Syphilis Symptoms in Females ∣ Sometimes Hidden

People seem to think that syphilis was a disease of the dark ages, like the plague, no longer an issue. Ladies (and gents), syphilis is alive, well, and living its best life.

If not caught early and treated, it is a devastating disease, eventually causing organ damage. 

Diagnosis is even more critical in child-bearing age women. Bacteria passing from mom to baby via the placenta causes stillbirth, severe disease, or disability in the newborn. ¹

Although the infection rate is lower in women than in men who have sex with men (MSM), I saw many positive tests in females.

“The cases of women testing positive were rising over the three years I consulted in Cape Town.”

In the USA between 2017 and 2021
“The reasons for syphilis’s rising rates in women are complex. An unfortunate fact of biology likely plays a part: People with vaginas are more susceptible to STIs than those with penises. But that anatomical reality, while extremely annoying, isn’t enough to explain why an easily curable STI (with just one dose of antibiotics!) is newly and uncontrollably surging among women.”

Keren Landman, reported in an article for Vox

That is why it is essential to be aware of the syphilis symptoms in females if you are sexually active and test regularly as part of routine STI screening. 

So, how do syphilis symptoms in females differ from those in men? They don’t; they are the same.

There are four syphilis stages in the disease timeline. Because syphilis, from phase to phase, has many varied and some non-specific “clinical manifestations, it has been named the “great imitator and mimicker.” ²

If you understand the condition’s progression, the symptoms will make sense.

I’ll give you a brief rundown.

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What is syphilis?

Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum.

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The syphilis timeline ∣ Days to decades

As the infection progresses, syphilis has four stages:

1. Primary 

This is the first stage. 

Symptoms occur at and near the site that the spirocetes entered.

On average, 3 to 4 weeks after infection, but this is not a hard and fast rule, varying within 7 days or as late 3 months post contact.

This phase will disappear even if you do not have treatment.

The primary stage is contagious.

2. Secondary

The second stage happens as the spirocete spreads into the bloodstream and around the body.

This commences 1 to 6 months after contact.

Like the primary phase, it will resolve without any treatment if ignored.

The secondary stage is contagious.

3. Latent 

The dormant symptomless phase could last years or decades.

4. Tertiary

This life-threatening phase presents with symptoms of organ damage that were silently progressing during the latent phase. This can occur decades after primary infection.

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As you can see, early detection in the primary and secondary stages is vital.

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Syphilis symptoms in females (and males) in order of stage

Primary

A painless raised red area develops at the spirocete entry site. This breaks down into a shallow sore, but still no pain. This is called a chancre.

This could occur in the mouth, genital or anal region.

“The tricky situation for ladies arises in stage 1 because we have vaginas that can hide these primary lesions called chancres.

How do you know it is there if you can’t see or feel it?”

There is usually one chancre, but there can be multiple.

Lymph nodes or glands, as you might call them, enlarge in the chancre area. 

A herpes simplex virus (HSV) lesion may look similar; however, it is painful.

Secondary

Treponema pallidum is now cruising through the blood vessels around the body involving the skin and organs, and the immune system reacts, causing flu-like symptoms.

• Fever
• Headache
• Sore muscles and joints
• Swollen lymph nodes (glands) all over the body
• Tiredness

On the skin:

• A generalized rash often develops and spreads onto the soles and palms.
• Greyish growths appear in moist areas like your mouth, groin, and armpits. 

Warning: discretion is advised. Click on this link for photos of the primary and secondary phase skin lesions.

Latent

There are no symptoms during this time; the bacteria are now dormant. Silently causing damage.

Tertiary

To this day, some patients are only diagnosed with syphilis when they present with organ damage. The symptoms are mostly non-specific and will not immediately raise the alert for a syphilis diagnosis. 

Lesions called gummas form over years when your immune system cannot eliminate the syphilis bacteria. Trying to contain the infection, white cells and scar tissue surround it. This reaction is called a granuloma. This could be any organ, including skin and bones.

Gummas present with:

• Swellings or lumps
• Ulcers
• Pain

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Summary

• Syphilis symptoms in females are the same as those in men. The chancre can be missed if it is in the vagina.
• Pregnant women can pass syphilis to their fetus, causing severe disability or stillbirth.
• Syphilis is devastating and life-threatening if not diagnosed early.
• Syphilis is easily treated with antibiotics.
• Always test for syphilis with any routine STI screening.
• If you test positive for another STI, ask your doctor also to exclude syphilis.

References

1. Centers for Disease Control and Prevention. (2022, August 11). Syphilis. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/pregnancy/effects/syphilis.html#:~:text=Approximately%2040%25%20of%20babies%20born,%2C%20meningitis%2C%20or%20skin%20rashes. 
2. Tudor ME, Al Aboud AM, Leslie SW, et al. Syphilis. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534780/