SECONDARY SYPHILIS

Syphilis is a sexually transmitted infection caused by the bacterium
Treponema pallidum. Ask for a history of a primary ulcer on the genital
area or elsewhere (lips) 1 to 2 months before the development of the
rash. Secondary syphilis presents with a generalised symmetric rash
which can mimic almost any other skin condition. A helpful diagnostic
symptom is the fact that secondary syphilis is not itchy. Also palms and
soles are usually affected as well as the face.
A positive RPR or VDRL screenings test is very likely based on syphilis if
confirmed by a positive TPHA (specific for Treponemal antibodies). In
yaws endemic areas positivity may however be caused by contact with
yaws. Results may be discordant in concomitant HIV-infection.
Management of secondary syphilis
- Benzathine penicillin 2,4 million units per IM injection weekly for 3 weeks.
- In case of penicillin-allergy: Erythromycin 500 mg 4 times daily for 2 weeks.
- Treat all partners!