Table 1.

The clinical manifestations of syphilis.

Stage of disease	Signs and symptoms
Secondary syphilis	Systemic: myalgia fever weight loss rash: maculo-papular (50–70%), papular (12%), macular (10%), annular (6–14%); rarely: framboiseform, lues maligna alopecia (4–11%) generalised lymphadenopathy (85%). Local: condylomata lata (10%): wart-like lesions which affect moist intertriginous areas (peri-anal, vulval, groin, scrotum) subclinical hepatitis (10%) (a mild transaminitis is common) renal (immune complex-mediated glomerulonephritis) (rare) neurological involvement: symptomatic meningitis, infectious arteritis (ischaemia, thrombosis, infarction), otosyphilis (hearing loss with or without tinnitus), ocular disease (28–51% of neurosyphilis) (anterior and posterior uveitis, iritis, chorioretinitis, necrotizing retinitis and optic neuritis).

Neurosyphilis	Asymptomatic – early/late: Abnormal CSF with no signs/symptoms. This is of uncertain significance as CSF abnormalities have been found in up to 70% of primary and secondary syphilis and less than 10% will develop disease.
	Meningovascular (2–7 years): Focal arteritis inducing infarction/meningeal inflammation; signs dependent on site of vascular insult. Occasional prodrome; headache, emotional lability, insomnia.
	General paresis (10–20 years): Cortical neuronal loss causing gradual decline in memory and cognitive functions. Emotional lability, personality change, psychosis and dementia. Seizures and hemiparesis are late complications.
	Tabes dorsalis: Inflammation of spinal dorsal column/nerve roots; lightening pains, areflexia, paraesthesia, sensory ataxia, Charcot's joints, optic atrophy, pupillary changes (eg Argyll Robertson pupil).
CSF = cerebrospinal fluid.