Primary causes painless ulcer at site of entry (genital, peri-rectal or oral) ~3w (range 2-6w) following exposure - though can go unrecognized
Secondary occurs weeks-to-2 months later w/rash on soles/palms, condyloma in genital/rectal area, peri-rectal pain or d/c, generalized adenopathy, fever, sweats, alopecia, mucosal patches; hepatitis, nehpritis (lab findings)
Early latent: within 1y of acquiring, no symptoms or findings; + serological evidence dz
Late latent: > 1y after acquiring, no symptoms or findings; + serological evidence dz; can remain in late latent phase for life (i.e. doesn't have to become tertiary)
Tertiary: years later, w/aortitis/aneurysms, granuloma development in skin, bones, ocular, otic, other organs
Neurosyphilis: can occur at any stage; assoc w/CNS related numbness, weakness, balance problems/ataxia, dementia, eye symptoms (red eye, pain, decreased vision)
Physical Exam Findings
Primary: painless genital, peri-rectal or oral ulcer, sometimes w/regional adnenopathy
Secondary: generalized non-puritic rash (can be macules and papules), w/predilection for palms, and soles, generalized adenopathy, Fever, sweats; condyloma lata--> frond-like growth in genital area
Neurosyphilis: numbness, weakness, balance issues/ataxic gait, incontinence, confusion/dementia; decreased vision, painful red eye, anterior or posterior uveitis
Tests
Initial testing should be with treponemal test; if that's positive, then non-treponemal test (e.g. RPR, VDRL) is done to confirm - and provides titers that can be used to follow response to treatment
Note that early in primary syphilis (e.g. first 2w), serologic tests can be falsely negative; if high index of suspicion (e.g. + RFs and chancre) consider treatment and repeat testing in 2w