Stages of Syphilis

Untreated syphilis typically progresses through several stages that can last for weeks, months, or even years. Each stage is characterized by different symptoms.

Primary Stage
The first stage of syphilis is marked by the appearance of a single sore, called a chancre, at the original site of infection, where the bacteria entered the body. Some people may have multiple chancres. Chancres are usually, but not always, firm, round, and painless. When painless chancres occur in locations that aren't visible, such as inside the vagina or anus, a person may not even realize they have these sores. Chancres last three to six weeks and heal with or without treatment. Even if the chancre goes away on its own, a person who doesn't receive treatment is still infected, and the disease will progress to the secondary stage.

Secondary Stage
The secondary stage of syphilis typically starts with the development of a rash on one or more areas of the body, which may appear when the primary chancre is healing up to several weeks after the chancre has healed. These rashes do not usually cause itching. In most cases, they appear as rough, red, or reddish brown spots on the palms of the hands and the bottoms of the feet, but rashes with a different appearance can appear elsewhere on the body as well. Mucous membrane lesions in the mouth, vagina, or anus are another characteristic symptom of the secondary stage. Other symptoms that can occur at this stage include:

  • Condyloma lata, which are large, raised, gray or white lesions that develop in warm, moist areas such as the mouth, underarm, or groin region
  • Fever
  • Swollen lymph nodes
  • Sore throat
  • Patchy hair loss
  • Headaches
  • Weight loss
  • Muscle aches
  • Fatigue

Like primary chancres, the symptoms of secondary syphilis will go away with or without treatment. Despite the disappearance of symptoms, untreated syphilis will progress to the latent and possibly tertiary stages of disease.

Latent Stage
The latent, or hidden, stage of syphilis is a period of time during which there are no visible signs or symptoms of the infection. Even though symptoms have gone away at this stage, syphilis remains in the body without treatment. Latent syphilis can last for years, and it's divided into early latent syphilis and late latent syphilis. Early latent syphilis is latent syphilis within the first 12 months of infection. Late latent syphilis is latent syphilis beyond 12 months of initial infection.

Tertiary Syphilis
When syphilis goes untreated for several years, the disease can reach the tertiary stage. Although this is rare, it can be fatal. Tertiary syphilis can occur 10 to 30 years after the infection was first acquired, and it can affect multiple organ systems, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. The symptoms of this stage vary depending on which organ system is affected.