Secondary syphilis

Alternative names

Syphilis - secondary

Definition

Secondary syphilis is the second stage of the sexually transmitted disease syphilis. This stage is the most contagious of all stages and is characterized by the spread of the bacteria which causes syphilis throughout the body.

Causes, incidence, and risk factors

Syphilis is a sexually-transmitted infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages: primary syphilis, secondary syphilis, and Tertiary syphilis.

Approximately one-third of untreated individuals with primary syphilis will progress to the second stage: secondary syphilis. This usually occurs at about 2 to 8 weeks after the appearance of the original painless sore (chancre) and in some cases the chancre may still be present.

In secondary syphilis, the bacteria have spread in the bloodstream and have reached their highest numbers. The most common symptoms include skin rash, which can be varied in appearance, yet frequently involves the palms and soles, in addition to lesions in the mouth, vagina or penis, called mucous patches. Other lesions that can appear are moist, warty patches on the genitalia or skin folds called condylomata lata.

During secondary syphilis, additional symptoms such as fever, malaise, loss of appetite, and swollen Lymph nodes may also be noted. This stage is the most contagious stage of syphilis. While it usually resolves within weeks, in some cases it may last up to a year.

Symptoms

• skin rash - usually throughout the body with both flat and raised patches which may involve the palms and soles
  
• enlarged Lymph nodes
  
• mucous patches (painless silvery ulcerations of mucous membranes - seen mostly in the mouth and on the genitals)
  
• condyloma lata: coalescing papules which form a grey-white plaque frequently in folds such as groin, genital areas, axilla and under the breasts
  
• Hair loss (alopecia)
  
• general symptoms such as fever, fatigue, loss of appetite, aches and pains in bones, achy muscles, and achy joints
  
• in a few cases of secondary syphilis, the original chancre may still be present
  

Signs and tests

The diagnosis of secondary syphilis is usually based on blood tests. An initial screening is done with the non-treponemal tests such as VDRL or RPR. If these are positive, the diagnosis is confirmed by another blood test for a specific - the FTA-ABS fluorescent treponemal test.