Syphilis Rash

Primary Syphilis: Characterized by the Chancre—a solitary, painless, indurated ulcer with a clean base. Usually found on genitals but can be extragenital (lips, fingers).

Secondary Syphilis: The "Great Imitator" rash. Classically non-pruritic, copper-colored (ham-colored) maculopapular lesions.

Key Distribution & Features:

• Palms and Soles: A pathognomonic finding; rarely seen in other viral/bacterial rashes.
• Condyloma Lata: Moist, wart-like papules in intertriginous areas (axilla, groin).
• Generalized Lymphadenopathy: Often involving epitrochlear nodes.
• Mucous Patches: Silvery-gray erosions on the tongue or buccal mucosa.

Pityriasis Rosea

• The Clue: Presence of a Herald Patch followed by a "Christmas Tree" distribution on the back. Lesions have a "collarette" of scale.
• Vs Syphilis: Pityriasis Rosea spares the palms and soles; Syphilis frequently involves them.

Psoriasis

• The Clue: Well-demarcated erythematous plaques with silvery scale. Auspitz sign (pinpoint bleeding when scale is removed).
• Vs Syphilis: Syphilitic lesions are usually less scaly and accompanied by systemic symptoms (fever, lymphadenopathy).

🚨 Urgent Referral Required if:

• Neurological Symptoms: Headache, altered mental status, or visual changes (suggests Neurosyphilis).
• Pregnancy: High risk of Congenital Syphilis; requires immediate desensitization if penicillin-allergic.
• Ocular Involvement: Eye pain or redness (Uveitis).
• HIV Co-infection: May require more aggressive monitoring and different workup.

First-Line Treatment (CDC)

• Primary, Secondary, or Early Latent: IM Benzathine Penicillin G 2.4 million units in a single dose.
• Late Latent: IM Benzathine Penicillin G 2.4 million units IM weekly for 3 weeks (3 doses).
  [Benzathine Penicillin G is safe in pregnancy]

Penicillin Allergy (Non-pregnant)

• Doxycycline 100mg BD for 14 days (Primary/Secondary, Early Latent).
• Doxycycline 100mg BD for 28 days (Late Latent).

⚠️ Jarisch-Herxheimer Reaction: Warn patients of acute febrile reaction (headache, myalgia) within 24h of first treatment.

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