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Histologic Features of Secondary Syphilis: A Systematic Review and Meta-Analysis.

Izadora Lapenda1,2, Amanda Tauana3, Alana Pereira4

  • 1Research Fellow, Rao Dermatology/NIDI Skin.

The American Journal of Dermatopathology
|March 18, 2026
PubMed
Summary
This summary is machine-generated.

Histopathology is key for diagnosing secondary syphilis, a condition mimicking other skin issues. Key features like endothelial swelling and plasma cell infiltration aid diagnosis when other tests are unclear.

Keywords:
dermatopathologyhistologic featuressecondary syphilis

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Area of Science:

  • Dermatology
  • Pathology
  • Infectious Diseases

Background:

  • Secondary syphilis, caused by Treponema pallidum, presents with diverse symptoms that can resemble other dermatological conditions.
  • The
  • great imitator
  • nature of secondary syphilis necessitates reliable diagnostic methods, especially when clinical or serologic findings are atypical.

Purpose of the Study:

  • To systematically analyze the key histopathological features of secondary syphilis.
  • To enhance the recognition of secondary syphilis through histopathology and reduce diagnostic errors.

Main Methods:

  • A systematic literature search was performed across PubMed, Embase, and Cochrane databases.
  • Meta-analysis of eight studies (384 patients, 460 lesions) using a random-effects model to determine the prevalence of histological features.
  • Statistical analyses were conducted using R version 4.3.2, with heterogeneity assessed via Cochrane Q test and I2 statistics.

Main Results:

  • Endothelial swelling was a prevalent feature (85%, 95% CI 0.75-0.96).
  • Moderate to dense plasma cell infiltration was observed in 83% of cases (95% CI 0.74-0.92).
  • Other noted features included acanthosis (66%) and perivascular inflammatory infiltrate (64%).

Conclusions:

  • Histopathology reveals consistent features in secondary syphilis, notably endothelial swelling and plasma cell-rich infiltrates.
  • These findings underscore the diagnostic utility of histopathology when clinical or serological evidence is inconclusive.