By a few weeks or months or possibly coincident with a primary lesion in secondary syphilis a variable overall, systemic or whole body illness develops. It is marked by a low-grade fever, feeling of unease, sore throat, headache, adenopathy and a cutaneous or mucosal rash. Secondary lesions is a manifestation of widespread hematogenous and lymphatic dissemination of T. pallidum. Spread to the central nervous system CNS is not typically happening with neurological signs. Standard therapy for early syphilis in persons without HIV infection appears equally effective for patients with or without abnormal CSF.
In beginning finding disseminated syphilis is an evanescent copper-colored macular rash that is usually overlooked by the patient and not seen by the physician. Within a few days, there is widespread papular eruption appearing. It involves palms of the hands and soles of the feet. The papules are red or reddish brown, discrete, and usually 0.5-2 cm in diameter. These marks are usually scaly, although they may be smooth, follicular, or rarely, pustular. Except for the involvement of palms and soles, syphilis may be difficult to distinguish from pityriasis rosea or psoriasis. Vesicles and bullae do not occur except in congenital syphilis of the newborn, although pustular lesions are seen on the palms or soles. Circular (annular) lesions occur on the face of dark-skinned persons. Hypo or hyperpigmentation may be seen. Alopecia occurs in some cases. Mucosal lesions, either small, superficial, ulcerated areas with grayish borders that resemble painless aphthous ulcers or larger gray plaques, also are common.
Condyloma lata is a term used to describe large, raised, whitish or gray lesions found in warm, moist areas. These lesions were originally described as a manifestation of secondary syphilis, resulting from the effects of local skin breakdown in warm, moist areas; most frequently, the axilla and groin were involved. Back to syphilis from secondary syphilis.