Pediatric emergency medicine trisk 1835 1835

One needs a high level of suspicion when viewing rashes in sexually active (or potentially abused) children to make the diagnosis of secondary syphilis, caused by the spirochete Treponema pallidum Manifestations of secondary syphilis usually occur to weeks after the appearance of the primary lesion, which may have gone unnoticed The exanthem extends rapidly and is usually pronounced The rash of secondary syphilis is characterized by a generalized cutaneous eruption, usually composed of brownish, dull-red macules or papules that range in size from a few millimeters to cm in diameter ( Fig 88.20 ) They are generally discrete and symmetrically distributed, particularly over the trunk, where they follow the lines of cleavage in a pattern similar to pityriasis rosea Papular lesions on the palms and soles, as well as the presence of systemic symptoms, such as general malaise, fever, headaches, sore throat, rhinorrhea, lacrimation, and generalized lymphadenopathy, help differentiate secondary syphilis Acquired syphilis is sexually contracted from direct contact with ulcerative lesions of the skin or mucous membranes of an infected individual Diagnosis may be presumed after a positive nontreponemal test, such as the VDRL slide test, rapid plasma reagin (RPR) test, or the automated reagin test Diagnosis should be confirmed by a treponemal test, such as the fluorescent treponemal antibody absorption test, the microhemagglutination test for T pallidum , or the T pallidum immobilization test Definitive diagnosis may also be made by identifying spirochetes by microscopic dark-field examination or direct fluorescent antibody tests of lesion exudate or tissue Penicillin is the treatment of choice unless contraindicated, in which case tetracycline, doxycycline, ceftriaxone, or erythromycin may be substituted Length of therapy should be based on duration and stage of infection Concomitant sexually transmitted diseases should be sought and treated empirically HIV testing is recommended for patients with secondary syphilis