Secondary syphilis is characterized by the following except –
Correct Answer: Painful and itchy maculopapular lesions
Description: The protean manifestations of the secondary stage usually include mucocutaneous lesions and generalized nontender lymphadenopathy. The skin rash consists of macular, papular, papulosquamous, and occasionally pustular syphilides; often more than one form is present simultaneously. The eruption may be very subtle, and 25% of patients with a discernible rash may be unaware that they have dermatologic manifestations. Involvement of the hair follicles may result in patchy alopecia of the scalp hair, eyebrows, or beard in up to 5% of cases. Constitutional symptoms that may accompany or precede secondary syphilis include sore throat (15-30%), fever (5-8%), weight loss (2-20%), malaise (25%), anorexia (2-10%), headache (10%), and meningismus (5%). Acute meningitis occurs in only 1-2% of cases. Less common complications of secondary syphilis include hepatitis, nephropathy, gastrointestinal involvement (hyperophic gastritis, patchy proctitis, or a rectosigmoid mass), ahritis, and periostitis. (Harrison's Principles of internal medicine, 20th edition, page 1382)
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