The Great Imitator: A Timeline of Syphilis, Its Symptoms, Treatment, & Prevention

Back in the day Syphilis was a pretty damn scary STD to catch. Being infected during the pre-antibiotics era was close to a death sentence, similar to the early decades when HIV first hit the scene and there was no treatment available, causing the development of full blown AIDS.

As a result, the afflicted suffered greatly, beginning with rashes and lesions on the body all the way to deformations and neurological damages to the brain and nervous system. Famous and infamous figures in recent history, from Tolstoy and Lenin to Al Capone, all suffered from Syphilis' debilitating effects.

A recent 2015 study by The Centers for Disease Control and Prevention's (CDC's) found that primary and secondary stages of Syphilis, the most infectious stages of the disease, had reached a 20 year high.

This includes increases of infection in almost every region and across all ages and ethnicities, with a whopping 19% increase per 100,000 people from 2014. At the current rate, it appears the number of those infected will only continue to rise for a disease once thought to be under modern medicine’s control.


Groups most at risk  are men who have sex with men (MSM), contracting the disease at almost 3x the rate of other group.


The Origins of Syphilis

There’s a couple competing schools of thought on where the disease originated from.

One popular theory is that it was brought back to Europe from the New World by during the era of the Columbian Exchange. Alongside turkey’s, avocados, and chiles, the New World sent along some of its diseases like Chagas caused by kissing bugs and of course, Syphilis.

The second theory is that the disease always existed in the Old world but was misdiagnosed as leprosy, given that they shared similar-looking symptoms. One of the earliest recorded instances of the disease dates back to the 1500s in Naples, Italy during a French invasion, which became known as the “French Disease.”

One of the first recorded methods of attempting to cure the disease involved the use of mercury with mixed results. In 1929, Penicillin was discovered and by 1940, mass production began for wide distribution, saving millions of lives.

One interesting note was Fleming’s warning to the world about antibiotic resistance, even before his antibiotics were used. He warned against the drug being used in insufficient amounts or too often for unnecessary reasons.

“The thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted.”

Symptoms of Syphilis

Compared to other STDs, which consist of the two stages "initial" and "latent," Syphilis is broken up into four tiers of symptoms: initial, secondary, latent, and tertiary, unfolding over a period 20-25 years in a pattern of symptomatic (visible symptoms) and asymptomatic (showing no symptoms) behavior. This is why in the early centuries Mercury was believed to have cured Syphilis, as it would appear the disease went “dormant,” so to speak.


Direct contact with the infected lesions of another person is the typical method of infection. 20-30 days after being infected is when symptoms begin to show. Typical symptoms include:

  • Painless skin lesions (chancre) at contact point
  • Swollen lymph nodes

If left untreated, the lesions can last for 3-6 weeks.



After 4-10 weeks of the disease being left untreated, the person begins to show symptoms of secondary Syphilis. Due to the variety of ways the disease can present itself at this stage, it's often given the name “The Great Imitator,” coined by Sir William Osler. It’s this stage that the disease is at its most contagious. Secondary symptoms include:

  • Red/pink non-itchy rash on hands
  • Flat, wart-like lesions called condyloma latum on mucus membranes (infectious)
  • Fever, sore throat
  • Weight loss
  • Hair loss


Left untreated, secondary symptoms begin to resolve and disappear on their own in about 3-6 weeks. However, if at this point you think it has run its course and you’re now in the clear, you’d be sadly mistaken. This is merely the “eye of the storm” with the worst yet to come. Latent Syphilis is when someone is identified as having the disease but never treated for it. Some people may have recurring secondary symptoms but most are simply asymptomatic. This stage can last for years before tertiary symptoms begin to occur.



This is when things start to get ugly (how can it?!). Tertiary breaks down into 3 forms: Gummatous, Late NeuroSyphilis, and Cardiovascular Syphilis. Thirty-three  percent of infected people will develop tertiary symptoms if left untreated.

Gummatous Syphilis develops on average of 15 years after the initial infection. Soft, tumor like balls of inflammation begin to form, most often around the skin, bone, and liver, but can form anywhere.

Deterioration of the nose can also occur at this stage, called “saddle nose.” Often prosthetic noses were assigned to cover it. Due to it being visible to others in public, a stigma began to be attributed to both the exposed nose and prosthetic , causing the afflicted to be seen as unclean or unfaithful.

Late NeuroSyphilis affects the nervous system, usually 4-25 years after the initial infection. Shooting pains in the lower body, seizures, and dementia can all occur at this stage.

Finally, Cardiovascular Syphilis can occur around 10-30 years after infection, leading to the formation of aneurysms.


It is worth mentioning that Syphilis, similar to herpes and HIV, can be transmitted to the womb during pregnancy or birth without showing any symptoms to the child. The most commonly seen symptoms occur after the first couple of years include:

  • enlarged liver and spleen
  • Rash
  • Fever

More rare symptoms involve neuroSyphilis and lung inflammation.


An RPR blood test can verify whether or not someone has been infected with Syphilis. Because of its complex and diverse set of symptoms, it is recommended that you get tested every 12 months if sexually active, especially for men who are sexually active with other men.

False positives can occur if the person being tested is currently suffering from the following issues:

  • chickenpox,
  • malaria
  • tuberculosis
  • lymphoma
  • pregnancy

Some hospitals have testing equipment where fluid taken from lesions can be immediately tested for Syphilis, however it must be done within 10 minutes of collecting the sample, making it difficult to examine.

Left: A prosthetic used to cover saddle nose. Right: A person seen wearing the prosthetic in the TV series The Knick.

Treatment of Syphilis

Penicillin remains the main choice of treatment for Syphilis. Those who are allergic are given either doxycycline or tetracycline. Depending on how advanced the disease has progressed, the injection is either given intramuscularly (how most shots are given) for early stages or large doses intravenously (IV) for a minimum of 10 days for late-stage infections.

Of all the STDs we’ve discussed so far, Syphilis in my opinion is by far the most terrifying because of what it can do to your body if left untreated, and also because of how difficult it may be to spot from other, less severe symptoms. It is important that you and/or your partner wear protection and be open about your sexual history, as well as when you were last tested for STDs. We’ve come a long way in how we treat these once debilitating diseases, but it is up to you to take the initiative to stay protected, and to get tested often if dealing with multiple partners.

Until next time,



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