Syphilis: Signs and Symptoms

Syphilis on hands

Syphilis symptoms can be hard to notice, and come and go over time. So the best way to know if you have syphilis is to get tested.

Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with syphilis and not notice any symptoms for years.

Syphilis – Symptoms

Syphilis develops in four stages, each with a different set of symptoms.

Primary stage

During the primary stage of syphilis, 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). The sores are usually painless and are not easily seen.
  • 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 usually 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 2 to 12 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 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.
  • Small, open sores may be present on mucous membranes. The sores may contain pus. Or moist sores that look like warts (called condyloma lata) may be present.
  • In dark-skinned people, the sores may be a lighter color than the surrounding skin.
The skin rash usually heals within 2 months on its own without scarring. After healing, skin discoloration may occur. 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 than101°F (38.3°C).
  • 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. The latent stage is defined as the year after a person becomes infected. 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

About 20 to 30 out of 100 people with syphilis have a relapse of the infection during its latent stage.1 A relapse means the person was symptom-free but then started having 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 infection to her developing baby and may have a miscarriage or 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 with syphilis may never experience 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. 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.

You might not notice any signs of syphilis.

Syphilis is sneaky, because you or your partner may not have any symptoms that you see or feel. Most of the time, people don’t even realize they have syphilis that’s part of the reason it’s a common infection (and why it’s so important to get tested).

The signs of syphilis can be so mild you don’t even notice them. Sometimes people confuse syphilis symptoms with other things, like pimples or rashes. Syphilis symptoms come and go over time, but that doesn’t mean the infection goes away. The ONLY way to get rid of syphilis is to take medicine for it.

Syphilis leads to serious problems if you don’t treat it. But it’s usually easy to cure it with antibiotics when you treat it early. That’s why regular STD testing is so important if you have sex, no matter how healthy you seem.

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