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Syphilis is described in terms of its four stages: primary, secondary, latent (hidden), and tertiary (late).
During the primary stage, a sore ( chancre) that is usually painless develops at the site where the bacteria entered the body. This commonly occurs within 3 weeks of exposure but can range from 10 to 90 days. A person is highly contagious during the primary stage.
Secondary syphilis is characterized by a rash that appears from 2 to 8 weeks after the chancre develops and sometimes before it heals. Other symptoms may also occur, which means that the infection has spread throughout the body. A person is highly contagious during the secondary stage.
A rash often develops over the body and commonly includes the palms of the hands and the soles of the feet.
The skin rash usually heals without scarring within 2 months. After healing, skin discoloration may develop. But even though the skin rash has healed, syphilis is still present and a person can still pass the infection to others.
When syphilis has spread throughout the body, the person may have:
If untreated, an infected person will progress to the latent (hidden) stage of syphilis. After the secondary-stage rash goes away, the person will not have any symptoms for a time (latent period). The latent period may be as brief as 1 year or range from 5 to 20 years.
Often during this stage an accurate diagnosis can only be made through blood testing, the person's history, or the birth of a child with congenital syphilis.
A person is contagious during the early part of the latent stage and may be contagious during the latent period when no symptoms are present.
About 20 to 30 out of 100 people with syphilis have a relapse of the secondary stage of syphilis during the latent stage.footnote 1 A relapse means the person had passed through the second stage, had no symptoms, then began to experience secondary-stage symptoms again. Relapses can occur several times.
When relapses no longer occur, a person is not contagious through contact. But a woman in the latent stage of syphilis may still pass the disease to her developing baby and may have a miscarriage, a stillbirth, or give birth to a baby infected with congenital syphilis.
This is the most destructive stage of syphilis. If untreated, the tertiary stage may begin as early as 1 year after infection or at any time during a person's lifetime. A person may never experience this stage of the illness.
The symptoms of tertiary (late) syphilis depend on the complications that occur. Complications of this stage include:
CitationsHook EW (2016). Syphilis. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 25th ed., vol. 2, pp. 2013–2020. Philadelphia: Saunders.
Current as of: February 11, 2021
Author: Healthwise StaffMedical Review: Kathleen Romito MD - Family MedicineThomas M. Bailey MD - Family MedicineAdam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineKirtly Jones MD - Obstetrics and GynecologyKevin C. Kiley MD - Obstetrics and Gynecology
Current as of: February 11, 2021
Author: Healthwise Staff
Medical Review:Kathleen Romito MD - Family Medicine & Thomas M. Bailey MD - Family Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Kirtly Jones MD - Obstetrics and Gynecology & Kevin C. Kiley MD - Obstetrics and Gynecology
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