Diagnosis Of Secondary Syphilis Research Articles

Annular Secondary Syphilis with Histopathologic Features of Granuloma Annulare

Syphilis is one of the most common sexually transmitted diseases in the world. It is known as “the great mimicker” due to its varied cutaneous presentations, which can make it challenging to diagnose. We report a case of a 20-year-old female presenting with a nonhealing, pruritic, annular plaque on the left malar area of 3-month duration. She was initially treated as a case of tinea faciei. The lesion was unresponsive to topical antifungals and steroids with continued increase in size and number. Skin biopsy revealed secondary syphilis with histopathologic features of granuloma annulare. Degenerated collagen, not a feature of secondary syphilis, was seen, prompting further studies to confirm the diagnosis of secondary syphilis. Alcian blue stain was negative, which helped rule out granuloma annulare. She was then given benzathine penicillin G 2.4 million U, which led to a significant decrease in the size of the lesion noted 1 week posttreatment. Only postinflammatory hyperpigmentation was noted after 1 month of treatment. Clinically, secondary syphilis may present as an annular lesion that can mimic tinea. This can also present with atypical histopathologic features and an in-depth investigation is needed to further confirm the diagnosis.

Secondary syphilis presenting with alopecia and leukoderma in a stable HIV-positive patient in a resource-limited setting: a case report

BackgroundSyphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis.Case presentationA virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully.ConclusionThis case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.

A Case of Oropharyngeal Syphilis.

We present a case of a 50-year-old male who complained of a sore throat persisting for 2 months. Upon physical examination, multiple mucous patches were observed in the oropharynx region, but no skin lesions were found. Fiberoptic laryngoscopy confirmed these findings. The Treponema pallidum particle agglutination test and toluidine red unheated serum test (TRUST) were positive with a titer of TRUST 1:64. The patient admitted to engaging in extramarital sexual activities with several females but no males. Based on the clinical manifestations and laboratory test results, a diagnosis of secondary syphilis of the oropharynx was established. He was treated with 2.4 million units of benzathine penicillin G by intramuscular injection once a week for 3 weeks. After 1 month, the lesions completely disappeared without any symptoms. The titer of TRUST reduced to 1:2 in 1-year follow-up. This report aims to enhance physicians' understanding and recognition of oropharyngeal syphilis, enabling timely diagnosis and effective management.

Clinicopathologic assessment of secondary syphilis avoids misdiagnosis: results of comprehensive evaluation of 114 cases.

Secondary syphilis is well-known for its protean cutaneous manifestations and therefore very easy to be misdiagnosed. The current study was to observe the frequency of histopathological features characterizing secondary syphilis, and summarize the diseases most likely to be misdiagnosed. In this study a total of 129 pathological specimens from 114 patients with biopsy-proven secondary syphilis were retrospectively analysed and categorized according to clinicopathologic characteristics. The frequency of histopathological features characterizing secondary syphilis were analysed by comparison with clinical features. We found that in a single sample there is at least one feature or at most 13 features exist concurrently, and most demonstrated between 5 and 9 diagnostic features. Plasma cells (97.6% overall vs. 94.0% ≤ 6 features), endothelial swelling (86.8% vs. 74.0%), epidermis hyperplasia (73.6% vs. 62.0%) especially irregular acanthosis, lymphocytes infiltration (71.3% vs. 52.0%) and interstitial patterns (69% vs. 72.0%) were the most common findings in all cases as well as in cases with ≤ 6 features. Granulomatous inflammation is an uncommon histopathologic pattern in secondary syphilis (12.4%). The rash morphologies of our biopsies mainly manifesting as macules and maculopapules were more likely to have 6 or fewer features, which were not only easily misdiagnosed for pityriasis rosea, tinea and erythema multiforme, but also mostly taken from the trunk and genitalia. Atypical morphologies can be combined with plasma cell infiltration and T. pallidum immunohistochemical stain to confirm the diagnosis. In this study plasma cells from superficial and deep perivascular distribution to nodular infiltration were a crucial clue for diagnosis of secondary syphilis.

