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 many non confluent, dome-shaped, red papules 1 to 4 mm in diameter. The amount of scale present is variable. Smaller lesions tend to have little visible scale, whereas larger lesions could possibly be fairly scaly. The papules in some cases coalesce to form little annular lesions, but the formation of substantial plaques virtually never occurs. Annular lesions are especially most 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 frequently located on the face, palms, and soles. In fact, palmar lesions are sufficiently characteristic as to almost often warrant a serologic test for syphilis regardless of the remainder of the clinical picture. Papules that happen on the palms and soles are normally larger, firmer, and additional brown-red than are those discovered elsewhere. Itching, when present at all, is not normally troublesome.

Other distinctive lesions of secondary syphilis consist of white plaques on the mucous membranes and flat-topped, red or white, moist papules (condylomata lata) in intertriginous web pages. Patchy alopecia of the scalp and loss of the lateral eyebrows happen in some patients. Lymphadenopathy, fever, and malaise might also be present. A history of an ulcerating main lesion (chancre) mayor could possibly not be obtainable.

A clinical diagnosis of secondary syphilis ought to be carried out either by identification of typical spirochetes on dark-field examination or via serologic testing. The histologic pattern on biopsy is also very distinctive, and from time to time instances are initial identified during examination of a biopsy specimen taken from an otherwise-unrecognized papulosquamous eruption.

Course and Prognosis

The ulcer of primary syphilis (chancre) appears two to three weeks right after exposure to an infected individual . It reaches its maximum size of 1 to two cm swiftly and then remains stable until it undergoes spontaneous resolution three to 4 weeks later. The eruption of secondary syphilis begins at about this time, i.e., approximately 6 weeks immediately after original contact. Occasionally, there is a brief period of overlap during which both main and secondary lesions are present. Of course, if the main lesion occurs in a hidden web site, the 1st apparent evidence of infection will be the secondary eruption. The lesions of secondary syphilis include motile spirochetes, and therefore contagion, particularly from moist lesions, is feasible.

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

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

About one-third of the patients with secondary syphilis who go untreated develop tertiary disease. Another 1-third stay zero cost of clinical disease but continue to have serologic evidence of activity (latent syphilis). The final one-third seem to undergo spontaneous clinical and serologic cure.

Therapy of patients with primary or secondary syphilis excepting often those with immunodeficiency) successfully halts all clinical progress of the illness. The serologic tests in these patients gradually grow to be negative over a 12- to 36 month period. Regrettably, 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 individual to person for the duration of close skin-to-skin contact such as occurs throughout 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 feasible 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 selection for syphilis. Penicillin is only powerful during the procedure of microbial replication, and given that T. pallidum replicates rather slowly, serum levels ought to be maintained for 10 to 20 days. This is most conveniently accomplished by way of the use of intramuscularly administered benzathine penicillin. The item Bicillin L-A ought to be specified, due to the fact Bicillin C-R contains a 50% mixture of brief-acting procaine penicillin.

Some authorities recommend that for primary and secondary syphilis, 2.four million units be given in a single injection. Most clinicians, still, administer an extra two.four million units 1 week later. Tetracycline 2. g/day for 15 days can be utilised for patients allergic to penicillin. Soon after therapy, serologic tests for syphilis need to be monitored at three-month intervals until the titer of antibody has returned to zero. A rising titer following treatment suggests reinfection and the want for retreatment.