Secondary syphilis

The interval between the appearance of the primary chancre and the onset of secondary manifestations varies from 6 to 8 weeks. Constitutional symptoms including fever, headache, malaise and general aches and pains may precede or accompany the signs of secondary syphilis. The most common feature of the secondary stage of infection is a rash, which is present in about 80% of cases. The rash is typically a symmetrical, generalised, coppery red maculopapular eruption on face, palms and soles and is neither itchy nor tender. It can resemble any skin disease except those characterised by vesicles. Other features may be:

• condylomata lata, which are broad-based, moist, warty or papular growths occurring in skin folds or creases

• patchy alopecia (scalp, outer third of eyebrow)

• oral, pharyngeal or vulvovaginal ulcers or 'mucous patches', which are round lesions with a greyish-white base edged by a dull red areola which may coalesce to produce a serpiginous ulcer—the 'snail-track ulcer'

• lymphadenopathy characterised by firm, enlarged painless nodes typically involving inguinal, suboccipital, posterior cervical, axillary and preauricular groups.

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