Anorectalis régiót érintő STI fertőzések

The authors present the case of a 20-year-old male patient, who was refered to their department by his family doctor with suspected drug allergy. He had several proctological examinations in the last half year, because of a chronic intermittently bleeding anal fissure, which has been treated with analgesic rectal cream and wound healing gel. During physical examination multiple maculopapular rash all over the body, infiltrated brownish papules on the soles and purulent discharge on the pharyngeal wall were detected. Differential diagnosis included secondary syphilis, viral exanthema and drug eruption. The syphilis serological tests confirmed the diagnosis of secondary syphilis. The patient received benzathine-penicillin treatment. Due to the non-healing anal fissure pelvic MR was performed, which did not reveal definitive fistula. Further STI screening tests showed Neisseria gonorrhoeae infection of the anus and after ceftriaxon administration the patient’s anorectal symptoms healed. Our case emphasizes the importance of sexually transmitted co-infections.

An Atypical Cutaneous and Histopathological Manifestation of Secondary Syphilis in an HIV-Positive Male: A Case Report

We present an atypical case of secondary syphilis concomitant with condyloma lata in an HIV-positive male. The patient presented with lesions on his lateral neck, soles, and palms. Spirochetes were examined on the biopsy of the palm, consistent with secondary syphilis, but not on the biopsy from the neck. The lesion on the neck was diagnosed as an evolving secondary syphilis lesion due to the extent of the lymphoplasmacytic infiltration, presence of acanthosis and epidermal hyperplasia, the accompanying diagnosis of secondary syphilis on the palm, the patient’s history of HIV, and the related diagnosis of condyloma lata on the dorsal shaft of the penis. Following this diagnosis, the patient was referred to an infectious disease specialist who treated him with a single intramuscular injection of 2.4 million units of benzathine penicillin, per CDC guidelines. This case highlights the importance of clinicians taking into consideration a variety of factors when diagnosing and treating cutaneous disorders with a broad-spectrum differential diagnosis, particularly in at-risk individuals.

Nodular Syphilis Seen in an HIV-Positive Man: A Case Study.

Syphilis is becoming an increasingly concerning sexually transmitted infection in the primary care setting with a precipitous rise in cases in the USA over the past decade according to the CDC surveillance data. This rise in cases is particularly relevant in military medicine as the greatest increase in cases is among adults in their 20s. Nodular syphilis is a rare presentation of the secondary stage of syphilis, and contrary to the well-known maculopapular rash seen with syphilis infection, little is known about effective treatment of nodular manifestations of the disease. We present a case of a 54-year-old HIV-positive man with nodular secondary syphilis effectively treated with an empiric 2-week course of oral doxycycline. Initial differential diagnosis included erythema nodosum, arthropod vector disease, skin infection, and erythema elevatum diutinum. Biopsy demonstrated granulomatous dermatitis, and serology revealed positive Treponema pallidum antibodies with a rapid plasma reagin of 1:256, confirming the diagnosis of secondary syphilis with granulomatous dermatitis. This case indicates that clinicians should consider this unusual cutaneous presentation of secondary syphilis when evaluating patients with nodular skin lesions, especially in high-risk individuals.

Secondary syphilis in oral cavity: Case report and literature review

Introduction: Syphilis is the most common sexually transmitted infection and may have heterogeneous clinical features. There are several studies that report the incidence and clinical features of secondary syphilis, but little emphasis is placed on unusual clinical patterns. Here, we report a case of secondary intraoral syphilis with the appearance of whitish plaques. Case Report: A 30-year-old woman complained of multiple plaques in the oral cavity that had not healed for 15 days. An incisional biopsy was performed and revealed histological features consistent with syphilis. Serological test of venereal disease research laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) were reactive. Diagnosis of secondary syphilis was closed. The patient underwent penicillin therapy. Conclusion: In conclusion, secondary syphilis can become a potential diagnostic challenge due to the distinct clinical spectrum.

