Health Conditions

There are four stages of syphilis, each of which is associated with distinct symptoms.

1. Primary syphilis is the stage of the bacteria's entry into the body.

• The classic sign of primary syphilis is a chancre (pronounced 'kang ker'). A chancre is a red, painless although sometime tender, skin lesion that appears at the location where the bacteria enter the body. The chancre develops approximately 14 to 21 days after a patient has been infected. The base of the chancre is usually smooth, and the borders are raised and firm. The chancre is usually a single lesion but multiple chancres can occur, especially in people infected with human immunodeficiency virus (HIV). Chancres occur in up to 60% of patients infected with syphilis and are usually seen in the genital, anal, or oral areas; however, any part of the body may be affected. If untreated, the chancre will heal typically on it's own within 3 to 8 weeks.



• During primary syphilis individuals are infectious. Being infectious means that you may pass the disease to other individuals through sexual contact or contact with a chancre.

2. Secondary syphilis results when the bacteria actually enter the bloodstream. It occurs approximately 4 to 10 weeks after the initial appearance of the primary chancre. Sometimes, secondary syphilis may occur at the same time as primary syphilis. During secondary syphilis patients are infectious, meaning that the disease can be transmitted to other individuals through sexual contact. Signs and symptoms of secondary syphilis may include the following:

• Skin rash is typically the first symptom of secondary syphilis. The rash is red or reddish-brown in color, and usually involves the trunk, legs, and palm of the hands and soles of the feet. The rash is usually scaly in appearance but sometimes appears smooth and can be mistaken as psoriasis.
• Increased or decreased skin color
• Circular lesions which appear mainly on the face of dark-skinned individuals and are described as looking like "clean-cut ham" or having a coppery tint color
• Swelling of all lymph nodes
• "Condyloma latum" which are one or more large, raised, whitish or gray warty-like lesions usually found in warm, moist areas such as around the vulva (opening of the vagina) or anus
• Loss or thinning of hair, eyebrows or beard
• Flu-like symptoms such as fever, weight loss, headache, muscle aches, or sore throat

3. Latent syphilis is the hidden (or latent) stage of syphilis.

• It generally begins when the secondary symptoms spontaneously resolve after a period of 3 to 12 weeks, leaving an individual free of symptoms. Even though the secondary symptoms resolve, the bacteria remain in the body and may begin to damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage may not appear until many years later, until the late or tertiary stage of syphilis. Damage that may occur during the latent stage though may be serious enough to cause death.



• Individuals are infectious during latent syphilis, meaning that the disease can be transmitted to other individuals through sexual contact.

4. Tertiary Syphilis, is the last stage, " the destructive stage," of the disease.

• Symptoms of tertiary syphilis may develop 2 or more years following the latent period. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. Complications (such as neurosyphilis, cardiovascular syphilis, late benign syphilis, periosteal inflammation, or skin damage) of syphilis typically occur in this stage. These complications can be serious and even life threatening. To learn more about the complications from syphilis, read the What is it? section concerning the complications of syphilis.



• Individuals are not infectious during tertiary syphilis.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.