Patients tend to be younger, with a history of unprotected sex.
Elderly patients may manifest late-stage syphilis left untreated many years before. In the primary stage of acquired syphilis, the patient develops a painless chancre at the site of inoculation, as well as regional lymphadenopathy. While primarily genital, chancres may develop on the eyelid and conjunctiva. Other ocular signs in the primary stage include conjunctivitis, blepharitis, and alopecia. In the secondary stage of acquired syphilis, the patient will develop malaise, lymphadenopathy, fever, maculopapular skin lesions on the palms and soles, joint pain, headache, and loss of appetite.