Late stage syphilis

Dear Alice,

What are the signs of an advanced case of syphilis, say twelve years down the road? Is treatment still possible or is it too late? I have reason to believe that I've been infected that long, and denying it. Would I still be contagious? Would I have been after five years?

— Clue me in

Dear Clue me in,

Even 12 years later, it is best for you to get tested. If you are diagnosed with syphilis, testing sooner means quicker access to treatment. In order to diagnose syphilis, two blood tests are used. If this battery of tests indicates the presence of syphilis, a health care provider may either suggest other tests or simply proceed with treatment with penicillin. For some stages of syphilis, medical providers will draw cerebrospinal fluid to test for the presence of syphilis in the central nervous system. After receiving treatment, a person must have at least two follow-up blood tests (six months and one year later) to ensure that the infection has been adequately treated.

Allowed to go unchecked in the body, the bacteria that cause syphilis can invade and destroy inner organs, including the heart and brain. In the late stage of syphilis, heart disease, blindness, or mental illness may develop. It would be difficult to tell you with any accuracy if you had been infectious after five years. In order to address this question and that of the signs of advanced stage syphilis, described below is the course of the disease, from infection through the three stages of syphilis. Bear in mind that this is a generalization. Each person experiences the disease at a pace and with symptoms unique to her or him.

  • Infection: Syphilis is spread through sexual or skin contact with someone who is infectious, meaning the infectious individual is in the primary, secondary, or early latent stage and symptoms are present. The bacteria leave the infectious person through open sores or rashes. The spirochete bacteria then penetrate the mucous membranes of the genitals, anus, mouth, or broken skin on other parts of the body.
  • Primary Stage: Anytime between nine days and three months after infection, a painless sore usually shows up, but not always. This sore, called a "chancre," resembles a pimple, blister, or open sore. Normally it appears on the genitals or near where the bacteria entered the body. It often hides and many people never realize that it is there. On women, the sore sometimes can be found hidden in the vagina or the folds of the labia. On men, it usually hides in the folds of the foreskin, under the scrotum, or near the base of the penis. Men more often than women will also have swollen lymph nodes in the groin. Chancres may also appear on the cervix, tongue, lips, or other parts of the body. At this stage, the chancre is very infectious. It will heal with or without treatment, but the bacteria will remain and begin to spread if untreated.
  • Secondary Stage: This stage begins one week to six months after the primary stage ends. It can last for weeks or months, perhaps up to a year. Secondary stage symptoms, which can be flu-like, can come and go for years. These symptoms may include a rash (over the entire body or just on palms of hands and soles of feet), a sore in the mouth, sore throat, swollen and painful joints, aching muscles, and a mild fever or headache. Some experience hair loss. Others discover raised areas around the genitals or anus. During this stage, the bacteria can be spread through any physical contact with mucous patches that may develop in the mouth or on the tongue, lips, penis, or vulva of an infected person. This stage usually resolves without treatment.
  • Latent Stage: This stage is divided into early and late latent phases and can last anywhere from a few to 25 years. The early latent period is the first one to two years of the disease and is characterized by occasional relapses of active lesions seen in the secondary stage. It is during the late latency stage that outward signs of the disease are absent. However, the bacteria are active inside the body, multiplying and attacking internal organs. When second stage symptoms completely disappear, the disease is no longer infectious. At this point, the "rule of thirds" comes into play. Among the total number of latent syphilis cases, one-third will resolve (go away) on their own, one-third will stabilize, and one-third of the cases will evolve to the next and last stage.
  • Tertiary Stage: Serious effects of the spirochetes' activity of the latent stage begin to appear. 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.

Check with your local health department to find free or reduced cost HIV/STI testing. You can also talk to your primary care provider for these options.  The following websites provide more information about STIs, support groups, and/or referrals to free and/or low-cost clinics located near you:

It's in your best interest to get tested, and treated, if you need it. Treatment and practicing safer sex can help protect you and your partners from syphilis and other sexually transmitted infections (STIs). Check out the links below for helpful info on STIs and condoms.

Last updated Jul 27, 2015
Originally published Mar 22, 1996

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