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SECONDARY (DISSEMINATED) SYPHILIS

Secondary syphilis is a systemic illness that may develop 2 to 12 weeks (mean, 6 weeks) after resolution of the chancre and occurs in about 25% of patients with untreated syphilis. During this stage, a high degree of spirochetemia occurs despite a vigorous immune response by the host. Constitutional symptoms are prominent during secondary syphilis, often with fever, malaise, anorexia, weight loss, and generalized lymphadenopathy. Involvement of epitrochlear lymph nodes is a classic finding. xlpharmacy.com

A rash is the most typical manifestation of secondary syphilis. Lesions usually begin on the trunk and may become widely distributed, characteristically involving the palms and soles. Lesions can be macular, maculopapular, papular, or pustular, but are never vesicular (except in cases of congenital syphilis).

Other characteristic findings of secondary syphilis include patchy alopecia due to involvement of hair follicles (follicular syphilids), condylomata lata - broad, grayish-white to erythematous eroded papules that develop in warm, moist intertriginous areas - and mucous patches - silvery-gray erosions with a red border that develop on mucous membranes. Condylomata lata and mucous patches are highly infectious and teeming with spirochetes. They are painless unless secondarily infected.

Central nervous system involvement occurs in up to 40% of patients during this stage. Cerebrospinal fluid (CSF) analysis often reveals elevated protein levels and a lymphocytosis. Symptoms may include headache, meningismus, and cranial nerve deficits, although only 1% to 2% of patients have symptoms of acute aseptic meningitis. Eye involvement, particularly uveitis, is present in 5% to 10% of patients with secondary syphilis, especially in HIV-infected patients, and gets worse with steroids.

Virtually any organ may be involved in secondary syphilis, with gastrointestinal, renal, and musculoskeletal disease reported. When untreated, patients spontaneously recover from secondary syphilis over the course of a few days to 10 weeks.

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