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Syphilis - Symptoms & Treatment

Syphilis is a chronic, infectious, sexually transmitted disease that begins in the mucous membranes and quickly becomes systemic, spreading to nearby lymph nodes and the bloodstream. Untreated, the disease progresses in four stages: primary, secondary, latent, and late (formerly called tertiary).

Incidence in the United States is highest among urban populations, especially in people between ages 15 and 39, drug users, and those infected with the human immunodeficiency virus (HIV).

Untreated syphilis can lead to crippling or death, With early treatment, the prognosis is excellent. The incubation period varies but typically lasts about 3 weeks.


The spirochete Treponema pallidum causes syphilis. Transmission occurs primarily through sexual contact during the primary, secondary, and early latent stages of infection. Prenatal transmission (from an infected mother to the fetus) also is possible.

Transmission by way of a fresh blood transfusion is rare. After 96 hours in stored blood, the T. pallidum spirochete dies.

Signs and symptoms

The symptoms of syphilis depend on the stage of the disease. In addition, a significant proportion of individuals may remain without symptoms.

Primary syphilis:

The symptoms of primary syphilis typically appear 2 to 6 weeks after sexual contact with an infected person. A painless red sore called a chancre appears, usually on the genitals. Depending on the type of contact, the chancre may also appear on the mouth or in the rectal area. Usually there are also enlarged lymph nodes (swollen glands) near the area of the chancre sore. Without treatment, the chancre heals after 4 to 6 weeks, leaving a thin scar, and the second stage of syphilis begins. These sores are the primary way that the disease is transmitted between people.

Secondary syphilis:

During the second stage of syphilis, there may be:

  • A flat, red skin rash. This may be on the soles of the feet or palms of the hands, or it may cover the entire body. The rash is very contagious.
  • Enlarged lymph nodes.
  • Hair loss.
  • Lumps on the genitals.
  • General tiredness.

If you are infected with syphilis and do not seek treatment, you can remain infectious for up to two years.

Late (Tertiary) Syphilis :

  • Neurologic problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.
  • Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta - your body's major artery - and of other blood vessels.

Diagnostic tests

The syphilis bacterium can be detected by a doctor who examines material from infectious sores under a microscope. Shortly after infection occurs, the body produces syphilis antibodies that are detected with a blood test. A syphilis blood test is accurate, safe, and inexpensive. A low level of antibodies will stay in the blood for months or years after the disease has been successfully treated, and antibodies can be found by subsequent blood tests. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.


Antibiotic therapy - penicillin administered I.M. - is the treatment of choice. For early syphilis, treatment may consist of a single injection of penicillin G benzathine I.M. (2.4 million units). Syphilis of more than 1 year's duration may respond to penicillin G bepzathine I.M. (2.4 million units/week for 3 weeks).

Patients who are allergic to penicillin may be sucessfully treated with tetracycline or erythromycin (in either case, 500 mg by mouth four times a day for 15 days for early syphilis, 30 days for late infections, Tetracycline is contraindicated during pregnancy.


Safer sexual practices and consistent condom use are important measures in the prevention of syphilis. In addition, early diagnosis and treatment is needed to prevent ongoing transmission of this disease, as is screening during any evaluation for a sexually transmitted disease.

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