It begins with the appearance of a profuse rash throughout the body, which is often preceded by a deterioration in well-being, the temperature may increase slightly. The chancre or its remains, as well as the enlargement of the lymph nodes, are still preserved by this time. The rash is usually small, uniformly pink spots covering the skin, not rising above the surface of the skin, not causing itching, and not peeling. Spotted rashes of this kind are called syphilitic roseola. Since they do not itch, people who are inattentive to themselves can easily overlook it. Even doctors can make mistakes if they have no reason to suspect syphilis in a patient and make a diagnosis of measles, rubella, scarlet fever, which are now often found in adults. In addition to roseola, there is a papular rash, consisting of nodules the size of a match head to a pea, bright pink, with a bluish, brownish tint. Pustular or pustular, similar to ordinary acne, or a rash with chickenpox are much less common. Like other syphilitic rashes, pustules do not hurt.
The same patient may have spots, nodules, and pustules. The rashes last from several days to several weeks, and then disappear without treatment, so that after a more or less long time they give way to new ones, opening the period of secondary recurrent syphilis. New rashes, as a rule, do not cover the entire skin, but are located in separate areas; they are larger, paler (sometimes hardly noticeable) and tend to group together, forming rings, arcs and other figures. The rash can still be spotty, nodular or pustular, but with each new appearance the number of rashes is less and less, and the size of each of them is larger. For a secondary relapse period, nodules on the external genitalia, in the perineum, near the anus, under the armpits are typical. They increase, their surface becomes wet, forming abrasions, wet growths merge with each other, resembling cauliflower in appearance. Such growths, accompanied by a fetid odor, are not very painful, but can interfere with walking. In patients with secondary syphilis, there is the so-called "syphilitic tonsillitis", which differs from the usual one in that with redness of the tonsils or the appearance of whitish spots on them, the throat does not hurt and the body temperature does not increase. On the mucous membrane of the neck and lips there appear whitish flat formations of oval or bizarre outlines. On the tongue, bright red areas of oval or scalloped outlines, on which there are no papillae of the tongue, stand out. There may be cracks in the corners of the mouth - the so-called syphilitic seizures. Brownish-red nodules encircling it sometimes appear on the forehead - the “crown of Venus”. Purulent crusts may appear in the circumference of the mouth, imitating normal pyoderma. A rash on the palms and soles is very characteristic. If any rashes appear in these areas, you should definitely check with a venereologist, although skin changes here may be of a different origin (for example, fungal).
Sometimes on the back and side surfaces of the neck, small (about the size of a fingernail of the little finger) rounded light spots are formed, surrounded by darker areas of the skin. "Venus Necklace" does not peel and does not hurt. There is syphilitic alopecia (alopecia) in the form of either uniform thinning of the hair (up to a pronounced), or small numerous foci. It resembles a moth-beaten fur. Often eyebrows and eyelashes also fall out. All these unpleasant phenomena occur 6 or more months after infection. An experienced venereologist should have a cursory glance at the patient to diagnose syphilis based on these signs. Treatment quickly leads to restoration of hair growth. In debilitated, as well as in alcohol-abusing patients, multiple ulcers covered with layered crusts (the so-called "malignant" syphilis) are often scattered throughout the skin. If the patient has not been treated, then a few years after infection, he may have a tertiary period.