Translated article] Condyloma Lata: A Useful Sign Pointing to a Diagnosis of Secondary Syphilis

Translated article] Condyloma Lata: A Useful Sign Pointing to a Diagnosis of Secondary Syphilis

SECONDARY PULMONARY SYPHILIS

TYPE: Late Breaking Case Report TOPIC: Chest Infections INTRODUCTION: Syphilis is a sexually transmitted disease that can affect any organ in its secondary stages. We describe a case of secondary syphilis with pulmonary involvement. CASE PRESENTATION: A 57 years old male came with SOB and cough since 1 week. He had history of fever, skin ulcers since1 month.He admits history of sexual exposure with commercial sex worker. CECT CHEST – Ground glass and nodular opacities in left upper and lower lobes. Punched out skin ulcers of 1x1 cm are seen over scrotum and right thigh. Veneral Disease Research Laboratory, Treponema Pallidum Haemagglutination,Flourescent Treponemal Antibody-Absorption - REACTIVE. • The diagnosis of secondary pulmonary syphilis was made based on History, Clinical examination, Serological tests for syphilis and Clinical improvement with anti syphilitic treatment. He was treated with BENZATHINE PENICILLIN 2.4 MU I.M per week for 4 weeks. Patient was followed for next 6 months.His skin lesions and lung infiltrates were completely cured in susequent examination. DISCUSSION: In 1983, Coleman et al.proposed five criteria for the clinical diagnosis of secondary syphilis with pulmonary involvement: [1] History and physical findings typical of secondary syphilis;[2] Serologic test results positive for syphilis;[3] Pulmonary abnormalities seen on radiographs with or without associated pulmonary symptoms or signs;[4] Exclusion of other forms of pulmonary disease when possible, using serologic tests, sputum smears and cultures, and cytologic examination of sputum; and[5] Therapeutic response to anti-syphilitic treatment visible on radiographs. CONCLUSIONS: Pulmonary syphilitic involvement should be suspected where clinical history along with pulmonary symptoms and radiological changes occur in cases positive for serological markers. DISCLOSURE: Nothing to declare. KEYWORD: SECONDARY PULMONARY SYPHILIS

Secondary Syphilis Occurring on the Tongue: Report of a Case

<h3>Objective</h3> According to the Centers for Disease Control the rate of syphilis has steadily increased nearly every year since 2001. Tertiary syphilis is associated with serious complications that can be avoided by early diagnosis and treatment. Although primary and secondary syphilis typically involve the genitals, the oral cavity may be the initial site of disease. Given the recent increase in incidence, it is critical to recognize this disease to aid in prevention of life-threatening complications. Here, we report a case of oral syphilis and present the clinical, histopathological and immunohistochemical features. <h3>Clinical Presentation</h3> A 21-year-old female presented to an oral and maxillofacial pathologist for evaluation of a lesion on the tongue of one-month duration. Her medical diagnoses included bipolar disorder and genital herpes. Her social history included smoking and cocaine abuse. Upon examination, a mildly erythematous elevated plaque of the posterior dorsal tongue measuring 2.0 × 1.5 cm was identified. <h3>Intervention and Outcome</h3> An incisional biopsy was performed under intravenous sedation by an oral and max- illofacial surgeon. Microscopic review showed oral mucosa demonstrating papillary hyperparakeratosis, neu- trophilic microabscesses and a moderateto-intense chronic inflammatory infiltrate possessing an abundance of plasma cells in the underlying connective tissues. These features were suspicious for a diagnosis of secondary syphilis. Tissue was sent to the Mayo Clinic for <i>Treponema pallidum</i> study by immunohistochemistry. Review of the stained slides showed numerous spirochetal organisms throughout the epithelium, confirming the diagnosis. The patient's primary care provider was contacted to initiate therapy. The NYC Department of Health and Mental Hygiene was notified of this diagnosis fulfilling mandatory reporting requirements. <h3>Conclusion</h3> The rate of syphilis diagnosis is on the rise. Presentation in the oral cavity, while rare, is important for oral healthcare providers to be familiar with as early diagnosis and treatment are likely to prevent serious complications.

