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Tertiary syphilis is a late phase of the sexually transmitted disease syphilis, caused by the spirochete Treponema pallidum.

Late syphilis; Tertiary syphilis

Syphilis is a sexually transmitted, infectious disease caused by the spirochete Treponema pallidum.

Syphilis has three main stages:

• Primary syphilis
• Secondary syphilis
• Tertiary syphilis

This article focuses on tertiary syphilis. Tertiary syphilis can follow the initial infection (primary syphilis) by 3 to 15 years.

In tertiary syphilis, the infection-causing organisms have continued to grow for years. Pockets of damage, or lesions, affects various tissues such as the bones, skin, nervous tissue, heart, and arteries. These areas are called gummas, and are very destructive.

Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment.

Symptoms of tertiary syphilis depend on which organ systems have been affected. They vary widely and are difficult to diagnose. In individuals with tertiary syphilis, the primary and secondary stages of syphilis usually have been long forgotten. Medical findings of aortic aneurysms and neurological problems require astute diagnostic ability to link them to syphilis. Some of the symptomatic problems are listed below.

• Cardiovascular syphilis which affects the aorta and causes aneurysms or valve disease
• Central nervous system disorders (neurosyphilis)
• Infiltrative tumors of skin, bones, or liver (gumma)

VDRL or RPR blood tests are used as screening tests. If they are positive, one of the following is needed to confirm the diagnosis of syphilis:

• FTA-ABS (fluorescent treponemal antibody test)
• MHA-TP

Spinal fluid examination in neurosyphilis shows signs of meningitis.

Late syphilis may be permanently disabling and may lead to death.

• Aneurysms
• Heart valve disease
• Neurosyphilis
• Syphilis infection of the heart

Untreated syphilis can result in serious health problems. It is very important that you tell your doctor if you think you might have had syphilis, even if it was many years ago.

If you are sexually active, practice safe sex and always use a condom.

All pregnant women should be screen for syphilis.

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 235.