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Stages of syphilis and all you need to know about it – Syphilis

Syphilis is a sexually transmitted disease (STD), produced by the bacterium Treponema pallidum. The symptoms of it depend on which stages of syphilis the patient is.

Syphilis is one of the most common STDs, affecting almost 6 million people every year. It may cause many complications, mostly if left untreated. Fortunately, the treatment is very simple and is available in nearly every country in the world. This has made that the symptoms have become less severe over the decades.

Sexually transmitted diseases often cause a lot of doubts. Still, in this article, you will find the answer to all of those questions. We’ll review in a simple way the essentials of syphilis. Frequently asked questions like how many stages exist, complications, and treatment answered by a doctor. By the end of this reading, you’ll find yourself with the necessary knowledge of this condition.

What is this disease?

Syphilis is a sexually transmitted infection. The cause is a bacterium whose name is Treponema pallidum. It is a spiral-shaped (spirochete), highly mobile bacterium.

This bacterium is unable to live outside of a host. This means that you won’t catch syphilis by having contact with surfaces and such. Its transmission mainly occurs from person to person, although there are some exceptions we will review further.

So, the main form of contagion is by sexual contact. This means you can get syphilis through vaginal, oral, and anal sex. You may also get it by kissing near a lesion. If your sexual partner has syphilis, you have a 60% chance of getting it too.

Notably, a female can transmit the syphilis infection to her baby. This happens because the spirochete can pass through the uterus and damaged membranes or skin. We will see more about this later on.

What are the different stages of syphilis?

There are four typical stages of syphilis. They are primary, secondary, latent, and tertiary.

Symptoms vary depending on which stage the patient is. There is another separate stage of syphilis, congenital syphilis. This occurs when the mother passes the infection to the baby, who is later born with syphilis. We’ll review the signs and symptoms of each stage separately.

What are the signs & symptoms of primary syphilis?

Usually, people acquire the primary syphilis stage by contact with other people’s skin lesions, rashes, or injuries. Once you get the infection, it takes about 10 to 90 days for the symptoms to appear.

The first symptom is almost always the chancre. It is a skin lesion that is painless, doesn’t itch, and as doctors define it, it is an ulcer. The chancre is small, up to 3cm in size. It can start off as a papule (which looks like a pimple) before becoming an ulcer (An injury in which there is a loss of skin layers on top).

File:Tongue with primary syphilitic sore on the tongue Wellcome L0062951.jpg
Tongue with primary syphilitic sore or chancre

Sometimes there can be multiple ulcers, but it’s not that common. These ulcers appear mostly in the genitals, but it can also be present in women’s cervix within the uterus’s inner portions. Other places where ulcers exist include the mouth, anus, or rectum, in the case of men who have sex with men.

These ulcers contain the bacteria that causes syphilis; this is why you can get syphilis from direct contact with the lesions.

Another symptom in the primary stage is the enlargement of lymph nodes. This happens with every infection. In this case, the lymph nodes affected are the ones in the inguinal area below the abdomen. The ulcers can persist from 3 to 6 weeks if you don’t receive treatment.

What are the signs & symptoms of secondary syphilis?

This stage begins about 4 to 10 weeks after the primary infection. And it can manifest in many ways. The most common symptoms include the skin, membranes of the organism, and lymph nodes.

The principal symptom in the skin includes a rash. This rash typically takes up your trunk and extremities, including palms of the hands and soles of the feet. It is mostly symmetrical, red, or pink in color, and it doesn’t itch. This rash can later change to wart-like lesions, which are also infectious.

Rash in a patient with Secondary Syphilis

Other symptoms develop because of the damage of mucous membranes in the body. This may result in joint inflammation, kidney disease, and more. Patients may also experience muscle aches and sore glands.

There is a group of manifestations that affect the eye; doctors name it ocular syphilis. Ocular syphilis includes uveitis (inflammation of the middle layer of the eye, the uvea) and the optical nerve’s inflammation.

This stage can last about three to six weeks. These symptoms may recur later. Usually, patients who get to this stage didn’t know they had the chancre of the primary stage.

What are the signs & symptoms of latent syphilis?

The latent stage is the third stage of syphilis. In this stage, the patient does not have any signs or symptoms of the disease. But even without symptoms, the patient still has a positive result in laboratory tests. Also, the patient can infect other people. This stage has a division into early latent syphilis and late latent syphilis.

Early latent syphilis is less than two years from the primary infection. In this stage, some patients can go through a recurrence of the secondary stage. This happens because the patients still have the syphilis bacterium in their bodies, and this bacterium continues to replicate.

Moreover, after two years of the primary infection, the patient can go into the late latent stage. Without treatment, this stage can last many years. In the late latent syphilis, the patient is not as infectious as the early stage. About a third of all the patients who get to this stage will develop tertiary syphilis.

What are the signs & symptoms of late syphilis?

The late stage of syphilis or tertiary stage can occur 3 to 15 years after the first infection. There are three different forms of late syphilis: neurosyphilis, cardiovascular syphilis, and gummatous syphilis.

A person with syphilis rarely gets to this stage. Also, it is essential to note that people at this stage are not infectious anymore.

  • In neurosyphilis: The infection impairs the central nervous system (the brain and its other necessary components). For example, it can involve the arteries that give blood flow to the central nervous system. Also, it may affect the spinal cord. Some of the symptoms of neurosyphilis include dementia, psychosis, depression, and seizures. Other manifestations of neurosyphilis include instability, impaired positional sensation, and pain in the trunk and limbs.
  • Cardiovascular syphilis: It includes complications in the heart and blood vessels. The most common manifestation is the syphilitic aortitis, which is the inflammation of the body’s most critical artery. This can also cause dilatations in the aorta, called aneurysms.
  • Gummatous syphilis: It is the most favorable form of late syphilis. Its primary manifestation is the formation of tumor-like balls throughout your body. The balls receive the name of gummas and are the result of the widespread inflammation because of the infection. These gummas can usually appear 15 years after the primary infection.
File:Face of a man affected with tertiary syphilis Wellcome L0062301.jpg
The face of a man affected with tertiary syphilis

What is congenital syphilis?

Congenital syphilis happens when a mother infected with syphilis passes the infection to her baby in the womb. The woman can get syphilis prior to or during the pregnancy and still transmit the infection.

This happens because the bacterium Treponema pallidum is very mobile and can pass through body membranes. The symptoms may take weeks to appear after birth. Other babies may be already born with some of the symptoms.

The division of symptoms in congenital syphilis is in early syphilis and late syphilis. In early syphilis, the symptoms appear a few weeks after birth. The symptoms form early syphilis include fever, skin problems, anemia, and enlarged liver and spleen.

One of the most characteristic symptoms is the shedding of the skin of the palms and soles. Also, symptoms of late congenital syphilis may appear five years after birth. They can even be absent all the way to adulthood. Late syphilis symptoms include bone pain, affectation of the eyes with blurry vision, and even retinal tearing.

How does syphilis affect a pregnant woman?

Syphilis in pregnant women can be asymptomatic, but it may also cause complications. It is essential to mention that pregnant women should get tested for syphilis throughout the pregnancy.

In the case of a positive result, pregnant women receive treatment with antibiotics, the same way that any other patient. Some of the complications include miscarriages and stillbirth. Babies born with syphilis may also die shortly after birth, even with treatment.

What are the causes of pediatric syphilis?

Pediatric syphilis, most of the time, starts as congenital syphilis. This means that a pregnant woman with the disease passed the infection to her child in the womb.

The baby may also get syphilis during childbirth. In the event of a child with syphilis, who didn’t have congenital syphilis, sexual abuse should be suspected. Remember, this is a sexually transmitted infection; there are other ways of getting syphilis, although rarer.

How long are the stages of syphilis?

The length of each stage of syphilis is variable. The first stage, primary syphilis, can last up to three to six weeks without treatment after the chancre’s appearance.

Then, the second stage, secondary syphilis, lasts up to three to six. Then the latent phase is a little bit longer. The early latent stage lasts up to two years after the infection, then comes the late latent stage.

Notably, the late latent stage can last many years before going into the tertiary stage. The tertiary stage can start three to 15 years after the syphilis infection, and its complications may last for a lifetime.

What is the natural course of untreated syphilis?

First, you get the infection by having direct contact with a person’s syphilis sore or chancre. You may not may aware of this because sometimes lesions are not exposed to the exterior. Then, 4 to 6 weeks after the exposure, you can have the chancre too. This is the primary stage, and it is the best time to get medical help. With treatment, you stop the progression of the infection to the next stages. If left untreated, the lesion may persist for around three to six weeks.

Then you get to the secondary stage. This happens from four to ten weeks after getting the infection. You may experience a rash, which is infectious. This stage also includes symptoms resulting from inflammation in many parts of your body. It may affect your joints and eyes. This stage can last from three to six weeks and may recur in the future.

After this, if you still don’t get treatment, you’ll go into the latent stage. In this stage, you’ll experience early latent syphilis, less than two years from the infection. Then, two years after the infection, you’ll go into late latent syphilis. This stage is called latent because the patient doesn’t experience any symptoms.

Finally, after many years without treatment, you’ll get to the tertiary stage. This is after 3 to 15 years after the initial syphilis infection. At this point, you may have many complications that are not reversible. Simply put, if you let syphilis continue its natural course, then you won’t be able to take back all the damage it has done.

Who is at risk of a syphilis infection?

Everyone who is sexually active is at risk of contracting syphilis. But other risk factors make it more possible to get this infectious disease.

