1. Secondary syphilis. Features of modern motion.
Lector: Shkilna M.

2. CONTENT Taxonomy. The mode of transmission.
Secondary syphilis signs and symptoms.
Rashes of secondary syphilis:
Mucocutaneous rash.
Papular eruptions rash.
Papulo-squamous rash.
Pustular rash.
Mucous patches.
Condylomata lata.
Moth-Eaten alopecia (Hair Loss).
Systemic Manifestations.

3. Syphilis is: A Bacterial Infection that can be chronic and systemic
Infectious During Specific Time Frames related to Stage
Sexually Transmitted (oral, vaginal, anal)
Curable 3

4. Family: Spirochaetaceae
Taxonomy
Domain: Bacteria
Phylum: Spirochaetes
Order: Spirochetales
Family: Spirochaetaceae
Genus: Treponema
Species: pallidum 4

5. Characteristics Venereal syphilis (pallidum)
Helical, tightly coiled, mobile
5-20 um in length, um in diameter
Pathogenic treponemes associated with 4 diseases
Venereal syphilis (pallidum)
Yaws (perfenue)
Endemic (endemicum)
Pinta (carateum)
Obligate parasites of humans 5

6. The mode of transmission can be:
Sexual, which is the most important mode of infection.
Kissing the genitalia can produce extra- genital chancres on the lips, fingers and nipples.
Sexual perversion ( homosexual and orogenital contacts ).
Accidental inoculation.
Through contaminated blood.
Transplacental infection, from an infected mother to the fetus.
During delivery as the baby passes through an infected canal.

7. Clinical stages of syphilis
Acquisition
(~30%) 1o 2o 2o 3o
2 years
1 to 30 years:
If untreated occurs in 40%, 25% clinically recognisable
Incubation period
10-90 days
(average 21 days)
Weeks to few months
Episodes may recur
(occurs in 25%)
Early syphilis
(infectious)
Late syphilis
(non-infectious)

8. Syphilis Staging Flowchart
Symptoms or Signs?
YES NO
1º (Ulcer)
2º (Rash, etc)
LATENT
PRIMARY
SECONDARY
ANY IN PAST YEAR?
Negative syphilis serology
Known contact to an early case of syphilis
Good history of typical signs/symptoms
This flow chart can help you stage your patient’s syphilis infection accurately.
The presence of signs or symptoms usually point to primary or secondary syphilis, since tertiary syphilis is now uncommonly encountered. Remember, however, that late syphilis can manifest neurologic symptoms.
Patient’s with positive syphilis serologies who have no signs or symptoms of disease have latent syphilis, and historical factors are used to determine the likely length of the infection, as less than a year or more than a year.
YES NO
UNKNOWN
or LATE LATENT
EARLY LATENT

9. WHO clinical classification of syphilis9

10. Secondary Syphilis Signs and Symptoms
Usually occurs 3-6 weeks after primary chancre
Rash (75-90%)
Generalized lymph node swelling (70-90%)
Constitutional symptoms (50-80%)
Mucous patches (5-30%)
Condyloma lata (5-25%)
Patchy alopecia or hair loss (10-15%)
Symptoms of neurosyphilis (1-2%)
Less common: meningitis, hepatitis,
arthritis, nephritis

11. Rashes of Secondary Syphilis
Macular
The rash can be highly variable in its presentation.
Palmar
Papular

12. Secondary Syphilis Macular Eruptions
Exanthematic erythema 6-8 weeks after chancre, extends rapidly, may last hours to months
Round indistinct, slightly scaling ham-colored macules
Pain, burning absent, pruritus may be present
Generalized shotty adenopathy

13. Rash of Secondary Syphilis

14. Generalized Mucocutaneous Rash of Secondary Syphilis

15. Macular 15

16. Rash of Secondary Syphilis

17. Secondary Syphilis Papular Eruptions
Arise later than macular, raw-ham, round, 2-5mm or more in diameter, slightly raised, smooth or thick scale
Face and flexures of arms and legs, trunk
Palmar and plantar yellowish-red spots
Ollendorf’s sign; papule tender to touch of a blunt probe

18. Palmer/Plantar Rash of Secondary Syphilis

19. Secondary Syphilis Papular Eruptions
Lues Maligna; rare, severe ulcerations, pustules, or rupioid lesions, accompanied by severe constitutional symptoms.
Condylomata lata; papular mass, weeping, gray 1-3cm, groin, anus (not vegetative like condylomata acuminata)
Syphilitic alopecia; irregular, scalp has a moth-eaten appearance 5% of pts

20. Papular 20

21. Maculo-papular 21

22. Papulo-squamous 22

23. Pustular 23

24. Secondary Syphilis Mucous Membrane
Present in 1/3 of secondary syphilis
Most common is “syphilitic sore throat”
Diffuse pharyngitis, hoarseness
Tongue; patches of desquamation of papillae
Ulcerations of tongue and lips in late stages

25. SECONDARY SYPHILIS
Mucous patches are oral lesions found on the lips, cheeks, tongue, palate, tonsils these are oval or circular, slightly raised patches, covered by a grayish sodden membrane . Superficial ulcers in the form of “ snail-track” are occasionally seen.

26. Mouth 26

27. Condyloma lata wart-like lesions in moist intertriginous areas.
Sessile
don’t bleed easily.
D.D.: Condyloma accuminata:
Pedunculated
Bleed easily.
All of these lesions teem with treponemes and are highly contagious. 27

28. Other Manifestations of 2o Syphilis
Condyloma lata

29. Secondary Syphilis Condyloma Lata, Penis

30. Anal Lesions in Secondary Syphilis

31. Mucocutaneous Lesions of Secondary Syphilis

32. Generalized lymphadenopathy
Discrete.
Rubbery.
Not tender. 32

33. Secondary Syphilis Moth-Eaten Alopecia (Hair Loss)

34. Less Common
Retinitis 34

35. Systemic Manifestations:
Malaise
Anorexia
Headache
Sore throat
Arthralgia
Low grade fever
Nephrotic syndrome. 35

36. Secondary Syphilis Diagnosis
Nontreponemal serologic tests for syphilis are strongly reactive (seronegativity rarely in AIDS)
Spirochetes on darkfield exam

37. Secondary Syphilis Ddx “Great Imitator”
Pityriasis rosea
Drug eruptions (pruitic)
Lichen planus; Wickham’s striae, Koebner’s, pruitic
Psoriasis; no adenopathy
Sarcoidosis; need serology and silver staining of biopsy
Infectious mononucleosis, false pos RPR
Geographic tongue
Aphthous stomatitis

38. THE END 38