Skin Disorders - How to Cure Secondary Syphilis (Secondary Lues)

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Diagnostic Hallmarks

Distribution: trunk and extremities, special predilection for the palms, soles, face, and genitalia

White plaques on mucous membranes

Patchy alopecia

Lymphadenopathy

Positive serologic tests for syphilis

Clinical Presentation

The eruption of secondary syphilis is characterized by the presence of various non confluent, dome-shaped, red papules 1 to four mm in diameter. The quantity of scale present is variable. Smaller lesions tend to have little visible scale, whereas bigger lesions may perhaps be fairly scaly. The papules often coalesce to form smaller annular lesions, but the formation of significant plaques practically never ever occurs. Annular lesions are especially likely to be identified on the face and genitalia.

The papules of secondary syphilis are randomly distributed on the trunk and extremities. In addition, they are regularly found on the face, palms, and soles. In fact, palmar lesions are sufficiently characteristic as to pretty much usually warrant a serologic test for syphilis regardless of the remainder of the clinical picture. Papules that occur on the palms and soles are typically bigger, firmer, and extra brown-red than are those located elsewhere. Itching, when present at all, is not commonly troublesome.

Other distinctive lesions of secondary syphilis include white plaques on the mucous membranes and flat-topped, red or white, moist papules (condylomata lata) in intertriginous internet sites. Patchy alopecia of the scalp and loss of the lateral eyebrows occur in some patients. Lymphadenopathy, fever, and malaise could also be present. A history of an ulcerating primary lesion (chancre) mayor may perhaps not be obtainable.

A clinical diagnosis of secondary syphilis have to be completed either by identification of typical spirochetes on dark-field examination or by way of serologic testing. The histologic pattern on biopsy is also really distinctive, and from time to time cases are first identified throughout examination of a biopsy specimen taken from an otherwise-unrecognized papulosquamous eruption.

Course and Prognosis

The ulcer of primary syphilis (chancre) appears two to 3 weeks after exposure to an infected person . It reaches its maximum size of 1 to two cm promptly and then remains stable until it undergoes spontaneous resolution 3 to 4 weeks later. The eruption of secondary syphilis begins at about this time, i.e., roughly 6 weeks right after original contact. Occasionally, there is a short period of overlap for the duration of which both main and secondary lesions are present. Of course, if the primary lesion occurs in a hidden site, the first apparent evidence of infection will be the secondary eruption. The lesions of secondary syphilis include motile spirochetes, and thus contagion, especially from moist lesions, is doable.

Left untreated, the lesions of secondary syphilis remain in place for about 2 months and then gradually undergo spotaneous resolution. Thereafter, over the subsequent 6 to 12, ollilts, recurrent crops of secondary lesions may redevelop.

Secondary syphilis is not merely a cutaneous infection. Systematic involvement in the form of lymphadenopathy, uveitis, hepatitis, or glomerulonephritis is frequently present.

About 1-third of the patients with secondary syphilis who go untreated create tertiary disease. A different one-third stay totally free of clinical disease but continue to have serologic evidence of activity (latent syphilis). The final 1-third seem to undergo spontaneous clinical and serologic remedy.

Treatment of patients with primary or secondary syphilis excepting oftentimes those with immunodeficiency) successfully halts all clinical progress of the disease. The serologic tests in these patients gradually turn out to be negative over a 12- to 36 month period. However, small or no permanent immunity is conferred as a result of main or secondary reinfection, and therefore reinfection is fairly doable.

Pathogenesis

Syphilis is caused by the spirochete Treponema pallidum. This organism is passed from person to person for the duration of close skin-to-skin get in touch with such as occurs during sexual clivity. Spirochetemia outcomes in the subsequent presence or infectious organisms in the mucocutaneous lesions of secondary syphilis. Antibody reaction to infections with T. pallidum is brisk, but this sort of immunologic response does not result in resolution of the disease in truth, reinfection is doable even when antibodies are present. The formation of these antibodies, together with the continued presence of treponemal antigen, outcomes in the development of circulating immune complexes that are Ihen responsible for some of the systemic symptoms and signs of the disease.

Therapy

Penicillin is the therapy of choice for syphilis. Penicillin is only successful in the course of the method of microbial replication, and given that T. pallidum replicates rather slowly, serum levels have to be maintained for 10 to 20 days. This is most conveniently accomplished via the use of intramuscularly administered benzathine penicillin. The item Bicillin L-A should be specified, given that Bicillin C-R contains a 50% mixture of short-acting procaine penicillin.

Some authorities recommend that for primary and secondary syphilis, 2.4 million units be given in a single injection. Most clinicians, on the other hand, administer an further 2.4 million units 1 week later. Tetracycline 2. g/day for 15 days can be utilised for patients allergic to penicillin. Right after treatment, serologic tests for syphilis should really be monitored at 3-month intervals until the titer of antibody has returned to zero. A rising titer following therapy suggests reinfection and the will need for retreatment.