SECONDARY SYPHILIS

About 8 weeks after the primary infection, lesions of secondary syphilis may develop.

Clinical

The rash of secondary syphilis is diffuse and often involves the palms and soles. Lesions are symmetric and coppery red in color. Itch is uncommon. There is no herald patch as in pityriasis rosea. Many morphologies are possible including macular (roseolar), papular, papulosquamous, annular, nodular, pustular, and ulcerative. Other changes include moth-eaten alopecia, alopecia of the eyebrows, condyloma lata (moist plaques occurring perianally and genitally, mucous patches, paronychia, and split papules at the corners of the mouth.

Rarely, secondary syphilis can appear like PLEVA.

Outline

• Prodromal (weight loss, fever, headache, sore conjunctivitis, arthralgias, myalgias) + LAD
• Early (10%): generalized non-pruritic eruption, roseola-like, discrete macules on flanks and shoulders
• Late (70%): generalized maculopapular and papulosquamous eruptions with corymbose arrangement (satellite papules around a larger central lesion), polymorphic in successive waves
• Localized syphilids
• Palms and soles: collarette of Biett
• Anogenital: condylomata lata
• Seborrheic: "corona veneris" hairline
• Chest: "necklace of Venus" hypopigmented macules

Treatment

The latest public health recommendations should be consulted. Previous recommendations include 2.4 million units of benzathine penicillin once intramuscularly. For those allergic to penicillin, the preferred treatment is desensitization to penicillin and subsequent penicillin treatment.

Additional Photos

Loss of eyebrow hair.

Mucous patches of secondary syphilis.

RegionalDerm

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