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The Histopathological Features of Secondary Syphilis: A Case Series
Ailish Hanly1,2, Gauri Panse1,2, Peggy Myung1,2
1Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.
Journal of Cutaneous Pathology
|April 8, 2026
Summary
Histopathological analysis of secondary syphilis reveals diverse presentations, challenging typical diagnostic patterns. Spirochete immunohistochemistry confirmed the infection in most cases, highlighting the need for broad diagnostic consideration.
Area of Science:
- Dermatopathology
- Infectious Disease Histology
- Syphilis Diagnosis
Background:
- Secondary syphilis presents with varied clinicopathological features.
- Diagnosis relies on spirochete detection and serology.
- This study examines histopathological patterns in secondary syphilis cases.
Purpose of the Study:
- To describe histopathological features of secondary syphilis.
- To identify typical patterns associated with positive spirochete immunohistochemistry.
- To assess the range of presentations for this infection.
Main Methods:
- Retrospective review of dermatopathology database (2016-2023).
- Analysis of H&E-stained slides, spirochete immunohistochemistry, and patient data.
- Inclusion of 33 biopsies from 27 patients with secondary syphilis.
Main Results:
- Common epidermal changes included acanthosis (36.4%) and flattened epidermis (21.2%).
- Granulomas (42.4%) and plasma cells (81.8%) were frequent dermal findings.
- Spirochetes were detected via immunohistochemistry in 81.8% of specimens.
Conclusions:
- Secondary syphilis exhibits a wide spectrum of epidermal and dermal reaction patterns.
- Typical features like elongated rete and lichenoid infiltrate are not always present.
- Consider secondary syphilis in the differential diagnosis of diverse inflammatory skin conditions.
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