Syphilis - secondary

• Alternative Names

  Secondary syphilis

• Causes, incidence, and risk factors

  Syphilis is a sexually transmitted infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages:

  • Primary syphilis
  • Secondary syphilis
  • Tertiary syphilis

  This article focuses on secondary syphilis.

  About a third of untreated individuals with primary syphilis will develop secondary syphilis. This usually occurs at about 2 to 8 weeks after the appearance of the original painless sore (chancre). Sometimes, the sore may still be present.

  In secondary syphilis, the bacteria has spread into the bloodstream.

• Symptoms

  The most common symptom is a skin rash, which varies in appearance, yet frequently involves the palms and soles. Lesions called mucous patches may be seen in or on the mouth, vagina, or penis.

  Moist, warty patches may develop on the genitalia or skin folds. These are called condylomata lata.

  During secondary syphilis, additional symptoms such as fever, general ill feeling, loss of appetite, muscle aches, joint pain, enlarged lymph nodes, and hair loss may occur.

• Signs and tests
  • Serum VDRL or serum RPR (used as screening tests). If these are positive, one of the following will need to be done to confirm the diagnosis:
    • FTA-ABS
    • MHA-TP
• Treatment

  Antibiotics are used to treat syphilis. The antibiotic of choice is penicillin, yet doxycycline may be used as an alternative in individuals with a penicillin allergy.

  For treatment of syphilis during pregnancy, penicillin is the drug of choice. Tetracycline cannot be used because it is toxic to the developing baby, and erythromycin may not prevent spread of the infection to the developing baby (congential syphilis). People allergic to penicillin should be desensitized to it before treatment.

  You must have follow-up blood tests at 3 and 6 months (and later if needed) to make sure the infection is gone. You should avoid sexual conduct until two follow-up tests show that the infection has been cured. Syphilis is extremely contagious in the primary and secondary stages.

  Several hours after treatment, some people have a reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include:

  • Chills
  • Fever
  • General feeling of being ill
  • General joint aches
  • General muscle aches
  • Headache
  • Nausea

  These symptoms usually disappear within 24 hours.

  Syphilis is a reportable infection -- that means that doctors must reported any cases of syphilis to public health authorities, so that potentially infected sexual partners may be identified and treated.

• Expectations (prognosis)

  Secondary syphilis can be completely cured if diagnosed early and treated effectively. While it usually goes away within weeks, in some cases it may last up to 1 year. Without treatment, up to one-third of patients will develop late complications of syphilis.

• Complications

  The complications of syphilis are related to the development of the syndromes associated with tertiary syphilis:

  • Cardiovascular complications (aortitis and aneurysms)
  • Destructive lesions of the skin and bones (gummas)
  • Neurosyphilis

  In addition, untreated secondary syphilis during pregnancy may spread the disease to the developing baby. This is called congenital syphilis.

• Calling your health care provider

  Notify your health care provider if you develop signs or symptoms of syphilis. Several conditions may have similar symptoms, so you will need to have a complete medical exam.

  If you have had intimiate contact with a person who has syphilis or any other STD, or have engaged in any high-risk sexual practices, including have multiple or unknown partners, or have used intravenous drugs, contact your doctor or get screened at at STD clinic or health department clinic.

• Prevention

  If you are sexually active, practice safe sex and always use condoms.

  All pregnant women should be screened for syphilis.

• References

  Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

  U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

  Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

  Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 235.

Review Date: 8/1/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Maternal & Child Health Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.