Syphilis in Women: Know the Signs and Symptoms

Syphilis rates in women across England have been climbing steadily since 2017 (UKHSA, 2024), and many cases are diagnosed late. The reason is simple: the early symptoms in women are easy to miss. A painless sore inside the vagina. A rash that comes and goes. No burning, no discharge, nothing that screams "infection." By the time it is noticed, it has often progressed.

If you are here because you are worried, the good news is that syphilis is one of the most treatable STIs. We test for it, diagnose it, and treat it in-house with an injection at our clinic. But you need to catch it first.

"Syphilis in women is on the rise in the UK, and the symptoms are frequently missed because the initial chancre is painless and may be internal. A blood test is the most reliable way to confirm or exclude the diagnosis."

Mr Hikmat Naoum, Consultant Gynaecologist, GMC 3047637

What is syphilis?

Syphilis is a bacterial infection caused by Treponema pallidum, spread through direct contact with a syphilis sore (chancre) during vaginal, anal, or oral sex; it progresses through distinct stages over months to years, and without treatment can cause serious damage to the heart, brain, and other organs.

In women, syphilis is frequently undiagnosed in the early stages because the initial sore often appears in locations that are not easily visible: inside the vagina, on the cervix, or around the anus. This makes self-detection nearly impossible without clinical examination.

Primary syphilis: the chancre

The first sign of syphilis is a chancre (pronounced "shanker") - a small, round, painless sore that appears at the site where the bacteria entered the body. It develops 10 to 90 days after exposure (BASHH, 2024), with an average of about 21 days.

In women, the chancre commonly appears on the:

• Vulva (labia, clitoral hood)
• Inside the vagina (often unnoticed)
• Cervix (invisible without speculum examination)
• Anus or perianal area
• Lips, mouth, or throat (after oral sex)

The chancre is painless, which is the central problem. Most women do not feel it. If it is inside the vagina or on the cervix, it is invisible. The sore heals on its own within 3 to 6 weeks regardless of whether you receive treatment, which creates the false impression that everything is fine.

This is why we recommend a syphilis test for any woman with a new or casual sexual partner, even without symptoms. A simple blood test (£85, results in 24 hours) catches what a physical examination might miss.

Secondary syphilis: the rash and more

If primary syphilis is not treated, the infection progresses to the secondary stage, usually 4 to 10 weeks after the chancre first appeared. This stage is more systemic and produces a wider range of symptoms.

The classic secondary syphilis rash is distinctive but frequently misdiagnosed:

• It appears on the palms of the hands and soles of the feet (unusual for most rashes)
• It can also cover the trunk, arms, and legs
• The rash is typically red or reddish-brown, and does not itch
• Individual spots are often rough-textured

Beyond the rash, secondary syphilis may cause:

• Flat, greyish-white wart-like growths in warm, moist areas (called condylomata lata) around the vulva, anus, or groin folds
• Patchy hair loss, sometimes giving a "moth-eaten" appearance
• Sore throat and swollen lymph nodes
• Fever, weight loss, and fatigue
• White patches inside the mouth (mucous patches)
• Headache and muscle aches

These symptoms also resolve on their own, usually within a few weeks to months. And again, this does not mean the infection is gone. It means it is moving into a phase where it hides.

Latent syphilis: the quiet phase

After secondary symptoms clear, syphilis enters a latent (hidden) stage. There are no visible symptoms, but the bacteria remain in the body. Latent syphilis is divided into:

• Early latent: within 2 years of initial infection, still potentially infectious
• Late latent: more than 2 years after infection, less infectious but untreated

Latent syphilis can only be detected through blood testing. This is the stage where many women are finally diagnosed, often during routine pregnancy screening or a comprehensive STI screen.

Tertiary syphilis: rare but serious

Without treatment, around 15-30% of people with syphilis will develop tertiary disease, which can appear 10 to 30 years after initial infection. Tertiary syphilis can affect:

• The cardiovascular system (aortic aneurysm, aortitis)
• The nervous system - neurosyphilis (meningitis, stroke, dementia, tabes dorsalis)
• Skin and bones (gummatous lesions)

Tertiary syphilis is rare in the UK because most cases are caught and treated before this point. But it is the reason syphilis should never be dismissed as minor.

Why syphilis is so often missed in women

We treat women for syphilis regularly at our clinic, and the same pattern repeats: the infection was there for weeks or months before anyone noticed.

The reasons are consistent:

The primary chancre is painless and frequently internal. Unlike a herpes outbreak, which is usually painful and visible, a syphilis sore causes no discomfort. If it is on the cervix, the only way to find it is a speculum examination.

The secondary rash is mistaken for other conditions. Dermatitis, psoriasis, allergic reactions, viral rashes - the differential diagnosis list is long. The palms-and-soles distribution is a giveaway, but not every case follows the textbook.

