Dr. Amy Spizuoco highlights key points from her lecture, "The Evolving Landscape of STIs , " at the 2nd Annual Elevate-Derm Alliance Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah.

In this video

In conversation with Lisa Weisz, Dr. Spizuoco walks through the timeline of syphilis. Primary syphilis presents as a painless chancre (sometimes two lesions) in the genital area about 21 days after exposure and resolves on its own. Secondary syphilis follows roughly six weeks to six months later — the long window reflects that patients often don't remember the painless primary lesion — showing up as a widespread papular or maculopapular rash, classically on the palms and soles. Tertiary syphilis can appear a year or two out, bringing the neurologic sequelae and gummas, inflammatory lesions that can be disfiguring on the skin and can occur in the heart and bones, with cardiac gummas ultimately causing heart failure and death.

On molluscum, she uses oral cimetidine mostly on request — "it can't hurt and possibly could help" — but leans on destructive measures instead: cantharidin for kids she doesn't want to hurt, and liquid nitrogen, curettage, or electrodesiccation for those who tolerate more pain. She often sends families home with a topical retinoid to apply nightly between visits to minimize lesions, and adds a topical steroid for itchy kids with underlying atopy. For HPV and genital warts, she recommends the nine-valent vaccine even when warts are already present, noting studies show it can be both preventive and therapeutic.

  • Syphilis moves through three stages: a painless chancre around 21 days, a palm-and-sole maculopapular rash at six weeks to six months, and tertiary disease with gummas that can cause disfigurement, bone involvement, and fatal heart failure.
  • The painless, self-resolving primary lesion is why so many patients don't recall it — keep secondary syphilis on the differential for widespread rashes involving the palms and soles.
  • Oral cimetidine for molluscum is harmless and worth offering on request, but Dr. Spizuoco relies on destructive options — cantharidin, liquid nitrogen, curettage, or electrodesiccation — matched to the patient's pain tolerance.
  • A nightly topical retinoid between visits helps minimize molluscum lesions, and a topical steroid can control itch in atopic kids.
  • Recommend the nine-valent HPV vaccine even for patients who already have genital warts — studies support it as both preventive and treatment, with good patient responses.