Syphilis in Women: Spotting Hidden Signs & Your Next Steps

Syphilis is a sexually transmitted infection (STI) that can quietly affect women at any age. It is caused by a bacterium called Treponema pallidum. While syphilis is treatable and curable in its early stages, it can cause serious health problems if it goes undiagnosed.

One of the biggest challenges with syphilis in women is that symptoms can be subtle, painless, or mistaken for something else. That's why understanding the hidden signs — and knowing what to do next — is so important.

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Why Syphilis Can Be Hard to Spot in Women

Syphilis is often called "the great imitator" because its symptoms can look like other common conditions. In women especially:

• Sores may be hidden inside the vagina or on the cervix.
• Rashes may resemble allergic reactions.
• Early symptoms may be mild or painless.
• Symptoms may disappear on their own — even though the infection is still present.

Because of this, many women don't realize they have syphilis until it has progressed to a later stage.

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The Stages of Syphilis and Their Symptoms

Syphilis develops in stages. Each stage has different signs.

1. Primary Syphilis

This stage usually appears 10 to 90 days after exposure.

Common signs include:

• A single painless sore (called a chancre)
• Sometimes multiple sores
• Swollen lymph nodes

In women, sores may appear:

• Inside the vagina
• On the cervix
• On the vulva
• Around the anus
• In the mouth (if transmitted orally)

Because the sore is painless and may be hidden, many women never notice it. The sore typically heals on its own within 3–6 weeks — but the infection remains.

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2. Secondary Syphilis

If untreated, syphilis progresses to this stage weeks or months later.

Symptoms may include:

• A rash (often on palms of the hands or soles of the feet)
• Skin lesions in moist areas (genital or anal regions)
• Fever
• Fatigue
• Swollen lymph nodes
• Sore throat
• Muscle aches
• Patchy hair loss (known as syphilitic alopecia)
• Weight loss

The rash usually does not itch, which can make it easier to ignore.

Hair loss from syphilis may appear as:

• Patchy thinning
• "Moth-eaten" areas of hair loss
• Eyebrow thinning in some cases

Symptoms may come and go. Even if they disappear, the infection is still active in the body.

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3. Latent Syphilis

At this stage, there are no visible symptoms.

The infection is still present in the body and can last for years. Without treatment, it may move to the next stage.

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4. Tertiary (Late) Syphilis

This stage can occur years or even decades after the initial infection.

It can affect:

• The brain (neurosyphilis)
• The heart and blood vessels
• The eyes
• The liver
• The bones and joints

Serious complications may include:

• Memory problems
• Vision or hearing loss
• Stroke
• Heart damage
• Paralysis

While this stage is less common today due to testing and antibiotics, it can be life-threatening if untreated.

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Syphilis and Pregnancy: A Critical Concern

If a pregnant woman has syphilis, the infection can pass to her baby. This is called congenital syphilis.

It can lead to:

• Miscarriage
• Stillbirth
• Premature birth
• Severe newborn illness
• Developmental problems

The good news is that early testing and treatment during pregnancy can prevent transmission. That's why routine prenatal screening is so important.

If you are pregnant or planning to become pregnant, talk to your healthcare provider about STI screening.

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Who Is at Risk?

Any sexually active woman can get syphilis. Risk factors include:

• Having unprotected vaginal, anal, or oral sex
• Having multiple sexual partners
• Having a partner who tests positive for syphilis
• Living in an area with higher infection rates
• Having another STI, including HIV

Syphilis does not discriminate by age, background, or relationship status.

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When Should You Get Tested?

You should consider testing if:

• You notice unusual sores or rashes
• You have unexplained hair loss
• You've had unprotected sex with a new partner
• A partner tells you they tested positive
• You are pregnant
• You have another STI

Because symptoms can be subtle, testing is often the only way to know for sure.

If you're experiencing any unusual symptoms like painless sores, unexplained rashes, or patchy hair loss and want to better understand what might be happening, try Ubie's free AI-powered Syphilis (Including Syphilitic Alopecia) symptom checker to help guide your next steps.

However, an online tool is not a diagnosis. If you have concerning symptoms, you should speak to a doctor promptly.

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How Is Syphilis Diagnosed?

Diagnosis typically involves:

• A blood test
• Examination of any visible sores
• Additional tests if neurological symptoms are present

Testing is simple and widely available through:

• Primary care doctors
• OB-GYN clinics
• Sexual health clinics
• Community health centers

Early detection makes treatment much easier.

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Treatment: What to Expect

Syphilis is treated with antibiotics, most commonly penicillin.

• Early-stage syphilis often requires just one injection.
• Later stages may require multiple doses.
• If allergic to penicillin, other antibiotics may be used.

Important things to know:

• Treatment cures the infection.
• It does not reverse damage already done.
• Sexual partners should also be tested and treated.
• You should avoid sexual activity until your doctor confirms it is safe.

Follow-up blood tests are usually needed to confirm the infection is fully cleared.

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Protecting Yourself Moving Forward

Prevention strategies include:

• Using condoms consistently and correctly
• Limiting the number of sexual partners
• Having open conversations about STI testing
• Getting routine screenings
• Avoiding sexual contact with anyone who has visible sores

Regular sexual health check-ups are part of overall wellness — not a sign that something is wrong.

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When to Speak to a Doctor Immediately

While many symptoms are mild at first, some signs require urgent medical attention:

• Sudden vision changes
• Severe headaches
• Confusion
• Weakness or numbness
• Chest pain
• Symptoms during pregnancy

If you experience anything that could be serious or life-threatening, seek medical care right away.

Even if symptoms seem minor, it's always better to speak to a doctor than to ignore them. Early treatment can prevent long-term complications.

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The Bottom Line

Syphilis in women is often quiet, subtle, and easy to miss — especially in its early stages. Painless sores, mild rashes, or unexplained hair thinning may not seem urgent, but they can be important warning signs.

The encouraging news is:

• Syphilis is curable with antibiotics.
• Early detection prevents serious complications.
• Testing is simple and widely available.

If something doesn't feel right, listen to your body. Consider using a symptom checker, schedule a test, and speak to a healthcare provider about any concerns — especially if symptoms are persistent, unusual, or potentially serious.

Taking action early protects not just your health today, but your long-term well-being.