Syphilis is an infection caused by the bacterium Treponema pallidum, primarily transmitted through sexual contact. The physical manifestations, often described as “bumps” or sores, change significantly depending on the stage of the disease. Syphilis progresses through distinct phases, and the appearance of lesions in the primary stage differs dramatically from those in the secondary stage. Since symptoms can be subtle, vary widely, or disappear on their own, medical consultation is necessary for accurate diagnosis and treatment.
The Appearance of the Primary Stage Sore
The first physical sign of infection is a sore known as a chancre, which develops where the bacteria entered the body. This lesion usually appears between 10 and 90 days after exposure, averaging about three weeks. The chancre presents as a firm, round, and often solitary ulcer with raised edges. This sore is generally painless, meaning it can easily go unnoticed, especially if located inside the vagina, rectum, or on the cervix.
The primary sore is highly infectious and may be accompanied by swelling of the nearby lymph nodes, which are usually not tender. A chancre is typically small, measuring around one centimeter, and may appear as an indurated ulcer with a clear, serous discharge. This initial lesion spontaneously heals within three to six weeks, even without treatment. However, the disappearance of the chancre does not mean the infection is gone; the bacterium remains in the body, and the infection progresses to the next stage.
Characteristics of the Secondary Stage Rash
The secondary stage begins weeks after the primary chancre has healed or is healing. This stage is marked by the systemic spread of Treponema pallidum throughout the body, resulting in a widespread rash varied in appearance. The characteristic rash often consists of rough, reddish-brown spots appearing on various parts of the body, including the trunk and extremities.
A hallmark symptom is the appearance of lesions on the palms of the hands and the soles of the feet, a location uncommon for most other rashes. This widespread rash is typically non-itchy (nonpruritic), making it easy to overlook or mistake for other skin conditions. The lesions may be flat (macular) or slightly raised (papular) and can range from very faint to a prominent, coppery-red color.
In warm, moist areas, such as the groin, under the breasts, or around the anus, the infection can manifest as large, gray or pink, wart-like growths called condyloma lata. These soft, flat-topped papules are extremely contagious and represent a distinct secondary lesion. Painless, silver-gray erosions called mucous patches can also form on the mucous membranes of the mouth, vulva, or anal canal. The signs of secondary syphilis can disappear without treatment, only to recur later in a cyclical pattern over months.
Next Steps After Identifying Symptoms
Anyone who notices suspicious sores or a rash, particularly those on the palms and soles, should seek medical attention immediately. Self-diagnosis based solely on appearance is unreliable, as syphilis is known as “the great imitator” for its ability to mimic other diseases. A healthcare provider, such as a doctor or public health clinic staff, will confirm the diagnosis using a blood test that detects antibodies produced in response to the infection.
In the primary stage, a fluid sample taken directly from the sore can be examined under a dark-field microscope to visualize the Treponema pallidum. If confirmed, syphilis is curable with a course of antibiotics. Penicillin is the preferred treatment for all stages and is typically administered via injection.
Following a diagnosis, patients must comply with the full treatment regimen and abstain from sexual contact until the infection is cured and all sores have healed. The patient will also be advised to notify recent sexual partners so they can be tested and treated, which prevents further transmission. Regular follow-up blood tests are necessary to ensure the treatment was successful and the infection eradicated.