What are the initial symptoms of syphilis?

Written by Huang Ling Juan
Dermatology
Updated on May 17, 2025
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The initial symptoms of syphilis typically refer to the symptoms of primary and secondary syphilis. The symptoms of primary syphilis mainly include a chancre, usually a single superficial ulcer located at the genital area with a clear border, scant discharge, no pain, and no tenderness. Serological tests would show a positive result for Treponema pallidum. Some patients may also experience local lymph node enlargement. In secondary syphilis, patients often develop papules, macules, and vesicles on the skin, and symmetrical copper-red macules appear on the hands and feet. For the treatment of syphilis infection, penicillin is primarily chosen. If there is an allergy to penicillin, macrolide antibiotics can be used as an alternative. It is crucial to treat syphilis promptly after infection.

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Written by Zhu Zhu
Dermatology
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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.

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Written by Zhu Zhu
Dermatology
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Does third-stage syphilis rash itch?

People with tertiary syphilis generally do not experience itching. Tertiary syphilis represents the later stages of the disease manifestation. Typically, the symptoms on the skin are neither painful nor itchy, which is the case for most individuals. However, some patients may feel differently from the majority, experiencing anomalies, or they might develop secondary conditions such as eczema or allergies, among others, possibly leading to mild itching and so on.

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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 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 Zhai Yu Juan
Dermatology Department
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Treatment of Syphilis

Syphilis is a sexually transmitted disease caused by infection with the syphilis spirochete. Transmission routes include sexual contact, mother-to-child transmission, close living contact transmission, and blood transmission. Sexual transmission is the main mode of transmission. After infection with syphilis, it can affect various organs throughout the body, causing a variety of symptoms. Syphilis is primarily diagnosed through hematological tests to determine if one is infected. After a diagnosis of syphilis, formal anti-syphilis treatment is needed, with the first choices being long-acting penicillin and benzathine penicillin. After treatment, regular follow-ups are necessary, generally over a three-year period: every three months in the first year, every six months in the second year, and once in the third year, to determine if the condition has improved. (Medication should be used under the guidance of a doctor.)