Secondary syphilis is the second stage of the infection caused by the spirochete Treponema pallidum, which has spread hematogenously throughout the entire body. It typically occurs 3-10 weeks after the appearance of the primary syphilitic chancre.

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.

The second stage of syphilis is manifested in the genital area with moist, hypertrophic, papular lesions known as condylomata lata. These lesions can be hyperplastic or verrucous and often look like condylomata acuminata. Condyloma lata can occur adjacent to the site of the primary chancre, especially in immunocompromised individuals. They are teeming with spirochetes and are, therefore, extremely infectious. Uncommonly in the genital area, there can be mucous patches, which are nonspecific, superficial erosions. There may be multiple anogenital lesions, and they may be painful.

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