The most common risk factors include:

  • Inconsistent condom use: Remember that condoms can protect from many STDs, and syphilis is not the exception. If you don’t use a condom every time you have sex, you may be at risk of getting syphilis.
  • Promiscuity (multiple sex partners): By having sex with many different people, you increase your chances of having sex with an infected person.
  • Men who have sex with men: This results from higher HIV rates in this group of people and the fragility of rectal tissue.
  • HIV infection: This happens because HIV affects your immune system and your capacity to fight all kinds of infections.
  • Drug use: The link between drug use and syphilis exists because certain drugs can make you engage in unsafe sexual practices. Also, people can acquire syphilis through blood transfusion or, in this case, by sharing needles.

Can you get it without being sexually active?

Yes, despite that syphilis is a sexually transmitted infection; it is possible. So, you can get syphilis by having sexual contact with an infected person’s lesions. Yet, this includes kissing near lesions without actually having sexual intercourse.

However, you can’t get syphilis from surfaces like toilet seats or contact with an infected person’s blood. The only other two ways syphilis is transmitted and doesn’t involve sexual contact is during pregnancy and receiving blood from an infected person (such as sharing needles while using drugs or blood transfusions).

Sadly, an infected pregnant woman may pass the infection to her unborn baby. The baby may get syphilis during pregnancy or during childbirth.

How can you reduce your risk of getting this disease?

Since syphilis is a sexually transmitted infection, the best way to prevent it is to avoid having sex. It is a bit extreme but effective.

Another form of preventing syphilis is to be monogamous, with a person who is not infected. If you are not monogamous either, the fewer number of different sexual partners, the less are your chances of being infected.

The second best way to prevent syphilis is by using a condom every time you have sex. But this only helps if the condom is covering the lesions. If you kiss an infected person with lesions in their mouth, you’ll still get syphilis.

How is syphilis diagnosed?

Syphilis may be diagnosed through two types of tests. The most common way of detection is by a blood test that detects the levels of antibodies. This type of test is called serology.

The specific serology for syphilis is the VDRL (Veneral Disease Research Laboratory). This will tell you if you’ve been exposed to the infection or not. This result might be positive even if you had the infection a long time ago.

The antibodies are the proteins your body produces to fight infections. Once these antibodies are produced, they stay in your body to defend you. This is why, once exposed to syphilis, the level of antibodies can help establish a diagnose. This diagnostic method is considered a nontreponemal test because it measures antibodies, not a treponemal bacterium.

There are treponemal tests that look for the bacterium instead. These treponemal tests can look for specific proteins in the bacterium. These tests are often performed after a positive result of a nontreponemal test, to confirm whether if the infection is active at the moment.

Another form of treponemal test is the darkfield microscopy. This is used with a sample of the chancre or the rash from the secondary stage. The sample is later put in a microscope with a darkfield to observe the spirochetes.

How is syphilis treated?

Syphilis treatment is very simple. However, it will depend on certain conditions. The treatment for this infection is Penicillin, more specifically, Benzathine Penicillin.

It will depend on infection in the early stages or later stages; it will also depend on a pregnant woman. A person in the early stages of the disease may receive just one intramuscular shot with Benzathine Penicillin, and that will do it. The patient may also receive treatment with Procaine Penicillin, but this treatment is longer, it takes about ten days.

If the patient is allergic to penicillin, the patient may undergo a desensitization process to receive this treatment. If desensitization is not possible, the adequate treatment is Doxycycline or, in some cases, Azithromycin.

Also, If the patient is in later stages, the treatment remains the same, but it takes longer. With Benzathine Penicillin, it is a shot per week for three weeks. However, these patients require blood tests to confirm if the infection has finally gone.

On pregnant women, the treatment is Benzathine Penicillin as well, but the newborn should get tests and receive preventive treatment. Pregnant women should not receive treatment with doxycycline as it can harm the fetus. Suppose these patients happen to be allergic to penicillin. In that case, they should visit a doctor to receive other possibilities of treatment for this disease.

Are all stages of the disease curable?

In a way, yes. You may get antibiotic treatment at any stage of the disease. This will prevent the infection continues to damage your body. The antibiotical treatment stops the natural course of the disease.

However, the treatment won’t reverse any damage that the disease has already made. This is the reason why it is so important to prevent syphilis from developing.

In the supposed event of getting syphilis, it is very important to get your treatment right away. Once you receive your treatment, you should not have any other syphilis complications in the future.

But this treatment does not stop you from contracting syphilis again; this is why prevention is so important.

Do you suspect you could have this disease?

This tool is a Syphilis Symptoms Checker. It gathers the most important sings, symptoms, and risk factors for the disease. Therefore, it would help to tell the likelihood of someone having right now syphilis. It is free to use and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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