What are the symptoms of syphilis?

Written by Qu Jing
Dermatology
Updated on March 26, 2025
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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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Does third-stage syphilis have transmissibility?

Syphilis is a disease that often causes fear among the general population. Syphilis is divided into three stages: primary, secondary, and tertiary, with tertiary syphilis being the most infectious stage. Syphilis is a chronic systemic infectious disease caused by the infection of the Treponema pallidum bacterium. It has a wide range of transmission methods, including sexual transmission, blood transmission, and mother-to-child transmission, among others. Therefore, the infectiousness of tertiary syphilis is the strongest, and everyone should pay extra attention and take precautions.

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Written by Zhu Zhu
Dermatology
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Is tertiary syphilis highly contagious?

The infectivity of tertiary syphilis is not very high, although it still possesses relatively weak contagiousness. Syphilis in its primary and secondary stages often shows high titers in tests and has stronger infectivity, while tertiary syphilis has reduced infectivity. However, tertiary syphilis can easily lead to various complications, including damage to tissues and organs, making it more harmful than the primary and secondary stages. Therefore, it is crucial to treat tertiary syphilis promptly.

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Written by He Jing
Obstetrics and Gynecology
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Is fungal vaginitis related to syphilis?

Yeast vaginitis and syphilis are unrelated. Yeast vaginitis is caused by a disruption in the vaginal environment leading to an infection with Candida albicans, resulting in increased vaginal discharge. This is accompanied by itching of the vulva and the discharge may appear like cottage cheese or have a curd-like texture. However, syphilis is caused by the infection of the bacterium Treponema pallidum. It is a sexually transmitted disease characterized primarily by painless ulcers on the genitals. The treatment methods for the two are also different. Yeast vaginitis can be treated by external washing with baking soda and inserting clotrimazole vaginal suppositories, typically resolving within about a week. Treatment for syphilis, on the other hand, generally involves intravenous injections of penicillin. (Medication use should be supervised by a professional doctor.)

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Written by Huang Ling Juan
Dermatology
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What are the early symptoms of syphilis in men?

Early symptoms of syphilis in men may include small papules, with the characteristic lesion of early syphilis being a chancre. From the infection with the syphilis spirochete to the appearance of skin symptoms, it usually takes about three weeks on average. The syphilis chancre in men is typically found on the genitals, though a minority may appear in the mouth. The earliest form of a chancre is a solitary papule, which gradually develops into a round or oval-shaped ulcer. The ulcer has clear boundaries, slightly raised edges, and a clean base, feeling firm like cartilage to the touch, without significant pain. When a chancre appears, if a secondary bacterial infection occurs, pain may arise. Men infected with syphilis must seek early treatment as early-stage syphilis can be completely cured.

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Written by Luo Hong
Dermatology Department
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Is syphilis without symptoms serious or not serious?

Syphilis without symptoms is generally called latent syphilis. Whether asymptomatic syphilis is severe or not cannot be generalized. Some people react late, and some just have latent syphilis, which is seropositive without other symptoms. Of course, there might also be cases where people have relatively high degrees of TRUST or particularly high low degrees of RPR in latent syphilis. In such cases, symptoms might not be mild, and this type is highly contagious, which might lead to abnormalities in the cerebrospinal fluid. If there are abnormalities in the cerebrospinal fluid, these symptoms might not be mild early on and are actually quite serious. Early-stage neurological issues might include memory decline, which is not easily detectable.