Syphilis can cause many different symptoms – or go completely unnoticed. Syphilis is one of the sexually transmitted diseases.

Syphilis (also called lues or lues venera) is an infectious disease that is transmitted mainly during sexual intercourse. The pathogen – the bacterium Treponema pallidum – enters the body via the mucous membrane or through small cracks in the skin. Syphilis is therefore one of the sexually transmitted diseases, such as gonorrhea (gonorrhea) or genital herpes.

Infection via blood contacts or blood transfusions is possible, but is very. Also, the transmission of disease from a pregnant woman to her unborn baby is rather an exception.

Syphilis can be treated successfully today. That’s why the disease is somewhat forgotten. But that must not hide the fact that it is still widespread worldwide, and that the numbers have even risen again in recent decades. Men are more likely to be affected, especially if they have sex with men.

Syphilis typically occurs in three to four different phases, called stages. Each stage manifests itself with other ailments (see below).

However, the individual case may differ significantly from this typical “pattern”. Not all stages are always following each other. Even the symptoms can vary greatly. When HIV infection is present, syphilis is often atypical. Several stages can occur simultaneously; in particular involvement of the central nervous system must be excluded.

Primary stage syphilis symptoms

The time between the infection with the syphilis pathogen and the onset of the first symptoms is usually between two and three weeks (in extreme cases between 10 to 90 days). At the point where the bacterium enters the body, a small, millet grain-sized, dark red knot or spot is formed. Since the syphilis is usually transmitted during sexual intercourse, the skin lesion is correspondingly often found on the penis, the labia, in the vagina or the anus. But it can just as well affect other parts of the body like mouth or breasts. The red spot produces a sharply defined, oozing ulcer it may look yellowish. The place is surrounded by a hard wall. The skin change is therefore also called hard chancre (ulcer durum). It is highly infectious. The skin condition is usually not painful. It can also occur several ulcers simultaneously. In the following weeks, the adjacent lymph nodes (ie, inguinal lymph nodes) swell. Usually, these symptoms disappear after a few weeks by itself again.

Secondary stage syphilis symptoms

After about two to three months, the pathogen spreads over the blood or lymphatic system in the whole body. This starts the secondary stage of syphilis. The symptoms are manifold: Possible symptoms are general symptoms such as:

  • Fatigue
  • Fever
  • Headache
  • Joint and muscle pain.

In addition, there are lymph node swellings all over the body, especially on the neck and shoulders.

Various skin changes can occur. A patchy, usually non-itchy rash spreads mainly to the body trunk. Palms and soles are also typically affected. The patches gradually become brownish-red nodules that sometimes shed or become wet. They contain pathogens, so they are potentially infectious. Very wide nodules often develop in the genital or anal area. They are called Condyloma lata.

Some patients also have moth-like hair loss. Other possible symptoms include changes to the oral mucosa: this may cause the mucosa to thicken in certain places. Almonds and throat may be red.

The symptoms are more or less pronounced, sometimes flare up again and again. Most of the time they disappear after about a year. The disease can still exist “hidden” (latent = hidden syphilis, lues latens).

Third stage syphilis symptoms

About a quarter of all untreated syphilis infections pass into the tertiary stage. However, this may only happen decades after the infection with Treponema pallidum. All tissues and organs of the body can then be affected. Tenderness changes on the skin. In organs and in the tissue, for example on the nose or tongue, ulcerated nodes (gums) form, which sometimes break up towards the surface of the skin and secrete secretions. Syphilis often also damages the walls of the large blood vessels, so that the blood circulation is disturbed. At the main artery (aorta) can form a dangerous deviation, an aortic aneurysm. Lues can also cause heart valves to leak (valvular insufficiency). An ocular involvement with inflammation of the optic nerve (optic neuritis) or the iris (iritis) leads to visual disturbances and may be an indication of involvement of the central nervous system.

Quaternary stage syphilis symptoms / metasyphilis

Untreated syphilis may result in spinal cord damage after many years. Possible symptoms are:

  • “lancinating”, ie lancet-like pain in the abdomen and legs
  • gait insecurities
  • emotional disorders
  • disorders of the bladder and bowel function and paralysis.

These symptoms are summarized under the name Tabes dorsalis.
Damage to the brain leads to psychic abnormalities such as delusions and hallucinations, in addition to a mental degradation to dementia. These symptoms are called progressive paralysis (progressive paralysis). These late episodes of untreated syphilis can lead to death.


Once the bacteria spreads in the body – as soon as the secondary stage is reached – they can always infect the central nervous system (CNS). Doctors then speak of neurosyphilis. The symptoms are manifold:

  • Headache
  • Neck stiffness
  • Hearing and visual disturbances or paralysis occur.

Sometimes the neurosyphilis also remains asymptomatic for a long time and can only be determined by laboratory tests.

Syphilis Treatment

The antibiotic penicillin helps against syphilis. For penicillin allergy, the doctor may prescribe alternative antibiotics. It is important that the patient informs his partner that he may have become infected and may also need to be treated. If the infection has been around for a long time, it is important to alert former partners to a possible risk of infection.

Syphilis: causes

Most people are infected by unprotected intercourse – ie sex without a condom. This also includes oral sex (sex with the mouth). Treponema pallidum enters the organism via the intact mucosa or small cracks in the skin. The likelihood of becoming infected with a syphilis infection during sex is on average 40 to 60 percent.

Very infectious are syphilis-infected in the first phase of the disease, if they have formed an ulcer, because the skin change is highly infectious. Through contact with the skin site, the bacteria can be passed on. Therefore, the use of condoms does not protect one hundred percent from syphilis. For the appearance of the skin does not always form on the penis, but can also be on the anus, on the labia, in the vagina or in the mouth – depending on the sexual practice. Patients without adequate treatment also remain contagious in the course of the disease – sometimes for many years. After a lukewarm, the body is not immune to the syphilis pathogen. A renewed infection is always possible.

Contagion due to blood contact

Very rarely, syphilis is transmitted via blood transfusions. Also theoretically conceivable, but probably very rare, is the infection with syphilis by other blood contacts – for example, a contaminated needle in drug use.

Transmission in pregnancy

If a pregnant woman is suffering from syphilis, she can pass the infection on to her unborn baby. The syphilis infection during pregnancy endangers the unborn child: It can even come to a miscarriage. Or the unborn child is born with syphilis.

There are two forms of this syphilis connata:

The syphilis connata precox affects newborns and infants. Around half of children infected with syphilis are inconspicuous at birth. Some, however, suffer from various symptoms such as dyspnea, water retention (edema), swelling of the liver and spleen, underweight, swollen lymph nodes and rashes.

The connective leucosis occurs later, during the first months of life, rarely in infancy, as a result of syphilis infection during maternal pregnancy. The children suffer from numerous ailments, for example bone changes on the palate, forehead and nose (saddle nose), bloody cold, fever, skin rash, knee problems, deafness and seizures.

Thankfully, syphilis-related illnesses have become very rare among babies and children. As part of the pregnancy examinations is routinely checked whether the mother (possibly without knowing it) is suffering from syphilis. So a timely therapy can be done.

About the author – Dr. H.S. Hermanides
Dr. H.S. Hermanides obtained a PhD for her research on HIV in the Caribbean. She is currently working as a specialist in infectious diseases at the Red Cross Hospital in Beverwijk, The Netherlands.