Question

In secondary syphilis, which one of the following features is NOT found?

• A. Maculopapular rashes
• B. Generalised nontender lymphadenopathy
• C. Aortitis
• D. Follicular syphilides

Hint:

Think about which finding takes years of untreated disease to develop rather than appearing during the early disseminated stage.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks which clinical feature does NOT belong to the secondary stage of syphilis, a systemic disease caused by Treponema pallidum that progresses through primary, secondary, and tertiary stages if untreated.

Step 2: Key Concept or Approach:
Secondary syphilis develops weeks after the primary chancre heals, once the spirochete disseminates through the bloodstream. It is a generalized, highly contagious stage marked by skin and mucosal involvement, along with reticuloendothelial activation, but it does not yet involve the destructive granulomatous lesions of late (tertiary) disease.

Step 3: Working Through the Options:
A symmetric maculopapular rash involving the trunk, palms, and soles is the hallmark cutaneous sign of secondary syphilis, so this option is a true feature. Generalised, non-tender ("rubbery") lymphadenopathy is also classic for this stage, reflecting bloodstream dissemination of spirochetes to lymphoid tissue. Follicular syphilides, a patchy "moth-eaten" alopecia caused by hair follicle involvement, likewise occur in secondary syphilis. Aortitis, in contrast, is a feature of tertiary (late) syphilis — it results from obliterative endarteritis of the vasa vasorum of the aorta, a process that takes years to develop and appears only after the disease has progressed well beyond the secondary stage.

Step 4: Conclusion:
Aortitis is the feature NOT found in secondary syphilis; it belongs to tertiary cardiovascular syphilis, making it the correct answer.