Clinical features of different stages of syphilis

Clinical features of different stages of syphilis

Primary syphilis: The primary lesion or chancre develops at the site of infection, usually in the genital area. A dull red macule develops, becomes papular and then erodes to form an indurated, painless ulcer (chancre) with associated inguinal lymphadenopathy. Without treatment, the chancre will resolve to leave a thin, atrophic scar. 

Secondary syphilis: Constitutional features such as mild fever, malaise and headache are seen. Maculopapular rash on the trunk and limbs that may later involve the palms and soles. Generalised nontender lymphadenopathy. Mucous patches, may affect the genitalia, mouth, pharynx or larynx, and are essentially modified papules, which become eroded. Rarely, confluence produces characteristic ‘snail track ulcers’ in the mouth.

 Tertiary syphilis: The characteristic feature is a chronic granulomatous lesion called a gumma, which may be single or multiple and can affect skin, mucosa, bone, muscles or viscera. After several years, cardiovascular syphilis, particularly aortitis with aortic incompetence, angina and aneurysm, and neurosyphilis, with meningovascular disease, tabes dorsalis or general paralysis of the insane, may develop