Condyloma Lata (Secondary
Syphilis)
The word "condyloma" comes from the Greek word meaning "knob." Any
knob-like or warty growth on the genitals is known as a condyloma.
Venereal warts caused by human papilloma virus are known as "condyloma
accuminata" (venereal warts). The skin lesions caused by Molitor
hominus are known as "condyloma subcutaneum" (molluscum contagiosum).
The skin lesions associated with secondary syphilis are called "condyloma
lata." They have in common with veneral warts the fact that they are
both raised lesions on the vulva (or penis), but there ends the
similarity.
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condyloma accuminata are cauliflower-like, while condyloma lata
are smooth.
-
condyloma accuminata are dry, while condyloma lata are moist.
-
condyloma accuminata are bulky while, condyloma lata are flat.
Examination of surface scrapings of condyloma lata lesions under darkfield microscopy will show
the typical spirochetes. Serologic test for syphilis (VDRL, RPR) will be positive.
Optimal treatment is:
But for those allergic to penicillin, you may substitute:
-
Doxycycline 100 mg orally twice a day for 2 weeks, or
-
Tetracycline 500 mg orally four times a day for 2 weeks.
-
Ceftriaxone 1 gram
daily either IM or IV for 8--10 days (possibly effective).
-
Azithromycin 2 grams
PO once (possibly effective).
If the patient is pregnant, tetracyclines should not be used. Should the pregnant
patient also be allergic to penicillin, desensitization is recommended by many, but
circumstances may not allow for that. Of primary importance is that sufficient antibiotic gets across the placenta and to the fetus.
If not, fetal
syphilis will be insufficiently treated.
Within 24 hours of treatment, you may observe the Jarisch-Herxheimer
reaction in patients. This reaction consists of fever, muscle aches and
headache and may be improved by concurrent treatment with antipyretic medication. This reaction is more common among those
treated for primary syphilis than secondary.
Both the patient and her sexual partner(s) need treatment. Otherwise,
she will be re-infected, even if the initial treatment is successful.
Further, secondary syphilis, untreated, can lead to permanent neurologic
injury and death, so full treatment of all sexual partners is very
important.
Long term followup is needed to make sure that the syphilis is
completely gone from the patient and her sexual partner(s). The means to
do that is complicated and current CDC recommendations are best followed.
CDC Treatment Guidelines
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