1. Syphilis – Clinical Aspects of Secondary Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health

3. Why a lecture on syphilis? Why a lecture on syphilis? Although syphilis is an eminently treatabledisease, its continuing occurrence illustrates that our control efforts still need to be improved. The disease remains elusive clinically even today, and unless thought of and sought for can silently cause disease as it has for centuries. Further, control of syphilis is vital because of its interactions with HIV. This lecture will focus on secondary syphilis.

4. Objectives To review the pathogenesis of secondary syphilis To demonstrate the clinical features of secondary syphilis To describe nondermatologic features of secondary syphilis

5. Clinical Stages Syphilis is conventionally divided into several stages: –Primary –Secondary –Latent –Late, or tertiary This lecture will focus on secondary syphilis

6. Natural History of Untreated Syphilis

7. Progression Into Secondary Syphilis Secondary syphilis is the most florid stage of syphilis Systemic infection –Dermatologic findings are most common –However, treponemes infect virtually all tissues Resolves when host immune response overcomes infection

8. Histopathology

9. Secondary Syphilis

11. An example of lesions of secondary syphilis on the foot, including the sole.

12. Secondary Syphilis

15. Condyloma Lata

16. Mucous Patch

17. Syphilis - Secondary Manifestation Percent of cases Skin90 Constitutional70 Mouth & throat 35 Genital lesions 20 CNS8-40 Renal, GI, Rheumatologic Unusual

18. Constitutional Symptoms Malaise Sore throat Headache Myalgias Pruritis

19. Constitutional Signs Fever (low-grade) Weight loss Lymphadenopathy –Inguinal most common –May be generalized Periosteal involvement Hepatitis Immune complex disease

20. Conclusions Secondary syphilis is a systemic disease and is typically florid Constitutional symptoms and signs are common and may cause diagnostic confusion Dermatologic findings are typically multiple and florid The basic pathology is obliterative endarteritis

21. Sources of Information The following sites are useful if more information on syphilis is sought: www.cdc.govwww.cdc.gov Centers for Disease Control www.who.intwww.who.int World Health Organization www.ashastd.orgwww.ashastd.orgAmerican Social Hygiene Association www.vnh.orgwww.vnh.org Virtual Naval Hospital