8 minutes read8 minutes readSummary:
- Syphilis looks different at each stage. It usually starts with one firm, painless sore, about 3 weeks after infection.
- Weeks later, a rash that doesn’t usually itch can appear, often on the palms and soles, along with warty growths, white patches in the mouth or patchy hair loss. Then the signs go, but the infection stays.
- You can’t confirm Syphilis by looks. The Better2Know Syphilis test is a blood test you can take from 9 days after sex, with results in 1 day.
Syphilis has been called the great imitator, because its signs are easy to miss and easy to mistake for something else. So what does Syphilis look like? It changes over time, and for long stretches there’s nothing to see at all. The good news is that it can be cured with antibiotics.
In this blog, we explain what Syphilis looks like at each stage, what it can be mistaken for, and how it’s tested and treated.
What does Syphilis look like at each stage?
It depends on how long you’ve had it. Syphilis moves through stages, and each one looks different:
| Stage | When | What you might see |
| First stage | About 3 weeks after infection, but anywhere from 9 to 90 days | One firm, painless sore where the infection got in |
| Second stage | Around 3 months after infection | A rash that doesn’t usually itch, warty growths, white patches in the mouth and patchy hair loss |
| Hidden stage | After the earlier signs clear | Nothing. Only a blood test can find it |
| Late stage | Years or decades later, in about a third of people who are never treated | Lumps or sores on the skin, in the mouth or in bone |
The NHS says the symptoms are often mild and hard to notice, and that they can come and go.
What does the first sore look like?
The first sign is usually a single, firm, painless sore, called a chancre. It appears where the infection got into your body.
- how it starts: as a small, firm, red bump, up to 1cm across, that doesn’t hurt
- how it changes: it quickly breaks down into an open sore with a clear edge and a clean base, which may weep clear fluid but not pus
- how many: usually one, although some people get several
- pain: usually none, but a significant minority of people have painful sores
- glands: the glands nearby, such as those in your groin, may swell
The sore can appear on the penis, vulva or cervix, around or inside the anus, in the mouth or on the lips, and sometimes on the hands. Sores inside the vagina, inside the bottom or in the mouth are easy to miss.
The sore heals by itself in 3 to 8 weeks, but the infection stays. Read more in “What does a Syphilis sore look like?”
What does the Syphilis rash look like?
The second stage usually brings a rash that doesn’t itch, often on the palms of the hands and the soles of the feet. It tends to appear 3 to 10 weeks after the sore.
- the rash: flat or slightly raised spots that are red, reddish brown or coppery red. It often covers the chest, tummy and back as well as the palms and soles, and it can be faint enough to miss
- warty growths: moist, flat-topped growths, usually white or grey, around the genitals or anus. They’re highly infectious
- the mouth: white or grey patches inside the mouth
- hair: patchy hair loss on the head, beard and eyebrows
- how you feel: swollen glands and flu-like symptoms, such as a high temperature, headaches and tiredness
Not everyone gets these signs. UK guidelines say about a quarter of people who aren’t treated develop them. They clear by themselves in 3 to 12 weeks, and they come back in about a quarter of untreated people during the first 2 years.
The hidden stage: when there’s nothing to see
Once the earlier signs go away, you feel well, but the infection is still there. Doctors call this the latent stage. It can last for many years, and only a blood test can find it.
- in the first 2 years: Syphilis can still be passed on to partners, and the second stage signs can come back
- after 2 years: it usually can’t be passed on through sex, but it can still pass to a baby during pregnancy
Read more in “Can you have Syphilis and not know it?”
What does late Syphilis look like?
Late Syphilis is now rarely seen. It affects about a third of people who are never treated, usually 20 to 40 years after infection.
- what you can see: lumps, patches or sores called gummas, most often on the skin and in bone, and sometimes in the mouth
- what you can’t see: damage to the heart, brain and nerves. The NHS lists heart failure, dementia, fits, shooting pains and joint damage among the problems it can cause
Syphilis can also affect the eyes and ears at any stage, causing sight and hearing problems. If you think you could have Syphilis and your sight or hearing changes, get urgent medical care. The NHS says untreated Syphilis can be life-threatening, which is why it’s worth finding and treating early. Read more in “What are the three stages of Syphilis?”
What can Syphilis be mistaken for?
Several common conditions look similar, so looks alone can’t confirm Syphilis.
| What you see | What else it could be | The typical difference |
| A sore on the genitals | Herpes | Herpes usually starts with tingling, burning or itching, then several small blisters that burst into painful sores. A Syphilis sore is usually single, firm and painless |
| A bump where you shave | An ingrown hair | An ingrown hair is a raised, itchy bump, sometimes with a trapped hair or pus. A Syphilis sore usually starts as a firm, painless bump and soon becomes an open ulcer that weeps clear fluid |
| Growths around the genitals or anus | Genital warts | Warts are small, rough lumps, sometimes in cauliflower-like groups. Syphilis growths are moist and flat-topped |
| A rash on the body | Pityriasis rosea, psoriasis, eczema or a reaction to a medicine | The Syphilis rash usually doesn’t itch and often affects the palms and soles, where pityriasis rosea is uncommon |
These are typical pictures, and real cases often don’t follow them. UK guidelines say Syphilis can cause several tender sores and be mistaken for Herpes. The NHS says having a test is the only way to confirm if you have Syphilis. Read more in “What can be mistaken for Herpes?”
How is Syphilis passed on?
Syphilis is passed on through direct contact with a sore or with the warty growths of the second stage, usually during vaginal, anal or oral sex.
