Syphilis may progress through 3 distinct stages. Sometimes not all 3 may be evident.
- Primary phase: The primary phase usually starts with a sore at the site of infection. The sore or lesion is called a chancre (pronounced shanker). This sore usually appears as a painless craterlike lesion on the male or female genitals, although any part of the body is at risk. Anyone who touches an infected sore can become infected. This initial lesion develops 2-3 weeks after infection and heals spontaneously after 3-6 weeks. Though the sore goes away, the disease does not. It progresses into the secondary phase.
- Secondary phase: The secondary phase may develop 4-10 weeks after the chancre. This phase has many symptoms, which is why syphilis is called "the great pretender." It may look like a number of other illnesses. This phase of syphilis can go away without treatment, but the disease then enters the third phase. These are the most frequently reported symptoms of the secondary phase:
- Latent (dormant) phase: The early latent phase (first 12 months following infection) is characterized by an absence of symptoms. Patients in this stage are still infectious, however. Late latent syphilis is an asymptomatic stage when the infection occurred more than 12 months earlier, and these patients are generally not infectious. However, you can still transmit the infection from mother to fetus or through blood transfusions.
- Tertiary Phase: About a third of people with latent syphilis will progress after many years (or decades) into tertiary syphilis. During this phase, the heart, brain, skin, and bones are at risk. Luckily, with the advent of penicillin, this phase is very rarely seen today.
- Congenital syphilis occurs after a fetus is infected in the womb. This form of syphilis causes teeth abnormalities, bone problems, liver/spleen/kidney enlargement, brain infection, failure to thrive/poor growth, swollen lymph nodes, yellow skin (jaundice), low blood counts, and skin rashes.
Scott E Rudkin, MD, MBA, RDMS
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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