Stages of Syphilis: Symptoms, Progression, and Treatment

Syphilis, caused by Treponema pallidum, progresses through distinct stages if untreated. Each stage has characteristic features and transmission risk.

Primary Syphilis

• Incubation: 10–90 days (average 21).
• Chancre: Single, painless, firm ulcer at inoculation site (genitals, anus, mouth). Heals in 3–6 weeks without treatment.
• Highly infectious.

Secondary Syphilis

• Onset: 4–10 weeks after chancre heals.
• Symptoms: Diffuse maculopapular rash (often palms/soles), mucous patches, condyloma lata, fever, lymphadenopathy, malaise, headache, weight loss, alopecia.
• Relapsing course: Symptoms wax and wane over months.
• Highly infectious.

Latent Syphilis

• Early latent: <1 year from infection; seroreactive, no symptoms; still infectious (rare sexual transmission).
• Late latent: >1 year; not sexually infectious (except vertical transmission).
• Can last decades.

Tertiary Syphilis

• Onset: 10–30+ years post-infection (≈30% of untreated).
• Manifestations: Gummatous lesions (skin, bone, liver), cardiovascular syphilis (aortitis, aneurysm), neurosyphilis (tabes dorsalis, general paresis).
• Can be fatal.

Congenital Syphilis

• Transplacental transmission → miscarriage, stillbirth, preterm birth, neonatal death, or multisystem disease in infant (snuffles, rash, bone lesions, Hutchinson teeth, neurosyphilis).

Treatment

• Penicillin G benzathine is the only recommended therapy. Dose and duration vary by stage.
• Alternatives (doxycycline, ceftriaxone) only for penicillin-allergic non-pregnant patients.
• Follow-up serology (RPR/VDRL) at 6, 12, 24 months to confirm response.