A 35-year-old prostitute is seen in a community health care clinic. About 4 months earlier, she had a painless labial sore and swelling of a right inguinal lymph node, both of which had subsided uneventfully over a period of several weeks. About 3 weeks later she developed fever and a generalized maculopapular skin rash that involved the palms of the hands and the soles of the feet. She has also has flattened, broad-based plaques in anogenital region. The most likely diagnosis is?

The patient presents with a lesion of secondary syphilis known as condyloma lata. This stage is marked by painless, superficial lesions of the skin and mucosal surfaces. It occurs 2 to 10 weeks after the primary chancre in approximately 75% of untreated people. Skin lesions frequently occur on the palms or soles of the feet and may be maculopapular, scaly, or pustular. Moist areas of the skin, such as the anogenital region, inner thighs, and axillae, may have broad-based elevated plaques called condylomata lata. The original lesion, the painless ulcer or chancre, is characteristic of primary syphilis. Chancroid is a similar lesion to the primary lesion in syphilis, but instead is painful. Condyloma acuminatum (anogenital was) is a similarly named lesion often referred to as a venereal wa and is due to HPV. Papillary hidradenoma is a common benign tumor of the vulva, presenting as a nodule that may ulcerate and bleed.