Spirochetes invade the body → disseminate systemically within hours → bind to endothelial cells → inflammatory reaction → endarteritis and perivascular inflammatory infiltrates
May be obliterating if reactive endothelial hyperproliferation occurs and results in ischemia and necrosis.
Clinical features
Secondary syphilis
Disseminated disease due to the systemic spread of the spirochetes, inducing an immunologic reaction
Begins approx. 2–12 weeks after primary infection and typically lasts 2–6 weeks
Constitutional symptoms
Generalized nontender lymphadenopathy
Fever, fatigue, myalgia, headache
Polymorphic rash
Typically disseminated, nonpruritic macular or papular rash
Involves trunk and extremities, also the palms and soles
Reddish-brown or copper-colored
Condylomata lata
Broad-based, wart-like, smooth, white papular erosions
Painless
Located in the anogenital region, intertriginous folds, and on oral mucosa
Additional lesions
Patchy alopecia (moth-eaten alopecia)
Diagnostics
Nontreponemal Tests
Examples: RPR, VDRL
Antibody: to cardiolipin-cholesterol-lecithin antigen
Sensitivity: Lower sensitivity in early infection
Treponemal Tests
Examples: FTA-ABS, TP-EIA
Antibody: to treponemal antigens
Sensitivity: Greater sensitivity in early infection