- how easily: UK guidelines say about a third of the sexual partners of someone with infectious Syphilis catch it
- condoms: they lower the risk, but a sore on skin the condom doesn’t cover can still pass it on
- other routes: it can pass to a baby during pregnancy, and between people who share needles
Read more in “Can you pass on Syphilis without a sore?”
Syphilis in pregnancy
Syphilis can pass to a baby during pregnancy, so every pregnant woman in the UK is offered a blood test for it. The test is offered early in pregnancy, ideally by 10 weeks, and you can ask for it again at any time.
Without treatment, Syphilis in pregnancy can cause miscarriage, premature birth and stillbirth. The UK Health Security Agency (UKHSA) says up to 40% of untreated affected pregnancies may end in stillbirth or the death of the newborn baby.
Treatment with antibiotics during pregnancy protects the baby, and cases are rare. In England, 13 babies born in 2023 were reported as confirmed, probable or possible cases.
How is Syphilis tested and treated?
A blood test is the main test, and if you have a sore, a swab is taken from it too.
- timing: a blood test can be negative before the sore appears and for up to 2 weeks afterwards. A swab from the sore can find the infection sooner
- repeat test: UK guidelines recommend another blood test 3 months after a possible exposure, because an earlier negative result can’t rule Syphilis out
- treatment: antibiotics. Early Syphilis is usually treated with one penicillin injection, and later stages with three, a week apart
- afterwards: the NHS advises not having sex until 2 weeks after you and your partner have finished treatment. You’ll have follow-up blood tests for about a year
Being treated doesn’t protect you from catching Syphilis again. Read more in “Can Syphilis be fully cured?”
Which test do you need?
Better2Know offers:
- Syphilis: a blood test from 9 days after sex, with results in 1 day. You can book it at one of our clinics, have a nurse visit you, or order a home test kit.
- Blemish Screen: if you have a sore, blister or lump on or around your genitals, it tests a swab for Syphilis, Herpes 1, Herpes 2 and HPV, with results in 5 days. It’s available at our clinics or as a home test kit.
- Peace of Mind: tests for Chlamydia, Gonorrhoea and Syphilis from 14 days after sex, with results in 2 days.
- Full Screen: tests for 7 infections, including HIV, Syphilis, Hepatitis B, Chlamydia and Gonorrhoea, from 28 days after sex, with results in 3 days (5 days for the home test).
If you test before 45 days, a negative HIV result needs a repeat test. A Syphilis test in the first 3 months after sex can miss the infection, so you may need a repeat test. Not sure which test you need? Our Patient Care Team is available 24/7 on 020 7099 0955.
FAQs
Is the Syphilis rash itchy?
Usually not. UK guidelines say the rash may itch, but usually doesn’t. A rash on the palms and soles that doesn’t itch is one of the more recognisable signs of Syphilis.
Can you have Syphilis with nothing to see?
Yes. The first sore can be hidden inside the vagina, bottom or mouth, many people never get second stage signs, and the hidden stage has none at all. A blood test is the only way to know.
How common is Syphilis in England?
There were 8,262 diagnoses of infectious Syphilis in England in 2025, 13.5% fewer than in 2024. Diagnoses fell in men, but rose by 4.8% in women who have sex with men. Read more in “Is Syphilis still rising in heterosexual men? The latest figures”
Final thoughts
Syphilis doesn’t have one look. It can be a single painless sore, a rash on the palms and soles, white patches in the mouth or patchy hair loss, and for much of the time there’s nothing to see at all. Because the signs heal by themselves and are easy to mistake for something else, a test is the only way to know. Found early, Syphilis is cured with antibiotics.
Book a Syphilis test at a clinic near you or order a home test kit. Our Patient Care Team is available 24/7 on 020 7099 0955.
About this article
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This article originally appeared on 5 January 2024 and was last updated on 3 October 2026.
This article is general information and not a substitute for personal medical advice.
Sources
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- Centers for Disease Control and Prevention, About syphilis, reviewed 30 January 2025. https://www.cdc.gov/syphilis/about/index.html
- UK Health Security Agency, UKHSA syphilis response plan, 23 March 2026. https://www.gov.uk/government/publications/syphilis-public-health-england-action-plan/ukhsa-syphilis-response-plan
- British Association for Sexual Health and HIV, UK national guideline for the management of anogenital herpes, 2024. https://www.bashh.org/_userfiles/pages/files/pateletal2024britishassociationofsexualhealthandhivuknationalguidelineforthemanagementofanogenital.pdf
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- NHS, Ingrown hairs, reviewed 1 September 2026. https://www.nhs.uk/conditions/ingrown-hairs/
- British Association for Sexual Health and HIV, National guideline for the management of anogenital warts in adults, 2024. https://www.bashh.org/_userfiles/pages/files/resources/agw_2024.pdf
- NHS, Genital warts, reviewed 10 July 2023. https://www.nhs.uk/conditions/genital-warts/
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- NHS, Screening for hepatitis B, HIV and syphilis, reviewed 23 January 2024. https://www.nhs.uk/pregnancy/your-pregnancy-care/screening-for-hepatitis-b-hiv-and-syphilis/
- NHS England, ISOSS syphilis report for pregnancies between 1 April 2022 and 31 March 2023, 11 December 2025. https://www.gov.uk/government/publications/isoss-syphilis-report-for-pregnancies-between-1-april-2022-to-31-march-2023/isoss-syphilis-report-for-pregnancies-between-1-april-2022-and-31-march-2023
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