Secondary syphilis – clinical picture, differential diagnosis, treatment.
When is the primary stage of syphilis goes untreated, it develops into secondary syphilis which is characterized by a rash that appears from 2 to 8 weeks. Serological tests are always positive. Rashes in secondary syphilis have 3 common features:
- Do not itch
- They are coppery-red
- The lesions are symmetrically distributed (involving the entire trunk, extremities, palm and soles)
This secondary stage is initiated by the appearance of a macular rash in about 8 weeks after the infection exposure. The basic lesions of Secondary syphilis are papules. Papules appear 3 month after the infection. Other symptoms are low-grade fever, malaise, sore throat, headache, adenopathy and cutaneous or mucosal rash.
- Clinical features:
- Early non-specific symptoms -> Headache, low-grade fever, arthralgia and myalgia. (more pronounced at night)
- Microlymphadenopathy – detected in the neck, occipital, auricular and axillary regions.
- Macular syphilis (roseolar rash) – roseolar spots do not scale or itch.
- Papular syphilis – basic lesion of seconday syphilis. It is firm and round.
- On genitals, around the arms and vagina, large eruptions of hypertrophy, coalesced papules (condylomata lata)
- Psoriasis form papules of the palms and soles are common in black people.
- Syphilitic alopecia – patchy hair loss. Eyebrows and beard may be affected.
- Bilateral tonsillitis may co-exist.
- Differential diagnosis:
- Skin manifestations – dermatoses
- With macular rash – Drug eruptions, measles, Rubella
- With Papular eruptions – psoriasis, Lichen planus
- Angiogenital region – Condylomata lata have been diagnosed as hemorrhoids and condylomata accuminata.
- Eruptions on palms and soles – psoriasis, mycoses
- Oral lesions – Aphthae and Tonsillitis.
- Treatment:
- Penicillin is the drug of choice for all stages of penicillin. So an injection of Benzathine penicillin G 2.4 MU i.m. single dose
- In case of penicillin allergy, 100mg of doxycycline twice daily x 14 days.
- 2mg of Azithromycin single oral dose.