Primary lesion appears after an incubation of 2-6 weeks
Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation
Minority of patients can have multiple lesions or atypical appearance
Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia
Heals in 4-6 weeks
Regional lymphadenopathy that is painless and firm
Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation
Minority of patients can have multiple lesions or atypical appearance
Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia
Heals in 4-6 weeks
Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues
Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.
They progress to more wide spread papular lesions that frequently involve the palms and soles.
Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks
Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. 
In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata
CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic.
Constitutional symptoms may accompany or precede secondary<unk> . Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus
Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass, arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities
Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks
Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. 
In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata
Detectable by serologic testing only
May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation
Spontaneous cure is rare
Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations
The most common manifestation in the US today is neurosyphilis in HIV infected persons.
Historical manifestations:
Gumma: granulomatous lesion
Cardiovascular<unk> : involves the vasa vasorum of the ascending aorta and can result in aneurysm formation
Late symptomatic neurosyphilis: tabes dorsalis and paresis
Ocular<unk>  should be considered equivalent to neurosyphilis
Gumma: granulomatous lesion
Cardiovascular<unk> : involves the vasa vasorum of the ascending aorta and can result in aneurysm formation
Late symptomatic neurosyphilis: tabes dorsalis and paresis
Ocular<unk>  should be considered equivalent to neurosyphilis
CNS
CSF-VDRL preferred test
Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits
RPR titers of ≥ 1:32 are at higher risk of having neurosyphilis, even higher if HIV infected.
Demonstrable in up to 25% of patients with latent infection and up to 40% of primary or secondary cases 
Patients with early<unk>  who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV
Meningeal: Headache, nausea/vomiting, neck stiffness, cranial nerve involvement, seizures, changes in mental status, uveitis, iritis or hearing loss
Meningovascular: Meningitis together with inflammatory vasculitis leading to stroke syndrome
Subacute encephalitic prodrome of headaches, vertigo, insomnia, and psychological abnormalities
Parenchymal: Paresis, hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/hallucinations, memory defects, speech changes.
Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light
Tabes dorsalis presents with a wide based gait ataxia, foot drop, paresthesias, bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations•	Cardiovascular
Patients with early<unk>  who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV
Subacute encephalitic prodrome of headaches, vertigo, insomnia, and psychological abnormalities
Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light
Tabes dorsalis presents with a wide based gait ataxia, foot drop, paresthesias, bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations•	Cardiovascular
Cardiovascular
10-40 years after infection
Endarteritis obliterans of the vasa vasorum leads
Aortitis, aortic regurgitation, saccular aneurysm (usually ascending), coronary ostial stenosis
Gumma
Commonly involves skin and skeletal system
Solitary lesions ranging from microscopic to several centimeters
Granulomatous inflammation with central area of necrosis due to endarteritis obliterans
Painless, indurate nodular or ulcerative lesions
Congenital<unk> 
Transmission across the placenta may occur at any stage of pregnancy
Treatment before the 16th week of pregnancy should prevent fetal damage
Treatment before the third trimester should treat the infected fetus
Most common clinical problem is a healthy-appearing baby with a positive serologic test
Syphilis
Ulcerative STDs
Smallpox
Proctitis
Leprosy
Genital Herpes
Rubella
Chancroid