Secondary syphilis is generally an immune complex disease presenting in various ways. In many cases symptoms are too mild to be of concern to the patient. The most common feature of the secondary stage of infection is a rash which is present in about 80% of cases. The rash is typically a symmetrical, generalised, coppery-red maculopapular eruption on face, palms and soles and is neither itchy nor tender. It can resemble any skin disease except those characterised by vesicles. Other features may be:

condylomata lata which are broad based, moist warty or papular growths occurring in skin folds or creases;

patchy alopecia;

oral, pharyngeal or vulvovaginal ulcers or ‘mucous patches’ which are round lesions with a greyish-white base edged by a dull red areola which may coalesce to produce a serpiginous ulcer — the ‘snail-track ulcer1; and

lymphadenopathy characterised by firm, enlarged painless nodes typically involving inguinal, suboccipital, posterior cervical, axillary and preauricular groups.

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