Case Of Secondary Syphilis In 62-Year-Old

The New England Journal of Medicine
  • 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 Medicine383(14), 1375-1375.

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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