Secondary syphilis is the second stage of the sexually transmitted disease syphilis. This stage is the most contagious of all stages and is characterized by the spread of the bacteria which causes syphilis throughout the body.

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 and tertiary syphilis . Approximately one-third of untreated individuals with primary syphilis will progress to the second stage: secondary syphilis . This usually occurs at about 2 to 8 weeks after the appearance of the original painless sore (chancre) and in some cases the chancre may still be present. Secondary syphilis is the stage where the bacteria have spread in the bloodstream and have reached their highest numbers. The most common symptoms include skin rash which can be varied in appearance, yet frequently involves the palms and soles, in addition to lesions in the mouth, vagina, penis called mucous patches. Other lesions which can also appear are moist warty patches on the genitalia or skin folds called condylomata lata. During secondary syphilis additional symptoms such as fever, malaise, anorexia, and swollen lymph nodes may also be noted. This stage is the most contagious stage of syphilis. While it usually resolves within weeks, in some cases it may last up to a year.

Signs and tests

The diagnosis of secondary syphilis is usually based on blood tests. An initial screening is done with the non-treponemal tests such as VDRL or RPR. If these are positive, the diagnosis is confirmed by another blood test for a specific antibody - the FTA-ABS fluorescent treponemal antibody test. In addition to blood tests, if skin or mucous membrane lesions are present, the organism which causes syphilis may be identified on darkfield microscopic examination.

Treatment

The mainstay of treatment of secondary syphilis is antibiotic therapy. The antibiotic of choice is penicillin (which is usually given by injection once a week for three weeks). In individuals allergic to penicillin, doxycycline may be used for a total of two weeks. After antibiotic treatment, follow-up blood tests (RPR) should be done at 3 and 6 months (and later if needed) to assess whether treatment was effective, as treatment may need to be repeated or additional evaluation performed. In some individuals, a febrile reaction called Jarish-Herxheimer reaction may occur several hours following treatment of secondary syphilis. This is characterized by fevers, chills, malaise, joint and muscle aches and is usually self-limited (24 hours).

Expectations (prognosis)

Secondary syphilis can be completely cured if diagnosed early and treated effectively. 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:

Calling your health care provider

Notify your provider if you have symptoms suggestive of syphilis . Also, if you have recently changed sexual partners, have multiple sexual partners or have been diagnosed with any other sexually transmitted diseases, you should be screened for syphilis even if you don't have any symptoms.

Prevention

Safer sexual practices and consistent condom use are important measures in the prevention of syphilis. In addition, early diagnosis and treatment is needed to prevent ongoing transmission of this disease, as is screening during any evaluation for a sexually transmitted disease.