What Does Syphilis Look Like in Women?

Syphilis is primarily caused by unprotected sexual contact. Since sexual intercourse is the main mode of transmission, high-risk sexual behavior with syphilis-infected individuals must be avoided. In women infected with syphilis, papules may appear on the external genitalia or around the anus; the epidermis of these papules may ulcerate and develop granulation tissue. Contact with an open, bleeding lesion on a syphilis patient’s skin may result in infection. So what does syphilis look like in women? Below, we address this question.

What Does Syphilis Look Like in Women?

1. Skin Rash Symptoms

Patients with secondary syphilis commonly develop generalized rashes. These rashes are typically copper-red in color and covered with fine scales. Additional manifestations may include moth-eaten alopecia, periostitis, ocular syphilis, and neurosyphilis. Moreover, symptoms of secondary syphilis are more pronounced than those of primary syphilis. As Treponema pallidum spreads from regional lymph nodes into the bloodstream and rapidly multiplies systemically, systemic symptoms often arise—such as low-grade fever, headache, myalgia, arthralgia, and generalized lymphadenopathy.

2. Genital Changes

Genital ulcers represent a classic manifestation of primary syphilis. Typically measuring about 1 cm in diameter, these ulcers most commonly occur on the labia majora, labia minora, or cervix in women. Because they lack obvious purulent discharge, they are frequently overlooked. As the disease progresses, the initial lesion rapidly breaks down into a small, round, red ulcer (approximately 1–2 cm in diameter), often covered with scant serous exudate. Concurrent inguinal lymphadenopathy may occur, although the enlarged nodes are typically non-tender, non-erythematous, non-warm, and non-suppurative.

3. Erosive Ulceration

Initially, a small, firm nodule appears—usually few in number. As the disease advances, the nodule gradually enlarges and adheres to surrounding skin, forming a dark-red, infiltrated plaque. The central portion softens progressively, leading to ulcer formation and the discharge of thick, gelatinous exudate. Furthermore, tertiary syphilis is extremely severe: Treponema pallidum not only invades the skin and mucous membranes but also affects multiple internal organs and tissues—including the nervous system, viscera, brain, reproductive organs, and gastrointestinal tract—resulting in widespread pathological changes. Patients may become bedridden and experience altered mental status.

The above outlines the clinical presentation of syphilis in women. We hope this information is helpful to you.