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Secondary syphilis is the second stage of the sexually transmitted disease syphilis. This stage is the most contagious.

Secondary syphilis

Syphilis is a sexually transmitted infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages:

• Primary syphilis
• Secondary syphilis
• Tertiary syphilis

This article focuses on secondary syphilis.

About a third of untreated individuals with primary syphilis will develop secondary syphilis. This usually occurs at about 2 to 8 weeks after the appearance of the original painless sore (chancre). Sometimes, the sore may still be present.

In secondary syphilis, the bacteria has spread into the bloodstream.

The most common symptom is a skin rash, which varies in appearance, yet frequently involves the palms and soles. Lesions called mucous patches may be seen in or on the mouth, vagina, or penis.

Moist, warty patches may develop on the genitalia or skin folds. These are called condylomata lata.

During secondary syphilis, additional symptoms such as fever, general ill feeling, loss of appetite, muscle aches, joint pain, enlarged lymph nodes, and hair loss may occur.

• Serum VDRL or serum RPR (used as screening tests). If these are positive, one of the following will need to be done to confirm the diagnosis:
  • FTA-ABS
  • MHA-TP

Secondary syphilis can be completely cured if diagnosed early and treated effectively. While it usually goes away within weeks, in some cases it may last up to 1 year. Without treatment, up to one-third of patients will develop late complications of syphilis.

The complications of syphilis are related to the development of the syndromes associated with tertiary syphilis:

• Cardiovascular complications (aortitis and aneurysms)
• Destructive lesions of the skin and bones (gummas)
• Neurosyphilis

In addition, untreated secondary syphilis during pregnancy may spread the disease to the developing baby. This is called congenital syphilis.

Notify your health care provider if you develop signs or symptoms of syphilis. Several conditions may have similar symptoms, so you will need to have a complete medical exam.

If you have had intimiate contact with a person who has syphilis or any other STD, or have engaged in any high-risk sexual practices, including have multiple or unknown partners, or have used intravenous drugs, contact your doctor or get screened at at STD clinic or health department clinic.

If you are sexually active, practice safe sex and always use condoms.

All pregnant women should be screened for syphilis.

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 235.