Stage Symptoms Time frame Primary Chancre: nontender, firm red lesion, often with associated nontender regional adenopathy As often found in the cervix or vagina, may not be noted by many women Due to disseminated spirochetemia Fever, influenza-like illness, generalized adenopathy, and dermal finding predominate in adults but are less prominent in young children These include condylomata lata and lesions on palms and soles (contact precautions should be used) Reactive serologic tests without symptoms 10–90 days after exposure Secondary Latent 2–10 wks after primary disease Early latent: 1 yr Tertiary Gummas: indolent localized dermal 3–10 yrs after secondary nodules caused by the host disease inflammatory reaction; in contrast to secondary syphilis, few spirochetes are found Neurosyphilis Paralytic dementia, meningitis, ≥5 yrs after primary seizures, gummas of the spinal disease cord, optic atrophy, or tabes dorsalis (myelopathy of the posterior columns of the spinal cord, resulting in loss of proprioception and vibration sensation) Cardiovascular Arteritis of the aorta and pulmonary 10–40 yrs after primary vessels that can result in valvular disease regurgitation or myocardial insufficiency