Chapter 29-15: Secondary Syphilis

TEXTBOOK PRESENTATION

Secondary syphilis presents as oval macules. The lesions are present diffusely, including on the palms and soles. A history of a transient, painless, genital ulcer in the preceding weeks can often be obtained.

DISEASE HIGHLIGHTS

1. Description of lesion: papules and plaques distributed over the entire body. They are copper red to hyperpigmented in color.

2. Character of the lesion

   1. Lesions may vary at different stages of disease.

      1. A fleeting eruption of symmetric, coppery red, round and oval macules may be seen early in the secondary stage, about 8 weeks after the infecting exposure.

      2. The later, classic eruption includes involvement of mucosal surfaces and palms and soles.

      3. In the latest phases, thick scales may cover the plaques.

   2. The rashes of secondary syphilis are nonpruritic.

   3. The lesions are generally symmetrically distributed.

EVIDENCE-BASED DIAGNOSIS

1. Tests for syphilis include non-treponemal and treponemal tests.

   1. Non-treponemal tests assess the reactivity of serum to a cardiolipin-cholesterol-lecithin antigen. They include the rapid plasma reagin (RPR) and the venereal disease research test (VDRL).

   2. Treponemal tests are qualitative tests (“reactive” or “nonreactive”) that detect antibodies directed against specific treponemal antigens. They include the fluorescent treponemal antibody (FTA), microhemagglutination Treponema pallidum (MHA-TP), and Treponema pallidum enzyme immunoassay (TP-EIA).

   3. Treponemal tests are more specific than non-treponemal ones.

2. Syphilis diagnosis is based on both treponemal and non-­treponemal tests. Most laboratories employ algorithms that use a treponemal test as the screening test followed by a non-treponemal test for confirmation if the treponemal test is positive.

TREATMENT

Penicillin is the treatment of choice for secondary syphilis.