Syphilis: Symptoms, Complaints, Signs

Only about 50% of infected individuals subsequently experience symptoms. The following symptoms and complaints may indicate syphilis:

Leading symptoms of the primary stage (syphilis I).

  • Painless primary effect with a rough edge wall (ulcus durum / ulcer) at the entry point of the pathogens (genital area or mouth), which also heals untreated after 4-6 weeks.
  • Regional lymphadenopathy (lymph node enlargement).

After about three weeks, in the area of the entry point of the pathogens from a papule forms an approximately coin-sized, rough so-called primary ulcer – “hard chancre”. This primary ulcer can occur on any part of the body, but more than 90% are found in the genital area. It is typically a single, painless papule – elevation of the skin – that rapidly becomes erosive and indurates. In particular, the characteristic cartilaginous substance can be palpated at the edge and base of the ulcer.In heterosexual men, the primary lesion is usually localized to the penis, whereas in homosexual men it may also occur in the anal canal or rectum or in the mouth.In women, the cervix uteri (cervix) and labia pudendi (labia) are the usual sites of first appearance. For these reasons, primary syphilis is more often misdiagnosed in women and in homosexual men than in heterosexual men. About six weeks after infection, there is swelling and inflammation of regional lymph nodes, now referred to as the “syphilitic primary complex”.The primary ulcer generally heals from 4 to 6 weeks, but swelling of the lymph nodes may remain for months. In about 30% of untreated syphilis cases, spontaneous healing occurs over a period of years (Oslo study)Secondary stage symptoms (Lues II) – begins 4-10 weeks after infection.

  • Bright to brown-red, macular (blotchy) exanthema (rash) all over the body with scarless healing (roseolae/small, red rashes), without pruritus (itching)
  • Generalized swelling of the lymph nodes
  • Accelerated erythrocyte sedimentation rate (ESR; inflammatory parameter).
  • General symptoms such as fever, headache and fatigue.
  • Hepatomegaly (enlargement of the liver).
  • Anemia (anemia)
  • Polyscleradenitis – lymphadenitis with hardening of the lymph nodes.
  • Syphilides – skin manifestations of various kinds, such as a measles-like, non-itching exanthema (rash) (palmoplantar syphilide).
  • Alopecia specifica areolaris – moth-eaten hair loss.
  • Depigmentation – loss of color pigments of the skin, occurring mainly on the neck.
  • Plaques muqueuses – dark red papules (nodular change) or blemishes of the oral mucosa.
  • Leukoplakia oris – white areas in the oral mucosa that can not be wiped off.
  • Clavi syphilitici – excessive callus formation on the hands and feet.
  • Condylomata lata – weeping, broad-based skin lesions (coarse, very pathogen-rich papules).
  • Arteritis – inflammation of an artery.
  • Meningitis (meningitis)
  • Periostitis (periosteum inflammation)
  • Iritis – inflammation of the iris of the eye.
  • Icterus syphiliticus praecox – yellowing of the skin.

Symptoms of the tertiary stage (lues III).

Symptoms of late stage syphilis are not observed until about five to ten years after infection:

  • Meningoencephalitis (combined inflammation of the brain (encephalitis) and meninges (meningitis)).
  • Exanthem (rash) – here in the course of increasingly unspecific recurrent exanthema: patchy, psoriasis-like rash on the soles of the hands and feet (palmoplantar syphilid)here in the course of increasingly unspecific recurrent exanthema: patchy, psoriasis-like rash on the soles of the hands and feet (palmoplantar syphilid).
  • Weeping, proliferating papules in the genital and anal area.
  • Angina syphilitica
  • Alopecia specifica – small patchy hair loss.
  • Syphilitic leukoderm – patchy discoloration of the skin.

