STAGES AND SYMPTOMS

The primary stage of syphilis is characterized by a small lesion, called a chancre, which appears at the site of infection three to six weeks after exposure. Fluid from the chancre is extremely infectious. In the secondary stage, occurring about six weeks later, a generalized rash appears. Painless ulcers develop in the mouth, and broad, wartlike lesions, which also are highly infectious, may appear in the genital area. Headache, fever, and enlarged lymph glands are sometimes observed. These symptoms usually disappear in 3 to 12 weeks.
The disease then enters a latent stage in which no outward signs or symptoms occur, but inflammatory changes may take place in the internal organs. The latent stage can last 20 to 30 years. In 75 percent of the cases, no further symptoms appear. When the final stage, tertiary syphilis, does occur, however, it may produce hard nodules, called gummas, in the tissues under the skin, the mucous membranes, and the internal organs. The bones are frequently affected, as well as the liver, kidney, and other visceral organs. Infection of the heart and major blood vessels accounts for most deaths.
A prominent part of neurosyphilis, which occurs in nearly 15 percent of the tertiary cases, is tabes dorsalis, or locomotor ataxia (see Paralysis). Also present are a lack of muscular coordination, loss of urinary control, and degeneration of the reflexes; psychosis may ensue. Infection in the uterus may lead to miscarriage, to stillbirth, or to the birth of a child with congenital syphilis. Infected children often bear typical signs, such as high forehead, saddlenose, and peg-shaped teeth. By the second decade of life, central nervous system deterioration may appear.