Clinical Stages of Syphilis

Note: the following signs and symptoms may or may not be present in syphilis cases. Syphilis signs and symptoms vary from patient to patient, with some patients being asymptomatic at all stages.

If left untreated, syphilis enters a secondary stage marked by a range of signs and symptoms that can come and go over 12 months. With treatment, symptoms resolve rapidly. Without treatment symptoms will spontaneously resolve within two years.

Some common secondary syphilis presentations include:

• A rash – commonly maculo-papular (small raised red bumps) but can vary
• Moist flat patches on mucosal membranes (condylomata lata) in the genital and groin areas, or moist papules (bumps), mucous patches or ulcers in the mouth
• Systemic symptoms such as low-grade fever, malaise (generally feeling unwell), headache, muscle aches and pains, lymphadenopathy (swollen lymph nodes)
• Maculopapular (small bumpy rash) or a scaly psoriatic type (dried skin) rash on the body involving palms and soles
• Patchy hair loss of the scalp and eyebrows

Stage of syphilis	Duration of infection from initial contact	Treatment	Infectious?
Early infectious syphilis	<2 years	Benzathine benzylpenicillin injection 2.4 million units (1.8 gm) IM stat, given as two injections containing 1.2 MU (0.9g)*	Yes – Infectious

*Treatment note: If an alternative treatment needs to be considered due to an allergy or other reasons, discuss with a specialist.

⚠ View clinical images: this section contains images of genitalia and medical procedures

Image credit: Melbourne Sexual Health Centre STI Atlas