Wednesday, June 03, 2015

Syphilis - primary

Table of Contents

Alternative Names

Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis


Primary syphilis symptoms include:

  • Chancre -- a small, painless open sore or ulcer on the genitals, mouth, skin, or rectum that heals by itself in 3 - 6 weeks
  • Enlarged lymph nodes in the area containing the chancre

The bacteria continue to multiply in the body, but there are few symptoms until the second stage.

Secondary syphilis symptoms include:

  • A skin rash (the most common symptom), which often involves the palms of the hands and soles of the feet. Sores called mucous patches may develop in or around the mouth, vagina, or penis.
  • Moist, warty patches may develop in the genitals or skin folds. These are called condylomata lata.
  • Other symptoms, such as fever, general ill feeling, loss of appetite, muscle aches, joint pain, enlarged lymph nodes, vision changes, and hair loss may occur.

Symptoms of tertiary syphilis depend on which organs have been affected. They vary widely and are difficult to diagnose. Symptoms of tertiary syphilis include:

  • Cardiovascular syphilis, which affects the aorta of the heart and causes aneurysms or valve disease
  • Central nervous system disorders (neurosyphilis)
  • Tumors of skin, bones, or liver (gumma)

Signs and tests
  • Dark field examination of fluid from sore
  • Echocardiogram, aortic angiogram, and cardiac catheterization to look at the major blood vessels and the heart
  • Serum RPR or serum VDRL (used as screening tests to detect syphilis infection -- if positive, one of the following tests will be needed to confirm the diagnosis:)
    • FTA-ABS (fluorescent treponemal antibody test)
    • MHA-TP
  • Spinal fluid examination

Review Date: 08/30/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (