Syphilis is sometimes called "the great imitator" because it has so many possible symptoms, and its symptoms are similar to those of many other diseases. Having HIV infection at the same time can change the symptoms and course of syphilis. Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.
The first symptom of primary syphilis is often a small, round, firm ulcer called a chancre ("shanker") at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres also can develop on the cervix, tongue, lips, or other parts of the body. Usually there is only one chancre, but sometimes there are many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout the body.) The chancre usually appears about 3 weeks after you're infected with the bacteria, but it can occur any time from 9 to 90 days after exposure.
Because a chancre is usually painless and can appear inside your body, you might not notice it. The chancre disappears in about 3 to 6 weeks whether or not you are treated. Therefore, you can have primary syphilis without symptoms or with only brief symptoms that could be overlooked. If primary syphilis is not treated, however, the infection moves to the secondary stage.
Most people with secondary syphilis have a non-itchy skin rash. Although the rash is usually on the palms of your hands and soles of your feet, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include
Swollen lymph glands
Less frequent symptoms include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area.
Your symptoms may be mild. The sores of secondary syphilis contain many bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will disappear even without treatment. Without treatment, however, the infection will move to the next stages.
You may have recurrences of secondary syphilis..
The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over.
In early latent syphilis, you might notice signs and symptoms, but the infection remains in your body. When you are in this stage, you can still infect a sexual partner.
In late latent syphilis, the infection is quiet and the risk of infecting a sexual partner is low or absent. If you don't get treated for latent syphilis, you will progress to tertiary syphilis, the most serious stage of the disease.
Even without treatment, only a small number of infected people develop the dreaded complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage.
Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurological problems, heart disease, and death. Late neurosyphilis (brain or spinal cord damage) is one of the most severe signs of this stage.