Syphilis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]Nate Michalak, B.A. Maha Jaffar Azhar, M.D.

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The history and symptoms of syphilis depends on stage of disease. The hallmark of syphilis infection is painless chancre. A positive history of painless chancre on genitalia, and presence of risk factors such as unprotected sex, multiple sexual partners, residence in highly prevalent area and previous history of sexually transmitted infections may be suggestive of syphilis infection. The most common symptoms of syphilis infection include painless chancre which progresses to ulcer with regional lymphadenopathy in primary syphilis. Secondary syphilis is characterized by rash and constitutional symptoms. Syphilis infection in tertiary syphilis can involve any organ system, hence named the "Great Imitator".[1][2][3]

History and symptoms

The history and symptoms of syphilis according to the stage of disease are described below:[1][2][3]

Stage of syphilis History and symptoms
Primary syphilis
  • History of risk factors (MSM, unprotected sex, multiple sex partners)
  • Onset within 3 weeks of contact
  • Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods
Secondary syphilis
  • Develops 6-8 weeks after the appearance of primary chancre
  • Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present
  • Skin eruptions may be subtle and asymptomatic
  • Classic:
  • Non-pruritic bilateral symmetrical mucocutaneous rash
  • Non-tender regional lymphadenopathy
  • Condylomata lata
  • Patchy alopecia
Latent syphilis
  • Previous history of chancre or rash
  • Asymptomatic
Tertiary syphilis Clinical manifestation of this stage depends on organ system involved:


Cardiovascular syphilis

Gummatous lesions

  • Presents with any organ system involved.
  • Nodular papular lesions in case of cutaneous gumma.


  1. 1.0 1.1 Singh AE, Romanowski B (1999). "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features". Clin Microbiol Rev. 12 (2): 187–209. PMC 88914. PMID 10194456.
  2. 2.0 2.1 Carlson JA, Dabiri G, Cribier B, Sell S (2011). "The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity". Am J Dermatopathol. 33 (5): 433–60. doi:10.1097/DAD.0b013e3181e8b587. PMC 3690623. PMID 21694502.
  3. 3.0 3.1 Wöhrl S, Geusau A (2007). "Clinical update: syphilis in adults". Lancet. 369 (9577): 1912–4. doi:10.1016/S0140-6736(07)60895-2. PMID 17560432.

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