Severe clinical course in the setting of underlying immunosuppression (e.g., concurrent HIV infection).

Special variant of secondary syphilis : malignant syphilis.

Sore throat (acute syphilitic tonsillitis).

Patchy alopecia ( moth-eaten alopecia ).

Located in the anogenital region, intertriginous folds, and on oral mucosa.

Broad-based, wart-like, smooth, white papular erosions.

Involves trunk and extremities, also the palms and soles.

Typically disseminated, nonpruritic macular or papular rash.

2–12 weeks after primary infection and typically lasts 2–6 weeks

Disseminated disease due to the systemic spread of the spirochetes, inducing an immunologic reaction.

Nontender regional lymphadenopathy (e.g., involvement of the inguinal lymph nodes in genital primary syphilis ).

Resolves spontaneously within 3–6 weeks, typically without scarring.

Evolves into a painle ss, firm ulcer with indurated borde rs and smooth base.

Typically starts out as a solitary, raised papule (usually on the genitals).

5–10%: extragenital primary syphilis (most commonly, the oral cavity, finger, and anus or perianal region).

See “Subtypes and variants” for details on neurosyphilis, ocular syphilis, and otosyphilis, which can occur at any stage of infection. First-line treatment for syphilis is penicillin G allergen sensitization should be initiated in patients with a penicillin allergy. pallidum (e.g., darkfield microscopy, PCR) if a specimen of infected tissue is obtainable.

Alternatively, the diagnosis can be made using tests that directly detect T. Treponemal or nontreponemal serological studies are used for screening, and diagnosis is typically made based on clinical assessment and the interpretation of the syphilis serologies. Neurosyphilis, ocular syphilis, and otosyphilis are serious manifestations that can occur at any stage of infection.

During the tertiary stage, characteristic granulomas ( gumma) may appear, which can cause irreversible organ damage, particularly in the cardiovascular system (e.g., syphilitic aortic aneurysm). The first two stages are followed by an asymptomatic phase ( latent syphilis), which may last indefinitely or progress to tertiary syphilis. Secondary syphilis is characterized by a polymorphic, maculopapular rash that appears on the palms and soles. Primary syphilis manifests with a painless chancre ( primary lesion), typically on the genitals. The disease presentation consists of four distinct, successive clinical stages if left untreated. Syphilis is a predominantly sexually transmitted bacterial infection caused by the spirochete Treponema pallidum.

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