From the Guidelines
The secondary syphilis rash typically occurs on the trunk and spreads peripherally, involving palms and soles. This is based on the most recent and highest quality study available, which describes the manifestations of secondary syphilis as involving virtually all organ systems, with the most common manifestations being macular, maculopapular, papulosquamous, or pustular skin lesions 1. The rash is often accompanied by generalized lymphadenopathy and fever, malaise, anorexia, arthralgias, and headache. Key characteristics of the rash include:
- Usually beginning on the trunk and spreading peripherally
- Involving palms and soles
- Accompanied by generalized lymphadenopathy and fever, malaise, anorexia, arthralgias, and headache
- Can resemble other conditions, such as papilloma virus infection, particularly condyloma lata, which are moist, flat, papular lesions in warm intertrigenous regions 1. It is essential to note that secondary syphilis can resemble acute primary HIV infection, with constitutional symptoms, nonfocal CNS symptoms, and CSF abnormalities being common to both conditions 1.
From the Research
Secondary Syphilis Rash Locations
The secondary syphilis rash typically occurs in various parts of the body, including:
- Palms and soles, as characteristically involving these areas 2, 3, 4, 5
- Trunk and limbs, presenting as a maculopapular rash 4, 5
- Face, particularly on the cheeks, and near the angle of the mouth, in cases of annular secondary syphilis 3
- Lower extremities, such as the chest and legs 2
- Generalized distribution, including the entire body, in some cases 2, 6
Atypical Presentations
In some cases, the secondary syphilis rash may present atypically, particularly in patients with HIV co-infection, and may involve: