There are four stages of syphilis in adults:
- Primary stage
- Secondary stage
- Latency stage
- Tertiary stage
Primary (First) Stage
Single or multiple lesions will appear. This can happen within 10-90 days of exposure. They occur in the area where the infection was originally passed. Common sites include the genitals, rectum, tongue, inside of the mouth, or lips.
At first the lesion is raised or blister-like and painless. It gradually breaks down to form an induration or ulcer. The ulcer is painless at first. It usually has raised edges and is firm and round. The ulcers usually last for 1-5 weeks. They will heal on their own.
Sometimes these lesions acquire a second bacterial infection. This can also become painful. During this time, you may notice enlarged lymph nodes in your groin. Without treatment, the infection may move to the secondary stage. This can happen even if the ulcers are no longer visible.
This stage develops from several weeks to months after infection. It starts with a pink or red-colored rash that usually doesn't itch. It often occurs with a sore throat , swollen glands, headache, and other flu -like symptoms. It may appear on one or more areas of the skin. The rash usually lasts 2-6 weeks and may appear as the following:
- Prickly heat
- Small blotches or scales
- Moist warts in the groin area
- Slimy white patches in the mouth
- Sunken dark circles the size of a nickel or dime
- Rashes on the palms and soles
- Swollen lymph nodes throughout the body
Latency (Resting) Stage
In this stage the infection persists but there are no symptoms. This may last for many years. It may or may not progress to the third stage. Blood tests for syphilis will be positive during this stage. This stage is then further divided into the following:
- Early latency—often lasts for the first year after the first two stages are done. This is the time when most syphilis infections are spread to others.
- Late latency—people are usually not infectious during this stage. However, a pregnant woman can pass the syphilis infection to her developing fetus during this stage.
Tertiary (Third or Late) Stage
This stage may begin months or even years after the initial infection. This stage has become very rare in developed countries. In this stage, the bacterium begins to damage:
- Brain and nerves
- Heart and blood vessels,
- Bones and joints
- Small bumps (called gummas) on the skin, bones, or internal organs
- Heart and blood vessel problems
- Central nervous system damage, including weakness, numbness, trouble walking, difficulty with balance, memory problems, and loss of bladder control
This type occurs when a pregnant women passes syphilis to her unborn child. This is now rare in developed countries. Syphilis testing is part of routine prenatal care. This can cause deafness and problems with the teeth and nose for the child.
The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will look for lesions or rashes on the body and genital area. In addition:
- Material from infectious lesions may be examined under a microscope.
- A blood test can detect antibodies to syphilis.
- If neurologic symptoms are present, a spinal tap may be done. This process uses a needle to remove fluid from the spine. It is done to check the fluid around the brain and spinal cord.