Clinical Manifestations Of Syphilis Research Articles

Clinical manifestations of syphilis in the oral cavity — a review

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection.

Atypical palmoplantar lesion in relapsed advanced latent syphilis with HIV co-infection

Syphilis is a systemic infection caused by Treponema pallidum subspecies pallidum, which has a major and various manifestations on the skin (the great imitator). Its prevalence is frequently associated with Human Immunodeficiency Virus (HIV) prevalence. Atypical and aggressive presentation of syphilis is more commonly found in persons with syphilis and co-infection of HIV. We report a case of a 30-year-old male with erythematous plaques and desquamation on his palms and soles with neither pain nor pruritus, and also Beau’s line on the hand and toe nails. HIV infection was detected. The diagnosis of the patient was relapse late latent syphilis with HIV co-infection. The diagnosis of syphilis was established based on clinical and serological testing. The clinical manifestations of syphilis in immunosuppressed patients are often atypical. In order to treat, the patient was prescribed with doxycycline 100 mg two times a day for a month and showed clinical improvement after three weeks course of medication. Serologic testing interpretation and treatment do not differ between syphilis patients with and without HIV co-infection.

Anemia in early congenital syphilis

The determination of blood parameters allowed us to establish that anemia develops in a number of infectious diseases, which is called "anemia of inflammation" or anemia of chronic diseases. The article presents a rare clinical case of the development of anemia of the inflammatory response, accompanied by a marked decrease in the content of hemoglobin (less than 110 g/l), hematocrit (less than 30%) and red blood cells (less than 3,0 х 1012/l), in a child with early congenital syphilis with symptoms of: specific rhinitis, papular infiltration, pemphigus, hepatosplenomegaly and damage to the nervous system. As a result of specific treatment with water-soluble benzylpenicillin salt at the rate of 100 U/kg of body weight for 28 days, and transfusion of erythrocyte mass of 15 ml/kg of child weight, there was a parallel regression of clinical manifestations of syphilis with positive dynamics of serological reactions and restoration of the number of red blood cells and the concentration of hemoglobin in the blood.

Malignant Syphilis as an Initial Presentation of HIV Infection: A Case Report

Abstract Introduction : Malignant syphilis (MS) is a rare and severe variant of secondary syphilis that is frequently associated with HIV infection. The clinical impact of HIV and syphilis co-infection is bidirectional, and the presence of MS is associated with acute HIV infection. Clinically, MS is characterized by nodular and ulcerative lesions affecting the trunk and extremities, which are covered with thick crusts. The treatment of choice for MS remains benzathine penicillin G. Herein, we report a case in which MS was the initial presentation of HIV infection. Case presentation : A 35-year-old male patient came with the chief complaint of extensive erythematous nodular rash for the past one month, with notable ulceration on some lesions with annular configuration along with fever and malaise. Based on the abovementioned clinical, laboratory, and histopathologic findings, the patient was diagnosed with MS and HIV. The diagnosis was established based on histopathological examination and syphilis serological testing. Discussion : Cutaneous disorders are a frequent presenting feature of HIV infection. The clinical manifestations of syphilis in immunosuppressed patients are often severe and/or atypical. The patient was then treated with weekly intramuscular administration of 2.4 million units of benzathine penicillin G for 3 weeks and achieved rapid and significant clinical improvement, with no Jarisch-Herxheimer reaction. Conclusion : Co-infection with syphilis and HIV alters the course of both diseases, and most HIV-infected patients with syphilis have typical disease manifestations associated with decreased CD4+ T-cell counts.

A cross-sectional descriptive study of clinical and serological prevalence of syphilis infection in people living with HIV and its effect on CD4+ T cells.

Context:The natural history of syphilis could be altered in the presence of HIV. It has been documented that syphilis infection increases the risk of HIV transmission by at least 3-fold.Aims:The aim of the study was (1) to study clinical presentation of syphilis in HIV individuals, (2) to estimate seroprevalence of syphilis in HIV individuals, and (3) to study the effect of syphilis infection on CD4+ T cells.Subjects and Methods:HIV-positive patients attending sexually transmitted infection clinic for a period of 1 year from June 2017 to May 2018 in the age group of 15–70 years were included in the study. A detailed history was taken; genital and dermatological examination was done. All patients were tested with VDRL and treponema pallidum hemagglutination assay (TPHA). Pearson's Chi-square test was used to compare categorical variables and Student's t-test was used to compare continuous variables.Results:Out of ninety study population, nine (10%) had clinical manifestations of syphilis. VDRL was positive with significant titers in all cases of syphilis. TPHA was positive in 88.9% of cases with clinical syphilis and 17.3% of cases without clinical manifestations of syphilis. Mean CD4 count was low among patients having syphilis infection compared to study population.Conclusion:This study shows high prevalence of syphilis in HIV and highlights the importance of preventing and promptly treating syphilis in people living with HIV, as the active infection is associated with fall in CD4 count, which leads to opportunistic infections.

Syphilitic hepatitis; a rare manifestation of a common disease.

Syphilis is a sexual transmitted disease caused by Treponema pallidum and an underdiagnosed and underreported cause of acute hepatitis. In recent years, reported cases of primary and secondary syphilis have been increasing, mostly in men who have sex with men. Clinical manifestations of syphilis are diverse, earning the name of "the great imitator" which can affect virtually any organ. Nonetheless, hepatic involvement is rare, but it can occur at any stage of the disease. We present the case of a 41-year-old immunocompetent male, that presents to us with a cholestatic hepatitis and a diffuse erythematous rash with palmo-plantar affection. The patient had no history of primary syphilis. After throughout aetiologic study, he was diagnosed with syphilitic hepatitis and treated with intramuscular Benzathine benzylpenicillin, with the disappearance of the rash and normalization of liver enzymes after 3 months. We would like to highlight that this aetiology should be considered in patients with unexplained elevation of liver enzymes (mainly cholestatic enzymes) and an epidemiologic context of unsafe sexual exposure.

ORAL SYPHILIS: CLINICAL, HISTOPATHOLOGIC, AND IMMUNOHISTOCHEMICAL ASPECTS

Syphilis is a sexually transmitted infection, caused by the spirochete bacteria Treponema pallidum (TP), for which humans are the only reservoir. There are several clinical manifestations of syphilis, depending on the stage of disease (primary, secondary, latent, and tertiary). The congenital syphilis is a consequence of infection of the fetus, via the placenta. We report a case of secondary syphilis diagnosed with an oral lesion biopsy. A 26-year immunocompetent man was referred with an asymptomatic, single reddish ulceration in the palate. The histopathologic analysis of tissue specimen obtained by biopsy showed an epithelium with pseudoepitheliomatous hyperplasia, ulceration, acanthosis, and exocytosis, with a chronic inflammatory infiltrate of plasma cells in the connective tissue. Immunohistochemical reactions for the spirochete bacteria using anti-TP antibody were positive. The diagnosis of syphilis was confirmed by venereal disease research laboratory and fluorescent treponemal antibody absorption complementary tests, and the patient was treated with penicillin, without recurrence after 2 years’ of follow-up.

Diagnosis and Management of Syphilis in Patients With HIV Co-infection

Syphilis cases are on the increase especially in men who have sex with men (MSM) in urban areas of high-income countries. There is a strong association between syphilis and HIV infections. We review the more recent literature regarding the epidemiology, clinical manifestations, diagnostic investigations, treatment and follow-up of syphilis in HIV infection. Although the clinical manifestations of syphilis in people living with HIV (PLHIV) and HIV-uninfected patients are broadly similar, differences have been described in PLHIV. Asymptomatic primary syphilis and secondary syphilis are more common in PLHIV as well as several atypical and severe syphilis presentations. Asymptomatic and symptomatic neurosyphilis are also more commonly described in the HIV infected. The use of penicillin regimes remains the mainstay of treatment, although there is evidence of the successful use of non-penicillin-based regimes, e.g. doxycycline. Syphilis infections in PLHIV are common and increasing. A low index of suspicion and testing with appropriate, rapid treatment should decrease the significant morbidity associated with this infection.

Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM. Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona

BackgroundSince 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. MethodsRetrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. ResultsA total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32–8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17–2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. ConclusionThe epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment.

Las características epidemiológicas y clínicas de la epidemia de sífilis en Barcelona

BackgroundSince 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. MethodsRetrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. ResultsA total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. ConclusionThe epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment.

Performance of the Syphilis Serology Algorithm Diagnosis

Abstract Syphilis is a chronic, sexually transmitted disease caused by Treponema pallidum. The clinical manifestations of syphilis are often non-specific. Serology tests are used for diagnosis. The aim of this study was to evaluate the reverse algorithm used at The Ohio State Wexner Medical Center (OSUWMC) for the diagnosis of syphilis. The algorithm consist of a treponemal test (Bio-Rad BioPlex Syphilis IgG) a multiplex flow immunoassay (MFI), which utilizes treponemal antigens coated on microspheres to detect IgG to T. pallidum. If reactive, a nontreponemal test, rapid plasma reagin (RPR), is used to detect antibodies against cardiolipin-cholesterol-lecithin antigens, though not specific they are present in most patients with syphilis. If results are reactive with MFI but nonreactive with RPR, a second treponemal-specific antibody test using T. pallidum particle agglutination (TP-PA) is used. Sera submitted at OSUWMC between 01/1/2013 and 10/13/2017 were tested for syphilis using the described algorithm. A total of 70,849 specimens were tested using the MFI assay, of these 96.5% were nonreactive (n= 68,394), 3.3% were reactive (n=2,318) and 0.2% produced an equivocal result (n= 137). Of the MFI reactive results, 1.5% confirmed reactive with RPR (n=1,031) and 1.8% (n=1,287) were nonreactive and considered discrepant. The discrepant specimens were tested by TP-PA, 0.6% (n=438) were confirmed nonreactive and 1.2 % (n=849) were reactive. Furthermore, 137 specimens that produced an equivocal result by the MFI were tested by RPR and TP-PA, 133 were nonreactive and 4 were reactive. In summary, only 2% (n=1,424) of the specimens were discrepant and required a third test for resolution.

Concomitant Primary and Secondary Syphilis: A Case Series from STD Clinic, Siriraj Hospital

Objective: To emphasize the importance of dermatologists in identifying the presence of concomitant primary and secondary syphilis in the same patient in order to effectively diagnose the disease and provide adequate treatment. Case presentation: The diversity of the clinical manifestations of syphilis is very common; however, atypical presentations of syphilis have a chance to occur. Such concomitant primary and secondary syphilis, which develop s chancre concomitant rash is an uncommon manifestation. Cases of atypical syphilis have been described most frequently in patients with concomitant human immunodeficiency virus (HIV) infection and men who have sex with men (MSM).This report presents the cases of 8 patients with primary and secondary syphilitic lesions. These cases are representative because of their clinical presentation, age range, gender distribution and diagnostic approach. Conclusion: The concomitant presence of primary and secondary syphilis in the same patient is unusual. The importance of our cases is to highlight some of the differences in clinical manifestations in HIV-infected men and HIV-uninfected men that might be important for early diagnosis for managing and curing such patients.

Clinical manifestations of syphilis in maxillofacial area. Part I

Clinical manifestations of syphilis in maxillofacial area. Part I

Clinical manifestations of syphilis in maxillofacial area. Part II

The article presents a review of the literature with a description of typical manifestations in the maxillofacial area in secondary, tertiary period of syphilis and the description of photo-images of the authors' clinical observations. In the secondary period of syphilis rashes can be found both on the skin and mucous membranes. In secondary reccurent syphilis the oral cavity is affected in 56% of the cases. Typical manifestations of this period are: roseola, papular and pustular syphilides. In the mouth the most frequently observed manifestation is popular syphilide or erythematous sore throat. The syphilitic papule of the mucous membrane of the mouth is flat, sharply demarcated, gets frequently eroded due to maceration or trauma. This papule is highly contagious element. Pustular syphilides are found mostly on the face and are a manifestation of a malignant course of the disease. Tertiary syphilis is a rare form of infection, which is observed as destructive injuries of organs and systems. The most frequent localization of gummy syphilide is the head. This article is highly revalent due to the high frequency of infection manifestation in maxillo-facial area, oral mucosa, and the high contagiousness symptoms, also affecting children.

ГАНГРЕНА ФУРНЬЕ

Importance. Fourniers gangrene occurs as a result of infectious processes of the urogenital tract, in immunocompromised patients with diabetes, obesity, malignant neoplasms. Fournier,s gangrene progresses for two to three weeks, causing tissue destruction. The basis of the treatment of Fourniers gangrene is an emergency surgical intervention in combination with antibacterial and detoxification therapy. The article reflects the importance of differential diagnosis of Fournier,s gangrene with a complicated form of primary syphiloma (phagadenic chancre). Purpose. To demonstrate the diversity of clinical manifestations of Fourniers gangrene, treatment, differential diagnosis. Materials and methods. The literature review of materials of domestic and foreign researchers, in which the etiology, pathogenesis, clinical and laboratory picture, diagnosis, treatment, and prognosis of Fourniers gangrene using the search engines Pubmed, Medline, Cochrane, Elibrary. The authors present the clinical cases of patients with Fournier,s gangrene, clinical features of complicated chancre in a patient with primary syphilis, which are necessary for adequate differential diagnosis. Results. Since 2007 to 2016 were seven men with Fournier,s gangrene on treatment in purulent surgery Department. Patients performed the autopsy, drainage of foci of necrosis, necrectomy systemic antibiotic therapy, followed by autodermoplasty. Conclusions. Fournier,s gangrene rare and severe form of lesions of the external genitalia. The prognosis of the disease is serious and depends on timely and correct treatment. The rise of complicated cases of hard chancre. It is necessary to differentiate Fournier s gangrene with clinical manifestations of syphilis.

