Secondary syphilis - Anogenital in
Secondary syphilis usually presents with a generalized rash that includes the palms and soles. Condyloma lata may be seen in moist anogenital locations or in the mouth. They are teeming with spirochetes and, therefore, are extremely infectious.
Symptoms may include malaise, appetite loss, fever, headache, stiff neck, myalgias, lacrimation, photophobia, red and painful eyes, back pain, arthralgias, pharyngitis, flu-like symptoms, pruritus (more common in immunocompromised patients), lymphadenopathy, splenomegaly, bursitis, and tenosynovitis. In late stages blindness and epigastric pain may occur.
The lesions of secondary syphilis heal in 2-10 weeks, with or without treatment.
Ocular screening (eg, slit lamp examination) is advised for patients with suspected or proven syphilis.
Related topics: Primary syphilis, Tertiary syphilis, Early congenital syphilis, Late congenital syphilis, Ocular syphilis
A51.39 – Other secondary syphilis of skin
240557004 – Secondary syphilis
The following differential will be focused on the mucocutaneous findings of secondary syphilis.
- Lichen planus – Very pruritic, associated with hepatitis C, violaceous, scaly papules; consider tissue biopsy.
- Lichen amyloidosis – Monomorphous papules.
- Pityriasis rosea – Look for herald patch, collarette of scale, and orientation of lesions (fir-tree pattern in skin tension lines).
- Pityriasis rubra pilaris – Look for orange-red, waxy-like keratoderma of the palms and soles; consider tissue biopsy.
- Guttate psoriasis – Systemic signs absent, palms and soles are spared; biopsy will aid in diagnosis.
- Drug eruption – Cutaneous lesions of drug eruption tend to be different than those seen in syphilis. Drug eruptions often present with urticarial, exanthematous, or vesicular / bullous lesions. Eosinophilia on CBC and histology are often seen (but not an invariable finding). Look for NSAIDs, sulfonamides, and penicillin medication history.
- Erythema multiforme – Characteristic target lesions (3 concentric colors that are round and well-demarcated) occur on the extremities more often than the trunk. Precipitating factors are infectious (HSV, mycoplasma, etc) and usually not medication related.
- Reactive arthritis (Reiter syndrome)
- Tinea corporis – Check KOH.
- Scabies – Check for scabies mite in mineral oil.
- Mycosis fungoides
- Granuloma annulare
- Subacute cutaneous lupus erythematosus