Syphilis - secondary

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Syphilis, secondary on the palms

Secondary syphilis

The mainstay of treatment of secondary syphilis is antibiotic therapy. The antibiotic of choice is penicillin (which is usually given by injection once a week for three weeks). In individuals allergic to penicillin, doxycycline may be used for a total of two weeks.

After antibiotic treatment, follow-up blood tests (RPR) should be done at 3 and 6 months (and later if needed) to assess whether treatment was effective, as treatment may need to be repeated or additional evaluation performed.

In some individuals, a Jarish-Herxheimer reaction may occur several hours following treatment of secondary syphilis. This is characterized by fevers, chills, malaise, joint and muscle aches, and usually lasts 24 hours.

Secondary syphilis can be completely cured if diagnosed early and treated effectively. 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 result in transmission to the fetus (congenital syphilis).

Notify your provider if you have symptoms suggestive of syphilis. Also, if you have recently changed sexual partners, have multiple sexual partners or have been diagnosed with any other sexually transmitted diseases, you should be screened for syphilis even if you don't have any symptoms.

Review Date: 06/15/2005
Reviewed By: Monica Gandhi, M.D., M.P.H., Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.