Ocular Manifestations and Full House Membranous Nephropathy as a Rare Presentation of Secondary Syphilis

Introduction: Syphilis is known as the great mimicker with symptoms that overlap many diseases. Here we present a patient with secondary syphilis which manifested as ocular symptoms, as well as membranous nephropathy with a full house staining pattern. Case Description: Our patient was a 54-year-old male who presented with a rash, joint pain, foamy urine and vision changes. Initial work up found a positive ANA and other autoimmune labs, and he was admitted for concern of lupus papillitis. Labs and CSF were positive for syphilis, and he was found to have nephrotic range proteinuria. Renal biopsy showed membranous nephropathy with full house staining, which is seen primarily in lupus nephritis with only one case report noting its presentation in syphilis (Jaunin E, Kissling S, Rotman S, Waeber G, Halfon M. Syphilis and parvovirus B19 co-infection imitating a lupus nephropathy: A case report. Medicine (Baltimore). 2019;98(36):e17040). He completed a course of penicillin and steroids with clinical improvement, and the diagnosis of secondary syphilis was made. Discussion: This case illustrates the importance of maintaining a broad differential diagnosis, and carefully examining all labs, imaging, pathology and symptoms in order to determine the definitive diagnosis. It also illustrates the importance of teamwork when faced with a challenge requiring input from multiple subspecialties to arrive at a final diagnosis.

False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis.

Syphilis is the oldest sexually transmitted infectious disease in humanity. In the last decades, it was noted the re-emergence of the disease, and actually it remains an important public health problem. Oral mucosa could be affected by the infection. Oral manifestations are commonly associated with secondary syphilis. It was described that the labial commissure could be involved as a split papule, also known as false cheilitis (FC). However, this clinical manifestation is poorly described in current literature. This brief report aims to determine the frequency of FC in patients diagnosed with secondary syphilis in our institution during the period 2009-2019. A cross-sectional retrospective study was conducted using the medical records of the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. The cases included were patients with provisional diagnosis of secondary syphilis with oral manifestations, confirmed by laboratory tests. Collection of clinical and serological data was performed. Absolute and relative values were obtained. In this study, 58 patients (26 males and 32 females) with an average age of 34.70 years old were included. The frequency of false cheilitis in these patients was 13% (8/58). All these patients with false cheilitis and secondary syphilis were young females with an average age of 25.12 years old. These lesions presented as angular cheilitis with an unilateral pattern with painful fissured papules associated with other oral lesions such as fissures, intraoral papules, tongue depapillation, white or red plaques, and the evidence of submandibular lymphadenopathies when examining the head and neck region. Our findings suggest that when angular cheilitis presents in young females as a painful, unilateral lesion, in the clinical context of other lesions and lymphadenopathies in the head and neck region, it could represent a suspicious clinical sign of syphilis. Considering the global re-emergence of sexually transmitted diseases, dentists should be aware of the oral clinical manifestations of syphilis as they play a significant role in the early detection of these conditions.

Pulmonary Involvement in Secondary Syphilis

In secondary syphilis, Treponema pallidum can spread to the lungs. A new case is described of a patient with multiple excavated subpleural pulmonary nodules, a rare localization of secondary syphilis. Despite the numerous pulmonary samples analysed in the literature, T. pallidum is rarely visualised directly on bronchial fibroscopy or biopsy. The diagnosis of secondary syphilis is suspected from historical and physical findings and confirmed by high values obtained from non-treponemal tests.

The Impact of the SARS-CoV-2 Pandemic on Human Immunodeficiency Virus and Bacterial Sexually Transmitted Infection Testing and Diagnosis in Oregon.

Human immunodeficiency virus, Neisseria gonorrhoeae/Chlamydia trachomatis, and syphilis testing decreased with the implementation of mitigation measures for SARS-CoV-2 and did not return to 2019 levels by September 2020. However, primary and secondary syphilis diagnoses increased during mitigation measures. Sexual health services are essential during the SARS-CoV-2 pandemic.

Pulmonary Involvement in Secondary Syphilis.

The clinical and radiological presentation of pulmonary involvement in secondary syphilis is non-specific, described as solitary or multiple subpleural nodular opacities that are rarely infiltrating.We confirm here that for this localization, biopsy of these nodules is not necessary for diagnosis.

Plaques en prairie fauchée

We report a clinical picture of a mowed meadow pattern of the tongue in a 29-year-old sexually active man who has sex with men. The painful lesions also called "Plaques en prairie fauchée", occur in the context of the discovery of a postive HIV serology. The diagnosis of secondary syphilis was confirmed by a positive syphilis serology (nontreponemal RPR test title of 64) and a positive Treponema pallidum PCR, amplifying the tpp47 gene, on a tongue swab. The lesions completely resolve with a penicillin treatment.

ORAL MANIFESTATION OF SECONDARY SYPHILIS WITH INTENSE EOSINOPHILIA: A CASE REPORT

Syphilis is a re-emergent disease of great importance in medicine and stomatology. The polymorphic clinical and histopathologic aspects of secondary syphilis lead to biopsy. A 29-year-old man presented with a 2-week painless ulcer in the midline of the tongue, well delimited, bleeding, and rapidly evolving. The patient was a smoker and alcoholic. He denies a previous known history of comorbidities. An incisional biopsy was realized and revealed the presence of pseudoepitheliomatous hyperplasia, hyperparakeratosis, hydropic degeneration, spongiosis, blood vessels with turgid endothelium, chronic inflammatory infiltrate with predominance of plasma cells, and lymphocytic exocytosis. In addition, intense eosinophilia was observed in the amount of 38 units per field (×400). After histopathologic aspects and suspicion of syphilis, the screening test was made and revealed the titration of 1:128. Associating histopathologic, laboratory, and clinical findings, the diagnosis of secondary syphilis with presence of eosinophilia was confirmed, and the patient was referred to a reference unit for treatment.

Oral forms of secondary syphilis: An illustration of the pitfalls set by the great imitator

Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation. We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations. Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8months; P=.02). Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.

Rectal syphilis - a case report

Introduction. Syphilis rarely affects anorectal region. The symptoms are nonspecific and are commonly disregarded in our country. Therefore, they pose a difficulty both for a diagnosis and for a treatment.We presented a patient with the clinical, laboratory, endoscopic and histological characteristics of rectal siphilis who was initially suspected to have inflammatory bowel disease. Case report. A 29-year-old man was hospitalized with a suspected inflammatory bowel disease, with symptoms such as frequent blood-stained diarrhea, lower abdominal pain and a loss of appetite. The physical examination showed maculopapular skin rash on the body. The ileocolonoscopic examination revealed finely granulated rectal mucosa, the loss of vascular pattern, and at 3 cm from the anal verge, an exulcerated submucosal lesion 1.2 cm in diameter, with two smaller, similar looking lesions. The histological examination of biopsies showed diffuse inflammatory-cell infiltration, with cryptitis, Paneth cell metaplasia with granuloma without caseous necrosis, which was highly suggestive of Crohn?s disease. The Treponema pallidum test results were positive [hemagglutination assay (TPHA)] with a titer 1 : 2,560 and the rapid plasma reagin test (RPR) with a titer 1 : 16. The ensuing detailed anamnesis on the patient?s sexual behavior showed that the patient had unprotected anal sexual relation with another man and the diagnosis of secondary syphilis was confirmed. After the treatment with benzathine penicillin G once a week, during a three-week period, the patient had no symptoms and had normal inflammatory markers, with a significant decrease of RPR titre and normal mucosa on rectosigmoidoscopy. Conclusion. Taking in consideration the variable clinical and endoscopic manifestations of this disease, it is necessary to take a detailed history of sexual behavior, since it can be crucial for determining the diagnosis and differential diagnosis of syphilis.