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Secondary Syphilis
Aka: Secondary Syphilis, Condyloma Lata, Condyloma Latum, Syphilitic Alopecia, Lues Maligna, Ulceronodular Syphilis, Malignant Syphilis
- See Also
- Syphilis
- Sexually Transmitted Disease
- Primary Syphilis
- Latent Syphilis
- Tertiary Syphilis
- Syphilitic Gumma
- Cardiovascular Syphilis
- Neurosyphilis
- Syphilis Testing
- Genital Ulcer
- 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
- Symptoms: Nonspecific
- Malaise
- Fatigue
- Headache
- Fever
- Pharyngitis
- Arthralgia
- Myalgia
- Lymphadenopathy
- Hepatosplenomegaly
- Signs
- Highly infectious lesions can occur on mucus membrane
- Generalized Lymphadenopathy
- Papulosquamous Dermatosis
- Painless maculopapular rash starting on face and trunk
- Characteristics
- Pale, pink to red discrete round Macular to papular lesions
- Scaling over surface
- Size: "Nickels and Dimes"
- Papules <1cm (Dimes): Usually 5-10 mm
- Plaques >1cm (Nickels)
- 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
- Pityriasis Rosea
- Psoriasis
- Drug eruption
- Viral Exanthem
- Scarlet Fever
- Condyloma Lata
- Painless, wart-like lesions
- Papules coalesce, macerate and may form flat, moist 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 moth-eaten appearance
- 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
- 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)
- Management
- See Syphilis
- See Neurosyphilis
- References
- Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10
- Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
- Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]