Syphilis is a sexually transmitted infection (STi’s) leading to a disease (STD) and is a bacterial infection. It has often been called “the great imitator” because so many of the symptoms are indistinguishable from those of other diseases.

Syphilis is transmitted from person to person through direct contact with a syphilis sore. This is most common during sex, however the infection can be passed through non sexual direct contact with a syphilis sore. Transmission generally occurs during vaginal, anal, or oral sex. Sores occur mainly on the external genitals, vagina, anus, or in the rectum, although sores can occur on the lips and in the mouth. Complications can result in the spreading of the infection to vital parts of the body, such as the brain or the heart. It is possible for pregnant women with the disease to pass it to the babies that they are carrying. Syphilis cannot be spread through contact external to the body such as toilet seats, doorknobs, swimming pools, bathtubs, shared clothing, or eating utensils. There has been an increase in cases of syphilis in men, mainly in men who have sex with other men, however rates of infection in women have remained reasonably steady.


Numerous people infected with syphilis do not have any noticeable symptoms for years, and remain at risk if they are not treated, therefore transmission may occur from persons who are unaware of their infection. The signs and symptoms of syphilis may occur and can be categorised into four stages – primary, secondary, latent and tertiary.

Primary Stage Syphilis

The primary stage of syphilis is usually marked by the arrival of a single sore or ulceration (called a chancre), however there may be multiple sores which may not be noticeable. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days the average being 21 days. There may also be a swelling in the lymph nodes in the groin.The chancre is usually firm, round, small, and painless. It arrives at the spot where the infection entered the body. The ulceration lasts 3 to 6 weeks, and heals without treatment. The signs and symptoms of primary syphilis typically disappear without treatment, but the disease remains and symptoms may reappear in the secondary or third (tertiary) stage.

Secondary Stage Syphilis

There are many way in which the secondary stage of the disease appears. Most frequent is the development of a rash on one or more areas of the body. These rashes may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. In moist areas of the body, the rash becomes flat broad whitish lesions. Mucous patches may also appear on the genitals or in the mouth. All of these lesions are highly infectious. Any individual with secondary stage syphilis is at their most contagious.

The appearance of these rashes may coincide with the healing of the first stage chancre, or manifest themselves several weeks later. The rash does not usually cause irritation. Rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Some symptoms maybe so mild that they are never noticed.

Other symptoms other than rashes may include;

  • fever,
  • sore throat,
  • malaise (a feeling of discomfort or uneasiness)
  • weight loss,
  • patchy hair loss
  • headache,
  • meningismus (an intolerance to bright light)
  • enlarged lymph nodes.

Rare manifestations include an acute meningitis that occurs in about 2% of patients and;

  • hepatitis,
  • renal disease,
  • patchy proctitis (inflammation of the anus),
  • ulcerative colitis (inflammatory bowel disease)
  • arthritis

The signs and symptoms of secondary syphilis may disappear with or without treatment, however without treatment, the infection will progress to the third (tertiary) and late stages of disease.

Latent Syphilis

The latent or hidden stage of syphilis begins when primary and secondary symptoms disappear. Latent syphilis can be described as either late or early. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection, without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk of transmission. In many cases the timing of initial infection is not known and therefore the Latent Syphilis should be believed to be late for the purpose of therapy. Early latent syphilis can be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. For infectiousness, however, late latent syphilis is not considered as contagious as early latent syphilis.

This latent stage can last for years and without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms the infection remains in the body.

Tertiary Syphilis

Tertiary syphilis usually occurs anywhere up to 10 years after the initial infection, though in some cases it can take decades. This stage is marked by the formation of gummas which are soft, tumor-like balls of inflammation known as granulomas. These form as a result of the individual’s immune system not being able to fully rid the body of its infections.

Consequences of Contracting

The late stages of syphilis, the disease may consequently damage internal organs, including the nerves, brain, eyes, heart, blood vessels, liver, bones, and joints. Signs of late stage syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.


First-choice treatment for all appearances of syphilis is penicillin. For early syphilis, one dose of penicillin is sufficient. Late latent syphilis is defined as latency for greater than one year. Penicillin is recommended as weekly doses for 3 weeks.


While abstinence from any sexual activity is very effective at helping prevent syphilis, it should be noted that the bacterium easily crosses intact mucosa and cut skin, including areas not covered by a condom. Proper and consistent use of a latex condoms is effective against the spread of syphilis through sexual contact.