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Aug 19, 1997

Could you please explain how syphilis may manifest itself and when tests would begin to show positive.

Response from Mr. Sowadsky

Hi. Thank you for your question. Syphilis is a bacterial infection that can be very serious (even fatal) if left untreated. When we are talking about the symptoms of syphilis, it can be very confusing. This is because the symptoms keep coming and going, and each time the symptoms re-appear, they are different from the time before. The following is a general and brief review about the symptoms of syphilis. Symptoms can be variable from person to person, but the symptoms discussed below are the ones that are noticed most often. The times that symptoms appear (and how long they appear) can also vary from person to person, but the time points discussed below, are the most common.

Initial Infection:

During the first 3 weeks after infection, there are usually no symptoms at all. The person is not infectious to others at this point.

Primary Stage:

About 3 weeks after infection, an open lesion called a "chancre" appears at the site of infection. There is usually only one chancre. This lesion usually appears on the penis, vagina, or rectum. This lesion is painless, so if it is in a location where a person cannot see it (like inside the vagina, or in the anus/rectum), a person can have the lesion and not even know it. The person is highly infectious to others at this point. Physical contact of the chancre with a partners mucous membranes (like the penis, vagina and rectum), can lead to transmission of this infection. This infection is NOT transmitted through casual contact. It is transmitted by direct genital/anal contact with the chancre. This lesion usually appears for about 3 weeks, and then it heals on its own, even without treatment. However, even though the lesion heals, the person is still infected. Blood tests for syphilis will not always show positive at this stage. However, if a person has a chancre, a physician can do a test called a "darkfield exam" to confirm a suspected diagnosis of primary syphilis.

Latent Stage:

After the chancre heals, the person will usually show no symptoms at this time. They are no longer infectious to others. This stage lasts for about a month on average.

Secondary Stage:

During this stage, the symptoms will re-appear, only now they will be entirely different. The most common symptom during this stage is a rash. This rash can appear anywhere on the body, but is most commonly found on the palms of the hands and the soles of the feet. This rash will usually not itch, and can be found on both sides of the body. At the same time, a person may have alopecia (a patch of hair that falls out). In addition, the person can have growths called Condyloma lata, which appear on the genital area; they can resemble genital warts. After about one month, even without treatment, all of the symptoms of Secondary Syphilis go away by themselves. However, the person is still infected. A person will often test positive on syphilis blood tests by this time.

Latent Stage:

Once the symptoms of secondary syphilis go away, the person will usually not show any symptoms for literally years! The person is not infectious at this time, and blood tests can detect the infection.

Tertiary Stage:

This stage can occur many years (even decades) after infection. At this stage, the person can start showing neurological symptoms (known as neurosyphilis). They can also have cardiovascular (heart) damage, skin lesions, and psychiatric problems. Ultimately death results. Unlike the symptoms of Primary and Secondary Syphilis, the symptoms of Tertiary Syphilis do not go away by themselves.

Syphilis is curable at all stages of infection. Very often, a person can have symptoms of syphilis and not seek medical attention. This is because these symptoms do not usually hurt, may not always be noticed, and all of the symptoms of Primary and Secondary Syphilis go away by themselves. Therefore, people often do not worry about these symptoms, especially since they only last for a few weeks, and they go away by themselves.

Because the symptoms of Syphilis are so variable from stage to stage, it can be a very confusing disease for people to understand. In persons with HIV, these symptoms can be more serious, and can occur much sooner, than in persons without HIV. If you have had any of the symptoms mentioned above, it is important that you see your physician. However, remember that the symptoms of syphilis often resemble symptoms of many other diseases. Therefore, you cannot assume you have Syphilis, unless a physician has diagnosed you through laboratory tests. This disease is usually diagnosed by blood tests, and is curable at all stages of infection.


What is a routine STD exam?
HCV infection

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