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Secondary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and Scalp
Other Resources UpToDate PubMed

Secondary syphilis - Oral Mucosal Lesion

See also in: Overview,Anogenital,Hair and Scalp
Contributors: David O'Connell MD, Samantha R. Pop MD, Belinda Tan MD, PhD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc, Susan Burgin MD
Other Resources UpToDate PubMed


Secondary syphilis is the second stage of the infection caused by the spirochete Treponema pallidum. Although syphilis (also known as lues) is seen worldwide, it is especially problematic in developing countries. It should be considered within the differential diagnosis of any oral mucosal patch, erythema, or erosion in those at risk.

Secondary syphilis typically occurs 3-10 weeks after the appearance of the primary syphilitic chancre and results from hematologic or lymphatic dissemination of the treponemes. There may be mucocutaneous as well as systemic disease.

Secondary syphilis can present with varied manifestations. Patients generally develop constitutional symptoms including malaise, appetite loss, fever, headache, stiff neck, myalgias, pharyngitis, and flu-like symptoms. Generalized lymphadenopathy is typically present. Cutaneous manifestations of secondary syphilis may include a generalized rash that includes the palms and soles. Patchy alopecia or telogen effluvium can be present. Ocular symptoms may include lacrimation, photophobia, and red, painful eyes.

Oral lesions of secondary syphilis can take the form of mucous patches and "snail-track" ulcers. The latter are confluent mucous patches that form a serpiginous outline. The median age of patients with acquired oral syphilis is in the third and fourth decades of life (aged 20s-30s). The oral locations involved may include the tongue, palate, lips, buccal mucosa, and labial commissure. Condylomata lata (gray, flat, moist papules and plaques) may be seen in moist anogenital locations or in the mouth. They are teeming with spirochetes and are, therefore, extremely infectious.

The lesions of secondary syphilis resolve in 3-12 weeks, with or without treatment. If left untreated, up to 25% of patients will relapse within the first 2 years.

Immunocompromised patient considerations: HIV infection can alter the clinical presentation of syphilis. Manifestations include multiple chancres, atypical cutaneous eruptions, increased severity of organ involvement (such as hepatitis and glomerulonephritis), and rapidly developing arteritis and neurosyphilis. Neurosyphilis can occur at any stage of 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

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Last Reviewed:09/02/2020
Last Updated:08/18/2021
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Patient Information for Secondary syphilis - Oral Mucosal Lesion
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Contributors: Medical staff writer


Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Secondary syphilis is the second of four stages of syphilis infection and it occurs typically 1-3 months after the first stage of syphilis. All patients who contract syphilis will go on to develop secondary syphilis if the infection is not treated.

Who’s At Risk

You can get syphilis by having unprotected vaginal, anal, or oral sex.

According to the US Centers for Disease Control and Prevention (CDC), secondary syphilis rates have increased since 2005 among men and men who have sex with men. An increase in syphilis cases has been reported in the United States in black and Hispanic individuals, sex workers, individuals who expose themselves to sex workers, and individuals with a medical history of other STIs.

Signs & Symptoms

Secondary syphilis typically includes skin rashes and sores in your mouth, anus, penis, or vagina. The rash often appears as red or brown, rough-looking spots on the palms or bottoms of feet. Other symptoms can include fever, sore throat, headaches, weight loss, fatigue, muscle aches, and hair loss.

Self-Care Guidelines

To reduce your chances of contracting syphilis, use a condom when having sex. Also, consult your partner(s) prior to having sex about their risk of infection.

When to Seek Medical Care

Seek medical care if you experience any of the symptoms of syphilis. You should be tested for syphilis routinely if you are a man who has sex with men, are pregnant, have HIV, or have a partner infected with syphilis.

Even if symptoms subside, without treatment, secondary syphilis can turn into tertiary syphilis, which can involve the brain and the heart with very serious side effects.


Syphilis must be treated with penicillin. If you are allergic to penicillin, you will need to be desensitized to it. You should also be tested for HIV infection. Syphilis can be completely cured, but only with treatment.
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Secondary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and Scalp
A medical illustration showing key findings of Secondary syphilis : Fever, Headache, Lymphadenopathy, Malaise, Oral white plaque, Widespread distribution, Arthralgia, Multiple sexual partners, Myalgia, Pharyngitis, Stiff neck
Clinical image of Secondary syphilis - imageId=2848052. Click to open in gallery.  caption: 'Multiple brown papules and small plaques, some with overlying thick scales and others with collarettes, on the palm.'
Multiple brown papules and small plaques, some with overlying thick scales and others with collarettes, on the palm.
Copyright © 2023 VisualDx®. All rights reserved.