A chronic, infectious, sexually transmitted disease, syphilis begins in the mucous membranes and quickly becomes systemic, spreading to nearby lymph nodes and the bloodstream. This disease, when untreated, is characterized by progressive stages: primary, secondary, latent, and late (formerly called tertiary).

The primary and secondary stages of syphilis have a high incidence among urban populations, especially in persons between ages 15 and 39, drug users, and those infected with the human immunodeficiency virus (HIV).

Untreated syphilis leads to crippling or death, but the prognosis is excellent with early treatment.


Infection from the spirochete Treponema pallidum causes syphilis. Transmission occurs primarily through sexual contact during the primary, secondary, and early latent stages of infection. Prenatal transmission from an infected mother to her fetus is also possible. (See Prenatal syphilis.)

Signs and symptoms

Each stage produces distinctive signs and symptoms.

Primary syphilis

After an incubation period that generally lasts about 3 weeks, symptoms of primary syphilis develop.

Initially, one or more chancres (small, fluid-filled lesions) erupt on the genitalia; others may erupt on the anus, fingers, lips, tongue, nipples, tonsils, or eyelids. These chancres, which are usually painless, start as papules and then erode; they have indurated, raised edges and clear bases.

Chancres typically disappear after 3 to 6 weeks, even when untreated. They are usually associated with regional lymphadenopathy (unilateral or bilateral). In women, chancres are frequently overlooked because they often develop on internal structures—the cervix or the vaginal wall.

Secondary syphilis

The development of symmetrical mucocutaneous lesions and general lymphadenopathy signals the onset of secondary syphilis, which may develop within a few days or up to 8 weeks after the onset of initial chancres.

The rash of secondary syphilis can be macular, papular, pustular, or nodular. Lesions are of uniform size, well defined, and generalized. Macules often erupt between rolls of fat on the trunk and on the arms, palms, soles, face, and scalp. In warm, moist areas (perineum, scrotum, vulva, between rolls of fat), the lesions enlarge and erode, producing highly contagious, pink or grayish white lesions (condylomata lata). Even without treatment, rashes clear up on their own.

Mild constitutional symptoms of syphilis appear in the second stage and may include headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat and, possibly, slight fever. Alopecia may occur, with or without treatment, and is usually temporary. Nails become brittle and pitted.

Latent syphilis

Although no clinical symptoms occur in latent syphilis, it produces a reactive serologic test for syphilis. Because infectious mucocutaneous lesions may reappear when infection is of less than
4 years’ duration, early latent syphilis is considered contagious.

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Jun 16, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Syphilis

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