The Stages of Syphilis 



Primary Syphilis 

- The chancre lesion is the hallmark of primary syphilis. It may appear 10-90 days after exposure. Common sites include penis and labia. Other sites include anus, oral mucosa. Without treatment, chancre disappears in 2-8 weeks. 



Secondary Syphilis 

 - Rash, pink to brown macules. Involves palms/soles in 50% of cases. 

 - Oral lesions called "mucous patches" resemblin snail tracks. 

 - Symptomatic early neurosyphilis, cranial nerve deficits and/or aseptic meningitis presentation. 

 - Ocular syphilis manifestations including anterior or posterior uveitis. 

 - Genito-inguinal rashes, including tinea-mimicker or heaped-up wart-like lesions called condyloma lata. 

 - Less common internal organ manifestations including acute hepatitis and nephrotic syndrome 



Latent Syphilis 

- Latent syphilis refers to asymptomatic infection after the period of primary and secondary syphilis (noticed or unnoticed) has passed. 

 - Early Latent - Early latent refers to asymptomatic patients with positive testing, in whom history can confirm exposure to or symptoms of primary or secondary syphilis within the last year.  This is group may receive single-dose penicillin like primary or secondary. 

 - Late Latent - Late latent patients have positive serology but do not meet criteria 

for early. Thus, multiple  doses of penicillin. 



Late (Tertiary) Syphilis 

 - Late Neurosyphilis. including tabes dorsalis, gait impairments, and dementia. Tabes dorsalis damages the dorsal columns and sensory nerve roots, causing a syndrome of pain and sensory deficits similar to those of B12 deficiency. 

 -Gumma are ulcerating granuIomas on skin, bone, and internal organs. 

 - Cardiovascular effects of late syphilis include aortic aneurysm and coronary arteritis. 



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** GrepMed Recommended Text: Comprehensive Review of Infectious Diseases - https://amzn.to/2WTEUXA