Healthy Living

What Are the Different Stages of Syphilis?

What Are the Different Stages of Syphilis?

Key Takeaways

  • The first sign of infection and main feature of this stage is the appearance of a single, firm, non-tender, raised, red lesion called a chancre sore (pronounced SHANG-ker) located at the site of bacteria invasion.
  • The characteristic feature of the secondary stage of syphilis is the appearance of a flat, rosy-colored, and non-itchy rash that usually erupts on the palms and the soles of the feet but may eventually cover the entire body.
  • Around 30% of the people with secondary syphilis reach the tertiary phase, the last and most dangerous phase of the disease. In most of the cases, this stage of syphilis will see progression to mental impairment and death.

Syphilis is a bacterial disease that is dangerous if not diagnosed early and treated. It is an infectious disease that spreads through sexual contact. It has 4 major stages but not all people go through these 4 stages. Still, it is important to get proper treatment.  

Syphilis has 4 stages in its pathogenesis:

Primary Stage

This is the first stage of this disease which occurs 2-10 weeks after acquiring the infection. A person can get the infection by sexual contact, kissing, through the placenta from mother to fetus, and through contaminated injection (particularly common in drug abusers). Once the Treponema pallidum bacterium is inside a human being, it takes time to show any symptoms since it divides slowly. The first sign of infection and main feature of this stage is the appearance of a single, firm, non-tender, raised, red lesion called a chancre sore (pronounced SHANG-ker) located at the site of bacteria invasion. The common places of invasion are the vagina, penis, anus, or cervix. The Treponema pallidum bacteria are plentiful in the chancre and can spread to others through contact. These lesions can also appear on the lips, mouth, tongue, or any body part that has touched the infected area. These chancres heal on their own after 6 weeks due to the body’s immune response. However, this doesn’t mean that your body has gotten rid of the infection. Medical intervention is needed to destroy the Treponema pallidum bacteria.

Secondary stage

This stage follows the primary one and occurs within few weeks after the primary stage if the infection not treated. The characteristic feature in this stage is the appearance of a flat, rosy-colored, and non-itchy rash that usually erupts on the palms and the soles of the feet but may eventually cover the entire body. The rash occurs around 6 weeks to 3 months after the chancre has healed. Multiple but painless lesions may also form in the mucous membranes of the mouth and throat, and on the bones and internal organs. The disease is highly infectious at this point, because of the bacteria in the secretions of the lesions.
An interesting fact is that not all people who have primary syphilis progress to secondary syphilis. Approximately three-fourth of untreated patients have secondary syphilis. Condyloma lata appear in areas of the body that tend to remain moist, such as armpits and the groin. These rashes are bigger, raised, and are greyish-white in color. At this stage, some additional symptoms may appear like lymphadenopathy (dysfunction of lymph glands which are a part of immune system), mild fever, malaise, and weight loss.

Some other symptoms of secondary syphilis may appear as warts on the genitals, fever, hair loss, swollen lymph glands, and white patches inside the mouth and on the tongue. Flu-like conditions can easily last a month or more. A few patients might also show signs of swelling in the liver, kidney, eyes, bones, joints, or spleen. Some may also experience muscle aches, weight loss, and a reduced appetite. Even though the symptoms go away after the first two stages, the later stages are very dangerous.

Latent period

As the name suggests, the bacteria as well as the symptoms remain hidden at this stage. There are completely no symptoms, and this stage may last a few years. During this time, the Trepenoma pallidum bacteria divide very slowly; therefore, if a patient is being treated at this stage, a longer duration of medication is required to completely eradicate the disease.

At this stage, blood tests can still detect the infection even if no symptoms are apparent. In the latent stage, syphilis is still treatable and curable, but none of the previous damage can be reversed. If the patient passes through the latent stage with no medical intervention, the infection progresses to the final tertiary stage.

Tertiary stage

Around 30% of the people with secondary syphilis reach this last and most dangerous phase of the disease. If a patient in the tertiary stage is still not getting medication for some reason, the patient is likely to die. In 2010, approximately 113,000 people died from syphilis. This is quite a dangerous disease if not taken care of at the right time. After the patient is first infected, the final tertiary stage can happen any time between 10-30 years. During this stage, other symptoms appear that could be potentially fatal. Some are very prominent such as blindness, decreased motor skills, and severe dementia. The central nervous system could be compromised. Organs like the brain, kidneys, heart, and bones are also damaged. In most of the cases, this stage of syphilis will see progression to mental impairment and death.

  • There are 3 typical manifestations of this stage:
  1. Cardiovascular syphilis - Valve insufficiency and aneurysms occur most commonly in people with this type of tertiary syphilis. It’s the body’s own immune response to the bacteria that are responsible for cardiovascular syphilis. Firstly, there is aortitis (inflammation of aorta) leading to dilation of aorta. This dilation leads to improper closure of the valves and bulging in the vessel wall (aneurysm). The latter could pose a serious threat to life. Therefore, if a person feels pain in the heart area and experiences bluish fingers and toes and breathing problems, immediate medical help should be sought. 
  2. Neurosyphilis - This occurs when bacteria enter the central nervous system. This can cause symptomatic syphilis or asymptomatic syphilis. Asymptomatic syphilis occurs when the bacteria are in the CNS but do not cause any significant symptoms. There will be certain changes in the cerebrospinal fluid like an increase in the amount of proteins, a decrease in glucose level, and an increase in inflammatory cells in the CSF. There are typical neurological symptoms in the symptomatic ones. They vary from person to person and depends on age. Some people may have neuropsychiatric problems like dementia or delirium, ocular problems which may also include complete blindness and dysfunction of optic nerve (the nerve responsible for perception of vision), or brain stem functional problems. All these may finally lead to partial or total paralysis. It is advisable that a person who has symptoms of neurosyphilis be checked for asymptomatic syphilis.
     
  3. Syphilitic gumma - This type of manifestation is quite rare due to efficient use of antibiotics. In this manifestation, there are benign tumor-like formations called gummas in bone, muscle, and skin. It may be responsible for ulcerative destruction of the skin. When the skeletal system is affected, patients experience pain, limited movement, and pathological fractures.

Given the dire consequences of syphilis that remains untreated, it is imperative that an infected person see a doctor right away at the first sign detected. A wait-and-see approach cannot be taken with respect to this highly infectious, malevolent disease.