Secondary Syphilis with Symmetric, Dusky Red Rash

Secondary syphilis
The hands of a 41-year-old woman with secondary syphilis show a symmetric, dusky red, and polymorphic papulosquamous rash, also present on her soles.

Case of secondary syphilis

The clinical image shows the hands of a 41-year-old with symmetric, dusky red and polymorphic papulosquamous rash, diagnosed with secondary syphilis. Examination is generally consistent with regular, round papules identified on palms of the hands, soles of the feet, the trunk and back. The primary chancres of syphilis may go undiagnosed till symptoms of secondary syphilis develop.

The primary infection is traditionally painless and heals within a few weeks

Syphilis, also known as the great imitator is caused by T. pallidum. In the primary infection a traditionally painless, syphilitic chancre is present. The chancre typically heals within a few weeks and for this reason, often goes undetected by the patient. Haematogenous dissemination of T. pallidum occurs up to 6 months after the initial infection, causing secondary syphilis. This prompts the patients to seek medical attention. The dermatological symptoms of secondary syphilis are non-specific and are also often diagnosed by practitioners outside of sexual health. A common manifestation is condylomata lata, which are non-tender and moist papules prevalent in the genital region. They are often also confused with genital warts. 90% of the patients present with a maculopapular rash. The rash is subtle and can easily be confused with pityriasis rosea, a drug reaction, HIV seroconversion and infectious mononucleosis.

One feature that distinguishes the rash from other conditions is the involvement of the palms of the hands and soles of the feet. Mucous patches, although may be subtle, are a hallmark feature of the condition. The lesions are often overlooked unless specifically examined for. If secondary syphilis is left untreated, it may lead to tertiary syphilis. For this reason, it is important for clinicians to do a thorough dermatological assessment of the palms, soles and oral cavity of the patients that present with genital lesions. This is required for making the correct diagnosis.

Source: NEJM

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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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