{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:22:38Z","timestamp":1781511758449,"version":"3.54.1"},"reference-count":86,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2005,1,1]],"date-time":"2005-01-01T00:00:00Z","timestamp":1104537600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Clin Microbiol Rev"],"published-print":{"date-parts":[[2005,1]]},"abstract":"<jats:sec><jats:title>SUMMARY<\/jats:title><jats:p>An important theme that emerges from all early historical accounts is that in addition to the decreased virulence of<jats:italic>Treponema pallidum<\/jats:italic>, the incidence of secondary syphilis has decreased drastically over the past three centuries. Even in the early 20th century, most syphilologists were of the opinion that the disease had undergone changes in its manifestations and that they were dealing with an attenuated form of the spirochete. Such opinions were based primarily on the observations that violent cutaneous reactions and fatalities associated with the secondary stage had become extremely rare. The rate of primary and secondary syphilis in the United States increased in 2002 for the second consecutive year. After a decade-long decline that led to an all-time low in 2000, the recent trend is attributable, to a large extent, by a increase in reported syphilis cases among men, particularly homosexual and bisexual men having sex with men. The present review addresses the clinical and diagnostic criteria for the recognition of secondary syphilis, the clinical course and manifestations of the disease if allowed to proceed past the primary stage of disease in untreated individuals, and the treatment for this stage of the disease.<\/jats:p><\/jats:sec>","DOI":"10.1128\/cmr.18.1.205-216.2005","type":"journal-article","created":{"date-parts":[[2005,1,14]],"date-time":"2005-01-14T21:37:05Z","timestamp":1105738625000},"page":"205-216","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":196,"title":["Secondary Syphilitic Lesions"],"prefix":"10.1128","volume":"18","author":[{"given":"Robert E.","family":"Baughn","sequence":"first","affiliation":[{"name":"Departments of Dermatology"},{"name":"Medicine"},{"name":"Baylor College of Medicine, and the Syphilis Research and Infectious Disease Laboratories, Veterans Affairs Medical Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Musher","sequence":"additional","affiliation":[{"name":"Departments of Dermatology"},{"name":"Medicine"},{"name":"Baylor College of Medicine, and the Syphilis Research and Infectious Disease Laboratories, Veterans Affairs Medical Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1986.00520020031012"},{"key":"e_1_3_2_3_2","first-page":"309","volume":"36","year":"1952","unstructured":"Bauer, T. J., E. V. Price, and J. C. Cutler. 1952. Spinal fluid examinations among patients with primary or secondary syphilis. Am. J. Syph.36:309-\u2022\u2022\u2022.","journal-title":"Am. J. Syph."},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.4049\/jimmunol.136.4.1406","volume":"136","year":"1986","unstructured":"Baughn, R. E., M. C. McNeeley, J. L. Jorizzo, and D. M. Musher. 1986. Characterization of the antigenic determinants and host components in immune complexes from patients with secondary syphilis. J. Immunol.136:1406-1414.","journal-title":"J. Immunol."},{"key":"e_1_3_2_5_2","first-page":"27.1","year":"2001","unstructured":"Baughn, R. E., and R. F. Schell. 2001. Immune responses to Treponema pallidum and Borrelia burgdorefi, p. 27.1-27.7. In R. R. Rich (ed.), Principles and practice of clinical immunology, 2nd ed. Mosby, St. Louis, Mo.","journal-title":"Principles and practice of clinical immunology"},{"key":"e_1_3_2_6_2","first-page":"1587","volume":"6","year":"1987","unstructured":"Berry, C. D., T. M. Hooton, A. C. Collier, and S. A. Lukehart. 1987. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N. Engl. J. Med.6:1587-1589.","journal-title":"N. Engl. J. Med."},{"key":"e_1_3_2_7_2","unstructured":"Bronzan R. L. Echavarria J. Hermida M. Trepka T. Burns and K. Fox. 2002. Syphilis among men who have sex with men (MSM) in Miami-Dade County Florida. Program Abstr. 2002 Nat. STD Prev. Conf. abstr. P135."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-86702003000400008"},{"key":"e_1_3_2_9_2","first-page":"75","volume":"44","year":"1995","unstructured":"Centers for Disease Control and Prevention. 