Neurosífilis: un problema antiguo que no pierde actualidad

Neurosyphilis is the clinical manifestation of syphilis that can arise during either the early or late stages of infection. Even though dedicated treatment for all clinical forms of syphilis has been available for many years, the advanced stages of the disease are still prevalent, with irreversible sequelae. This article reviews the current evidence, diagnostic methods and specific treatment for tertiary syphilis

Retrospective investigation of diagnosis and treatment of 282 cases with syphilis

Objective To summarize the distribution of departments, conditions of diagnosis and treatment of the syphilis patients in the general hospitals, and thus to improve the level of diagnosis and treatment. Methods A retrospective analysis of epidemiology and clinical data of 282 cases with syphilis in recent 5 years were conducted. Results The ratio of male to female was about 1: 1.9.Female showed a high incidence in the 21-50 years old, average (41.68±0.96)years old, but for male in the 41-70 years old, average (53.25±1.59) years old.The cases combined with other infectious diseases accounted to 22.0 % (62/282). The cases from the department of obstetrics and gynecology were the most (106 cases), followed by surgery (86 cases) and internal medicine (49 cases). Only 23 cases showed the clinical manifestations of syphilis in the 79 cases, which must be treated.The test rate of TRUST was only 39.0% (110/282). Furthermore, it was very low for the rate of treatment and standard treatment. Conclusion Syphilis is the most in department of obstetrics and gynecology in general hospital, and it is also common in the surgery and internal medicine.The most prominent problems are that the non-special doctors had weak awareness for definite diagnosis of syphilis, and the low rate of treatment and standard treatment. Key words: Syphilis; Diagnosis; Treatment

Immune mechanisms in syphilis and its concurrence with human immunodeficiency virus infection

The intensity and duration of cellular immune response determine differences in clinical manifestations of syphilis. Macrophages, CD4+ T lymphocytes, CD8+ T lymphocytes and natural killer (NK) cells all play important roles in cellular immunity in syphilis. Concurrent human immunodeficiency virus (HIV) infection increases the complexity of immune pathogenesis as well as variety in clinical manifestations of syphilis. In secondary syphilis concurrent with HIV infection, T helper type 1 (Th1) and Th17 cell-mediated immunity are enhanced, while changes in Th2 cell-mediated immunity remain unclear. The concurrence of syphilis and HIV infection may alter their immunologic mechanisms, clinical course and therapeutic outcomes. Thus, it is necessary for timely and effective treatment to screen for HIV infection in patients with syphilis and for syphilis in patients with HIV infection. Key words: Syphilis; HIV; Immunity; Treponema pallidum; Infection

Advances in molecular epidemiology of Treponema pallidum and its neurotropic subtypes

Since the development of molecular typing system for Treponema pallidum based on acidic repeat protein(arp)gene and Treponema pallidum repeat(tpr)gene in 1998, there have been reports on the epidemiological characteristics of Treponema pallidum subtypes from various countries in the world. The tp0548 and rpsA genes also have been used for enhancing the molecular typing of Treponema pallidum. Predominant subtypes of Treponema pallidum have been reported in various regions, and there is a high variety in the subtypes of Treponema pallidum, with 14d and 14f as the most frequent subtypes. Further more, some specific subtypes of Treponema pallidum are associated with clinical manifestations of syphilis. Studies have found that some neurotropic subtypes of Treponema pallidum, for example, 14a, 14d/f and 19d/c types are related to neurosyphilis. Determining specific Treponema pallidum subtypes associated with neurosyphilis is of great significance for the clinical diagnosis, treatment and prediction of prognosis of syphilis. Key words: Syphilis; Treponema pallidum; Neurosyphilis; Epidemiology; Molecular typing