From the Guidelines
Syphilis progresses through three distinct stages: primary, secondary, and tertiary, each with unique characteristics and potential consequences if left untreated. The primary stage is marked by a painless sore called a chancre that appears at the site of infection, typically on the genitals, rectum, or mouth, about 3-4 weeks after exposure, as noted in the guidelines by the Centers for Disease Control and Prevention 1. This sore heals on its own within 3-6 weeks.
Key Characteristics of Syphilis Stages
- Primary syphilis: characterized by a painless chancre at the infection site
- Secondary syphilis: develops 2-8 weeks after the primary stage, manifesting as a non-itchy rash often on the palms and soles, along with flu-like symptoms
- Tertiary syphilis: the most severe stage, occurring in about 30% of untreated cases, 10-30 years after initial infection, causing serious damage to multiple organ systems
Secondary syphilis develops 2-8 weeks after the primary stage and manifests as a non-itchy rash that often appears on the palms and soles, along with flu-like symptoms including fever, sore throat, headaches, and fatigue, as described in the treatment guidelines 1. Tertiary syphilis occurs in about 30% of untreated cases, developing 10-30 years after initial infection. This most severe stage can cause serious damage to multiple organ systems including the heart, brain, nerves, eyes, blood vessels, liver, bones, and joints. It can lead to neurosyphilis, cardiovascular syphilis, and gummatous syphilis (soft tissue tumors).
Treatment Considerations
- All stages are treated with antibiotics, primarily penicillin G benzathine
- Dosage and duration of treatment vary by stage
- Early detection and treatment are crucial as damage from tertiary syphilis cannot be reversed
- The treatment of choice for all stages of syphilis remains long-acting preparations of penicillin, supported by over 40 years of clinical experience and recent clinical trials 1.
From the Research
Stages of Syphilis
The stages of syphilis include primary, secondary, latent, and tertiary syphilis.
- Primary syphilis typically presents as a solitary, painless chancre, usually in the genitoanal region 2, 3.
- Secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum 2.
- Latent syphilis is characterized by the absence of clinical manifestations, with infection only apparent on serologic testing 2, 4.
- Tertiary syphilis can manifest years after infection as gummatous disease, cardiovascular disease, or central nervous system involvement, including neurosyphilis 2, 4, 3.
Key Differences
The key differences between primary, secondary, and tertiary syphilis are:
- The presence and nature of clinical manifestations, with primary syphilis typically presenting with a chancre, secondary syphilis with a range of symptoms, and tertiary syphilis with serious complications such as cardiovascular disease or neurosyphilis 2, 3.
- The time frame in which each stage occurs, with primary syphilis occurring shortly after infection, secondary syphilis usually within a few weeks to months, and tertiary syphilis potentially years after infection 2, 3.
- The need for different treatment approaches, with parenterally administered penicillin G considered first-line therapy for all stages of syphilis, but with alternative regimens available for non-pregnant patients with no evidence of central nervous system involvement 2, 4, 5, 6.