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Syphilis Stages & Symptoms

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Syphilis Stages & Symptoms

writtenByWritten by: Andy Wong
Andy Wong

Andy Wong

Andy is the Chief Marketing Officer at PlushCare. He's passionate about advancing healthcare solutions and improving access to care via health technology.

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August 23, 2017 Read Time - 8 minutes

Syphilis Stages Symptoms

According to a 2015 report by the Center for Disease Control, around 15 of every 200,000, or .0075% of individuals in the United States reports contracting syphilis, a rare but potentially devastating sexually transmitted disease.  Left untreated, syphilis can have unalterable and fatal repercussions, but with the proper care and management, is completely treatable.  Syphilis is a bacterial genital ulcerative disease that develops in stages, which are characterized by their symptomatic manifestations, or by their latency.  Syphilis is almost always symptomatic, but symptoms may take months or even years to appear, so it is possible to acquire or transmit the disease without knowledge.

Timing is extremely important in understanding the effects of syphilis, as each stage has its own associated symptoms, appearance, severity, and treatment.  It is crucial to recognize syphilis early on, as it becomes more and more dangerous as time passes, and deadly once it reaches the tertiary (post latent, third symptomatic) phase.  It is also heavily linked with the facilitation of HIV transmission and acquisition.

What is Syphilis?

Syphilis is a contagious bacterial disease caused by the Treponema Pallidum bacterium, which is transferred via direct, typically sexual, contact with the lesions or bodily fluids of an infected individual.  Syphilis is a phasal disease, as it progresses through specific, sequential stages, with very little variation from person to person.   So, how long does syphilis last?  If diagnosed and treated in the primary or secondary stages, syphilis can be eliminated from the body within days.  If untreated, the disease can last for several decades, usually ending in fatality.  The first stage has the least severe symptoms, while the final stages, if left untreated, can be destructive.

These stages can progress quickly or take decades to manifest, but how do you know if you have it?  So, what are the symptoms of syphilis?

What are the Symptoms and Stages of Syphilis?

The first symptoms of syphilis can occur from as soon as 10 days to as long as 3 months after acquisition.  The average onset of syphilis symptoms is 21 days.  So, what should you look for?

Primary Syphilis

The first, or primary stage of Syphilis is mild and can go by unnoticed, even when symptomatic.  The first sign of syphilis is the appearance of one or multiple chancre sores at the primary site of infection.  Chancre sores are typically firm, round, and painless.  Syphilis chancres start as pustules, spots with hard sloping edges with a fluid filled center, capable of bursting when pressure is applied.

Since syphilis is a sexually transmitted infection, chancres can occur on, in, and around the genitals, on the anus, in the rectum, or on the upper and inner thighs.  Syphilis can also be contracted in the mouth or throat, with oral chancres typically located on the pharynx.  The chancre pustule then scabs over to become an ulcer, which takes about 3 to 6 weeks to heal fully, regardless of treatment or lack thereof.

For men, the chancre is most likely to develop on the glans (tip) or the shaft of the penis.  For women, the initial chancre is most likely to develop on the vulva, in the vagina, or on the cervix.  Due to the potential internal growth, and the chancre’s tendency to be painless, primary syphilis may be difficult to detect in women.  This may contribute to why physicians report fewer cases of primary syphilis in women.

Secondary Syphilis

The secondary stage of syphilis is markedly more severe and may overlap with the healing process of the primary stage.  The first sign of secondary syphilis is a reddish-brown rash upon several areas of the body.  The most characteristic area of syphilis rash is on the palms and the bottom of feet, but rashes like this and other skin inflammation may occur elsewhere on the body.

These body rashes often resemble those of other diseases and conditions, such as contact dermatitis, acne, chicken pox, etc.  This characteristic has lead to syphilis’s acquisition of the moniker, “The Great Pretender.”  Syphilitic rashes are not usually itchy or painful, and can be so faint that they might not even be noticeable.

Along the mucous membranes and warm, moist areas of the body, such as the mouth, throat, genitals, and anus, and underarms, large white or grey lesions appear.  These are known as Condyloma Lata, which contain vast amounts of infectious T. pallidum spirochetes, making them highly contagious.  These occur in about 33% of syphilitic individuals.

