chills, headache or aches. This is a known, temporary reaction to the infection being cleared, not an allergy or a sign anything is wrong, and it settles quickly. Your clinician will explain what to expect.
Follow-up and treating partners
After treatment, follow-up blood tests over the following months confirm the infection is clearing, by showing the relevant levels falling as expected — so it’s worth keeping those appointments even when you feel completely well. Recent sexual partners need to be tested and, in many cases, treated, whether or not they have symptoms, since syphilis is so often silent. Partner notification can be handled confidentially and, where preferred, anonymously. Treating partners protects them and prevents you being reinfected, because having had syphilis gives you no immunity against catching it again.
Why treating syphilis matters
Left untreated, syphilis doesn’t simply go away when the sore and rash do — it can progress over years to damage the heart, brain, nerves and other organs, and it can affect the eyes and nervous system even earlier. In pregnancy, untreated syphilis can be passed to the baby with tragic outcomes. Against all of that, the treatment is simple and highly effective. There is no reason to leave syphilis untreated once it’s found — and the only reliable way to find it, given how quietly it behaves, is to test.
Frequently asked questions
Syphilis is a sexually transmitted infection caused by a bacterium, spread through contact with a syphilis sore during vaginal, anal or oral sex, and from a pregnant person to their baby. It progresses through stages, with signs that appear then disappear on their own while the infection persists. It’s completely curable, especially when treated early.
It depends on the stage. The first sign is usually a single, firm, painless sore where the infection entered — the genitals, anus or mouth. Later, a rough red or reddish-brown rash may appear, classically on the palms and soles, and usually not itchy. Both the sore and rash heal on their own, but the infection remains.
Early on, a painless sore; weeks to months later, a rash (often on palms and soles), mucous patches, hair loss, fever, swollen glands and feeling unwell. After that, symptoms disappear and syphilis becomes silent, detectable only by a blood test. Many people have no symptoms they notice at all, which is why testing matters.
Primary (a painless sore around three weeks after exposure), secondary (a rash and other signs weeks to months later), latent (no symptoms, detectable only by blood test, lasting years), and tertiary (serious organ damage years later if untreated). Syphilis can also affect the nervous system or eyes at any stage. Each earlier stage is easier to treat.
The main test is a simple blood test, which detects syphilis at any stage, including the silent latent stage. If you have a visible sore, a swab of it can also be tested. Syphilis is included in most standard STI screens. No special preparation is needed, and results are usually available within a few days.
Get tested if you have a painless sore or an unexplained rash on the palms or soles, if a partner has been diagnosed, if you’re pregnant, or as part of routine STI screening. After a recent exposure it can take up to around three months for the blood test to become reliably positive, so a repeat test may be advised.
Syphilis is cured with an antibiotic injection. Early syphilis usually needs a single injection; later infection needs a longer course. Alternatives exist for those allergic to the standard injection, and in pregnancy it’s used with desensitisation if needed. Treatment cures the infection but can’t reverse late-stage damage, so early treatment is best.
Yes, completely — especially when caught early. A course of antibiotic treatment clears the infection and stops it progressing. What it can’t do is reverse damage already caused in the late stages, which is why testing and treating early matters so much. Follow-up blood tests confirm the treatment has worked.
In men, the first sore usually appears on the penis, but can be around the anus or in the mouth, and sores at those sites are easily missed. Because it’s painless and heals by itself, many men don’t realise they’ve had it. A later rash may appear on the palms and soles. Any painless genital or anal sore warrants a test.
In women the first sore often forms internally — on the cervix or inside the vagina — where it can’t be seen or felt, so many women pass through the early stage unaware. A later rash may appear on the palms and soles. Because syphilis in women can be silent and matters greatly in pregnancy, routine testing is important.
Untreated syphilis in pregnancy can pass to the baby (congenital syphilis) and cause miscarriage, stillbirth, newborn death or lifelong disability. This is why syphilis testing is routine in antenatal care. The good news is that it’s treatable in pregnancy, and treating it protects the baby, preventing almost all cases when caught in time.
Yes. Recent partners need to be tested and often treated, whether or not they have symptoms, because syphilis is so often silent. Partner notification can be handled confidentially and, where preferred, anonymously. Treating partners protects them and prevents you being reinfected — having had syphilis gives no immunity against catching it again.
Untreated syphilis doesn’t go away when the sore and rash do. Over years it can damage the heart, brain, nerves and other organs, and can affect the eyes and nervous system even earlier. In pregnancy it can be passed to the baby with tragic outcomes. Given how simple and effective treatment is, there’s no reason to leave it untreated.
