Clinical manifestation of syphilis

Stage	Clinical manifestations
Primary syphilis	Single painless ulcer (chancre) at site of inoculation, regional adenopathy
Secondary syphilis	Rash (disseminated and/or involving the palms and soles), fever, malaise, mucocutaneous lesions, hepatitis, arthritis, glomerulonephritis, condyloma lata, pharyngitis, alopecia
Latent syphilis	Asymptomatic
Early latent (<1 year after initial infection)
Late latent (>1 year after initial infection)
Tertiary (late) syphilis
Gummatous disease	Granulomatous disease of the skin and subcutaneous tissues, bones, or viscera
Cardiovascular disease	Aortic aneurysm, aortic insufficiency
Central nervous system disease (neurosyphilis)	Tabes dorsalis, Argyll-Robertson pupils, paresis, seizures, subtle psychiatric manifestations, dementia. May be asymptomatic.
Neurosyphilis (can occur at any time during the course of infection)
Early	Asymptomatic meningitis, symptomatic meningitis, or, less commonly, meningovascular disease (ie, meningitis and stroke). Vision or hearing loss with or without concomitant meningitis may also be present, and ocular/otologic syphilis is treated as neurosyphilis.
Late	Most common forms involve the brain and spinal cord (dementia [general paresis] and tabes dorsalis).

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