Secondary syphilis

1. Twenty five percent of untreated patients progress to secondary syphilis 2-6 months after exposure. Secondary syphilis lasts for 4-6 weeks.

2. Bilateral, symmetrical, macular, papular, or papulosquamous skin lesions become widespread. The lesions are non-pruritic and frequently involve the palms, soles, face, trunk and extremities. Condyloma lata consists of rash and moist lesions. Secondary syphilis is highly infectious. Mucous membranes are often involved, appearing as white patches in the mouth, nose, vagina, and rectum.

3. Generalized nontender lymphadenopathy and patchy alopecia sometimes occur. A small percentage of patients have iritis, hepatitis, meningitis, fever, and headache.

4. The serologic test (VDRL. RPR) is positive in >99% of cases; the test may be falsely negative because of the prozone phenomenon caused by high antigen titers. Retesting of a diluted blood sample may be positive. No culture test is available.

C. Latent syphilis consists of the interval between secondary syphilis and late syphilis. Patients have no signs or symptoms, only positive serological tests.

D. Late syphilis is characterized by destruction of tissue, organs, and organ systems.

1. Late benign syphilis. Gummas occur in skin or bone.

2. Cardiovascular syphilis. Medial necrosis of the aorta may lead to aortic insufficiency or aortic aneurysms.

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