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Secondary Syphilis Rash

Shun Takei, Kiyozumi Suzuki, Hiromasa Otsuka, and Seishi Watanabe
Department of General Medicine, Ageo Central General Hospital, Saitama, Japan

Corresponding author: Kiyozumi Suzuki, kiyozumi.suzuki.med@gmail.com

DOI: 10.31662/jmaj.2023-0068

Received: May 1, 2023
Accepted: June 8, 2023
Advance Publication: September 13, 2023
Published: October 16, 2023

Cite this article as:
Takei S, Suzuki K, Otsuka H, Watanabe S. Secondary Syphilis Rash. JMA J. 2023;6(4):546-547.

Key words: secondary syphilis, Treponema pallidum, skin rash, palms and soles

A 57-year-old heterosexual male with diabetes was admitted to our hospital for glycemic control. During his physical examination, a nonpruritic rash was found on his trunk and extremities, including palms and soles (Figure 1). He reported a previous genital lesion and a similar rash that resolved spontaneously. Six months earlier, he had unprotected sex with a casual female partner. He was diagnosed with secondary syphilis based on being positive for rapid plasma reagin and Treponema pallidum hemagglutination. The test for human immunodeficiency virus was negative. He was treated with amoxicillin, which resulted in the healing of the rash.

Figure 1. Diffused erythematous maculopapular rash on the trunk (A).
Multiple rounded erythematous or reddish-brown spots on the palms and soles, partly with scale (B, C).
» Full size image

The rash of secondary syphilis is typically diffuse, nonpruritic, symmetric, and maculopapular on the trunk and extremities; however, the rash is nonspecific and difficult to distinguish from other skin rashes (1), (2). Nonetheless, the rash involving the palms and soles is a crucial clue to the diagnosis of secondary syphilis (2). Considering the rapid increase in the number of syphilis cases in Japan (3), (4), physicians should conduct a thorough dermatological assessment, including the examination of the palms and soles, to avoid overlooking the diagnosis of syphilis.

Article Information

Conflicts of Interest

None

Author Contributions

Shun Takei: Writing - Original draft, Methodology

Kiyozumi Suzuki: Methodology, Writing - review and editing

Hiromasa Otsuka: Methodology, Writing - review and editing

Seishi Watanabe: Methodology, Writing - review and editing

All authors critically reviewed the manuscript.

Informed Consent

Consent was obtained from the patient for the use of images for publication.

Approval by Institutional Review Board (IRB)

In this study, IRB approval was not required.

References

  1. 1.

    Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev. 2005;18(1):205-16.

  2. 2.

    Hughes Y. Do not miss secondary syphilis: examine the palms and soles. BMJ Case Rep. 2020;13(11):e237725.

  3. 3.

    Takahashi T, Arima Y, Yamagishi T, et al. Rapid increase in reports of syphilis associated with men who have sex with women and women who have sex with men, Japan, 2012 to 2016. Sex Transm Dis. 2018;45(3):139-43.

  4. 4.

    Yoshikura H. Changing demography of genital chlamydia, gonorrhea, genital herpes, condyloma, and syphilis infections in Japan. Jpn J Infect Dis. 2021;74(1):35-41.

JMA Journal is an Open Access journal distributed under the Creative Commons Attribution 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by/4.0/).
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