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Syphilis is a bacterial sexually transmitted infection caused by the spirochaete Treponema pallidum. It affects both men and women and can present in distinct stages, each with different characteristics. The symptoms of syphilis vary widely between individuals, and some people experience no noticeable signs at any point during the course of the infection.
In women, syphilis may be particularly difficult to recognise because initial sores can develop in locations that are not easily visible, such as the cervix or inside the vaginal canal. As the infection progresses through its stages, symptoms may appear, resolve, and reappear — or may never become apparent at all.
Because of this variability, laboratory testing is the only reliable method to confirm a syphilis infection. This article outlines the stages of syphilis, the symptoms that may occur in women, and the circumstances under which testing may be appropriate.
Syphilis in women may begin with a painless sore at the site of exposure, often on the genitals, anus, or mouth. Later stages can involve rash, flu-like symptoms, or no noticeable signs at all. Because symptoms can be mild or absent, laboratory testing is required to confirm infection. The presentation varies considerably between individuals, and many women remain unaware of infection without screening.
Many cases progress without obvious symptoms.
Syphilis is transmitted through direct contact with a syphilis sore during sexual activity. This includes vaginal sex, anal sex, and oral sex. The bacteria can enter the body through mucous membranes or small breaks in the skin, making any form of intimate contact with an active sore a potential route of transmission.
Direct skin-to-skin contact with a sore is sufficient for transmission, even without penetrative sex. This means that syphilis can be passed between partners through close genital or oral contact if an active chancre is present.
Syphilis is not spread through casual contact. It cannot be transmitted through toilet seats, shared utensils, swimming pools, or hugging. The bacteria require direct contact with an infected lesion or, in some cases, contact with a rash during the secondary stage.
The first stage of syphilis is known as primary syphilis. It is characterised by the appearance of a single sore called a chancre at the site where the bacteria entered the body. In women, this sore may appear on the vulva, vaginal walls, cervix, anus, or mouth.
A chancre is typically firm, round, and painless. Because it does not usually cause discomfort, it can easily be overlooked — particularly when located on the cervix or inside the vaginal canal, where it is not visible during everyday activities. The sore usually appears between 10 and 90 days after exposure.
Without intervention, the chancre will eventually resolve on its own. However, the disappearance of the sore does not mean the infection has cleared. The bacteria remain in the body, and the infection progresses to the next stage if not detected through laboratory testing.
If syphilis is not detected during the primary stage, it may progress to secondary syphilis. This stage is characterised by a range of systemic symptoms that can affect multiple areas of the body. The hallmark symptom is a rash, which frequently appears on the palms of the hands and the soles of the feet, though it can occur elsewhere on the body.
In addition to the rash, individuals may experience mild flu-like symptoms including fatigue, headaches, muscle aches, and a low-grade fever. Swollen lymph nodes are also commonly reported during this stage. Some individuals may develop additional sores in the mouth, genital area, or other mucous membrane sites.
The symptoms of secondary syphilis may come and go over a period of weeks or months. They can overlap with symptoms of other common conditions, making clinical identification without laboratory testing unreliable. As with the primary stage, symptoms may resolve without intervention, but the underlying infection persists.
Following the secondary stage, syphilis enters what is known as the latent phase. During this period, the infection remains present in the body but produces no visible symptoms. An individual in the latent stage may feel entirely well and show no outward signs of infection.
Latent syphilis is divided into early latent (within the first one to two years of infection) and late latent (beyond two years). During both phases, the infection can only be detected through blood testing. There are no clinical signs that would alert either the individual or a healthcare professional to the presence of the bacteria.
This is one of the key reasons why laboratory screening is so important for individuals who may have been exposed. Without testing, latent syphilis can remain undetected for years, during which time the infection continues to be present in the body.
In a small proportion of cases where syphilis remains undetected and unaddressed for an extended period, the infection may progress to a later stage. This stage can develop years or even decades after the initial exposure and may affect internal organs.
Later-stage syphilis is uncommon in the context of modern healthcare, particularly where screening and awareness are accessible. Early detection through laboratory testing significantly reduces the likelihood of progression to this stage.
The purpose of mentioning later-stage syphilis is not to cause concern but to illustrate the importance of timely detection. When identified early, syphilis is a well-understood and manageable condition. Routine screening remains the most effective way to identify infection before it progresses.
Yes. Syphilis can be entirely asymptomatic in women, particularly during the primary and latent stages. The initial chancre may develop on the cervix or inside the vaginal canal, making it invisible without a clinical examination. Many women are unaware that the sore has appeared and resolved.
Even during the secondary stage, the rash may be mild, short-lived, or located in areas that are not immediately noticeable. Some individuals experience such subtle symptoms that they do not connect them with a possible STI. The latent phase, by definition, produces no symptoms at all.
Because of this, laboratory testing is the only reliable method of confirming or ruling out syphilis. A syphilis test detects antibodies produced in response to the bacteria, providing accurate results regardless of whether symptoms are present.
Syphilis is diagnosed through blood testing. The test detects antibodies that the body produces in response to the Treponema pallidum bacterium. There are different types of blood tests used for syphilis, including screening tests and confirmatory tests, which laboratories may use in combination to provide accurate results.
Blood testing is a straightforward, confidential process. A small blood sample is taken and sent to an accredited laboratory for analysis. Results are typically available within a few working days, depending on the laboratory.
Syphilis testing may be performed as an individual test or included as part of a comprehensive STI screening panel. We provide laboratory-based STI screening. Treatment arrangements are managed separately if required.
There are several circumstances in which women may wish to consider syphilis testing. If you have had a new sexual partner, testing can provide reassurance about your infection status. Similarly, if you have had unprotected vaginal, anal, or oral sex, screening may be appropriate.
If you are experiencing any symptoms that could be consistent with syphilis — such as an unexplained sore, a rash on the palms or soles, or swollen lymph nodes — laboratory testing can help determine whether syphilis is the cause. However, the absence of symptoms does not exclude the possibility of infection.
Routine sexual health screening is an appropriate consideration for any sexually active individual, regardless of symptoms. Regular testing helps maintain awareness of your sexual health status and supports early identification of infections that may otherwise go unnoticed.
No. Syphilis cannot be reliably diagnosed based on symptoms alone. The symptoms of each stage — from the initial chancre to the secondary rash — can resemble a wide range of other conditions. Syphilis has historically been referred to as "the great imitator" precisely because of this overlap.
In women, the situation is further complicated by the fact that sores may be internal and entirely invisible without examination. The rash of secondary syphilis can be subtle and easily attributed to other causes. During the latent phase, there are no symptoms at all to suggest infection.
For these reasons, blood testing is the only definitive method of confirming a syphilis infection. Laboratory analysis detects antibodies produced by the immune system, providing objective evidence of infection regardless of whether symptoms are present.
A syphilis sore, known as a chancre, typically appears as a painless, firm, round ulcer at the site of exposure. In women, it may develop on the vulva, cervix, anus or mouth. Because it is painless and may be located internally, it can easily go unnoticed without clinical examination. The sore usually heals on its own within a few weeks, but the underlying infection remains.
Yes. Early syphilis symptoms, including the initial sore and secondary rash, may resolve on their own even if the infection has not been addressed. However, the disappearance of symptoms does not indicate that the infection has cleared. The bacteria remain present in the body and the infection can progress to later stages without visible signs.
No. While a rash on the palms and soles is a well-known feature of secondary syphilis, some individuals have minimal or no visible symptoms at any stage. The absence of a rash does not rule out infection. Laboratory blood testing is the only reliable way to confirm whether syphilis is present, regardless of visible signs.
Yes. Syphilis sores can resemble other skin conditions such as ingrown hairs, cold sores, or minor abrasions. The secondary rash may also be confused with allergic reactions or other dermatological conditions. Because of this symptom overlap, laboratory blood testing is required to distinguish syphilis from other causes and provide a definitive result.
Routine screening may be appropriate for sexually active women, particularly after unprotected sex, with a new sexual partner, or when a partner has been diagnosed with an STI. Many syphilis cases are asymptomatic, making laboratory testing the most reliable way to identify infection early and maintain awareness of your sexual health status.
This article is for general information. Laboratory testing is required to confirm any infection. MD.co.uk provides private STI testing services. We do not provide diagnosis, prescriptions or treatment. If you have concerns about your health, please consult a qualified healthcare professional.