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Syphilis is sometimes called "the great imitator." This is because it has so many possible symptoms, and its symptoms are like those of many other diseases. Having HIV infection at the same time as syphilis can change the symptoms of syphilis and how the disease develops.

Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.

Primary Syphilis

The first symptom of primary syphilis is often a small, round, firm ulcer (sore) called a chancre ("shanker") at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres also can develop on the cervix, tongue, lips, or other parts of the body. Usually there is only one chancre, but sometimes there may be many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout your body.) The chancre usually appears about 3 weeks after you're infected with the bacteria, but it can occur any time from 9 to 90 days after you have been infected.

Because a chancre is usually painless and can appear inside your body, you might not notice it. The chancre disappears in about 3 to 6 weeks whether or not you are treated. Therefore, you can have primary syphilis without symptoms or with only brief symptoms that you may overlook.

If primary syphilis is not treated, however, the infection moves to the secondary stage.

Secondary syphilis

Most people with secondary syphilis have a skin rash that doesn't itch. The rash is usually on the palms of your hands and soles of your feet. However, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include

  • Sore throat
  • Tiredness
  • Headache
  • Swollen lymph glands

Other symptoms that happen less often include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area.

Your symptoms may be mild. The lesions of secondary syphilis contain many bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will seem to disappear even without treatment, but secondary syphilis can return. Without treatment, however, the infection will move to the next stages.

Latent syphilis

The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over.

In early latent syphilis, you might notice that signs and symptoms disappear, but the infection remains in your body. When you are in this stage, you can still infect a sexual partner.

In late part of latent syphilis, the infection is quiet and the risk of infecting a sexual partner is low or not present.

If you don't get treated for latent syphilis, you may move on to tertiary syphilis, the most serious stage of the disease.

Tertiary syphilis

Even without treatment, only a small number of infected people develop the severe complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage.

Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurologic problems, heart disease, and death.

Late neurosyphilis (brain or spinal cord damage) is one of the most severe complications of this stage.

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Last Updated October 27, 2014