Signs and symptoms of syphilis

Syphilis can be classified into four different stages.  The stages are known as primary, secondary, latent and tertiary syphilis.  The symptoms and signs which are found in syphilis vary according to the stage in which the disease is in. The progression of the disease varies greatly.  People are most contagious during the primary and secondary stage of syphilis. Congenital syphilis also presents differently to sexually acquired syphilis.  Syphilis has many different signs and symptoms and can easily be misdiagnosed.  The different stages and forms of syphilis are briefly discussed:

Primary syphilis

Primary syphilis is the initial presentation of syphilis.  Syphilis is acquired by sexual contact with another person who has an infective syphilis lesion.  Many times this lesion may go unnoticed.  Primary syphilis develops about an average of 21 days after contact with an infected person.  It can also develop as soon as 3 days after sexual contact or take as long as 90 days to develop.

    single chancre

    Single chancre on clavicle

  • Single chancre
  • A single painless skin ulceration on the penis or in the mouth is the classic presentation of primary syphilis.  The ulcer is usually between 0.3 and 3cm in size.  The lesion is usually firm and not itchy. Although the lesion is usually painless it may be painful in some people.   The lesion usually disappears spontaneously and may last up to six weeks without treatment.  The chancre often goes unnoticed and the person may not even know that they have become infected.

    Multiple lesions

    Multiple lesions

  • Multiple lesions
  • When the patient is infected with HIV there may be multiple lesions on the penis or on the mouth.  This is because HIV lowers a person’s immune system which causes any infection and diseases to be more severe.

  • Enlarged lymph nodes
  • Lymph node enlargement occurs in the genital region.  The lymph nodes generally enlarge after 10 days since the appearance of the chancre.

Secondary syphilis

Secondary syphilis occurs after primary syphilis. It usually occurs about 10 weeks after primary syphilis has ended.  Secondary syphilis can present in many different ways and almost always involves the skin.

    Skin rash

    Skin rash

  • Skin rash
  • The skin rash is usually not itchy and not very painful.  It is a reddish rash which appears on the abdomen, back, arms and legs.  The rash of secondary syphilis is also found on the palm of the hand and soles of the feet in most patients.  This rash may become raised and filled with pus.  Bacteria can be found in these lesions.  This rash is more severe in patients with HIV or other conditions which lower immunity.

  • Weight loss
  • Unexplained weight loss may be a sign of secondary syphilis.  A 10% loss of body weight without change of diet or increased exercise is considered significant.

  • Hair loss
  • Patchy areas of hair loss may be a sign of secondary syphilis.

  • Chronic headache
  • A chronic headache may accompany the skin rash.  It might even be present with no skin rash.

  • Any other symptoms
  • Although the most common presentation of secondary syphilis is a skin rash, it may present with various other symptoms. Syphilis is known as the “great imitator” and can present with virtually any symptoms.  Rare presentation of secondary syphilis is hepatitis, arthritis, neuritis and uveitis.

  • Hepatitis
  • Hepatitis is inflammation and infection of the liver and the patient usually develops jaundice which is a yellow discoloration of the skin and sclera of the eyes.

  • Arthritis
  • Arthritis is inflammation of a joint or inflammation of various joints in the body.  It most commonly presents as poly-arthritis in which a number of joints in the body are affected.  It may also present as mono-arthritis where one joint is affected.

  • Neuritis
  • Neuritis is infection and inflammation of neurons which are nerve cells.  Syphilis may cause neuritis which may cause many different symptoms depending on what nerves are affected.  Optic neuritis may occur when syphilis affects the nerve to the eye.  This may cause blindness.  Neuritis usually only occurs if the patient has a compromised immune system.

  • Uveitis
  • Syphilis may affect any structures in the eye.  Uveitis is inflammation of the uvea.

Latent syphilis

Latent syphilis is when no symptoms are present but the patient still has syphilis.  This is the period between secondary syphilis and tertiary syphilis.  Latent syphilis can last for many years until tertiary syphilis develops.  During this stage symptoms and signs of syphilis are hidden.

Tertiary syphilis

Tertiary syphilis develops 4 to 25 years after the initial infection.  About a third of untreated patients develop tertiary syphilis.  This is the most dangerous and most debilitating form of the disease.

  • Gummas
  • Gummas are roundish, soft balls of inflammation which vary in size.  Gummas are usually found on the skin, but they may be present anywhere in or on the body.  They may be a disfiguring mass on the face or be a cause of dysfunction of any organ in the body.

  • Neurological symptoms
  • When syphilis affects the central nervous system it causes neurosyphilis to develop.  There are many different ways in which neurosyphillis may present.  It may cause seizures to occur, shooting pains in the lower extremities, dementia, dizziness and poor balance.  Another sign of neurosyphilis is Argyll Roberton pupils.  This is when the patient’s pupils do not constrict when they are exposed to bright light but they are still able to constrict when focusing on nearby objects.  Subtle personality changes or severe psychosis may be as a result of syphilis.

  • Cardiac symptoms
  • The most common cardiac abnormality which develops as a result of syphilis infection is an aneurysm of the aorta.  The aorta is the biggest artery in the body.  Syphillis infection weakens the wall of this artery which eventually leads to a weak bulge in the wall of the aorta which is called an aneurysm.  If the walls of an aortic aneurysm rupture, the patient will die if emergency surgery and resuscitation is not performed immediately.

  • Any symptoms
  • Tertiary syphilis is known as “the great imitator” because it can present with virtually any symptoms and signs.