1995. Morb. Mortal. Wkly. Rep.44:75.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_10_2","unstructured":"Centers for Disease Control and Prevention. 1998. Primary and secondary syphilis\u2014United States 1997. Mob. Mortal. Wkly. Rep. 47 : 493-497."},{"key":"e_1_3_2_11_2","first-page":"773","volume":"48","year":"1999","unstructured":"Centers for Disease Control and Prevention. 1999. Resurgent bacterial sexually transmitted disease among men who have sex with men\u2014King County, Washington, 1997-1999. Morb. Mortal. Wkly. Rep.48:773-777.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_12_2","first-page":"117","volume":"50","year":"2001","unstructured":"Center for Disease Control and Prevention. 2001. Outbreak of syphilis among men who have sex with men\u2014Southern California, 2000. Morb. Mortal. Wkly. Rep.50:117-120.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_13_2","first-page":"853","volume":"51","year":"2002","unstructured":"Centers for Disease Control and Prevention. 2002. Primary and secondary syphilis among men who have sex with men\u2014New York City, 2001. Morb. Mortal. Wkly. Rep.51:853-856.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_14_2","unstructured":"Centers for Disease Control and Prevention. 1999. The national plan to eliminate syphilis from the United States. U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for HIV STD and TB Prevention Atlanta Ga."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-197804000-00009"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-198010000-00002"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200305000-00008"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)33445-9"},{"key":"e_1_3_2_19_2","first-page":"81","volume":"40","year":"1964","unstructured":"Collart, P., L.-J. Borel, and P. Durel. 1964. Significance of spiral organisms found, after treatment, in late human and experimental syphilis. Br. J. Vener. Dis.40:81-89.","journal-title":"Br. J. Vener. Dis."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)33455-1"},{"key":"e_1_3_2_21_2","unstructured":"Dennis C. C. 1962. A history of syphilis. Charles C Thomas Springfield Ill."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1995.tb04441.x"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(92)90574-U"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1977.03630140012006"},{"key":"e_1_3_2_25_2","first-page":"363","volume":"23","year":"1992","unstructured":"Edlin, B. R., K. L. Irwin, D. D. Ludwig, et al. 1992. High-risk sex behavior among young street-recruited crack cocaine smokers in three American cities: an interim report. J. Psychoactive Drugs23:363-371.","journal-title":"J. Psychoactive Drugs"},{"key":"e_1_3_2_26_2","first-page":"221","volume":"56","year":"1980","unstructured":"Engel, S., and W. Diezel. 1980. Persistent serum immune complexes in syphilis. Br. J. Vener. Dis.56:221-222.","journal-title":"Br. J. Vener. Dis."},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199704000-00004"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1980.03300500026022"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(83)90268-4"},{"key":"e_1_3_2_30_2","unstructured":"Fracastoro H. 1930. De contagione et contagiosis morbis et eorum curatione libri III. Translated by W. C. Wright. G. P. Putnam's Sons New York NY."},{"key":"e_1_3_2_31_2","unstructured":"Frederick W. R. R. Delapenha S. Barnes et al. 1988. Secondary syphilis and HIV infection. Program. Abstr. 28th Intersci. Conf. Antimicrob. Agents Chemother. abstr. 1175 p. 320."},{"key":"e_1_3_2_32_2","first-page":"371","volume":"60","year":"1984","unstructured":"Goh, B. T., G. W. Smith, L. Samarasinghe, V. Singh, and K. S. Lim. 1984. Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid. Br. J. Vener. Dis.60:371-373.","journal-title":"Br. J. Vener. Dis."},{"key":"e_1_3_2_33_2","unstructured":"Goodman H. 1943. Notable contributions to the knowledge of syphilis. Froben Press New York N.Y."},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200004000-00003"},{"key":"e_1_3_2_35_2","unstructured":"Gorbach S. L. J. G. Bartlett and N. R. Blacklow (ed.). 2003. Infectious diseases 3rd ed. Lippincott Williams & Wilkins Philadelphia Pa."},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199412013312201"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-118-5-199303010-00005"},{"key":"e_1_3_2_38_2","first-page":"167","volume":"20","year":"1985","unstructured":"Harris, R. L., P. A. Rutecki, D. T. Donovan, M.