Stage I syphilis
The hard chancre appears about 2-4 weeks after infection, mostly in the genital area, in the coronal groove, penis and foreskin in men. In women, it is found in the labia majora and minora or the cervix. In recent years, it has been seen in the anus, rectum or inside the mouth because of homosexuality.
It starts as a papule and quickly breaks down into a small red ulcer, about 1-2 cm, garden-shaped, with clear boundaries, with a small amount of plasma discharge attached, containing a large number of syphilis spirochetes. The hard chancre is often solitary, with cartilage-like hardness, without pain, and if left untreated, it naturally resolves within 3-8 weeks, leaving no local traces or mild atrophic scars.
The inguinal lymph nodes are enlarged, hard, without redness, swelling, pain or heat, and not suppurating, and contain syphilis spirochetes.
About 7-8 weeks after the appearance of hard chancre, the syphilis seropositivity changes from negative to positive.
Stage II Syphilis
As the syphilis spirochete enters the bloodstream from the lymph nodes, systemic symptoms appear after dissemination in the body. 7-10 weeks after infection, there may be low-grade fever and headache, muscle and joint pain, etc., and generalized lymph node enlargement.
A rash appears all over the body, manifesting as macules, papules, pustules, oyster shell rash, etc., coppery red with a small amount of scales attached. It is often symmetrically distributed and dense without fusion. No conscious symptoms, this syphilis rash has diagnostic significance if it occurs on the palmoplantar area.
Due to the gradual formation of antibodies in the body, immunity, syphilis rash can naturally subside, but can recur, called the second stage recurrent syphilis rash, but the distribution range is small, the number of rashes is small.
The mucous membrane damage: the performance of mucous membrane redness and swelling vesicles, exudate, and a often occur in the anus, the external genitalia around the flat papules, because often subject to friction, the surface is easy to vesicle exudate, so called flat warts, containing a large number of syphilis spirochetes, highly infectious.
In addition, the second stage of syphilis in addition to skin and mucous membrane invasion, can also appear worm-like hair loss. Osteochondritis occurs mostly in the long bones of the limbs and is painful at night. Ocular syphilis: manifest iridocyclitis, retinitis, optic neuritis, etc. Neurosyphilis: such as meningitis or asymptomatic neurosyphilis, but positive syphilis seropositivity of brain crest fluid.
Patients with stage II syphilis have a strong positive seropositivity.
Tertiary syphilis
Not only invades the skin and mucous membrane, but also can involve all internal organs or tissues of the body, which is very destructive, but the syphilis spirochete is not easy to find, so it is less infectious.
Dendritic swelling: It is the main manifestation of stage III syphilis, which is a syphilitic granulation tissue that begins to form a small hard nodule with a small number, gradually expands and adheres to the skin to form a dark red infiltrated plaque, the center softens and gradually becomes an ulcer, discharging viscous gel-like secretion, the ulcer often heals on one side and continues to develop on the other side, forming a horseshoe-shaped ulcer and atrophic scar, commonly found on the head and extremities, generally without conscious symptoms, and the ulcer can also heal itself. Dendritic swelling occurs in the palate and nose of the mouth, involving cartilage and ulceration, making the soft palate and nasal septum perforated.
Nodular syphilis rash: occurs in clusters of small nodules, such as soybean size, more on the face and extremities, asymmetric, copper-red, sometimes arranged in rings or forming small ulcers, and new small nodules occur at the edges, with minimal conscious symptoms.
Visceral syphilis.
Bone syphilis: similar to the symptoms of stage II syphilis, but the pain turns lighter.
Cardiovascular syphilis: manifests aortic valve atresia insufficiency, aortitis, aortic aneurysm, coronary artery orifice stenosis, etc.
Neurosyphilis: the main manifestations are cremasteric consumption and paralytic dementia.
In addition, the eye, whistle, gastrointestinal tract, liver and spleen, and testes can be involved and syphilitic lesions can occur.
At this stage, the syphilis seropositivity is mostly positive, but the longer the infection, the lower the positivity rate.