Syphilis Symptoms in Women: Early Signs, Stages and When to Test

Perhaps you have noticed a sore that appeared and disappeared, a rash you cannot quite explain, or nothing at all — but something prompted you to search. Whether you are experiencing symptoms or simply wondering what syphilis looks like in women, it is a sensible question to ask.

Syphilis is a staged infection, meaning its symptoms change — and sometimes vanish — as the infection progresses. In women, early signs can be particularly easy to miss because the initial sore may develop in locations that are not easily visible. Some stages produce no symptoms at all, which is why many infections go undetected without testing.

This article explains how syphilis presents in women at each stage, why symptoms can be subtle or absent, and when laboratory blood testing may be appropriate. This is general information — symptoms vary between individuals, and only laboratory testing can confirm infection status.

What Is Syphilis and How Is It Transmitted?

Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum. It is transmitted through direct contact with a syphilis sore or lesion during vaginal, anal or oral sex. The bacterium enters the body through mucous membranes or small breaks in the skin.

Because syphilis sores can appear on external genitalia, in the vagina, on the cervix, around the anus, or in the mouth, transmission can occur through any form of sexual contact that involves these areas. A person does not need to have visible symptoms to transmit the infection — particularly during the early stages when sores may be small, painless and hidden.

Syphilis can also be transmitted from mother to baby during pregnancy, which is why screening during pregnancy is standard practice. This article focuses on symptoms and testing for sexually acquired syphilis in women.

Why Syphilis Can Be Hard to Spot in Women

Syphilis is sometimes called a "great imitator" because its symptoms can resemble many other conditions. In women, detection is further complicated by several factors:

These factors mean that syphilis can progress through its stages without a woman ever realising she has been infected. This is one of the key reasons why laboratory blood testing — rather than symptom-based assessment — is the reliable approach to identifying syphilis.

Primary Syphilis in Women (Early Stage)

The primary stage of syphilis begins with the appearance of a chancre — a small, firm, painless sore at the site where the bacterium entered the body. The chancre typically appears within a few weeks of exposure, though the timing can vary.

In women, the chancre may develop on the vulva, inside the vagina, on the cervix, around the anus, or in the mouth — depending on the type of sexual contact involved. Because it is painless and may be located internally, many women are unaware it is there.

The chancre usually heals on its own within a few weeks, even without treatment. However, the disappearance of the sore does not mean the infection has resolved — it means the infection is progressing to the next stage. The fact that the sore heals spontaneously is one of the reasons syphilis is so frequently missed in its earliest and most easily identifiable phase.

If you notice any unusual sore — even one that is painless — in the genital area, around the anus, or in the mouth, testing may be appropriate.

Secondary Syphilis (Weeks to Months Later)

If primary syphilis is not identified and treated, the infection progresses to the secondary stage. This phase typically develops weeks to months after the initial sore and involves more widespread symptoms as the bacterium spreads through the body.

The rash associated with secondary syphilis is often subtle and may not be itchy or painful, which means it can be easily overlooked or attributed to an allergic reaction, dermatitis or another skin condition. Symptoms in this stage vary considerably between individuals — some experience multiple symptoms, while others notice only mild changes.

Like the primary chancre, secondary symptoms will eventually resolve without treatment. However, the infection remains present and may progress to the latent stage.

Latent Syphilis: When There Are No Symptoms

After the secondary stage resolves, syphilis can enter a latent phase — a period during which the infection is present in the body but produces no outward symptoms. A person with latent syphilis may feel completely well and have no visible signs of infection.

Latent syphilis is divided into early latent (within the first year or so of infection) and late latent (beyond that point). During the early latent phase, secondary symptoms may occasionally recur. During late latency, the infection is typically silent.

The fact that syphilis can persist without symptoms for extended periods is one of the most important reasons why testing after potential exposure is valuable — you cannot rely on feeling unwell or noticing symptoms to detect infection. Without laboratory testing, latent syphilis may remain undiagnosed indefinitely, with the potential for long-term complications if not addressed.

When Should You Test for Syphilis?

Because syphilis can be present without symptoms, testing may be appropriate in a range of situations — not only when symptoms are present.

Syphilis is detected through blood testing that identifies specific antibodies produced in response to the Treponema pallidum bacterium. A syphilis test can identify infection even during the latent phase when no symptoms are present.

We provide confidential laboratory-based STI screening. All blood samples are processed by accredited laboratories.

Syphilis vs Other Conditions: Why You Should Not Self-Diagnose

One of the reasons syphilis is frequently missed — or misidentified — is that its symptoms overlap significantly with other common conditions. Genital sores may be attributed to herpes, ingrown hairs or irritation. The secondary rash may be mistaken for an allergic reaction, eczema or dermatitis. Flu-like symptoms may be dismissed as a seasonal illness.

If you are uncertain about any symptoms or concerned about potential exposure, confidential testing is available at our private sexual health clinic London location. Testing provides reliable answers — guessing does not.

What Happens After a Positive Test?

A positive syphilis result means the infection has been identified through laboratory blood testing. While receiving a positive result can feel concerning, it is important to understand that syphilis is treatable. With appropriate prescribed medication arranged through the relevant medical services, the infection can be effectively managed — particularly when identified early.

At our clinic, we provide screening and laboratory testing. If a test returns a positive result, we will explain the findings clearly and confidentially. Treatment is arranged separately through appropriate medical services.

Partner notification is typically recommended, as sexual partners may also need testing. Follow-up blood testing may be advised to confirm the infection has responded to treatment.

When syphilis is identified, comprehensive screening for other STIs is also appropriate, as co-infection is possible. An HIV test may be recommended alongside syphilis testing, as these infections share overlapping risk factors.

Reducing Risk and Protecting Partners

While no prevention method is completely risk-free, there are practical steps that can reduce the likelihood of syphilis transmission.

• Use condoms consistently during vaginal, oral and anal sex — condoms reduce the risk of syphilis, though they may not cover all potentially infectious areas
• Consider regular STI screening, particularly after new sexual partners or if you have multiple partners
• Avoid sexual contact if sores, rashes or lesions are present until testing has been completed
• Communicate openly with sexual partners about testing and sexual health

Comprehensive screening — covering syphilis alongside other infections — provides the most thorough assessment. A chlamydia and gonorrhoea test can be included alongside syphilis screening for a broader picture of infection status.

These measures are practical and straightforward. They are not guarantees, but they reduce risk meaningfully and support proactive sexual health management.