Stage | Clinical manifestations |
Primary syphilis | Single painless ulcer (chancre) at site of inoculation, regional adenopathy |
Secondary syphilis | Rash (disseminated and/or involving the palms and soles), fever, malaise, mucocutaneous lesions, hepatitis, arthritis, glomerulonephritis, condyloma lata, pharyngitis, alopecia |
Latent syphilis | Asymptomatic |
Early latent (<1 year after initial infection) |
Late latent (>1 year after initial infection) |
Tertiary (late) syphilis |
Gummatous disease | Granulomatous disease of the skin and subcutaneous tissues, bones, or viscera |
Cardiovascular disease | Aortic aneurysm, aortic insufficiency |
Central nervous system disease (neurosyphilis) | Tabes dorsalis, Argyll-Robertson pupils, paresis, seizures, subtle psychiatric manifestations, dementia. May be asymptomatic. |
Neurosyphilis (can occur at any time during the course of infection) |
Early | Asymptomatic meningitis, symptomatic meningitis, or, less commonly, meningovascular disease (ie, meningitis and stroke). Vision or hearing loss with or without concomitant meningitis may also be present, and ocular/otologic syphilis is treated as neurosyphilis. |
Late | Most common forms involve the brain and spinal cord (dementia [general paresis] and tabes dorsalis). |