So this is where it gets interesting. Syphilis is divided into three stages, each with different signs and symptoms.
Primary Stage: Syphilis usually appears first as a red, firm, painless and sometimes wet ulcer or open genital sore, which disappears without a scar. “It can appear in the back of the throat and be missed entirely,” according to Dr. Demetre Daskalakis, an infectious disease expert at Mount Sinai Hospital in New York City. This first phase is the most infectious stage.
This chancre (pronounced: SHANG-ker) appears 3 weeks to 90 days (up to 12 weeks) after infection either on the penis, scrotum, mouth, back of the throat or anus. It’s often misdiagnosed as a herpes sore. It then scabs over and heals. Also, the glands nearest to the sore (neck or groin) may swell. Treatment of the sore with antiseptics or antibiotic creams has no effect since the treponeme has already infected the nearby lymph nodes. The sore is usually painless (as are the swollen nearby lymph glands) and feels like a small hard button just below the skin surface. It varies between barely visible to the size of a small fingernail.
The primary chancre is usually a single ulcer that is hard to miss when found on the penis but difficult when on the vulva, vagina or cervix, or in either gender when near the anus. A chancre can be found on the lips, nipples, tongue or other sites. One unlucky site is the base of the penis (called a “condom chancre”) when a sore on the vulva has come into contact with the lower part of the penis NOT covered by the condom.
The chancre will disappear on its own in 1-6 weeks (3 weeks average) but the disease doesn’t go away. In fact, if the infection hasn’t been treated, the disease will continue to get worse.
The primary sore is still present in perhaps 15% of secondary stage cases.
Secondary Stage: About 3-8 weeks after infection, the bacterium has spread throughout the body. A rash appears in most people on hands, palm and the soles of the feet. It might seem like this rash is the most important problem. But the treponeme can be found affecting all the parts of the body, from the liver to the lungs and the brain to the bones. People with secondary syphilis feel generally unwell, with a temperature, aches and pains, and loss of appetite. Half have enlarged lymph glands. Other symptoms are condylomata lata (fancy term for wart growths), lymph node enlargement, spotty baldness/hair loss, mild fever, fatigue, ulcers in the mouth and anus, and weight loss. There is an involvement of the central nervous system in 20% of cases, with nothing more than a slight headache.
Sometimes the rashes associated with syphilis can be very faint or look like rashes from other infections and, therefore, may not be noticed. Remember, sores sometimes appear on the lips, mouth, throat, vagina, and anus — but many people with secondary syphilis don’t have sores at all.
Secondary symptoms may last 2 to 6 weeks (4 weeks average) and may recur. The symptoms of this secondary stage will go away with or without treatment. But if the infection hasn’t been treated, the disease can continue to progress. Syphilis is still contagious during the secondary stage.
After some weeks, the rash and other complications disappear and the disease enters its next stage.
Early latent stage: If syphilis still hasn’t been treated, the person will have a period of the illness called latent (hidden) syphilis. This means that all the signs of the disease go away, but the disease is still very much there. Even though the disease is “hiding,” the spirochetes are still in the body. This stage can last for 2 years without signs or symptoms although infectious bacteria are still present in the tissues. Syphilis can remain latent for many years. Chancres or rashes may recur in this early latent stage.
Late latent stage or Tertiary Stage: If the disease still hasn’t been treated at this point, some develop tertiary (or late-stage) syphilis. This means the spirochetes have spread all over the body and can affect the brain, the eyes, the heart, the spinal cord, and bones. Symptoms of late syphilis can include difficulty walking, numbness, gradual blindness, and possibly even death. One third of people reach this stage, also called neuro-syphillis. It can appear up to 30 years after infection. The good news is that there is no chance of syphilis being passed on in this stage. It’s also been found that many who have reached this stage can look forward to no further trouble from their infection and may die of old age or an unrelated condition. The lesion in tertiary syphilis is known as the gumma. A gumma results from blockage of small arteries and can cause spots and lumps or nodules in skin, tongue, bones, muscles and internal organs. These later manifestation of syphilis are very uncommon in the western world today. If untreated, there can serious damage to the nervous system, heart, brain and other organs. Sometimes no clinical signs, but vascular and neurological damage may be occurring.
There is something called a dark-ground or dark-field microscope examination that looks at a little fluid from the primary sore of the secondary rash. Also, serological tests measure the presence of antibodies in the blood.
– Treponemal antibody tests, TPHA, TPPA, FTA or EIA stay positive forever even after successful treatment. These continuing positive results simply say that the person has had the infection in the past.
– Non-treponemal antibody tests, VDRL and the RPR tell us whether the syphilis is still active, depending on how strongly positive the test is. This distinguishes between a positive treponemal test owing to older treated infection or a new infection.