What are the symptoms of primary, secondary and tertiary syphilis?

The syphilis can be divided into four stages: primary, secondary, latent and tertiary. The evolution of the disease is slow and can present symptomatic and asymptomatic periods.

The infected patient, if not treated after reaching secondary syphilis, has 2 latency periods, which are the recent (less than 2 years of the disease) and the late (more than 2 years). Understand each stage:

Primary syphilis

After the person is infected with  T. pallidum , there is a period when the agent is in the body but does not show symptoms, called the incubation period, which can be between 10 and 90 days after the infection.

In general, the first and most evident sign of contagion is the appearance of a lesion in the mouth or close to the place where the bacteria invaded the body (mouth, penis, vulva, vagina, anus or other parts of the skin).

This lesion, called a hard cancer or protosyphiloma, is usually isolated (there are no other wounds on the body) and does not itch, burn or hurt. The wound base is hardened and appears to contain a serous secretion that is full of bacteria.

In addition, small lumps (lumps) may appear in the groin. In a short time, usually between 2 and 6 weeks, the manifestations improve and disappear spontaneously.

Secondary syphilis

If it is not diagnosed and treated in the primary phase, syphilis progresses to the secondary phase, in which the agent invades the body’s organs and fluids.

Between 6 weeks and 6 months after the first wound appeared and healed spontaneously, the patient may have spots along the body, including the soles of the feet and the palms of the hands.

Like the initial wound, there is no pain or itching, but more intense symptoms of fever , malaise, headaches, nausea, vomiting and lumps may occur  .

The skin then presents spots and changes, such as macules and papules, which have a reddish appearance, which can be broad and concentrated (macules) or isolated, as small spots distributed over the skin (papules).

These lesions or spots can form plaques on the skin, that is, manifest themselves in close places and occupy all or a large part of the skin surface.

Stains can also occur on the entire body, especially on the palms of the hands and soles.

Usually, these manifestations occur between the 6th week and the 6th month after the first injury (hard cancer) and can last for an average of 1 to 3 months.

Some patients may even experience symptoms such as:

  • Skin peeling;
  • Headache;
  • Muscle pain;
  • Sore throat;
  • Discomfort;
  • Tingling in the arms and legs;
  • Changes in vision and hearing;
  • Mild fever, usually below 38 ºC;
  • Lack of appetite;
  • Capillary remains;
  • Memory loss;
  • Neurological dysfunctions;
  • Weight loss.

Once they appear, these manifestations tend to improve quickly as well, similar to the stage of primary syphilis. But,  even if the signs disappear, the infectious agent remains in the body and the disease has not been cured .

Latent syphilis

When the patient who reaches secondary syphilis, does not undergo treatment and the signs disappear, the latent period of infection begins. This phase is divided between  recent  (up to the 2nd year) and  late (after 2 years of infection).

It is important to note that at this stage, syphilis does not present any symptoms or clinical manifestation, but in a few patients, it can be interrupted or crossed by specific manifestations characteristic of the third phase of the disease.

Approximately 15% to 30% of untreated infected people reach the tertiary stage of the disease. In some cases, the patient may not go through the latent stage, going directly to tertiary syphilis.

Tertiary syphilis

The manifestation of tertiary syphilis can take long periods to occur. In general, the average time for this phase to start is between 2 and 4 years after infection, but it can take more than 20 years.

When it occurs, it usually manifests itself through inflammation and destruction of body tissues, in which the patient has lesions on the skin surface, in the bones, cardiovascular and neurological alterations and dysfunctions.

In addition, there may be consequences related to these changes (such as arrhythmia, heart problems, memory difficulties and concentration). The stage is severe and can lead to death when left untreated.

In addition to the signs on the body, usually after long years without treatment (between 10 and 30 years), the tertiary phase can be accompanied by:

  • Nausea and vomiting;
  • Neck stiffness, with difficulty in moving the head;
  • Convulsions;
  • Hearing Loss;
  • Vertigo;
  • Insomnia;
  • Stroke;
  • Exaggerated reflexes;
  • Dilated pupils.

Some neurological changes can occur and cause delusions, hallucinations, reduced memory, difficulties in orientation and spatial location, in addition to affecting speech and locomotion.


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