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Although biblical and ancient Chinese writings are consistent with descriptions of late syphilis, the relationship between the cutaneous eruptions of secondary syphilis and the primary lesions or genital sores does not seem to have been recognized until late in the 15th century ( 40, 66). Historical Perspectives Regarding Secondary SyphilisĪmong etiologic agents and their respective infectious disease entities, Treponema pallidum and syphilis unquestionably have one of the richest recorded histories known to humankind. 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.

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 rate of primary and secondary syphilis in the United States increased in 2002 for the second consecutive year. Such opinions were based primarily on the observations that violent cutaneous reactions and fatalities associated with the secondary stage had become extremely rare.

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. An important theme that emerges from all early historical accounts is that in addition to the decreased virulence of Treponema pallidum, the incidence of secondary syphilis has decreased drastically over the past three centuries.