A 32-year-old man presents with a painless papule on the glans that ulcerates and heals spontaneously. Two months later he develops a generalised maculopapular rash involving the palms and soles, mucous patches in the mouth, and condylomata lata in the perianal region. VDRL is reactive at 1:128. What distinguishes the condylomata lata seen here from condylomata acuminata caused by HPV?
- A Condylomata lata are painful; condylomata acuminata are painless
- B Condylomata lata show acetowhitening; condylomata acuminata do not
- C Condylomata lata are verrucous and keratinised; condylomata acuminata are smooth and flat
- D Condylomata lata are flat, moist, broad-based papules highly infectious with spirochaetes; condylomata acuminata are cauliflower-like, dry, and HPV-induced ✓
Explanation
This presentation describes secondary syphilis, which appears 6–8 weeks after the primary chancre. Condylomata lata are broad, flat, moist papules or plaques in moist intertriginous areas (perianal, vulval, axillary), caused by spirochaetal proliferation and teeming with Treponema pallidum — making them the most infectious lesions of syphilis. They are grey-white and have no keratotic surface. Condylomata acuminata (HPV 6/11) are cauliflower-like, keratinised, warty papillomas showing acetowhitening. The VDRL titre is a key distinguisher — high titres (1:128) support secondary syphilis.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.