Condyloma Lata (Secondary Syphilis)

These skin lesions are associated with secondary syphilis and resemble condyloma acuminata (venereal warts), except their surface is smooth. They are raised, painless, flat lesions. Examination of the surface scrapings under darkfield microscope will show the typical spirochetes. Serologic test for syphilis (VDRL, RPR) will be positive.

Optimal treatment is:

• Benzathine penicillin G 2.4 million units IM in a single dose

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.

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 operational circumstances may not allow for that. In such cases erythromycin or Azithromycin can be effective, although the optimal dosage is unknown. The main concern here is that if insufficient antibiotic gets across the placenta and to the fetus, fetal syphilis will be insufficiently treated.

CDC Treatment Guidelines