Secondary Syphilis

Aka: Secondary Syphilis, Condyloma Lata, Condyloma Latum, Syphilitic Alopecia, Lues Maligna, Ulceronodular Syphilis, Malignant Syphilis

1. See Also
   1. Syphilis
   2. Sexually Transmitted Disease
   3. Primary Syphilis
   4. Latent Syphilis
   5. Tertiary Syphilis
   6. Syphilitic Gumma
   7. Cardiovascular Syphilis
   8. Neurosyphilis
   9. Syphilis Testing
   10. Genital Ulcer
2. Course
   1. Begins 2 to 8 weeks following onset of Chancre
3. Symptoms: Nonspecific
   1. Malaise
   2. Fatigue
   3. Headache
   4. Fever
   5. Pharyngitis
   6. Arthralgia
   7. Myalgia
4. Signs
   1. Highly infectious lesions can occur on mucus membrane
   2. Generalized Lymphadenopathy
   3. Papulosquamous Dermatosis
      1. Characteristics
         1. Pale, pink to red discrete round macular to papular lesions
         2. Scaling over surface
      2. Size: "Nickels and Dimes"
         1. Papules <1cm (Dimes): Usually 5-10 mm
         2. Plaques >1cm (Nickels)
      3. Distribution: Symmetric palms, soles and trunk
   4. Condyloma Lata
      1. Wart-like lesions
      2. Papules coalesce, macerate and may form flat, moist, infectious lesions
      3. Become large, flat highly contagious lesions
         1. Involves moist areas
         2. Involves genitalia and intertriginous areas
   5. Syphilitic Alopecia (up to 12% of Secondary Syphilis cases)
      1. Alopecia with moth-eaten appearance
5. Complications
   1. Lues Maligna (Ulceronodular Syphilis, Malignant Syphilis)
      1. Severe form of Secondary Syphilis (especially in immunosuppressed patients)
   2. Hepatitis
   3. Periostitis
   4. Nephropathy
   5. Uveitis or Iritis
6. Labs
   1. See Syphilis Testing
   2. Blood testing is typically positive in Secondary Syphilis
   3. Dark field microscopy
      1. Indicated in Condyloma Lata and other skin lesions with direct pathogen infiltration
      2. Treponemes will be visible
7. Management
   1. See Syphilis
   2. See Neurosyphilis
8. References
   1. Mattel (2012) Am Fam Physician 86(5): 433-40