Syphilis is described in terms of its four stages: primary,
secondary, latent (hidden), and tertiary (late).
During the primary stage, a sore (chancre) that is
usually painless develops at the site where the bacteria entered the body. This
commonly occurs within 3 weeks of exposure but can range from 10 to 90 days. A
person is highly contagious during the primary stage.
Secondary syphilis is characterized by a rash that appears from 2
to 8 weeks after the chancre develops and sometimes before it heals. Other
symptoms may also occur, indicating that the infection has spread throughout
the body. A person is highly contagious during the secondary stage.
A rash often develops over the body and commonly includes the palms
of the hands and the soles of the feet.
The skin rash usually heals without scarring in 2 to 12 weeks. After
healing, skin discoloration may develop. However, just because the skin rash
has healed does not mean the syphilis is cured or that a person cannot pass the
infection to others.
When syphilis has spread throughout the body, the person may
If untreated, an infected person will progress to the latent
(hidden) stage of syphilis. After the secondary-stage rash goes away, the
person will not have any symptoms for a time (latent period). The latent period
may be as brief as 1 year or range from 5 to 20 years.
Often during this stage an accurate diagnosis can only be made
through blood testing, the person's history, or the birth of a child with
A person is contagious during the early part of the latent stage
and may be contagious during the latent period when no symptoms are
About 20% to 30% of people with syphilis have a relapse of the
secondary stage of syphilis during the latent stage.1 A relapse means the person had passed through the second
stage, was symptom-free, then began to reexperience secondary-stage symptoms.
Relapses can occur several times.
When relapses no longer occur, a person is not contagious through
contact, but a woman in the latent stage of syphilis may still pass the disease
to her unborn baby and may have a miscarriage, a stillbirth, or give birth to a
baby infected with congenital syphilis.
This is the most destructive stage of syphilis. If untreated, the
tertiary stage may begin as early as 1 year after infection or at any time
during a person's lifetime. A person may never experience this stage of the
The symptoms of tertiary (late) syphilis depend on the
complications that develop. Complications of this stage include:
CitationsHook EW (2008). Syphilis. In L Goldman, D
Ausiello, eds., Cecil Medicine, 23rd ed., pp. 2280–2288. Philadelphia: Saunders.
September 30, 2009
Sarah Anne Marshall, MD - Family Medicine & Jeanne Marrazzo, MD, MPH - Infectious Disease
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