Diagnosis Of Primary Syphilis Research Articles

Phagedenic ulcer of the chancre in young woman

The literature data on such severe and rare complications of chancre in primary syphilis as gangrene and phagedenic ulcer, that developing normally in the background of immunodeficiency patients, especially in alcoholics, are presented. Infection and the development of chancre significantly change the clinical manifestations of primary syphilis, which can lead to diagnostic errors. The clinical observation of the patient suffering from alcoholism, which had a diagnosis ofprimary syphilis chancre on the basis of complicated phagedenic ulcer, regional lymphadenitis, positive serological reactions, acute reaction to the beginning of specific treatment, is presented. The treatment with Benzylpenicillin sodium was performed and led to the scarring of the chancre.

P44 Rpr-negative primary syphilis in men who have sex with men: a case series

<h3>Background/introduction</h3> Diagnosis of primary syphilis is confirmed by serological tests suggestive of the stage of the disease. In most cases specific (IgM/IgG) and non-specific (RPR) antibodies develop in response to primary treponemal infection. Lack of development of such antibodies is known to occur amongst HIV positive patients but is unusual among HIV negative patients with no significant comorbidities. <h3>Aim(s)/objectives</h3> To present a cluster of four cases of primary syphilis from our clinic with unexpected serological results. <h3>Methods</h3> We describe four unusual cases of HIV-negative MSM, all of whom presented with penile lesions (three chancres and an atypical lesion). These cases were identified by clinicians between July 2014 and January 2015. Clinical and laboratory records were retrospectively interrogated. Clinical photographs will be used to illustrate these cases. <h3>Results</h3> In all cases, patients with no history of previous syphilis returned positive results on one or more specific treponemal serological tests with persistently negative RPR. Three cases had recent negative syphilis screening at our clinic. Darkfield microscopy also failed to demonstrate T. pallidum in those with chancres. In all cases, treatment of presumed syphilis led to the resolution of the lesions. <h3>Discussion/conclusion</h3> These cases demonstrate the ongoing difficulties with treponemal diagnostic test interpretation. There are reports in the literature that men over 35 may be more likely to return a false negative RPR result, but overall prevalence of false negative RPR in primary syphilis is uncertain. Over-reliance on serology may result in under diagnosis of syphilis even in HIV-negative MSM.

Primary syphilitic chancre on the upper arm in an HIV-1-infected patient

A 32-year-old HIV-infected man presented with an ulcerating skin lesion with indurated borders on the upper right arm. Both dark-field microscopy and syphilis serology confirmed the diagnosis of primary syphilis. Extragenital syphilitic chancres are uncommon but nevertheless have to be kept in mind as they often delay diagnosis.

Analysis of Acid-Base Disorders in Patients With Chronic Respiratory Failure

Clean microscopic slides are dipped in a solution of mercuric chloride and sucrose in 30% alcohol and allowed to dry. A thin transparent film of cytological fixative is thus formed on both sides of the slide. Fixative slides, prepared in this manner, can be stored indefinitely provided that they are not exposed to a warm, humid atmosphere. When a drop of fluid containing bacteria, protozoa, or mammalian cells is spread over the surface of such a slide the formed elements are immediately fixed, the finer cytological details being well preserved. Staining and examination are carried out when the specimen arrives at the laboratory. This method is particularly suitable for a diagnostic laboratory service in which most of the specimens arrive by mail. The method has been successfully employed in the diagnosis of <i>Trichomonas vaginalis</i> infection of the female genital tract. This parasite was found by phase-contrast microscopy in 47% of 1,000 women examined at a police court clinic. Fixative slide preparations were also obtained from these women at the time of their medical examination. Of these specimens, 38·6% showed the presence of <i>Tr. vaginalis</i>, and 10% were also found to be infected with <i>N. gonorrhoeae.</i> The fixative slide technique may also prove of value in such widely separated fields as exfoliative cytology and the diagnosis of primary syphilis.

The influence of concomitant HIV infection on the serological diagnosis of primary syphilis in southern Africa.

The authors investigated the utility of both a nontreponemal (RPR) test and a treponemal (FTA-ABS) test for the diagnosis of primary syphilis during the emergence of the HIV epidemic in southern Africa. The serological tests were performed on 868 patients with genital ulcerations, seen in five centres. While primary syphilis was diagnosed by multiplex PCR in 163 cases (18.8%), the overall RPR and FTA-ABS seroprevalences were 24.3% and 51.5% respectively. The sensitivities of the RPR and FTA-ABS to detect primary syphilis were 69.3% and 89.6% respectively, while the specificities were 86.1% and 58.5% respectively. The performance characteristics of these tests were influenced negatively by concomitant HIV infection and the presence of other genital ulcer disease pathogens in lesions found to be Treponema pallidum PCR positive.

48. TREPONEMA PALLIDUM PCR: APPLICATION AND DIAGNOSTIC VALUE IN 2 CASES OF PRIMARY SYPHILIS

Epidemics of infectious syphilis have been ongoing in large cities in industrialised countries since the turn of the millennium. These epidemics have almost exclusively involved homosexually active men, with a disproportionately high rate among HIV infected individuals. Genital ulcerative disease, including syphilis, has a strong correlation with onward transmission of viral and bacterial sexually transmitted infections. Due to the lack of a culture system for Treponema pallidum, the causative organism of syphilis, other direct test methods are needed in the evaluation of skin lesions possibly due to syphilis. Dark ground microscopy was once commonly used by sexual health clinicians, but skills in this method have waned in recent years. Polymerase chain reaction (PCR) assays are being increasingly used in the diagnosis of infectious syphilis. We describe the use of a nucleic acid amplification assay for Treponema pallidum, which targets the 47 kilodalton gene, in the diagnosis of primary syphilis in 2 patients with genital lesions. The first patient was an HIV infected man who presented with an ulcer typical of a chancre but who denied any recent risk behaviour. The second was an HIV negative homosexually active man with an atypical genital lesion. In both cases, Treponema pallidum PCR was positive and serology was consistent with the diagnosis of primary syphilis. Conclusion/Recommendation: Appropriately validated Treponema pallidum nucleic acid amplification assays could replace dark ground microscopy and direct fluorescent antigen tests as a direct test for early infectious syphilis. It could be particularly useful in individuals who have treponemal skin lesions of atypical appearance.