-W. Bradshaw, and T. W. Williams, Jr. 1985. Fever, headache and hearing loss in a young homosexual man. Hosp. Pract.20:167-170.","journal-title":"Hosp. Pract."},{"key":"e_1_3_2_39_2","first-page":"119","volume":"45","year":"1990","unstructured":"Held, J. L., M. Ross, V. Beltrani, Jr., S. R. Kohn, and M. E. Grossman. 1990. Noduloulcerative or \u201cmalignant\u201d syphilis in an otherwise healthy woman: report and review of a dramatic dermatosis. Cutis45:119-122.","journal-title":"Cutis"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-107-4-492"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(40)90037-2"},{"key":"e_1_3_2_42_2","unstructured":"Holcombe R. C. 1938. The holy wood and the Haitian myth of the origin of syphilis p. 12-19. In Syphilis. Publication 6. American Association for the Advancement of Science Washington D.C."},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(92)90673-Y"},{"key":"e_1_3_2_44_2","unstructured":"Howles J. K. 1943. A synopsis of clinical syphilis p. 59-98 and p. 466-499. The C. V. Mosby Co. St. Louis Mo."},{"key":"e_1_3_2_45_2","first-page":"56","year":"1956","unstructured":"Hudson, E. H. 1956. Treponematosis. Current Lit. Vener. Dis., Spec. Issue, p. 56.","journal-title":"Current Lit. Vener. Dis."},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-121-2-199407150-00003"},{"key":"e_1_3_2_47_2","unstructured":"Ingraham N. R. Jr. 1938. Spirochaeta pallida and the etiology of syphilis p. 40-46. In Syphilis. Publication 6. American Association for the Advancement of Science Washington D.C."},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198706183162503"},{"key":"e_1_3_2_49_2","first-page":"129","volume":"62","year":"1986","unstructured":"Jorgensen, J., G. Tikjob, and K. Weisman. 1986. Neurosyphilis after treatment of latent syphilis with benzathine penicillin. Genitourin. Med.62:129-131.","journal-title":"Genitourin. Med."},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/153.6.1014"},{"key":"e_1_3_2_51_2","first-page":"344","volume":"24","year":"1977","unstructured":"Jozsa, L., M. Timmer, T. Somogyi, and J. Feher. 1977. Hepatitis syphilitica: a clinico-pathological study of 25 cases. Acta Hepatogastroenterol.24:344-347.","journal-title":"Acta Hepatogastroenterol."},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1993.00540030009006"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.3.388"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.1998.12.921"},{"key":"e_1_3_2_55_2","first-page":"12","year":"1964","unstructured":"Leslie, N. 1964. Treatment of early infectious syphilis with benzathine penicillin G, p. 12-19. InProc. World Forum Syphilis Other Treponematoses. USPHS publication 997. U.S. Public Health Service, Washington, D.C.","journal-title":"Proc. World Forum Syphilis Other Treponematoses"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-109-11-855"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-109-11-855"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-195602000-00002"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1086\/313725"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199303000-00005"},{"key":"e_1_3_2_61_2","first-page":"732","volume":"123","year":"1996","unstructured":"Misery, L., V. Besnard, R. Badel, E. Marneffe-Delalande, M. Faure, and J. Thiovolet. 1996. Malignant syphilis in human immunodeficiency virus infection. Ann. Dermatol. Venereol.123:732-734.","journal-title":"Ann. Dermatol. Venereol."},{"key":"e_1_3_2_62_2","first-page":"1549","volume":"319","year":"1989","unstructured":"Morgello, S., and H. Laufer. 1989. Quaternary neurosyphilis. N. Engl. J. Med.319:1549.","journal-title":"N. Engl. J. Med."},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-113-11-872"},{"key":"e_1_3_2_64_2","first-page":"101","year":"1983","unstructured":"Musher, D. M., and J. M. Knox. 1983. Syphilis and yaws, p. 101-120. In R. E. Schell and D. M. Musher (ed.), Pathogenesis and Immunology of treponemal infections. Marcel Dekker, Inc., New York, N.Y.","journal-title":"Pathogenesis and Immunology of treponemal infections"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1084\/jem.14.6.557"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1128\/mr.57.3.750-779.1993"},{"key":"e_1_3_2_67_2","unstructured":"Parran T. 1938. Syphilis: a public health problem p. 187-193. In Syphilis. Publication 6. American Association for the Advancement of Science Washington D.C."