Nodular syphilitic lesions are formed on the skin and more rarely on the mucous membranes, which have a tendency to ulceration and scarring healing. They can also affect the internal organs and bones in the form of so-called gums. A special form of the tertiary stage is neurosyphilis (Lues IV), which affects the nervous system.In the course of neurosyphilis, the spinal cord is affected and gray matter of the brain is destroyed. An early form of neurosyphilis is syphilitic meningitis, which can lead to the following symptoms:

  • Headache
  • Intracranial pressure increase – increase de intracranial pressure.
  • Nausea/vomiting
  • Meningismus (painful stiffness of the neck)
  • Cranial nerve palsies
  • Aphasia (speech disorder)
  • Seizures

In the absence of treatment, neurosyphilis as a late state leads to progressive paralysis with many different neurological abnormalities. It leads to death within a few years. Symptoms of progressive paralysis are based on chronic encephalitis with the symptoms described below:

  • Paresis (paralysis) of arms and/or legs.
  • Concentration disorders
  • Memory disorders
  • Personality changes
  • Sleep disturbances
  • Psychological changes
  • Illusions
  • Delusions
  • Hallucinations
  • Dementia
  • Cerebral ischemia – circulatory disorders of the brain.
  • Tremor (shaking)
  • Incontinence – inability to hold urine / stool.

Furthermore to be observed is the so-called tabes dorsalis (spinal torsion). Here, the posterior cords of the spinal cord degenerate, resulting in the following symptoms:

  • Shooting pain in the lower abdomen and legs.
  • Ataxia (gait unsteadiness)
  • Paresthesias (insensations)
  • Bladder disorders
  • Rectal disorders
  • Impotence
  • Areflexia – the reflexes are no longer triggerable
  • Temperature insensitivity
  • Loss of deep pain sensation
  • Optic atrophy – atrophy of the optic nerve.
  • Accommodation disorders – disorders in the adaptation of the eye to sharp vision.

Another late complication circa 30 years after infection is mesaortitis luica. This involves the destruction of smooth muscle cells and elastic fibers in the aorta (main artery), which can cause it to dilate greatly (called aneurysm). Rupture (rupture) of the aorta, which can be fatal, rarely occurs with an aortic aneurysm in syphilis.Furthermore, atherosclerosis (arteriosclerosis, hardening of the arteries) can occur as a result of late syphilis.

Syphilis connata

This form of syphilis is transmitted from the infected mother to the unborn child beginning in the fourth month of pregnancy. This can lead to early stillbirth of the child (in about 40%) or syphilis connata in the case of early syphilis in the mother. Infants infected by the mother with syphilis are usually premature. Symptoms of syphilis connata praecox include:

  • Generalized lymphadenitis (inflammation of the lymph nodes).
  • Interstitial pneumonia (pneumonia)
  • Iritis – inflammation of the iris of the eye.
  • Anemia (anemia)
  • Thrombocytopenia – decreased number of platelets (blood platelets; important for blood clotting).
  • Leukocytosis – increase in white blood cells (responsible for immune defense).
  • Rhinitis syphilitica (syphilitic rhinitis).
  • Superficial skin desquamation
  • Skin lesions
  • Petechiae (skin bleeding)
  • Mucosal lesions
  • Condylomata lata – coarse, very pathogenic papules.
  • Hepatitis (inflammation of the liver)
  • Polyscleradenitis – lymphadenitis with hardening of the lymph nodes.
  • Pemphigus syphiliticus – blistering of the skin.
  • Osteochondritis – inflammation of bone and cartilage.
  • Perichondritis (inflammation of the cartilage skin)
  • Osteomyelitis (bone marrow inflammation)
  • Rhagades (skin tears), especially at the corners of the mouth and lips.
  • Formation of papules
  • Purulent, bloody rhinitis due to infestation of the nasal mucosa.
  • Hepatosplenomegaly (enlargement of the liver and spleen).
  • Icterus (jaundice)

A late form of syphilis connata is also known and occurs around the age of 3. This form is accompanied by:

  • Sensorineural hearing loss to deafness.
  • Keratitis parenchymatosa – allergic reaction of the cornea of the eye with visual disturbances.
  • Hutchinson teeth – deformed teeth.
  • Saber tibia – deformation of the tibia.
  • Chorioretinitis – inflammation of the retina and choroid of the eye.
  • Optic atrophy – atrophy of the optic nerve.
  • Corneal opacity – clouding of the cornea.
  • Interstitial keratitis (inflammation of the cornea)
  • Arthropathies (joint changes)
  • Saddle nose
  • Square skull
  • Frontal hump
  • Perforations of the nasal septum and palate
  • Oral and nasal angle rhagades (skin tears).
  • Periostitis (inflammation of the periosteum)
  • Asymptomatic neurosyphilis – changes in the brain, but only shown in cerebrospinal fluid (nervous fluid) changes.

Warning signs (red flags)

  • Detection of syphilis in children may indicate child abuse