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Clinical Manifestations and Sequelae (continued)
Secondary Syphilis
Secondary lesions generally first appear 3-6 weeks after the primary chancre appears. Therefore, primary and secondary stages may overlap.
- A rash occurs in 75%-100% of secondary syphilis cases. The rash can be
macular,
papular, or
squamous,
pustular (rarely), or a combination. Rashes are usually nonpruritic, and they
characteristically involve the palms and soles. Any new onset of macular, papular, or squamous rash should be evaluated to rule out secondary syphilis.
- Lymphadenopathy occurs in 50%-86% of cases.
- Malaise is
a common constitutional symptom.
- Mucous patches, present in 6%-30% of cases, are flat patches involving the oral cavity, pharynx, larynx, and genitals.
- Condylomata lata (10%-20%) are moist, heaped, wart-like papules that occur in warm
intertriginous
areas (most commonly, gluteal folds, perineum, perianal);
these lesions are very infectious.
- Alopecia (5%) is patchy, occipital or bitemporal, and causes loss of lateral eyebrows.
- Liver and kidney involvement can
occur. Splenomegaly is occasionally present.
Serologic tests for syphilis are usually highest in titer during secondary syphilis. Relapses of secondary symptoms may occur in up to 25% of untreated patients, usually within the first year of infection.
Signs and symptoms of secondary syphilis often are the first observed clinical manifestation of syphilis in those practicing receptive vaginal or anal intercourse, because primary lesions may occur in the anus or vagina and may not be recognized by the patient.
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