Women are less frequently tested for syphilis than men. Routine STI screens at some clinics and most home testing services may not include syphilis. Our Bronze Screen (£250) includes syphilis testing alongside HIV, chlamydia, and gonorrhoea specifically because we believe it should never be left out.

Symptoms are intermittent. Each stage resolves on its own, creating gaps where the patient feels fine and does not seek care.

Syphilis and pregnancy

Syphilis during pregnancy is particularly concerning because Treponema pallidum crosses the placenta. Congenital syphilis can cause miscarriage, stillbirth, premature birth, and serious health problems in the baby. All pregnant women in the UK are screened for syphilis at their booking appointment, but infections acquired after that screen will be missed.

If you are pregnant or planning pregnancy and have had a new sexual partner, a syphilis test is strongly recommended regardless of symptoms. NICE recommends rescreening in the third trimester for women at higher risk.

How we diagnose syphilis

Diagnosis uses a combination of blood tests:

Test	What it detects	Turnaround	Cost
Syphilis IgG/IgM (screening)	Antibodies to Treponema pallidum	24 hours	£85
As part of Bronze Screen	HIV, syphilis, chlamydia, gonorrhoea	Bloods 24 hrs	£250
As part of Gold Screen	11+ infections including syphilis	Bloods 24 hrs	£475-490
FAST Screen Simple	HIV, syphilis, chlamydia, gonorrhoea	6 hours	£350
HIV/HBV/HCV/Syphilis combo	Early detection PCR + syphilis	3 days	£291.25

The standard syphilis blood test is accurate from approximately 3 to 4 weeks after exposure. If you have a visible sore, a doctor can sometimes make a presumptive diagnosis clinically and begin treatment the same day while awaiting blood results.

All our tests use UKAS-accredited laboratories. Walk-in testing is available, and you can register under a pseudonym if privacy matters to you.

How we treat syphilis

This is where we differ from most private clinics and home testing services. We do not just test for syphilis: we treat it on-site.

The standard treatment for early syphilis (primary, secondary, and early latent) is a single intramuscular injection of benzathine penicillin G 2.4 million units, administered by our doctors at the clinic. Treatment for late latent syphilis requires three injections given at weekly intervals.

You walk in, get tested, receive your results (usually within 24 hours), and if the result is positive, you receive your injection at the clinic. There is no referral, no waiting for a GUM clinic appointment, and no delay. For syphilis treatment, we are a genuine one-stop service.

If you have a penicillin allergy, alternative antibiotic regimens are available, and our doctors will discuss these with you.

Who should test for syphilis?

BASHH recommends syphilis testing for:

• Anyone with symptoms suggestive of syphilis (painless sore, unexplained rash, especially on palms and soles)
• Women with a new sexual partner or multiple partners
• Women whose partner has been diagnosed with syphilis
• Pregnant women (standard NHS screening, plus retesting if new partners)
• Women who have sex with women (risk exists through skin-to-skin and oral contact with sores)
• Anyone diagnosed with another STI (co-infection is common; gonorrhoea and syphilis often occur together)
• Anyone with known exposure to syphilis

Our screening packages for women are designed to catch infections that are commonly asymptomatic, including syphilis. The consultation fee (£150) is included when you book a package.

Frequently asked questions

Can you get syphilis from oral sex?

Yes. Syphilis spreads through direct contact with a sore, which can be on the lips, tongue, or throat. Oral sex is a well-documented transmission route for syphilis. If your partner has a chancre in or around their mouth, the risk is real. A sore throat alongside other symptoms warrants testing.

How long does syphilis take to show up on a test?

The standard syphilis blood test becomes reliable at 3 to 4 weeks after exposure (BASHH, 2024). If you have a visible sore, a doctor can sometimes diagnose syphilis earlier based on clinical examination combined with testing. We recommend testing at 4 weeks for screening accuracy.

Can syphilis come back after treatment?

Treatment cures the active infection, but it does not provide immunity. You can be reinfected through subsequent contact with someone who has syphilis. We recommend repeat screening after treatment, particularly if you have ongoing risk factors. Our STI prevention page covers reducing reinfection risk.

Is syphilis curable?

Yes. Syphilis is fully curable with antibiotics, particularly when caught in the primary or secondary stages. A single penicillin injection is the gold standard treatment worldwide and has been used effectively since the 1940s. Late-stage syphilis is also treatable, though any organ damage that has already occurred may not be fully reversible. Early testing and treatment prevent complications entirely.

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Concerned about syphilis? We test and treat in the same clinic, with results in 24 hours and same-day injection treatment. Walk in to 117a Harley Street or book online. All screening packages include consultation, examination, and testing.

References

• UKHSA (2024). Syphilis: epidemiology in England, 2023.
• BASHH (2024). UK National Guidelines on the Management of Syphilis.
• NICE CKS (2024). Syphilis.
• NHS (2024). Syphilis — Symptoms.