Secondary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and ScalpAlerts and Notices
Synopsis
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
Codes
ICD10CM:A51.39 – Other secondary syphilis of skin
SNOMEDCT:
240557004 – Secondary syphilis
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Differential Diagnosis & Pitfalls
- Herpes simplex virus
- Aphthous ulcers
- Traumatic ulcer
- Squamous cell carcinoma
- Lichen planus
- Erythroplakia
- Erosions due to oral candidiasis
- Reactive arthritis (Reiter syndrome)
- Sarcoidosis
- Pemphigus vulgaris
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Last Reviewed:09/02/2020
Last Updated:08/18/2021
Last Updated:08/18/2021
Patient Information for Secondary syphilis - Oral Mucosal Lesion
Overview
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.
Treatments
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.Secondary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and Scalp