Topic Overview

Syphilis is described in terms of its four stages: primary, secondary, latent (hidden), and tertiary (late).

Primary stage

During the primary stage, a sore ( chancre) that is usually painless develops at the site where the bacteria entered the body. This commonly occurs within 3 weeks of exposure but can range from 10 to 90 days. A person is highly contagious during the primary stage.

• In men, a chancre often appears in the genital area, usually (but not always) on the penis. These sores are often painless.
• In women, chancres can develop on the outer genitals or on the inner part of the vagina. A chancre may go unnoticed if it occurs inside the vagina or at the opening to the uterus (cervix), because the sores are usually painless and are not easily visible.
• Swelling of the lymph nodes may occur near the area of the chancre.
• A chancre may also occur in an area of the body other than the genitals.
• The chancre lasts for 3 to 6 weeks, heals without treatment, and may leave a thin scar. But even though the chancre has healed, syphilis is still present and a person can still pass the infection to others.

Secondary stage

Secondary syphilis is characterized by a rash that appears from 2 to 8 weeks after the chancre develops and sometimes before it heals. Other symptoms may also occur, which means that the infection has spread throughout the body. A person is highly contagious during the secondary stage.

A rash often develops over the body and commonly includes the palms of the hands and the soles of the feet.

• The rash usually consists of a reddish brown, small, solid, flat or raised skin sore or sores that are less than 2 cm (0.8 in.) across. The rash may look like other more common skin problems.
• Small, open sores may be present on mucous membranes. The sores may contain pus, or moist sores that look like warts may be present (condyloma lata).
• In dark-skinned people the sores may be a lighter colour than the surrounding skin.

The skin rash usually heals without scarring within 2 months. After healing, skin discoloration may develop. But even though the skin rash has healed, syphilis is still present and a person can still pass the infection to others.

When syphilis has spread throughout the body, the person may have:

• A fever of usually less than 38°C (100.4°F).
• 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 of secondary syphilis, which can include neck stiffness, headaches, irritability, paralysis, unequal reflexes, and irregular pupils.

Latent (hidden) stage

If untreated, an infected person will progress to the latent (hidden) stage of syphilis. After the secondary-stage rash goes away, the person will not have any symptoms for a time (latent period). The latent period 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.

A person is contagious during the early part of the latent stage and may be contagious during the latent period when no symptoms are present.

Relapses of secondary syphilis

About 20 to 30 out of 100 people with syphilis have a relapse of the secondary stage of syphilis during the latent stage.^{footnote 1} A relapse means the person had passed through the second stage, had no symptoms, then began to experience secondary-stage symptoms again. Relapses can occur several times.

When relapses no longer occur, a person is not contagious through contact. But a woman in the latent stage of syphilis may still pass the disease to her developing baby and may have a miscarriage, a stillbirth, or give birth to a baby infected with congenital syphilis.

Tertiary (late) stage

This is the most destructive stage of syphilis. If untreated, the tertiary stage may begin as early as 1 year after infection or at any time during a person's lifetime. A person may never experience this stage of the illness.

The symptoms of tertiary (late) syphilis depend on the complications that occur. Complications of this stage include:

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