Secondary Syphilis

What Is Secondary Syphilis?

Syphilis is a sexually transmitted infection (STI). There are four stages of the disease: primary, secondary, latent, and tertiary (also known as neurosyphilis). Primary syphilis is the first stage of the disease. It causes one or more small, painless sores in or around the genitals, anus, or mouth.

If you don’t get treatment for the primary stage of the disease, it may progress to the second stage, which is secondary syphilis. If you aren’t treated for secondary syphilis, the disease will likely progress to the latent stage, and may even progress to the tertiary stage.

The secondary stage of syphilis is curable with medical treatment. It’s important to get treatment to prevent the disease progressing to the tertiary stage, which may not be curable, and can cause damage to your organs, as well as dementia (memory loss), paralysis, or even death.

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How Is Syphilis Transmitted?

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Syphilis is caused by a spirochete (a worm-like spiral-shaped bacteria) called Treponema pallidum. You can get the bacteria in the following ways:

  • direct contact with a syphilis sore (usually found on the vagina, anus, rectum, in the mouth, or on the lips)
  • during vaginal, anal, or oral sex with an infected person
  • an infected mother can pass syphilis to her unborn child, which can result in serious complications or even death of the unborn child

The primary and secondary stages of syphilis are extremely contagious. Tell your previous sexual partners if you are diagnosed with syphilis so that they can get tested to see if they have the disease.

You can’t catch syphilis from doorknobs, toilet seats, swimming pools, clothing, bathtubs, or silverware.

There is a high correlation between syphilis and HIV, since HIV can be transmitted through syphilitic sores. Since the behaviors that lead to the spread of STIs are the same for both syphilis and HIV, having syphilis is an indicator that you are also at risk for contracting HIV.

What Are the Symptoms of Secondary Syphilis?

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Primary syphilis usually presents itself as a single sore. This sore typically appears three weeks after the initial infection, but could show as soon as 10 days or as late as 90 days. This sore, called a chancre, is small, firm, round, and painless. It appears at the original infection site, usually the mouth, anus, or genitals. You may not even notice it. Untreated, the initial sore heals in a month or so.

If you don’t receive treatment during this initial appearance of symptoms, the bacterium that caused this STI will spread through your bloodstream, and you’ll soon have secondary syphilis.

The symptoms of secondary syphilis develop two to eight weeks after a person first becomes infected with primary syphilis. The secondary stage is usually marked by a nonitchy rash.

The rash might be confined to one part of your body, or it could spread over several parts. The appearance of the rash varies. One common manifestation is rough, reddish-brown spots on the bottoms of your feet and on the palms of your hands. Usually, the rash feels scaly, but it could also be smooth. Sometimes, the rash looks like one caused by another disease, making diagnosis trickier. It may also be so faint that it’s overlooked.

Other symptoms of secondary syphilis include:

  • sore throat
  • fever
  • swollen lymph glands
  • headaches
  • fatigue
  • muscle aches
  • wart-like patches around skin folds or genitals
  • loss of appetite
  • joint pain
  • enlarged lymph nodes

How Is Secondary Syphilis Diagnosed?

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To diagnose secondary syphilis, your doctor will want to do a physical examination and ask you questions about your medical history. If you have sores, your doctor might use a microscope to examine material taken from your sores. The syphilis bacteria will show up under the microscope — this technique is known as darkfield microscopy.

Testing your blood with a rapid plasma regain (RPR) test is also a reliable, inexpensive way for your doctor to determine whether you have syphilis. Your body makes antibodies, proteins that try to fight off infections, in response to infections and foreign invaders. If the blood test reveals these syphilis antibodies, then you have been infected with syphilis. The RPR test is important for pregnant women to do, as undiagnosed syphilis can be passed on to your unborn child, and could be life-threatening for the baby.

Your doctor can also determine whether you have syphilis by testing your spinal fluid.

How Is Secondary Syphilis Treated?

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Syphilis can’t be cured by over-the-counter treatments or home remedies. If it’s caught early enough, however, you’ll only need one penicillin injection. If you’ve had the STI for a longer period of time, several doses will be necessary.

People with penicillin allergies can use other antibiotics, such as doxycycline or tetracycline. Penicillin is the best drug if you’re pregnant, however, since other antibiotics may harm your developing baby or fail to protect them from syphilis.

Antibiotics will kill the syphilis bacterium and stop it from further damaging your body. Common antibiotics used include:

  • benzathine penicillin G
  • doxycycline
  • tetracycline

However, antibiotics can’t repair any damage that has already occurred.

If you’re receiving treatment for syphilis, do not have sex until your sores heal completely and you have completed your full course of antibiotic treatment. Let your sexual partners know about your condition so they can also get help and avoid spreading the infection.

Complications of Treatment

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Without treatment, your syphilis will likely continue to progress. It can be 10 or 20 years before you experience the worst effects. Eventually, untreated syphilis will lead to damage to the brain, eyes, heart, nerves, bones, joints, and liver. You could also become paralyzed, blind, demented, or lose feeling in the body. Untreated syphilis can also lead to stillborn or developmentally delayed babies.

Even if you have been cured of syphilis, you could still get it again.

People being treated for syphilis are also at risk for Jarisch-Herxheimer reaction. As your body breaks down the syphilis bacteria, a reaction may be triggered. Symptoms of Jarisch-Herxheimer include:

  • chills
  • rash
  • fever of up to 104 degrees Fahrenheit
  • tachycardia (rapid heart rate)
  • hyperventilation
  • headache
  • muscle aches
  • joint pain
  • rashes
  • nausea

The Jarisch-Herxheimer reaction is common and potentially serious. If you experience such symptoms, be sure to seek immediate medical treatment.

Additionally, open syphilis wounds increase your chances of contracting HIV and other STIs. Because of this, it’s a good idea to get tested for HIV and other STIs if you have secondary syphilis.

How to Prevent Getting Secondary Syphilis

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You can prevent getting secondary syphilis by getting treatment for primary syphilis before it develops into the secondary stage. You can also prevent getting primary syphilis by practicing safe sex practices, such as using a condom. You should be regularly tested for syphilis and other STIs if you are sexually active and have unprotected sex or multiple partners.

People who should be regularly tested for syphilis include:

  • pregnant women
  • people who are at greater risk of syphilis (including men who have sex with men and people in prison)
  • people with HIV
  • those who have a sexual partner who has syphilis

If you notice any unusual sore or rash, especially near your genitals or anal area, stop having sex and go see a doctor. The earlier syphilis is caught, the easier it is to treat and the better your outcome. Notify all of your sexual partners immediately so that they can be treated as well. Syphilis is a very contagious disease.

Long-Term Outlook

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If syphilis is diagnosed and treated early enough, it can be thoroughly cured. With treatment, secondary syphilis will most likely go away within a few weeks to a year.

If secondary syphilis goes untreated and your symptoms go away, you will still have the latent form of syphilis. The latent stage is a symptom-free period that can last for many years. You may never again develop symptoms.

Without treatment, however, you have a greater chance of progressing to the tertiary stage of syphilis. This can lead to many serious complications, including brain damage and death. Make an appointment with your doctor as soon as you have any concerns so you can be tested and treated as soon as possible. 

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