Symptoms typically include fever, malaise, headache, nausea, anorexia, and joint pains. Many other organs can be involved at this stage, including the liver, kidneys, GI tract. The characteristic lesion of benign tertiary syphilis is the gumma. Histologically, the gumma is a granuloma. They are usually found in the skin and mucous membranes, but can occur anywhere in the body, and have been found in the choroid and iris.
Cardiovascular syphilis can involve the coronary arteries or aorta.
Neurosyphilis can affect the CNS via vascular pathways or direct involvement of parenchyma. Though it can occur acutely during early secondary syphilis, syphilitic uveitis will take on a chronic course if untreated. Syphilitic uveitis is one of the few types of uveitis that will commonly present as a granulomatous inflammation, and can present with iris nodules similar in appearance to those seen in other granulomatous diseases. Syphilitic uveitis can present in conjunction with interstitial keratitis. The posterior involvement can take on many different forms, such as vasculitis, macular edema, stellate maculopathy, pseudo-RP, and neuroretinitis.