In the first stage of syphilis, a painless open sore will appear at the site of infection three to four weeks after transmission Table 01. The typical round, open sore is surrounded by firm, raised edges, and if left untreated, can last for two to six weeks. While chancres are most commonly located on the genitals, they can appear wherever direct contact was made, for example, in the anal area or within the oral cavity. In addition, lymph nodes in the area of the chancre may be swollen, though not tender. Because chancres are typically painless and may be located on such inconspicuous sites as the cervix, within the vagina, or near the anus, these sores go unnoticed by one-third of infected men and half of the infected women. Sores that appear on the lips and fingers tend to be painful.
In the second stage of syphilis, you will experience a rash and flulike symptoms Figure 01. The second stage of syphilis starts 6 to 12 weeks after the initial infection, often beginning while the first chancre is healing. You may feel ill, and have a fever, sore throat, headache, or a rash and enlarged lymph nodes. Rashes have a variety of appearances, and more than one type can appear simultaneously. The rash may appear as rough, “copper penny” spots on the palms of the hands and bottoms of the feet; fine red dots; small blisters filled with pus; slimy white patches in the mouth; or thick gray or pink patches. The rash may be short-lived, come and go, or last as long as a year. Mouth sores are common.
Figure 01. Secondary Syphilis Rash
Inflammation throughout the body can produce seemingly unrelated symptoms. More unusual signs and symptoms due to inflammation throughout the body can include blurred vision, aching joints, and jaundice, which gives the skin a yellow tinge. Some patients also develop an infection of the brain (meningitis) with headache, neck stiffness, and hearing problems.
A symptom-free period follows the second stage of syphilis, and may last for years, or for the rest of a person's lifetime. After secondary syphilis, a latent stage begins that is referred to as early latent syphilis during the first year after initial infection, and as late latent syphilis thereafter.
If left untreated, syphilis can lead to heart or mental symptoms, or formation of small lumps throughout the body Figure 02. The serious, late form of syphilis (known as tertiary syphilis) can develop if the disease is left untreated.
About one-third of untreated patients develop tertiary syphilis, which typically takes one of following three forms:
- Benign tertiary syphilis is rare, and involves the growth of small lumps, called gummas, throughout the body. These painless, circular sores may be evident on the skin. Gummas may also develop on the liver, causing tenderness and low-grade fever; on the bones, causing pain; or on the stomach or upper respiratory tract. They may also invade the part of the palate or nasal passages, causing perforations.
- Cardiovascular syphilis may cause inflammation of the major blood vessel leaving the heart (the aorta), leading to a weakened area that balloons out (an aneurysm), or a leaky valve within the heart. Symptoms include cough, shortness of breath, hoarseness, trouble swallowing, chest pain, or heart failure.
- Neurosyphilis can lead to many symptoms, including headache, dizziness, personality changes, convulsions, changes in mental function, and paralysis. Eye or ear involvement can lead to blindness or deafness.
Figure 02. Gummas
Table 1. Symptoms of Syphilis
Primary syphilis Painless sore (chancre) at site of infection, with hard edges and an open center that oozes fluid Secondary syphilis Rash Fever, malaise, and other flulike symptoms Mouth sores Tertiary syphilis Small lumps on the skin (gummas), pain, low-grade fever Symptoms of heart disease: cough, shortness of breath, hoarseness, trouble swallowing, chest pain Neurological manifestations: headache, dizziness, personality changes, convulsions, changes in mental function, and paralysis
People who engage in unprotected sexual activity with multiple partners are at the highest risk for contracting syphilis. Syphilis is most often transmitted through direct contact with a chancre. While such sores usually appear on the genitals, they can also develop in the anal area, mouth, or even on the fingers. Safe sex practices to prevent contact with sores are essential because sores may be hidden in such areas on the body as the cervix or in the vagina, and are normally painless. This hidden quality means that not only are people often unaware of being infected with the disease, but that the disease-transmitting sores will not always be apparent to their sexual partner.
In the U.S., the rate of new cases was on the decline until 2001, when new cases started to increase. According to the CDC, this increase was primarily in men who have sex with men. The CDC has reported declining rates among other groups, including African Americans and those living in Sourthern states.
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