American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common clinical manifestation of secondary syphilis?

1. A generalized rash

2. Fever and malaise

3. Severe headache

4. Joint pain

The correct answer is: A generalized rash

The most common clinical manifestation of secondary syphilis is a generalized rash. This rash is typically diffuse and may present as reddish-brown spots or lesion distributions over large areas of the body, including the trunk, extremities, and sometimes the palms and soles. The rash is due to the systemic dissemination of the Treponema pallidum bacterium, leading to widespread inflammatory response. In addition to the rash, secondary syphilis often includes mucous membrane lesions known as mucous membrane pemphigoid, which are also characteristic. While other symptoms like fever, malaise, headache, and joint pain can accompany secondary syphilis, they are not as defining or prevalent as the generalized rash. The rash itself serves as an important diagnostic clue in identifying secondary syphilis, distinguishing it from other stages of syphilis and other diseases.