What is the secondary stage of syphilis?

Jon Johnson 
by Jill Seladi-Schulman, PhD
Causes Diagnosis When to see a doctor Treatments Takeaway
Syphilis, which the bacterium
Treponema pallidum causes, is a form of sexually transmitted infection. There
are four stages of syphilis. The infection can be serious or cause severe
complications without treatment.
Primary syphilis includes the
first sign of syphilis, which is typically a small and painless sore near the
genitals, anus, or mouth, near the site of infection.
If a person does not seek
treatment after noticing these first signs appear, syphilis may progress to the
second stage.
According to one 2016 study
that appeared in the journal Head and Neck Pathology, around 25 percent of
people who have an infection of the Treponema pallidum bacterium will develop
secondary syphilis.
At the secondary stage of the
disorder, syphilis is still curable with medication. If the person does not
work to treat the condition, however, it may progress to further stages, where
medical treatment is more difficult or impossible.
The most common sign of
secondary syphilis is a rash that does not itch or cause pain. The rash may
appear on one part of the body or be more widespread.
doctor checking person’s neck
for signs of syphilis
Secondary syphilis can cause
the lymph nodes to swell.
Primary syphilis typically
shows up as a single, open sore around the genitals, mouth, or anus. The sore,
which doctors call a chancre, is painless.
It is a small, firm bump-like
sore that appears anywhere from 10 to 90 days after the infection occurs. The
Centers for Disease Control and Prevention (CDC) note the average time for the
first symptom to appear is 21 days.
The initial sore may also
appear on the inside of the mouth, anus, or vagina, making detection difficult
until the secondary stage.
Secondary syphilis occurs as
the infection progresses. More lesions may appear on the mouth, anus, or vagina
during this stage.
Some people may also experience
a rash. The characteristic rash from secondary syphilis appears as rough,
reddish-brown spots that usually appear on the palms of the hands or bottoms of
the feet.
The rash is typically painless
and does not itch. It may appear in one area of the body or spread to multiple
However, rashes may have
different appearances and occur in many locations on the body.
For instance, some people may
experience condyloma lata, which are large, grayish-white lesions that appear
in warm and damp environments such as the armpits, mouth, or groin. Sometimes,
it is very faint, and a person may hardly notice that they have a rash.
Other symptoms that may help
doctors diagnose secondary syphilis include:
sore throat
muscle aches and pains
swollen lymph glands
patchy hair loss
weight loss
Symptoms will disappear with
or without treatment. However, without treatment, the infection will simply
become latent, or hidden.
After a time, latent syphilis
may lead to late-stage, or tertiary, syphilis, which may harm entire organ
systems and possibly lead to death.
Treating syphilis as soon as
possible is important to avoid potential for complications or the spread of the
Syphilis is a sexually
transmitted infection (STI), so sexual contact may expose people to the
The CDC note that in recent
years, 58 percent of new primary and secondary syphilis diagnoses occurred in
men who have sex with men. However, syphilis is still prevalent in sexually
active heterosexual couples and in females.
Syphilis passes between people
through direct contact with syphilis sores. These sores typically occur in
areas that have to do with sexual contact, such as the:
The sores may also appear on
the inside of the genitals, anus, or mouth, making them less obvious to the
infected person or their partner. This may cause people to spread the infection
without knowing that they have it. The primary and secondary stages of syphilis
are extremely contagious.
Congenital syphilis may also
be an issue, but it only accounts for a small percentage of new infections.
Congenital syphilis occurs when a pregnant person who has the syphilis
infection passes it to their unborn or newborn child. This can lead to
potentially life-threatening complications in the child.
It is not possible to catch
syphilis from secondary items, such as sharing a toilet seat, bathtub, or
clothes with a person who has the infection.
Diagnosis for secondary
syphilis generally begins with a physical exam.
Doctors may ask about symptoms
and the person’s medical history. The doctor may also ask about sexual activity
and may want to know if the person’s family or partner is experiencing similar
symptoms. The doctor may also want to inspect any active sores.
If they suspect that syphilis
is the cause, the doctor may order blood tests to check for the antigens the
body creates as it fights off syphilis.
Doctors may also diagnose
syphilis by testing some of the fluid from an open sore under a microscope.
This practice is rare today, as blood tests are cheaper and more available.
to see a doctor
man seeing doctor about
secondary syphilis
People can see their doctor if
they have any symptoms of syphilis.
Anyone with open sores on
their genitals, anus, or mouth should see a doctor. Even in cases where the
cause is not syphilis, other STIs or infectious diseases may cause similar
symptoms, and a quick diagnosis may help avoid complications.
Anyone with a recent sexual
partner testing positive for syphilis should also see a doctor.
Men who have sex with men
should consider routine testing for syphilis.
People who have HIV or are
taking PrEP, a medication to prevent HIV, and are sexually active should also
consider regular testing for syphilis.
As a safety precaution,
doctors will generally recommend that pregnant people have blood tests for
syphilis. This is because without treatment, syphilis may be harmful or even
fatal to an unborn baby.
Treatment may vary slightly
depending on the results of blood tests or other factors, such as whether
someone is pregnant.
If a doctor catches the
infection early enough, a simple round of penicillin will probably clear up the
infection and eliminate symptoms. If the infection progresses, however, it may
take more than one round of penicillin or a longer treatment period.
Other antibiotics may also
work if the person does not respond well to penicillin or has an allergic
reaction. Doctors tend to recommend penicillin for pregnant people, as some
other drugs may potentially harm a developing fetus.
Treatment may eliminate the
infection, but it will not repair any damage from the infection itself, which
is another reason why early detection and treatment is crucial.
Prompt treatment for secondary
syphilis is important. Without treatment, syphilis may progress and can lead to
serious or potentially life-threatening complications.
It is important to avoid
sexual contact while going through treatment, as the infection may still be
contagious until it is gone. After syphilis treatment, the infection will not
flare up or come back.
However, it is possible for a
person to catch the infection again. Using latex condoms may help prevent
spreading syphilis infections in some cases.
With early detection and
treatment, the infection will clear up relatively quickly.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.