Other possible symptoms of secondary stage syphilis include:

  • Fatigue
  • Fever
  • Hair loss
  • Headaches
  • Myalgia (muscle pain)
  • Sore throat
  • Swollen lymph nodes
  • Weight loss

Just as in the primary stage, secondary symptoms will go away on their own accord with or without treatment. However, if untreated, the infection will progress to the next stage.

Latent Syphilis

Around 30% of those infected with syphilis are currently living in the latent, or dormant period of syphilis.  In the latent stage, there are no symptoms.  The bacteria reside in the spleen and lymph nodes, inactive for 3 to 30 years.  If untreated during the latent stage, the disease will develop into the tertiary stage.

Tertiary Syphilis

The tertiary stage of syphilis may take years or even decades to arrive, but around 30-40% of all seropositive individuals will progress to it, since the undiagnosed primary and secondary syphilis followed by a long, asymptomatic period can lead to a false sense of security.

Though at this stage in the infection the bacteria are typically no longer contagious, their effects on the body can be devastating.  The bacteria living inside have at this point congregated and multiplied in one or more organ systems of the body.  Common infections include those of the central nervous system, the cardiovascular system, the bones, and the skin.

  • Neurosyphilis
  • Cardiovascular Syphilis
  • Gummatous Syphilis

Further possible complications of syphilis

As with many viral infections, syphilis increases your risk of contracting other diseases.  Syphilis increases your susceptibility to STDs and other complications such as:

  • Chlamydia
  • Gonorrhea
  • HIV/AIDS
  • HPV
  • Trichomoniasis
  • Congenital SyphilisCongenital syphilis, or neonatal syphilis occurs when a pregnant, syphilitic woman transmits the infection to her unborn child.If syphilis is left untreated during pregnancy, there is an 80% chance of transmission, and a 40% chance of miscarriage, stillbirth, or death in early infancy.If treated with penicillin during pregnancy, there is a 98% chance of non-transmissionSymptoms in babies infected with congenital syphilis include:AnemiaThe infected does not possess enough healthy red blood cells, often coincides with iron deficiencyBlindnessBone deformityDeafnessEnlarged spleenJaundiceSkin condition in which the epidermis is yellow due to infection or immature liver development.Meningitis
  • HIVThose infected with syphilis have a 200-500% greater chance of developing HIV

If you or someone you know displays these symptoms and complications, consult immediate help from an urgent care center or doctor near you.

Syphilis Transmission and Prevention

How Do You Get Syphilis?

Syphilis is transmitted via direct contact with the open sores or bodily fluids of an infected person.  The T. pallidum spirochetes enter the contracting host’s body through microscopic cracks in the skin and through the mucus membranes along the penis, vagina, mouth, and anus.

Syphilis Risk Factors

According to a 2015 CDC report, men are far more likely to contract syphilis in their lifetime than women.  In 2015, men from ages 15-19 experienced 8 cases per 100,000 individuals, compared to women of the same age range, who reported 2.8 cases per 100,000.  That is a 286% higher likelihood of 15-19 year old men to contract syphilis.  Men aged 20-24 reported 35.7 cases per 100,000, compared to women who reported 5.1 cases per 100,000, 700% more likely for men!

Within the male population, MSM, or men who have sex with men are more likely to contract syphilis than MSW, men who exclusively have sex with women.

Unprotected sex and having multiple partners is also a large risk factor for syphilis.

Preventing Syphilis Transmission

The only way to ensure you do not contract or transmit syphilis is by abstaining from vaginal, oral, and anal sex.  However, if you are sexually active, there are ways to prevent the spreading of syphilis from or to your sexual partner:

  • Maintaining a mutually monogamous sexual relationship with a partner who has been tested for STDs
  • Proper usage of condoms and dental dams during vaginal, anal, and oral sex; even gloves during manual stimulation can help prevent the proliferation of syphilis.

To learn about the methods of syphilis testing, click here.

For information on syphilis treatment, click here.

If you think you have symptoms of syphilis, call or book online with PlushCare to set up a phone appointment with a top U.S. doctor today.

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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