It takes about three weeks for the defences to be mobilized, which is why the person who has been infected with syphilis has no symptoms or signs for three weeks. Then the sensitized blood cells attack the treponemes, which are still multiplying in the tissues of the beach-head – in this case the mucous membrane of the penis. This attack causes the first sign of syphilis, a raised pimple on the penis. In the next few days many of the treponemes are killed, as are many of the white blood cells, with the result that a zone of hard tissue develops around the pimple. It also leads to a reduction in blood supply to the pimple, so that its centre dies and sloughs off leaving an ulcer. The infected person has a hard chancre. In time the ulcer heals, leaving a scar. This takes from 3 to 8 weeks. Unfortunately, in some cases, the ulcer is quite small, or is not even noticed, so that the infected person does not seek treatment.
At the same time as the white blood cells are being mobilized, the treponemes which have invaded the bloodstream cause another reaction. They induce the blood to make a chemical substance called an antibody. The formation of antibody to the treponemes is a slow process, but 4 to 8 weeks after the primary infection, it can be measured by taking a sample of blood from a vein. Once formed, the antibody to syphilis tends to persist for years, unless the syphilis is cured, when it usually disappears from the blood over a period of about a year.
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