What Does Your Skin Look Like If You Have Syphilis?

Syphilis cases are on the rise in the U.S. and are the highest they have been since 1950. Hamilton County has seen an increase on par with national statistics and, like other counties, has had to contend with a national shortage of the antibiotics used to treat it. In Tennessee, the number of Stage 1 and Stage 2 syphilis cases rose 86% between 2017 and 2021. With cases increasing across the nation, people are seeking answers to help them better understand the disease.

Syphilis is a serious sexually transmitted disease (STD). It is caused by the tiny corkscrew-shaped germ, Treponema pallidum, and spreads from one-on-one contact. The potential consequences can deeply impact individuals and their partners. It’s important to recognize the signs and symptoms of syphilis at its various stages and what contracting it might mean for your skin and overall health.

Stage One: The Prelude of Primary Syphilis

The first stage of syphilis begins with a solitary sore, known as a chancre, emerging somewhere between 10 to 90 days post-infection which can last 3-6 weeks. This inconspicuous sore, often resembling a painless, benign pimple silently marks the entry point of the bacterium. Its small size and painless nature can help it go unnoticed in the nooks and crannies of the body. During this stage, people are highly contagious and may unwittingly pass the infection on to unsuspecting partners.

Stage Two: Secondary Syphilis

Months later, in the second stage of infection a skin rash, often starting on the trunk of the body emerges and may spread to the limbs. It does not itch and can manifest as a red, rough rash, or as a very faint rash making it tricky to notice. It may come and go for up to two years, leaving those affected grappling with its mysterious presence. The rash can last anywhere from 2-6 weeks but has no long-term impact on the skin.

Other symptoms include:

• sore throat
• fatigue
• muscle aches
• headaches
• wart-like sores in the mouth or genitals
• fever
• swollen lymph glands
• hair loss can be patchy
• weight loss

Eventually, these symptoms will go away whether you receive treatment or not. Without treatment, the infection will remain in your system, but will simply move to the latent stage which might progress to the dangerous tertiary stage.

Stage Three: The Hidden/Latent Syphilis

Stage three is called the hidden stage because the person does not feel or see anything wrong. Unexpectedly, symptoms vanish leaving no visible traces of the infection, but it is still lurking below the surface and could resurface at any moment. At this stage, it is only detectable through serological blood tests, however, the tests cannot determine the current stage of the disease. Even though there are no symptoms, the germ is still in the body.

Stage Four: Tertiary Syphilis

Syphilis can take a tragic turn as latent syphilis transitions into tertiary syphilis—and it can take years for the problems to show up.

Multiple organ systems can be affected by Tertiary syphilis, including the:

• Brain & nerves (neurosyphilis)
• Eyes (ocular syphilis)
• Ears (otosyphilis)
• Spinal cord
• Heart
• Blood vessels
• Liver
• Bones
• Joints

To confirm this stage of the disease requires multiple tests. With consequences that can span decades and lead to irreversible harm, this stage serves as a stark reminder of syphilis’s formidable presence.

Syphilis: Who is at Risk?

You should be tested regularly for syphilis if you are sexually active and:

• are a gay or bisexual man
• have HIV
• are taking pre-exposure prophylaxis (PrEP) for HIV prevention
• have partner(s) who have tested positive for syphilis

Syphilis can be passed to a baby, sometimes with dire consequences, therefore all pregnant people should receive syphilis testing at their first prenatal visit. Pregnant people should receive syphilis testing again during the third trimester at 28 weeks and delivery.

Protecting Yourself and Others

There are steps one can take to steer the story towards a safer conclusion. Mutual monogamy, regular testing, and the proper use of barriers like condoms and dental dams offer shields against syphilis transmission. The good news is that syphilis can be treated with common antibiotics if caught early.

It is possible to have syphilis yet not observe any skin issues, especially if the first lesion goes unnoticed and if the rash that often accompanies the second stage of syphilis is very mild or even imperceptible. However, if you have multiple intimate partners, or your partner might, regular testing should be part of your regular health management plan to protect your health and the health of others. Should you test positive, you should notify all partners you have had going back two years.

Our team at AFC Urgent Care Ooltewah is fully equipped and ready to help you with your testing needs.