Syphilis can be very secretive and go unnoticed for a very long time. Frequently, people that has the disease do not even realize they have it and this is part of the reason that syphilis is a common sexually transmitted disease.

Signs and symptoms can be so light that the patient do not even notice them until they are more visible. At first, people can confuse the symptoms with other more common diseases, such as a rash, an ingrown hair or a pimple. Also, the syphilis symptomatology comes and goes over time, but that does not mean the disease has disappeared. Remember that the only way of getting rid of it is by taking medicine for it.

Syphilis can lead to serious complications if not treated, but the positive side is that with proper antibiotics, the disease will disappear.

This disease has different stages of signs and symptoms, and it can be very confusing due the overlapping that happens. You may pass times with no symptoms at all, but with the infection very active inside you. The clinical manifestations can vary with each stage.

Primary Syphilis:

Appearing 10 to 90 days after the infection, the typical primary lesion is the chancre (where the infection entered into your body), which usually starts as a single and painless papule that becomes eroded and indurated. Usually there is a single lesion, but a minority of patients can develop multiple ones. In men, is more frequently seen on the penis, but it can also be found in the anal region, mouth or external genitalia. In women, is common seeing the primary lesion on the cervix and labia.

Atypical primary lesions are common. This has clinical relevance especially regarding the amount of infectious Treponema pallidum (bacteria producing the disease) that the patient has and his immunologic status. The genital lesions must be differentiated from those appearing in herpes simplex virus infection, chancroid, donovanosis and traumatic injury.

Regional lymphatic lesions (usually inguinal) can accompany the primary lesion, appearing after 1 week of lesion onset. These nodes are firm, painless and nonsuppurative. Usually is bilateral and may appear with every regional chancres. The primary lesion generally heals after 4 to 6 weeks of appearing with or without treatment, although lymphadenopathy may last for months.

Secondary Syphilis:

This stage usually appears 2 to 8 weeks after the first chancre and, includes mucous and cutaneous lesions, as well as generalized indurated lymph nodes. In the 15% of patients, the primary lesion may still be present. Generalized skin rash (especially on the trunk and proximal extremities) not itchy and with multiple lesions is common, but in some cases it can be very mild to the point that the patients do not notice it. Spots can become papules and/or pustules, and frequently involve the palms of hands and soles of feet.

Patchy alopecia of the scalp hair, beard or eyebrows appears in 5% of cases if there is hair follicles involvement. In warm and moist regions, lesions can progress to highly infectious gray-white lesions called condylomata lata in 10% of patients with this stage. There can be silver mucosal erosions, usually on the mouth or genitalia, with a red ring.

Systematic symptomatology include fever, sore throat, weight loss, anorexia, muscle aches, headache and meningismus. Less common complications of this stage include hepatitis (most common), nephropathy, gastrointestinal disorders, ocular issues, arthritis and periostitis. As the first stage, clinical manifestations of secondary syphilis resolve spontaneously after 1 to 6 months.

Latent Syphilis:

In an untreated person, positive serologic tests for syphilis and absence of clinical manifestations indicates the diagnosis of latent syphilis. Is suspected based on history of syphilis lesions. Early latent syphilis goes until the first year after infection, while late latent syphilis goes after that first year after infection. This does not mean that treatment is not necessary, is just a stage were the pathogens are at sleep or hidden. If not treated, syphilis can progress to the third and final stage.

Tertiary (Late) Syphilis:

Generally occurs 10 to 30 years after the initial infection. At this time, the patient can have serious health problems involving brain (neurosyphilis), heart, eyes, kidneys, liver, bones, joints, among others. Loss of motor skills and paralysis, numbness, blindness and dementia are the most common complications. In the majority of cases, this stage is known for the progress into mental illness, continued by death.

This disease can be easily treated in time, but the damage produced by the infection in the tertiary stage cannot be changed or healed.

Get tested for Syphilis

Syphilis is treated with antibiotics. Later stages of the illness could require more aggressive treatment, possibly in a hospital. Act immediately and get tested today!

Get tested for STDs today
Mark Riegel, MD
Mark Riegel, MD

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