secondary syphilis

Question 1

manif

Answer 1

skin manif occur in 80% or more of pxs w secondary syphilis.
early eruptions are symmetric more or less generalized superficial non destructive exanthematous transient and macular. later they are maculopapular or ppular eruptions. wc are usually polymorphous and less oftn scaly pustular or pigmented.

dist: face shoulder flank palm and soles and anal or genital regions.
presence of lesions in palms and soles are stornglybsuggestive

Question 2

macular eruption

Answer 2

earliest form of macular sec syphilis behins w app of exanthematous erythema 6-8 weeks after dev of chancre wc may still be present.
may be evanescent lasting only a few hour sor days or months or partially recur after having disappeared.
appears 1st on sides of trunk about the navel and inner surface of extremities.
color: light pink or rose to brownish red.
pain burning itch usually absent. pruritus may be present in 10-40% of pxs.
simultaneous w onset of eruption, gemeralized shotty adenopaghy most rradily plpable in posterior cervical , axillary and epitrochlear areas.

Question 3

papular eruption

Answer 3

arise slightly later than macular eruption. fully dev lesions are round and of a raw ham or coppery shade. 2-5 mm. nodules to large plaque can occur. surface is smooth and sometimes shiny. and other times covered a a thick adherent scale.
dist on: face, flexures or arms and lower legs. dist all over the trunk.
palmar and plantar inv char appears indurated yellowish red spots.

Ollendorf (Buschke-Ollendorff sign)- papules is temder to touch of a blunt probe.

Question 4

annular syphilid

Answer 4

as w sarcoidoss more common in blacks.
loc on cheeksX close to angle of mouth; where it may form annular arcuate pr gyrate patterns of delicate slightly raised infiltrated finely scaling ridges. ridgesare made up of minute flat topped papules. boundary bet ridges diff to discern.

“nickels and dimes”

Question 5

corymbose syphilid

Answer 5

occur late in secondary stg.

large central papule is surr by a group of tiny satellite papules.

Question 6

pustular sy

Answer 6

rare
widely scattered over trunk and extremities but they usually inv face spec forehead.
pustule arises on a red infiltrated base. thank

Question 7

lesions where ulceration is deep are called

Answer 7

ecthymatous

Question 8

a rare form if sec sy with severe ulcerations, pustules, or rupoid lesions acc by severe constitutional symptoms.

Answer 8

Lues maligna.

common in HIV infected men

Question 9

char feature kf secondary sy

Answer 9

inv of palms and soles

Question 10

may occur after tx w sec sy

Answer 10

aneroderma

Question 11

syphilitic alopecia

Answer 11

moth eating appearance

5% of pxs w secondary syphilis.

Question 12

most comin musosal lesion in early phase is

Answer 12

syphilitic sore throat.

Question 13

most char mucous membrane lesions if sec sy. macerated flat grayish rounded lesionscovered by andelicate soggy membrane. 5mm. occur on tonsils tongue pharynx gums lips buccal areas or genitalia cheofly in women

Answer 13

mucous patches

Question 14

useful in confirming dx

Answer 14

t pallidum specific immunoperoxidase stain.

Question 15

relapsing secondary syphilis

Answer 15

early lesions undergo invol spont or w tx. relapses occur in 25% of untreated px.
90% within 1st yr.
such relapses may take plaxe at the site of prev lesions on the skin or in viscera. recurrent eruptions tend to be more configurate annular larger a d asymmetric. thank

Question 16

systemic inc.

Answer 16

lymphatic system in secondary syphilis is involved.
LN affected are- inguinal, posterior cervcal, post auricular and epitrochlear.
nodes are shotty, firm, sligjtly enlarged, non tender, and discrete.

Question 17

H

Answer 17

Neutrophils within s corneum
elongation of rete ridges
interface dermatitis w a lymphocyte in every vacuole.
interstitial infiltrate(busy dermis)
perivasular plasma cells
lymphocytes w visible amphophilic cytoplasm
endothelial swelling.

plasma cells absent in 30% of cases.

Question 18

in early sy skin lesions, spirochetes ar emost numerous within

Answer 18

epidermis and around superficial vessels.

Question 19

may identify t pllidum infection when silver stains are negative

Answer 19

pcr and immunoperoxidase assay.

Question 20

long been known as

Answer 20

“great imitator”

bec various cutaneous manif may stimulate almosg any cutaneous or systemic dx.

Question 21

latent sy

Answer 21

no clinical signs.
serologic tests- reactive.
during early latent period, infectivity persists for atleast 2 years. a woman w early latent period may infect her unborn child.

for tx purpose, impt to distinguish early latency (<1ur durstion) from late latency (>1yr or unkown duration)