},{"key":"e_1_3_2_68_2","doi-asserted-by":"crossref","unstructured":"Pusey W. A. 1933. The history and epidemiology of syphilis. Charles C Thomas Springfield Ill.","DOI":"10.1097\/00007611-193310000-00029"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200307000-00006"},{"key":"e_1_3_2_70_2","first-page":"510","volume":"50","year":"1946","unstructured":"Riverius, L. 1946. Of causes of French pox. Urol. Cutan. Rev.50:510-515.","journal-title":"Urol. Cutan. Rev."},{"key":"e_1_3_2_71_2","first-page":"13","volume":"42","year":"1993","unstructured":"Rolfs, R. T. 1993. Surveillance for primary and secondary syphilis\u2014United States, 1991. Morb. Mortal. Wkly. Rep.42:13-19.","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199707313370504"},{"key":"e_1_3_2_73_2","first-page":"373","volume":"20","year":"2003","unstructured":"Romero-Jimenez, M. J., L. I. Suarez, P. J. M. Fajardo, and F. B. Baron. 2003. Malignant syphilis in patient with human immunodeficiency virus (HIV); case report and literature review. An. Med. Intern.20:373-376.","journal-title":"An. Med. Intern."},{"key":"e_1_3_2_74_2","unstructured":"Rosebury T. 1971. Microbes and morals: the strange story of venereal disease. Viking Press New York N.Y."},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1989.01670240066015"},{"key":"e_1_3_2_76_2","first-page":"527","volume":"22","year":"1905","unstructured":"Schaudinn, F., and E. Hoffmann. 1905. Bericht uber das Vorkommen von Spirochaeten in syphilitischen Krankheitsprodukten und bei Papillomen. Arb. Kaiserl. Gesurndheisamte22:527-532.","journal-title":"Arb. Kaiserl. Gesurndheisamte"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1972.03200180015003"},{"key":"e_1_3_2_78_2","first-page":"23","volume":"53","year":"1977","unstructured":"Shrivastav, S. N., and C. Singh. 1977. Extensive condyloma lata. Br. J. Vener. Dis.53:23-25.","journal-title":"Br. J. Vener. Dis."},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199601000-00003"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1990.tb03472.x"},{"key":"e_1_3_2_81_2","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1001\/jama.1976.03270200044030","volume":"236","year":"1976","unstructured":"Tramont, E. C. 1976. Persistence of Treponema pallidum following penicilling G therapy. A report of two cases. JAMA>236>:2206-2207.","journal-title":"JAMA"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM194208062270601"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0738-081X(01)00249-8"},{"key":"e_1_3_2_84_2","first-page":"116","volume":"44","year":"1968","unstructured":"Yobs, A. R., J. W. Clark, Jr., S. E. Mothershed, J. C. Bullard, and C. W. Artley. 1968. Further observations on the persistence of Treponema pallidum after treatment in rabbits and humans. Br. J. Vener. Dis.44:116-130.","journal-title":"Br. J. Vener. Dis."},{"key":"e_1_3_2_85_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/146.5.606"},{"key":"e_1_3_2_86_2","first-page":"260","volume":"18","year":"1986","unstructured":"Zaidman, G. W. 1986. Neurosyphilis and retrobulbar neuritis in a patient with AIDS. Ann. Ophthalmol.18:260-261.","journal-title":"Ann. Ophthalmol."},{"key":"e_1_3_2_87_2","first-page":"1","volume":"7","year":"1987","unstructured":"Zambrano, W., G. M. Perez, and J. L. Smith. 1987. Acute syphilitic blindness in AIDS. J. Clin. Neurol. Ophthalmol.7:1-5.","journal-title":"J. Clin. Neurol. Ophthalmol."}],"container-title":["Clinical Microbiology Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/CMR.18.1.205-216.2005","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/CMR.18.1.205-216.2005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T16:28:35Z","timestamp":1682958515000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/CMR.18.1.205-216.2005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1]]},"references-count":86,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2005,1]]}},"alternative-id":["10.1128\/CMR.18.1.205-216.2005"],"URL":"https:\/\/doi.org\/10.1128\/cmr.18.1.205-216.2005","relation":{},"ISSN":["0893-8512","1098-6618"],"issn-type":[{"value":"0893-8512","type":"print"},{"value":"1098-6618","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,1]]},"assertion":[{"value":"2005-01-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}