Secondary Syphilis

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

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II. Course

  1. Begins 6 to 8 weeks (as early as 2 weeks) following onset of Chancre (Primary Syphilis)
  2. Follows 3-6 weeks asymptomatic period after Chancre resolves but before Secondary Syphilis manifestations
  3. Resolves spontaneously in weeks to months without treatment

III. Symptoms: Nonspecific

  1. Malaise
  2. Fatigue
  3. Headache
  4. Fever
  5. Pharyngitis
  6. Arthralgia
  7. Myalgia
  8. Lymphadenopathy
  9. Hepatosplenomegaly

IV. Signs

  1. Highly infectious lesions can occur on mucus membrane
  2. Generalized Lymphadenopathy
  3. Papulosquamous Dermatosis
    1. Painless maculopapular rash starting on face and trunk
    2. Characteristics
      1. Pale, pink to red discrete round Macular to papular lesions
      2. Scaling over surface
    3. Size: "Nickels and Dimes"
      1. Papules <1cm (Dimes): Usually 5-10 mm
      2. Plaques >1cm (Nickels)
    4. Distribution
      1. Starts on face, trunk and flexor extremity surfaces (may be absent, with only palm and sole lesions)
      2. Progresses to involve symmetric lesions on palms and soles
    5. Differential Diagnosis
      1. Pityriasis Rosea
      2. Psoriasis
      3. Drug eruption
      4. Viral Exanthem
      5. Scarlet Fever
  4. Condyloma Lata
    1. Painless, wart-like lesions
    2. Papules coalesce, macerate and may form flat, moist lesions
      1. Highly infectious, teaming with Spirochetes
    3. Become large, flat highly contagious lesions
      1. Involves moist areas
      2. Involves mouth, genitalia and intertriginous areas (perineum, axilla, between toes)
  5. Syphilitic Alopecia (up to 12% of Secondary Syphilis cases)
    1. Alopecia with moth-eaten appearance

V. Complications

  1. Lues Maligna (Ulceronodular Syphilis, Malignant Syphilis)
    1. Severe form of Secondary Syphilis (especially in immunosuppressed patients)
  2. Hepatitis
  3. Periostitis
  4. Nephropathy or Nephrotic Syndrome
  5. Uveitis or Iritis

VI. Labs

  1. See Syphilis Testing
    1. Diagnostic blood testing is typically positive in Secondary Syphilis
  2. Dark field microscopy
    1. Indicated in Condyloma Lata and other skin lesions with direct pathogen infiltration
    2. Treponemes will be visible
  3. Other associated lab findings
    1. Serum transaminase elevations may occur (hepatitis)
    2. Urinalysis with Proteinuria (in Nephrotic Syndrome)

VII. Management

  1. See Syphilis
  2. See Neurosyphilis

VIII. References

  1. Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10
  2. Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
  3. Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]

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Related Studies

Ontology: Syphilitic alopecia (C0002181)

Concepts Disease or Syndrome (T047)
ICD9 091.82
ICD10 A51.32
SnomedCT 59307008
Italian Alopecia sifilitica
Dutch syfilitische alopecie, alopecia syfilitisch
Japanese 梅毒性脱毛症, ﾊﾞｲﾄﾞｸｾｲﾀﾞﾂﾓｳｼｮｳ
English secondary syphilis with alopecia, secondary syphilis with alopecia (diagnosis), Alopecia syphilitic, Syphilitic alopecia, Syphilitic alopecia (disorder)
Czech Syfilitická alopecie
Hungarian alopecia syphilitica, syphilises alopecia
Spanish alopecia sifilítica (trastorno), alopecia sifilítica, Alopecia sifilítica
Portuguese Alopecia sifilítica
French Alopécie syphilitique
German syphilitische Alopezie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Syphilis, secondary (C0149985)

Concepts Disease or Syndrome (T047)
MSH C536773
ICD9 091.9
SnomedCT 154382002, 186865002, 240557004
English Unspecified secondary syphilis, SYPHILIS SECONDARY, secondary syphilis (diagnosis), secondary syphilis, Secondary syphilis NOS, Syphilis, secondary, syphilis secondary, Unspecified secondary syphilis (disorder), Secondary syphilis, Secondary syphilis (disorder), syphilis; secondary
Italian Sifilide secondaria, Sifilide secondaria non specificata
Dutch niet-gespecificeerde secundaire syfilis, syfilis; secundair, secundaire syfilis
French Syphilis secondaire non précisée, Syphilis secondaire
German unspezifische sekundaere Syphilis, sekundaere Syphilis
Portuguese Sífilis secundária NE, Sífiles secundária
Spanish Sífilis secundaria no especificada, sífilis secundaria no especificada (trastorno), sífilis secundaria no especificada, sífilis secundaria (trastorno), sífilis secundaria, Sífilis secundaria
Japanese 第２期梅毒, 詳細不明の第２期梅毒, ﾀﾞｲ2ｷﾊﾞｲﾄﾞｸ, ｼｮｳｻｲﾌﾒｲﾉﾀﾞｲ2ｷﾊﾞｲﾄﾞｸ
Czech Sekundární syfilis, Blíže neurčená sekundární syfilis
Hungarian nem meghatározott másodlagos syphilis, másodlagos syphilis
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Condyloma latum (C0275828)

Concepts Disease or Syndrome (T047)
ICD10 A51.31
SnomedCT 123203001, 91554004
LNC LA21233-4
Italian Condiloma piano
Japanese ﾍﾝﾍﾟｲｺﾝｼﾞﾛｰﾏ, 扁平コンジローマ
Czech Condyloma latum
English flat condyloma, condyloma latum, condylomata lata, condyloma lata, Condyloma latum, Condylomata lata, Flat condyloma, CL - Condylomata lata, Condyloma latum (disorder), condyloma; latum, latum; condyloma, Condyloma latum -RETIRED-
Hungarian Condyloma latum
Spanish condiloma lato (concepto no activo), condiloma lato (trastorno), condiloma lato, condiloma plano, pápula húmeda, pápula mucosa, Condiloma latum
Dutch condylomata; lata, lata; condylomata, condyloma latum
Portuguese Condiloma plano
French Condylome plat
German Condyloma latum
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Malignant syphilis (C1096230)

Concepts Disease or Syndrome (T047)
Italian Sifilide maligna
Dutch lues maligna, maligne syfilis
German Lues maligna, Syphilis maligna
Japanese 悪性梅毒, ｱｸｾｲﾊﾞｲﾄﾞｸ
Czech Maligní syfilis, Lues maligna
Hungarian rosszindulatú syphilis, Lues maligna
English Lues maligna, Malignant syphilis
Portuguese Sífilis maligna
Spanish Sífilis maligna
French Syphilis maligne
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Sexually Transmitted Disease

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