Stages of Syphilis

Overview

Syphilis develops in four stages. Each stage has a different set of symptoms.

Primary stage

During the primary stage of syphilis, one or more sores (chancres) form at the site where the bacteria entered the body. This often occurs within 3 weeks of exposure but can range from 10 to 90 days. A person is highly contagious during the primary stage and can easily pass the infection to others.

• A chancre often appears in the genital area. But sores may also occur in or near the anus or in or near the mouth. The sores are usually painless, so they may go unnoticed if they're inside the vagina or the rectum.
• Swelling of the lymph nodes may occur near the area of the chancre.
• The chancre usually lasts for 3 to 6 weeks. It heals without treatment and may leave a thin scar. But even though the chancre has healed, the person still has syphilis. They can still pass the infection to others.

Secondary stage

During secondary syphilis, a person is highly contagious. A rash appears 2 to 12 weeks after the chancre develops and sometimes before it heals. The rash often forms over the body, often on the palms of the hands and the soles of the feet.

• The rash usually consists of reddish brown, small, solid, flat or raised skin sores that are less than 2 cm (0.8 in.) across. But the rash may look like other more common skin problems.
• There may be small, open sores on mucous membranes. The sores may contain pus. Or there may be moist sores that look like warts (called condyloma lata).
• In people who have dark skin, the sores may be a lighter color than the skin around them.

The skin rash usually heals within 2 months on its own without scarring. After the rash heals, the skin may be discolored. But even though the skin rash has healed, the person still has syphilis and can still pass it to others.

Other symptoms may also occur. This means that the infection has spread throughout the body. The person may have:

• A fever.
• A sore throat.
• A vague feeling of weakness or discomfort throughout the body.
• Weight loss.
• Patchy hair loss, especially in the eyebrows, eyelashes, and scalp hair.
• Swelling of the lymph nodes.
• Nervous system symptoms. These can include neck stiffness, headaches, grouchiness, paralysis, unequal reflexes, and irregular pupils.

Latent (hidden) stage

Without treatment, an infected person will progress to the latent (hidden) stage. During this stage, the bacteria that cause syphilis stay in the body without causing symptoms. This time with no symptoms usually happens after the secondary-stage rash goes away. But the latent stage can also happen between the primary and secondary stage. It may be as brief as 1 year or range from 5 to 20 years.

Often during this stage, an accurate diagnosis can only be made through blood testing, the person's history, or the birth of a child with congenital syphilis.

Some people have a relapse of the infection during its latent stage. A relapse means that the person was symptom-free but then started having symptoms again. Relapses can occur several times.

When relapses no longer occur, a person isn't contagious through contact. But those who are pregnant may still pass the infection to their baby. They may have a miscarriage or a stillbirth. Or their baby may be born infected (congenital syphilis).

Tertiary (late) stage

This is the most destructive stage of syphilis. If a person doesn't get treatment, this stage may start as early as 1 year after infection or at any time during the person's lifetime. A person with syphilis may never have this stage of the illness.

During this stage, syphilis may cause serious blood vessel and heart problems, mental disorders, blindness, nerve system problems, and even death. The symptoms of tertiary (late) syphilis depend on the complications that develop. They may include:

• Gummata. These are large sores inside the body or on the skin.
• Cardiovascular syphilis. This affects the heart and blood vessels.
• Neurosyphilis. This affects the nervous system.