Classification of Syphilis
Stage | Description | Symptoms and Signs |
|---|---|---|
Acquired | ||
Primary | Contagious | Chancre (a small, usually painless skin sore), regional lymphadenopathy |
Secondary | Contagious Occurs weeks to months after the primary stage | Rash (which may be confused with those due to several other disorders), sores on mucous membranes, hair loss, fever, many other symptoms |
Latent | Generally not contagious May persist indefinitely or be followed by late-stage disease | Asymptomatic Early latent syphilis (infection < 1 year duration), sometimes with recurrence of infectious lesions Late latent syphilis (infection ≥ 1 year duration), rarely with recurrences; positive serologic tests |
Tertiary or late | Symptomatic; not contagious | Clinically classified as benign tertiary syphilis, cardiovascular syphilis, or neurosyphilis (eg, asymptomatic, meningovascular, or parenchymatous neurosyphilis; tabes dorsalis) |
Congenital*† | ||
Early | Symptomatic Occurring up to age 2 years | Overt disease (eg, hepatosplenomegaly, jaundice, rhinitis, rash, lymphadenopathy, skeletal abnormalities) |
Late | Symptomatic Occurring after age 2 years | Hutchinson incisors, eye or bone abnormalities |
* Congenital syphilis can result in preterm birth, stillbirth, or neonatal death. More than 30% of infants born to people with untreated syphilis are stillborn or die of the infection as a neonate (Wozniak PS, Cantey JB, Zeray F, et al. The Mortality of Congenital Syphilis. J Pediatr. 2023;263:113650. doi:10.1016/j.jpeds.2023.113650). | ||
† Congenital syphilis also can exist in a permanently latent (asymptomatic) state. | ||