II. Pathophysiology
- Secondary Syphilis represents the bacteremic stage of Syphilis (replication and systemic spread)
- Contrast with the localized disease (Chancre) in Primary Syphilis
III. Course
- Begins 6 to 8 weeks (as early as 2 weeks) following onset of Chancre (Primary Syphilis)
- Follows 3-6 weeks asymptomatic period after Chancre resolves but before Secondary Syphilis manifestations
- Resolves spontaneously in weeks to months without treatment
IV. Symptoms: Nonspecific
V. Signs
- Highly infectious lesions can occur on mucus membrane
- Generalized Lymphadenopathy
-
Papulosquamous Dermatosis
- Painless maculopapular rash starting on face and trunk (and spreading to palms and soles)
- Resolves over a 6 week course
- Characteristics
- Size: "Nickels and Dimes"
- Distribution
- Starts on face, trunk and flexor extremity surfaces (may be absent, with only palm and sole lesions)
- Progresses to involve symmetric lesions on palms and soles
- Differential Diagnosis
- Condyloma Lata
- Painless, wart-like lesions
- Like the Papulosquamous Dermatosis, resolves over a 6 week course
- Papules coalesce, macerate and may form flat, moist, ulcerated lesions
- Highly infectious (teaming with Spirochetes)
- Become large, flat highly contagious lesions
- Involves moist areas
- Involves mouth, genitalia and intertriginous areas (perineum, axilla, between toes)
- Syphilitic Alopecia (up to 12% of Secondary Syphilis cases)
- Alopecia with patchy, moth-eaten appearance
- Eyebrows may also be lost
VI. Complications
- Lues Maligna (Ulceronodular Syphilis, Malignant Syphilis)
- Severe form of Secondary Syphilis (especially in immunosuppressed patients)
- Hepatitis
- Periostitis
- Nephropathy or Nephrotic Syndrome
- Uveitis or Iritis
VII. Labs
- See Syphilis Testing
- Diagnostic blood testing is typically positive in Secondary Syphilis
- Dark field microscopy
- Indicated in Condyloma Lata and other skin lesions with direct pathogen infiltration
- Treponemes will be visible
- Other associated lab findings
- Serum transaminase elevations may occur (hepatitis)
- Urinalysis with Proteinuria (in Nephrotic Syndrome)
VIII. Management
- See Syphilis
- See Neurosyphilis
IX. References
- Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10
- Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9
- Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
- Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]
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Related Studies
| 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 |
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 |
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 |
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 |
