Symptoms

Stages of Syphilis

1. Primary

2. Secondary

3. Latent

4. Late

Primary Syphilis

Following an incubation period of anywhere from 10 days to 3 months, a chancre,  characteristic sign of primary syphilis appears where the treponeme entered the body. A chancre is usually painless and indurated, with a serous exudate that is highly contagious. Regional lymph nodes may be enlarged. The chancre remains for 2 to 6 weeks and disappears without treatment, although the disease may persist.

Secondary Syphilis

The manifestations of secondary syphilis appear 2 weeks to 6 months after the healing of the chancre ad are extremely variable. Skin eruptions commonly occur and may be macular, popular, pustular, or nodular lesions. Characteristically, the lesions are generalized, bilateral, and painless and appear on the palm of the hand and soles of the feet. Mucous patches which are slight erosions of the mucous membrane may occur in the mouth. Condylomata lata can occur in the genital region. These are raised, tabletopped, or mushroom shaped papules which are pale in color. Alopecia, generalized lympadenopathy, and a flulike symptom may also occur. All the moist skin and mucous membrane lesions of secondary syphilis are highly contagious. If not treated, the manifestations of secondary syphilis disappear after 2 to 6 weeks and the patient enters the latent stage.

Latent Syphilis

During latent syphilis the untreated patient is without clinical manifestations of disease, although serologic tests for syphilis are positive. Latent syphilis is divided into two periods: early, latent, asymptomatic syphilis of less than 4 years duration, and the late latent, asymptomatic syphilis of more than 4 years duration. Approximately one-fourth of patients have recurrent mucocutaneous lesions of secondary syphilis during the early phase of treatment. Most patients with latent syphilis remain asymptomatic for the rest of their lives.

Late Syphilis

About one-fourth of infected individuals with untreated syphilis develop clinically apparent late or tertiary syphilis. Symptoms usually occur many years after the primary syphilis infection. A person with late syphilis will rarely infect others by sexual contact or blood donation. The one important exception is the pregnant syphilitic who may transmit syphilis to the fetus regardless of the duration of her disease. Congenital syphilis can result in multiple defects including abnormal teeth, decreased visual acuity, bone deformities, deafness, and cutaneous lesions with scarring.

	Primary	Secondary	Latent	Late
Duration	2 to 8 weeks	Appears 2 to 4 weeks after chancre appears extends over 2 to 4 years	5 to 20 years	Terminal if not treated
Signs and Symptoms	Hard sore or pimple on vulva or penis that breaks and forms painless, draining chancre; groups of more than one; may be present also on lips, tongue, hands, rectum, or nipples; chancre heals, leaving almost invisible scar	Depends on site; low grade fever, headache, anorexia, weight loss, anemia, sore throat, hoarseness, reddened and sore eyes, jaundice with or without hepatits, aching of joints, muscles, long bones; sores on body or generalized fine rash; Condylomata acuminate (venereal warts) on rectum or genitalia	No Clinical Signs	Tumorlike mass (gumma) on any area of the body; damage to heart valves and blood vessels; meningitis; paralysis; lack or coordination; paresis; insomnia; confusions; delusions; impaired judgment; slurred speech
Communicability	Exudates from lesions and chancre are highly contagious	Exudates from lesions highly contagious; blood contains organisms	Contagious for about 2 yrs.; not contagious to other after that; blood contains organisms; may be transmitted placentally to fetus	Noncontagious; spinal fluid may contain organisms