Incubation

Develops in 25% of untreated patients, typically 3 months after infection acquired.

Symptoms and Signs

• Multi-system involvement within the first 2 years of infection
• Often associated with a generalised rash affecting palms and soles, mucocutaneous lesions, condylomata lata (confluent wart like lesions) and generalised lymphadenopathy and fever.
• Less commonly: patchy alopecia, anterior uveitis, meningitis, cranial nerve palsies, hepatitis, splenomegaly, periosteitis, arthritis and glomerulonephritis.

Dark-ground microscopy and PCR: from mucous patches or condylomata lata

Serological tests: invariably all positive

Other tests: Full blood count, liver and renal function tests

Rapid tests: Some centres have a small supply of Abbott Determine TP fingerprick tests. These are especially useful for confirming clinical suspicion of secondary syphilis. Discuss with Senior Doctor and see pack for instructions on how to use. They are insufficiently sensitive to exclude syphilis completely and should not replace formal serological testing.

As for primary syphilis, unless the patient is pregnant or has neurological/opthalmological signs/symptoms.

For those with neurological/opthalmological symptoms and signs (and those who are pregnant) discuss management with GUM Consultant (and the relevant speciality) as imaging, lumbar puncture, pre-treatment steroids and admission for antibiotic treatment may be recommended.

SEE section on neurosyphilis.

DO NOT defer therapy if a single blood test is positive and the clinical picture fits: start treatment and take a confirmatory blood test.

Partner notification may need to extend to 2 years.