Syphilis: What Happens

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What Happens

About 3 weeks—although the range is from 10 to 90 days—after being infected with syphilis, a sore (chancre) that is usually painless often appears on the genitals. This first stage in the course of syphilis is referred to as the primary stage. The chancre usually heals without treatment in 28 to 42 days.

If syphilis is not treated during the primary stage, it often progresses to later stages.

In the secondary stage of syphilis, a skin rash will usually develop about 2 months after the chancre appears. The symptoms usually disappear without treatment in 1 to 12 weeks.

After the rash clears, a person may have a period with no symptoms. This symptom-free period is called the latent (hidden) stage. Even though symptoms disappear, the bacteria that cause syphilis remain in the body and begin to damage the internal organs. The latent period may be as brief as 1 year or range from 5 to 20 years.

A person is contagious during the primary and secondary stages and may still be contagious during the early part of the latent stage. During this time, symptoms characteristic of the second stage of syphilis may reappear—this is called a relapse and can occur several times.

If not detected and treated, syphilis may then progress to the tertiary (late) stage, the most destructive stage of syphilis. During this stage, syphilis may cause serious blood vessel and heart problems, mental disorders, blindness, nerve system problems, and even death. It may begin as early as 1 year after infection or at any time during the infected person's life. Approximately one-third of untreated people who are infected with syphilis will develop the complications of tertiary (late) syphilis. Any organ system (such as the central nervous system) may become involved.

Complications of tertiary (late) syphilis include:

• Gummata, which are large sores inside the body or on the skin.
• Cardiovascular syphilis, which affects the heart and blood vessels.
• Neurosyphilis, which affects the brain or the lining that covers the brain.

Congenital syphilis refers to syphilis passed from the mother to the baby during pregnancy or during labor and delivery.⁵ Congenital syphilis can cause complications in newborns and children.

Last updated:	October 02, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Kathleen Romito, MD - Family Medicine, Jeanne Marrazzo, MD, MPH - Infectious Disease
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC