How long after the disappearance of a chancre does secondary syphilis occur?

Written by Luo Hong
Dermatology Department
Updated on May 13, 2025
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Secondary syphilis generally occurs three to four weeks after the disappearance of the primary chancre, which means it often occurs 9 to 12 weeks after the infection by the Treponema pallidum. Of course, it is rare yet possible for it to appear simultaneously with the primary chancre. The main reason secondary syphilis develops is either due to untreated primary syphilis or incomplete treatment. The Treponema pallidum enters the bloodstream from the lymphatic system, causing bacteremia and spreading throughout the body, leading to systemic damage including skin and mucosal lesions, known as secondary syphilis. Common signs of secondary syphilis include erythema on the palms and soles, which is a characteristic manifestation. Another sign includes flat, moist warts around the anus and genital areas, similar to condyloma acuminatum, but these warts are flatter and less protruding.

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Written by Zhu Zhu
Dermatology
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Can third-stage syphilis be completely cured?

Third-stage syphilis and late-stage syphilis generally have a longer duration, with many cases exceeding two years. Third-stage syphilis can cause damage to the cardiovascular and nervous systems, and there may be residual symptoms after improvement. However, with persistent long-term standard treatment, it is still possible to achieve a cure. Therefore, if one contracts third-stage syphilis, it is crucial to adhere to the treatment and cooperate actively with the therapy.

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Written by Zhu Zhu
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Can you still have children with third-stage syphilis?

Third-stage syphilis is the most severe stage of the disease, and it is not possible to have children if one has third-stage syphilis, because syphilis can be transmitted from mother to fetus. The infectivity is particularly strong during the third stage. If a child is conceived at this time, it could lead to stillbirth. Besides stillbirth, even if the child is born by chance, they may have abnormal development or be born with diseases. This is tremendously painful and tormenting for both the parent and child. Therefore, one cannot have children with third-stage syphilis.

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Written by Kang Jian Hua
Reproductive Center
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Can the eugenic five-item test detect syphilis?

To know whether the eugenic five-item test includes syphilis, it is first necessary to clarify the components of this test. The eugenic five-item test includes screenings for toxoplasmosis, rubella virus, cytomegalovirus, and herpes simplex virus types 1 and 2, and it does not include a test for syphilis. Therefore, the eugenic five-item test does not cover syphilis. These five tests are mainly aimed at checking for viral infections before or during early pregnancy. The presence of any of these infections can be harmful to the fetus, potentially leading to early miscarriage, stillbirth, or congenital malformations. Thus, the eugenic five-item test does not include a syphilis test, which falls under sexually transmitted disease screenings.

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Written by Luo Hong
Dermatology Department
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Can syphilis antibodies be detected during the hard chancre stage?

During the hard chancre phase of syphilis, a portion of cases can test positive for Treponema pallidum, although some tests may return negative results. In such cases, it is advisable to retest after one month. The earliest detectable antibodies for Treponema pallidum are usually of two types: a Treponema pallidum-specific antibody, which appears earlier than the non-specific antibodies. There are tests for non-specific antibodies, commonly referred to as RPR or TRUST, which are standard practices in major hospitals. Therefore, in early-stage syphilis or primary syphilis with hard chancre, it is possible to find Treponema pallidum-specific antibodies positive, RPR or TRUST negative, or both negative. If syphilis is strongly suspected in such cases, a retest is recommended after one month.

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Written by Zhu Zhu
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Will third-stage syphilis be asymptomatic?

In the case of third-stage syphilis, it is generally not asymptomatic, as it is already a late stage of the disease that invades multiple systems, such as the musculoskeletal system, nervous system, and even the cardiovascular system. When these systems are invaded, they become damaged, leading to various complications. Therefore, third-stage syphilis typically presents with various signs of organ dysfunction, and it is unlikely to be without any symptoms once it has progressed to this stage.