Syphilis Natural History: 4 Stages from Chancre to Tertiary Destruction
Untreated Treponema pallidum infection progresses:
- Primary (10–90d post-exposure) – single, painless, indurated chancre at inoculation site; heals spontaneously in 2–6 wks.
- Secondary (4–10 wks post-chancre) – disseminated: maculopapular rash (palms/soles), condylomata lata, mucous patches, fever, lymphadenopathy, alopecia.
- Latent – seropositive, asymptomatic. Early (<1 yr) vs. late (>1 yr or unknown). Can relapse to secondary.
- Tertiary (10–30 yrs) – gummatous (skin, bone, liver), cardiovascular (aortitis, aneurysm), neurosyphilis (tabes dorsalis, general paresis).
Penicillin G cures all stages; dosing/duration varies. Jarisch-Herxheimer reaction common early. Partner notification essential.
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