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What is syphilis?

Jun 26, 2025 Source: Cainiu Health
Dr. Yang Ziqi
Introduction
The pathogen of syphilis is Treponema pallidum, which has a spiral structure, is motile, and is not easily stained. The mucopolysaccharidase on the surface of Treponema pallidum may be related to its pathogenicity. This enzyme has a high affinity for the skin, aorta, eyes, placenta, and other tissues, leading to localized necrosis, ulcers, and other lesions. Sexual contact is the primary mode of transmission for syphilis.

Under normal circumstances, syphilis is a systemic, chronic, sexually transmitted disease caused by infection with Treponema pallidum. If discomfort symptoms occur, it is recommended to seek timely medical consultation at a hospital and undergo standardized treatment under the guidance of a physician. Specific analysis is as follows:

The pathogen of syphilis is Treponema pallidum, which has a spiral structure, motility, and is difficult to stain. The mucopolysaccharidase on the surface of Treponema pallidum may be related to its pathogenicity. This enzyme has high affinity for tissues such as the skin, aorta, eyes, and placenta, leading to local necrosis and ulceration. Sexual contact is the main route of transmission for syphilis. Additionally, syphilis can also be transmitted from mother to child, through blood transfusion, or via indirect contact.

Clinically, syphilis presents with diverse manifestations and can be divided into primary, secondary, and tertiary stages. Primary syphilis mainly presents as a chancre and indurative lymphadenitis. Chancres commonly occur on the external genitalia, appearing as round or oval shallow ulcers with clear margins, slightly raised edges, clean ulcer surfaces, and no significant pain or tenderness. Indurative lymphadenitis primarily affects lymph nodes on one side of the groin or near the affected area, causing markedly enlarged, painless, firm lymph nodes.

Secondary syphilis mainly manifests as syphilitic rash, including macular, maculopapular, papular, squamous, follicular, or pustular rashes. These rashes may symmetrically distribute across the body and are often scattered on the palms and soles. They are typically non-pruritic and non-painful. Tertiary syphilis mainly presents with nodular syphilitic rash, gummatous lesions, and damage to various organ systems. Nodular syphilitic rash appears as round, red-brown, firm papules or nodules, which may desquamate or develop into necrotic ulcers. Gummatous lesions can occur in any part of the body; the initial skin lesions often present as subcutaneous nodules that progressively enlarge and ulcerate. The ulcers emit a foul odor due to the presence of necrotic tissue and leave atrophic scars upon healing.

In daily life, it is important to avoid unsafe sexual practices, use condoms correctly, and maintain good personal hygiene. If discomfort symptoms arise, timely medical consultation at a hospital should be sought to select an appropriate treatment plan.

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What are the differences between syphilis rash and common rash?
Syphilis rash is caused by infection with Treponema pallidum and represents a cutaneous manifestation of the sexually transmitted disease; it is contagious. Common rashes are usually caused by factors such as allergies, viral infections, or bacterial infections—for example, contact with allergens or invasion by cold viruses—and are mostly non-contagious. Syphilis rash and common rashes generally differ in terms of etiology, affected body sites, associated symptoms, and other aspects.
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How long does syphilis rash last?
Syphilis rash usually disappears within approximately 2 to 12 weeks without treatment, and generally fades within about 2 to 4 weeks with appropriate treatment. Without treatment, the syphilis rash may fade slowly due to continuous replication of Treponema pallidum in the body and repeated immune responses stimulating the skin and mucous membranes. It often resolves within 6 to 12 weeks and may leave pigmentation or scarring after fading.
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Does syphilis rash hurt?
Syphilis rash typically does not present with significant pain. It is recommended to seek timely medical attention, determine the cause, and undergo appropriate treatment under a doctor's guidance. The key to treating syphilis rash is to follow standardized and adequate antibiotic therapy targeting syphilis itself. Patients may use medications such as procaine penicillin for injection, benzathine penicillin for injection, or potassium furoylbenzylpenicillin for injection according to medical advice.
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Does syphilis rash cause itching when it starts to develop?
In general, syphilis rashes typically do not itch when they first appear, although mild itching may occur in some cases. It is recommended to seek timely medical attention, determine the cause, and undergo symptomatic treatment under a doctor's guidance. If syphilis rash occurs, patients may follow medical advice to use medications such as benzathine penicillin for injection, potassium phenethicillin urea for injection, and minocycline hydrochloride capsules.
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Will syphilitic rash disappear on its own?
Whether syphilis rash resolves spontaneously mainly depends on the stage of syphilis infection and the individual's immune status. It is recommended to seek timely medical attention, clarify the cause, and undergo symptomatic treatment under a doctor's guidance. In the late stage of syphilis, the rash may present as refractory lesions that do not resolve spontaneously. To avoid unnecessary harm to the body, diagnosis and treatment should be conducted under the guidance of a qualified physician.
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Will a syphilis rash get larger?
In general, syphilitic rash does not typically enlarge progressively. It is recommended to seek timely medical attention, determine the cause accurately, and undergo symptomatic treatment under a doctor's guidance. The key to treating syphilitic rash is to provide standardized and adequate antibiotic therapy targeting syphilis itself. Patients may follow their physician's instructions to use medications such as procaine penicillin for injection, benzathine penicillin for injection, or potassium furoate benzylpenicillin for injection.
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Is pityriasis rosea syphilis?
Pityriasis rosea is a self-limited inflammatory skin disease with an unclear etiology, potentially associated with viral infection. The typical presentation begins with a single, larger primary patch, followed by the appearance of multiple secondary patches of varying sizes on the trunk and proximal limbs after 1–2 weeks. The long axis of the rash often aligns parallel to the skin纹理 (note: "纹理" may refer to "skin lines" or "skin纹理" should be clarified as "skin lines" in professional context), and the surface is covered with fine, thin scales. Most patients do not experience significant subjective symptoms.
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Does syphilis rash appear overnight?
Syphilis rash is a manifestation of secondary syphilis, typically appearing 6–8 weeks after infection with Treponema pallidum or 1–2 weeks after the resolution of the primary chancre. Prior to this stage, the pathogen proliferates and spreads within the body, and after a latent period, it leads to mucocutaneous lesions. Early symptoms may initially resemble influenza-like manifestations, such as fever, headache, and fatigue, followed gradually by the development of a rash.
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