Sífilis secundaria, 590 dilemas resueltos

Abstract

espanolIntroduccion: La Organizacion Mundial de la Salud (OMS) hasta agosto de 2016 reporto que cada ano 5.6 millones de personas contraen sifilis en todo el mundo. En la actua-lidad, existe un incremento global de la incidencia de la enfermedad, que es constante en la ultima decada. La sifilis secundaria es la etapa de la enfermedad conocida como «la gran simuladora», debido al polimorfismo que muestra en sus diversas formas de presentacion, lo que suele dificultar el diagnostico con el agravante de la infectividad que representa este estadio de la enfermedad. Objetivos: Mostrar las formas actuales de presentacion de la sifilis secundaria de acuerdo con lo observado en la seccion de Enfermedades de Transmi-sion Sexual (ETS) en un hospital de enfermedades infecciosas en la Ciudad Autonoma de Buenos Aires (CABA), a la luz del aumento creciente de casos de la enfermedad. Observar el diverso espectro de presentacion y establecer diferentes parametros identificatorios de la enfermedad que puedan orientar por su sola presencia a la sifilis secundaria. Material y metodos: Se realizo estudio transversal de los casos de sifilis diagnosticados entre marzo de 2014 y marzo de 2017 en el sector de ETS. Los pacientes fueron evaluados segun edad, genero, sexualidad y formas clinicas de presentacion. Resultados: Se diagnosticaron 1,236 casos de sifilis tempra-na. La prevalencia de sifilis secundaria fue de 48%. Setenta por ciento de los afectados eran hombres. Cuarenta y nueve por ciento de los casos de ambos sexos se presentaron en la franja de entre 20 y 30 anos. El 68% de los enfermos refirio ser heterosexual. El 44% de los afectados tuvo compromiso cutaneo mucoso, 28% solo mostro compromiso de mucosas y 47% presento adenopatias perifericas. Conclusion: Esta numerosa cohorte, la mayor de acuerdo con la bibliografia publicada a la fecha, muestra una incidencia sostenida de sifilis secundaria en un hospital publico. Se destaca que ante la aparicion de exantema con o sin compromiso mucoso y adenopatias se debe pensar hoy mas que nunca en sifilis secundaria entre los diagnosticos diferenciales EnglishIntroduction: As reported by the World Health Organization (WHO), until August 2016, 5.6 million people were infected with syphilis every year. Currently, there is a global increase in the incidence of the disease, which is constant in the last decade. Secondary syphilis is the stage of the disease known as «the great imitator», due to the polymorphism that it shows in its various forms of presentation, which usually makes diagnosis difficult with the aggravating factor of the infectivity that represents this stage of the disease. Objectives: To show the current forms of presentation of the secondary syphilis according to what was observed in the Sexually Transmitted Diseases (STDs) section in a hospital of infectious diseases in the Autonomous City of Buenos Aires (CABA), in light of the increasing number of cases of the disease. To observe the diverse spectrum of presentation and to establish different identifying parameters of the disease which can orient, by its simply presence, to the identification of secondary syphilis. Material and methods: a cross-sectional study of the cases of syphilis diagnosed between March 2014 and March 2017 in the STD section was carried out. The patients were evaluated according to age, gender, sexuality and clinical forms of presentation. Results: 1,236 cases of early syphilis were diagnosed. Prevalence of secondary syphilis was 48%. 70% were men, 49% of both genders were between 20 and 30 years old.Sixty-eight percent (68%) of the patients reported to be heterosexual. Forty-four percent (44%) had mucosal and cutaneous manifestations, while 20% showed only mucosal manifestations and 47% had peripheral adenopathies. Conclusion: This large cohort, the largest according to the bibliography published to date, shows a sustained incidence of secondary syphilis in patients of a public hospital. It is important to emphasize that in the presence of exanthema, with or without mucosal compromise and adenopathy, secondary syphilis should be considered as part of the differential diagnosis