What Are the Symptoms of Syphilis?

Clinically, syphilis is categorized based on its mode of transmission and timing of onset into acquired syphilis and congenital syphilis, as well as early syphilis and late syphilis. Thus, in clinical practice, “acquired syphilis” is commonly referred to and further divided into primary, secondary, and tertiary stages. What, then, are the symptoms of syphilis? The following section addresses this question.

What Are the Symptoms of Syphilis?

1. Symptoms of Primary Syphilis

The hallmark manifestations of primary syphilis include the chancre (a painless, indurated ulcer) and inguinal lymphadenopathy (painless lymphadenitis). Typically, the lesion begins as a small, firm papule that rapidly ulcerates into a round, red, painless ulcer measuring approximately 1–2 cm in diameter. It is covered with a small amount of serous exudate. Concurrently, patients often develop enlarged inguinal lymph nodes; however, these nodes show no signs of erythema, tenderness, warmth, or suppuration.

2. Symptoms of Secondary Syphilis

Symptoms of secondary syphilis are more pronounced than those of primary syphilis. Cutaneous and mucosal manifestations include diverse syphilitic rashes, condylomata lata, neurosyphilis, ocular syphilis, osseous syphilis, articular syphilis, and cardiovascular syphilis. As Treponema pallidum disseminates from regional lymph nodes into the bloodstream and proliferates rapidly throughout the body, systemic symptoms commonly develop—such as low-grade fever, headache, myalgia, arthralgia, and generalized lymphadenopathy.

3. Symptoms of Tertiary Syphilis

A characteristic feature of tertiary syphilis is the gumma (also termed syphilitic gumma). Initially, it presents as one or several small, firm nodules. As the disease progresses, these lesions gradually enlarge and become adherent to the overlying skin, forming dark-red, infiltrated plaques. The central portion softens and eventually ulcerates, discharging thick, gelatinous material. Moreover, tertiary syphilis is highly destructive: Treponema pallidum may invade not only the skin and mucosa but also virtually any internal organ or tissue—including the nervous system, viscera, brain, reproductive organs, and gastrointestinal tract—leading to widespread pathological changes. At this stage, patients may become bedridden and exhibit altered mental status.

The above outlines the clinical manifestations of syphilis. We hope this information proves helpful.