- Secondary syphilis is characterised by a rash that appears 2 to 8 weeks after chancre development and sometimes before it heals.
- If other symptoms occur, it means the infection has spread throughout the body.
- Direct contact with a syphilis sore during vaginal, anal or oral sex with an infected person can transmit the infection.
A 62-year-old male patient presented to the emergency department with complaint of generalised weakness and a diffuse rash.
The patient’s temperature was 38.1°C (100.6°F) on examination. Physical examination showed a maculopapular, hyperpigmented and scaly eruption on his palms (Panel A), soles (Panel B) and trunk (Panel C). Hypopigmented plaques were also seen on the patient’s genitals. The patient’s history revealed that he had unprotected intercourse with multiple partners and had not noticed the chancres or genital ulcerations.
To confirm the diagnosis, a rapid plasma regain test was performed which showed an elevated titer of 1:128. In addition, a fluorescent treponemal antibody absorption test was reactive. He tested negative for human immunodeficiency virus.
The diagnosis of secondary syphilis was made. Primary syphilis infections are often asymptomatic. For this reason, an initial painless chancre may go unnoticed. The patient was prescribed intramuscular penicillin G benzathine. The rash had completely resolved at 3 months follow-up and a rapid reduction in plasma regain titre of 1:32 was also noted.
Bhugra, P., & Maiti, A. (2020). Secondary Syphilis. New England Journal of Medicine, 383(14), 1375-1375.