The first symptom of primary syphilis is an ulcer called a chancre ("shan-ker"). The chancre can appear within 10 days to three months after exposure, but it generally appears within two to six weeks. Because the chancre may be painless and may occur inside the body, it may go unnoticed. It usually is found on the part of the body exposed to the partner's ulcer, such as the penis, the vulva, or the vagina. A chancre also can develop on the cervix, tongue, lips, or other parts of the body. The chancre disappears within a few weeks whether or not a person is treated. If not treated during the primary stage, about one-third of people will progress to chronic stages.
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Secondary syphilis is often marked by a skin rash that is characterized by brown sores about the size of a penny. The rash appears anywhere from three to six weeks after the chancre appears. While the rash may cover the whole body or appear only in a few areas, the palms of the hands and soles of the feet are almost always involved. Because active bacteria are present in these sores, any physical contact - sexual or nonsexual - with the broken skin of an infected person may spread the infection at this stage. The rash usually heals within several weeks or months. Other symptoms also may occur, such as mild fever, fatigue, headache, sore throat, as well as patchy hair loss, and swollen lymph glands throughout the body. These symptoms may be very mild and, like the chancre of primary syphilis, will disappear without treatment. The signs of secondary syphilis may come and go over the next one to two years. If untreated, syphilis may lapse into a latent stage during which the disease is no longer contagious and no symptoms are present.
Many people who are not treated will suffer no further consequences of the disease. Approximately one-third of those who have secondary syphilis, however, go on to develop the complications of late, or tertiary, syphilis, in which the bacteria damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. This stage can last for years, or even for decades.
Late syphilis, the final stage, can result in mental illness, blindness, other neurologic problems, heart disease, and death.
Syphilis bacteria frequently invade the nervous system during the early stages of infection, and approximately 3 to 7 percent of persons with untreated syphilis develop neurosyphilis.
Some persons with neurosyphilis never develop any symptoms. Others may have headache, stiff neck and fever that result from an inflammation of the lining of the brain. Some patients develop seizures.
Patients whose blood vessels are affected may develop symptoms of stroke with resulting numbness, weakness, or visual complaints. In some instances, the time from infection to developing neurosyphilis may be up to 20 years. Neurosyphilis may be more difficult to treat and its course may be different in people with HIV infection.