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This disease has three stages;

  • Primary Stage:

It is the primary stage where the infected person may experience multiple sores. It lasts 3 to 6 weeks and heals regardless of whether a person is treated or not.

  • Secondary Stage

This stage typically starts with the development of a rash on one or more areas of the body.

  • Latent and Late Stages

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis infection in their body even though there are no signs or symptoms.

  • Tertiary

The last stage of infection is tertiary syphilis. Approximately 15 to 30 percent of people who don’t receive treatment for syphilis will enter this stage


  • The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.
  • Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre. Chancres occur mainly on the external genitals, vagina, anus, or in the rectum. Chancres also can occur on the lips and in the mouth which makes possible (even though it’s quite rare) for a man to get infected. This case may happen if the man has open wound around his nipples and receives nipple stimulation from a with syphilis lesion on her mouth.
  • Treponema Pallidum is an obligate internal parasite, meaning that it requires a mammalian host for survival. In the absence of mammalian cells, the bacterial will be killed by the absence of nutrients, exposure to oxygen and heat.

How common

Syphilis sores can be found on the penis, vagina, and anus and in the rectum. However, syphilitic chancres can also occur in extra genital regions, including sites of lips, tongue, palate, conjunctiva (A thin, clear, moist membrane that coats the inner surfaces of the eyelids), neck, breasts, abdomen, intra scapular region (between the scapulae or shoulder blades), arms, palms, fingers, and thighs with an estimate of incidence ranging from 2% to 31%.  

Chances of being infected

There’s a documentation regarding Primary Syphilis presenting as bilateral nipple-areola eczematous lesions published by the Department of Dermatology of Hospital of China in 2013. In this report, the hospital recorded a case where a 36-year-old man got pruritic skin lesions (itchy skin) on both nipple areolas persisting for 2 weeks. Both lesions increased in size gradually with development of nipple erosions. Based on the test result, the lesions were then interpreted as primary syphilis. The patient had unprotected sex with a woman who nibbled both his nipples during sexual contact about 2 weeks before the lesions developed. In total, the hospital recorded 6 cases of male patients with extra genital syphilitic chancres on nipple region.

Among the 6 patients described with solitary syphilitic chancre on the nipple, 5 of them had bites and nibbles on the nipple during sexual intercourse. The remaining 1 patient stated to only have oral contact on the nipple without sexual intercourse.  Syphilis is generally transmitted through contact with the infectious patients and facilitated by minor trauma of the skin or mucous membrane. The hospital concluded it is therefore likely that a nipple bite or nibble might be a transmission mode of Syphilis in such patients.

How to detect if someone has it

Syphilis has been called “The Great Pretender”, as its symptoms can look like many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months, or even years.

  • Primary

syphilitic lesion - Detect

During the first (primary) stage of syphilis, you may notice that the infected person has a single sore, but there may be multiple sores.

A primary syphilitic lesion is described as a firm, painless and non-itchy ulceration.

  • Secondary

mucous membrane lesions - detect

During the secondary stage, the infected person may have skin rashes and/or sores in his/her mouth, vagina, or anus (also called mucous membrane lesions). This stage usually starts with a rash on one or more areas of the body. The rash can look like rough, red, or reddish brown spots on the palms of hands and/or the bottoms of feet.

  • Latent

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Unfortunately during the late latency stage that outward signs of the disease are absent, so we might not be able to see if someone has this stage of syphilis by looking at them physically.

    • This stage can be likened to an army that has infiltrated an enemy’s defences. Since this army has incurred heavy casualties, the need to rest, regroup and further plan for a major invasion is inevitable.
    • This latent period can be divided into two stages; early latent and the late latent syphilis. The early latent happens within the first year after invasion. The likelihood of transmitting the disease at this stage is very high.
  • Tertiary

Tertiary syphilis - Detect

This stage can be characterized by damage to the heart, eyes, brain, nervous system, bones, joints, liver, or other organs. This can result in mental illness, blindness, neurologic and cardiovascular problems, and even death.


Unfortunately there is no vaccine for syphilis, no acquired immunity to syphilis, and past infection provides no protection.


  • Benzathine penicillin G injection for primary, secondary or early latent syphilis

A single intramuscular injection of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) will cure a person who has primary, secondary or early latent syphilis. Three shots of Benzathine penicillin G (2.4 million units) at weekly intervals is recommended for individuals with late latent syphilis or latent syphilis of unknown duration. All the mentioned drugs must be prescribed.

Important note:

  • Patients receiving treatment with penicillin can develop a rash, headache, fever and chills. This is referred to as the jarish-herxheimer reaction. It’s a normal response to therapy and should not be a cause of alarm.
  • Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.
  • Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be treated presumptively for early syphilis, even if serologic test (a blood test to detect the presence of antibodies against a microorganism) results are negative.

Best sources for more information

The risk chart is the heart of this guide, and it can be found here

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