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secondary syphilis

see syphilis Etiology: - unprotected intercourse with individual infected with syphilis - failure to recognize or to treat primary syphilis Pathology: - infection with Treponema pallidum (syphilis) - elongation of rete ridges, interface dermatitis, endothelial edema, lymphocytic & plasma cell infiltrate - immunostaining may reveal Treponema pallidum within the lower 1/3 of the epidermis Clinical manifestations: - fever - generalized weakness - diffuse rash affecting the trunk & palms of hands & soles of feet - maculopapular, hyperpigmented, & scaly eruption on palms, soles & trunk [1] - hypopigmented plaques on genitals [1] - papulosquamous lesions on the trunk [2] - copper-colored papules on the palms & soles with peripheral adherent scale [2] - Biett sign [3,4] * see images [1,2] Laboratory: - fluorescent treponemal antibody absorption test is reactive - elevated titer of rapid plasma reagin test - HIV1 RNA Management: - intramuscular penicillin G benzathine

General

syphilis

References

  1. Bhugra P, Maiti A. Images in Clinical Medicine: Secondary Syphilis. N Engl J Med 2020; 383:1375. Oct 1. PMID: 32997911 https://www.nejm.org/doi/full/10.1056/NEJMicm2001103
  2. Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449
  3. Weng PC, Li SH Biett Sign as an Indicator of Secondary Syphilis. Mayo Clinic Proceedings, 2024 Oct 99(10):1545-1546 PMID: 39254624 https://www.mayoclinicproceedings.org/article/S0025-6196(24)00219-2/fulltext
  4. Zheng Y, Xu M Biett's sign in secondary syphilis QJM. 2023. Aug 26 PMID: 37632786 https://academic.oup.com/qjmed/article/117/1/55/7252254