Secondary syphilis develops 6 weeks after chancre
emergence and is characterized by constitutional symptoms, skin lesions, mucosal lesions and systemic involvement.
How HIV may affect the course and treatment of syphilis * Higher RPR or T pallidum hemagglutination assay titer * False-negative syphilis serology * More frequent prozone phenomenon (* 68) * Higher rate of asymptomatic primary syphilis (66-68) * Multiple or deeper chancres
during primary syphilis (69) * Overlap of primary- and secondary-stage features of syphilis (66,68) * Shorter latency period before meningovascular syphilis * Increased rate of early neurologic and ophthalmic involvement (66,68) * More rapid progression to tertiary manifestations (69) * Reduced efficacy of standard therapy for early syphilis ([dagger] 66) * More frequent relapse ([dagger] 68,70) * Delayed normalization of CSF values after treatment (69) Adapted from Pialoux et al.
Infection in travelers is usually characterized by an acute febrile illness, sometimes associated with a macular evanescent rash or chancre
Adding to the frustration, syphilis itself may be asymptomatic during many stages of the disease or the present chancres
are painless, atypical, or located in an inconspicuous anatomical site, thus confounding the clinical diagnostic capabilities (19).
Note venereal disease is defined as including: syphilis, gonorrhea, soft chancres
, and Nicolas-Favre-Krankheit (lymphogranuloma venereum and lymphopathia venerium).
Secondary syphilis is marked by a rash that typically appears 3-6 weeks after the chancres
emerge, (18) although it can appear months later.
Syphilis, being sexually transmitted disease, is expected to cause those pesky chancres
in areas that touch the genitalia.
often mimic other genital ulcers, including those caused by different sexually transmitted diseases such as chancroid (as a result of infection with Haemophilus ducreyi) or granuloma inguinale (Klebsiella granulomatis).
The diagnoses were confirmed by clinical characterization of genital necrotic and painful chancres
An increased frequency of ocular disease, multiple and slower resolving primary chancres
, and a higher titer RPR have been reported (1-6).