The second or secondary stage of syphilis is usually seen anywhere from 4-14 weeks after the primary infection. Secondary syphilis has a diverse presentation and can mimic other diseases. The symptoms usually involved in secondary syphilis include the following:
- Skin: A rash is not always seen in secondary syphilis, but when it occurs, it is seen as red/pink dots that essentially look like flat, painless bug bites. It is most common on the extremities (usually the bottom of the feet and palms) and the trunk. The rash is usually reddish-purple and may cover the entire back and extremities. Over the next few weeks, the rash lightens in color and then disappears.
- Condyloma latum: Associated with the rash are lesions that appear like warts, also known as condyloma latum. These lesions are seen in about 30% of patients with secondary syphilis. The lesions vary in size from 0.5-2 centimeters, appear like warts, are soft and fleshy to touch and have a broad base. They are most commonly found in areas of a body that are moist, like the genitals, anal area, and around the groin. These lesions are highly infectious and contain a high concentration of the bacteria that causes syphilis. In most cases, condyloma latum is painless and spontaneously disappears in a matter of weeks. However, sometimes, these lesions may require treatment if they bleed, ulcerate, or become infected.
- Constitutional symptoms: The secondary stage of syphilis is also marked by constitutional symptoms that may present as a flu-like illness; the individual may develop a sore throat, headache, fatigue, sore muscles and joints, lack of appetite, a low-grade fever and even hair loss.
The diagnosis of syphilis is easily made by swabs from the skin lesions and blood tests. It is important to know that this stage is highly infectious, and one can pass the infection to others through oral, vaginal, and anal sex.