Can third stage syphilis be detected?

Written by Zhu Zhu
Dermatology
Updated on June 07, 2025
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Third-stage syphilis can be detected. Syphilis is divided into primary, secondary, and tertiary stages, with the severity progressively increasing from the primary to tertiary stage, making tertiary syphilis a relatively advanced and serious condition. It can be detected by measuring the titers in serum, although the titers in tertiary syphilis may be lower than in the primary and secondary stages, and may sometimes present as negative. However, through the symptoms of tertiary syphilis, particularly some complications affecting the skin, cardiovascular system, bones, joints, and other organs, combined with the titer levels, it can definitely be detected.

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Written by Qu Jing
Dermatology
1min 49sec home-news-image

What are the symptoms of syphilis?

Syphilis is divided into acquired syphilis and congenital syphilis, which is transmitted via the fetus. Acquired syphilis, based on the duration of the disease and using two years as a boundary, is further divided into early-stage syphilis and late-stage syphilis. Early-stage syphilis, particularly primary syphilis, mainly presents symptoms such as a chancre and scleradenitis, generally without systemic symptoms. Secondary syphilis occurs when primary syphilis is untreated or not completely treated, allowing the virus to enter the bloodstream from the lymphatic system and spread throughout the body. This causes damages to the skin, mucous membranes, and systemically, known as secondary syphilis. It can manifest as various forms of syphilitic rash, some resembling papular rashes, others similar to dermatitis, eczema, flat lichen, urticaria, psoriasis, pustular disease, and others. Some secondary syphilitic rashes are similar to flat genital warts, and sometimes syphilis can lead to alopecia. Syphilis can also affect mucous membranes, appearing in the mouth, tongue, pharynx, larynx, and genital mucous membranes, characterized by one or more areas of distinct erythema, vesicles, erosion, covered with a grayish-white membrane, generally painless. Some syphilis cases might affect bones, causing damage to bones and joints. Latent syphilis presents no obvious symptoms, and late-stage syphilis might involve the cardiovascular and nervous systems.

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Written by Zhu Zhu
Dermatology
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Can tertiary syphilis be breastfed?

Syphilis is a common infectious disease caused by the syphilis spirochete, with tertiary syphilis being the most severe and most infectious stage. Therefore, breastfeeding is not allowed if one has tertiary syphilis, as breastfeeding is one of the transmission routes of syphilis. If breastfeeding occurs, syphilis can potentially be transmitted to the child through the breast milk. The breast milk of syphilis patients contains syphilis spirochetes, and if a syphilis patient breastfeeds a child, it essentially means transmitting this pathogen to the newborn through the milk. Thus, syphilis patients are prohibited from breastfeeding.

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Written by Huang Ling Juan
Dermatology
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How to determine if you have syphilis

To determine if one has syphilis, initial assessments should integrate clinical symptoms, including the presence of a chancre and syphilis rash. Subsequently, it is advised to visit an accredited hospital to undergo serological testing for syphilis, which involves the detection of both specific and non-specific antibodies of syphilis. A comprehensive evaluation of these findings can assist in diagnosing whether one is infected with syphilis. Once syphilis is confirmed, it is crucial to commence systematic and standardized treatment promptly. Generally, if both the syphilis-specific antibody test and the non-heated treponemal pallidum particle agglutination test are positive, these indicate an active syphilis infection. Treatment should be sought at a reputable medical facility, promptly utilizing penicillin for standardized treatment. If there is an allergy to penicillin, tetracycline antibiotics can be considered as an alternative.

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Written by Cui Lin Jing
Dermatology
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What are the symptoms of tertiary syphilis?

Tertiary syphilis mainly occurs two to three years, or even five to ten years or longer, after infection. The primary skin manifestations are gummas, which often occur on the extensor side of the lower legs, and can present as ulcerations, erosions, nodules, and hyperplasia. It may also involve bones, joints, the heart, and blood vessels. The main manifestations include aortitis, aortic valve insufficiency, and aortic aneurysms. When the nervous system is involved, it can present as spinal tuberculosis and general paralysis, which are symptoms of paralytic dementia. The diagnosis of tertiary syphilis requires serological tests and cerebrospinal fluid analysis. The treatment involves primarily penicillin and benzathine penicillin, with erythromycin or tetracycline as alternatives for patients allergic to penicillin, and requires a longer course of treatment.

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Written by Zhu Zhu
Dermatology
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Does tertiary syphilis have titers?

If one is suffering from stage three syphilis, syphilis titers will be present. However, syphilis titers do not always correlate directly with the severity of the condition. It is possible for the titers in stage one and two syphilis to be higher than in stage three. It's often the case that stage three syphilis represents the late stages of the disease, and the titers might decrease as the disease progresses into these later stages. Examples include titers such as 1:8 or 1:4, although some patients might exhibit titers of 1:16.