Secondary syphilis is the second stage of the sexually transmitted disease syphilis. This stage is the most contagious.

Syphilis is a sexually-transmitted infectious disease caused by the spirochete Treponema pallidum. Syphilis has three main stages: primary syphilis, secondary syphilis, and tertiary syphilis.

About a third of untreated individuals with primary syphilis will develop secondary syphilis. This usually occurs at about 2 to 8 weeks after the appearance of the original painless sore (chancre). Sometimes, the sore may still be present.

In secondary syphilis, the bacteria has spread into the bloodstream.

The most common symptom is a skin rash, which varies in appearance, yet frequently involves the palms and soles. Lesions called mucous patches may be seen in or on the mouth, vagina, or penis.

Moist, warty patches may develop on the genitalia or skin folds. These are called condylomata lata.

During secondary syphilis, additional symptoms such as fever, general ill feeling, loss of appetite, muscle aches, joint pain, enlarged lymph nodes, and hair loss may occur.

Blood tests can be done to detect substances produced by the bacteria that causes syphilis. An initial screening is done with the VDRL test or RPR. If these are positive, the diagnosis is confirmed by another blood test called FTA-ABS.

Antibiotics are used to treat syphilis. The antibiotic of choice is penicillin, yet doxycycline may be used as an alternative in individuals with a penicillin allergy.

You must have follow-up blood tests at 3 and 6 months (and later if needed) to make sure the infection is gone. You should avoid sexual conduct until two follow-up tests show that the infection has been cured. Syphilis is extremely contagious in the primary and secondary stages.

Several hours after treatment, some people have a reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include:

• Fever
• Chills
• Headache
• Nausea
• General feeling of being ill
• General joint aches
• Genera muscle aches

These symptoms usually disappear within 24 hours.

Syphilis is a reportable infection -- that means that doctors must reported any cases of syphilis to public health authorities, so that potentially infected sexual partners may be identified and treated.

Secondary syphilis can be completely cured if diagnosed early and treated effectively. While it usually goes away within weeks, in some cases it may last up to 1 year. Without treatment, up to one-third of patients will develop late complications of syphilis.

The complications of syphilis are related to the development of the syndromes associated with tertiary syphilis:

• Neurosyphilis
• Cardiovascular complications (aortitis and aneurysms)
• Destructive lesions of the skin and bones (gummas)

In addition, untreated secondary syphilis during pregnancy may spread the disease to the developing baby. This is called congenital syphilis.

Notify your health care provider if you develop signs or symptoms of syphilis. Several conditions may have similar symptoms, so you will need to have a complete medical exam.

Also call your health care provider for an appointment if you have had sexual contact with someone who has syphilis.

If you are sexually active, practice safe sex and always use condoms.

All pregnant women should be screened for syphilis.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005:2274-2276.

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med 2004; 2: 362-365.