The Etiology of Genital Ulceration in Rwanda

The etiology of genital ulcer disease was determined in 210 consecutive patients (110 men and 100 women) who presented at a clinic in Kigali, Rwanda, because of genital ulcers. When mixed infections are included, syphilis (21%), chancroid (24%), and genital herpes (17%) were about equally frequent in men. Lymphogranuloma venereum with ulceration was found in 11% of patients. Syphilis (40%) was the most common diagnosis in women; genital herpes (20%), lymphogranuloma venereum with ulceration (19%) and chancroid (12%) also were frequent diagnoses. Microscopic examination for treponemes after silver-impregnation staining had a poor sensitivity and specificity for the diagnosis of primary syphilis. Overall, 59% of the patients (43% of the men and 77% of the women) had IgG antibodies to the human immunodeficiency virus.

Syphilis: Clinical Manifestations, Diagnosis, and Treatment

Clinical manifestations of primary, secondary, congenital, and late syphilis are described. Darkfield examination is the most important laboratory method for diagnosis of primary syphilis. The VDRL and FTA-ABS are the most common serologic tests used for diagnosis and follow-up. Penicillin remains the treatment of choice in nonallergenic patients.

Infectious syphilis mimicking neoplastic disease

Five patients who were initially evaluated for malignant neoplasm actually had infectious syphilis (one primary, two secondaries, two secondaries with persistence of primary). Two patients were considered for radical surgery and one for extensive radiation and/or chemotherapy. In four patients an elevated routine admission VDRL was the first indication of the correct diagnosis. Dark-field examination is the most important laboratory test in the diagnosis of primary syphilis; VDRL and FTA-ABS are most important in confirming secondary syphilis. Penicillin remains the drug of choice for therapy. At a time when the incidence of sexually transmitted diseases is increasing, it is extremely important to develop adequate educational programs for medical students and physicians. (<i>Arch Intern Med</i>137:156-160, 1977)

Dark-Field Examination In Early Primary Syphilis

To the Editor.— We did not intend to detract from the importance of the dark-field examination in the diagnosis of primary syphilis. Seronegative primary syphilis is well known. The point we wish to make is that by the time a patient comes for treatment, the vast majority (91%) will have seropositive results with the FTA-ABS test. Two of the six patients had dark-field-positive, FTA-ABS-negative results two and four months later, respectively, and remained seronegative to both the VDRL and FTA-ABS tests. Two of the patients in our study stated that their lesions had been present only three days: in one, the VDRL test was nonreactive; in the other, the VDRL test was reactive with a titer of 1:2; in both, the FTA-ABS test was reactive. How early is very early?

PREPARATION AND USE OF FIXATIVE SLIDES FOR THE DIAGNOSIS OF TRICHOMONAS VAGINALIS.

Clean microscopic slides are dipped in a solution of mercuric chloride and sucrose in 30% alcohol and allowed to dry. A thin transparent film of cytological fixative is thus formed on both sides of the slide. Fixative slides, prepared in this manner, can be stored indefinitely provided that they are not exposed to a warm, humid atmosphere. When a drop of fluid containing bacteria, protozoa, or mammalian cells is spread over the surface of such a slide the formed elements are immediately fixed, the finer cytological details being well preserved. Staining and examination are carried out when the specimen arrives at the laboratory. This method is particularly suitable for a diagnostic laboratory service in which most of the specimens arrive by mail. The method has been successfully employed in the diagnosis of Trichomonas vaginalis infection of the female genital tract. This parasite was found by phase-contrast microscopy in 47% of 1,000 women examined at a police court clinic. Fixative slide preparations were also obtained from these women at the time of their medical examination. Of these specimens, 38.6% showed the presence of Tr. vaginalis, and 10% were also found to be infected with N. gonorrhoeae. The fixative slide technique may also prove of value in such widely separated fields as exfoliative cytology and the diagnosis of primary syphilis.

PENICILLIN-RESISTANT EARLY SYPHILIS

Since the inauguration of penicillin therapy, resistant early infectious cases have rarely been encountered. To our knowledge only 1 such case has been reported. 1 It is the purpose of this paper to present a case of penicillin-resistant early syphilis. REPORT OF A CASE A 24 year old Negro was admitted to the Dermatology and Syphilology section on Sept. 5, 1946 because of a penile lesion of six weeks' duration. After appearance of the lesion no treatment had been sought for three weeks. At that time the patient had received one intravenous injection of arsphenamine from a private physician, after which treatment the lesion became swollen and painful and did not heal. No further treatment was obtained until his entrance to the hospital. At admission, dark field examination revealed Treponema pallidum and Kahn and Wassermann tests of the blood elicited positive reactions; a diagnosis of primary syphilis was made,

INCIDENCE OF EXTRAGENITAL CHANCRES

A review of the records of the outpatient department of the Boston City Hospital for the years 1908 to 1930, 1 inclusive, showed 691 cases in which a diagnosis of primary syphilis was made; extragenital chancre was observed in 38 cases, approximately 6 per cent. The location of these chancres is shown in the following tabulation:

The Diagnosis of Primary Syphilis

The Diagnosis of Primary Syphilis