Syphilis Clinical Aspects of Secondary Syphilis. Part III

Clinical Aspects of Secondary Syphilis Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health 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. Objectives • To review the pathogenesis of secondary syphilis • To demonstrate the clinical features of secondary syphilis • To describe nondermatologic features of secondary syphilis Clinical Stages • Syphilis is conventionally divided into several stages: – Primary – Secondary – Latent – Late, or tertiary • This lecture will focus on secondary syphilis Natural History of Untreated Syphilis 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 Histopathology Secondary Syphilis Secondary Syphilis Secondary Syphilis An example of lesions of secondary syphilis on the foot, including the sole. Secondary Syphilis Secondary Syphilis Secondary Syphilis Condyloma Lata Mucous Patch Syphilis - Secondary Manifestation Skin Constitutional Percent of cases 90 70 Mouth & throat Genital lesions CNS Renal, GI, Rheumatologic 35 20 8-40 Unusual Constitutional Symptoms • Malaise • Sore throat • Headache • Myalgias • Pruritis Constitutional Signs • Fever (low-grade) • Weight loss • Lymphadenopathy – Inguinal most common – May be generalized • Periosteal involvement • Hepatitis • Immune complex disease 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 Sources of Information The following sites are useful if more information on syphilis is sought: www.cdc.gov Centers for Disease Control www.who.int World Health Organization www.ashastd.org American Social Hygiene Association www.vnh.org Virtual Naval Hospital