Doses Of Penicillin Research Articles

Transmission potential of Streptococcus pyogenes during a controlled human infection trial of pharyngitis.

Controlled human infection (CHI) models can provide insights into transmission of pathogens such as Streptococcus pyogenes (Strep A). As part of the Controlled Human Infection with Penicillin for Streptococcus pyogenes (CHIPS) trial, we explored the potential for transmission among participants deliberately infected with the Strep A emm75 strain. Three approaches to understanding transmission were employed: the use of agar settle plates to capture possible droplet or airborne spread of Strep A; measurement of distance droplets could spread during conversation; and environmental swabbing of high-touch items to detect Strep A on surfaces. Of the 60 (27%) CHIPS trial participants across five cohorts, 16 were enrolled in this sub-study; availability of study staff was the primary reason for selection. In total, 189 plates and 260 swabs were collected. Strep A was grown on one settle plate from a participant on the second day, using plates placed 30 cm away. This participant received the placebo dose of penicillin and had met the primary endpoint of pharyngitis. Whole-genome sequencing identified this to be the challenge strain. Strep A was not detected on any swabs. In this small sample of CHI participants, we did not find evidence of Strep A transmission by the airborne route or fomites, and just one instance of droplet spread while acutely symptomatic with streptococcal pharyngitis. Although these experiments provide evidence of minimal transmission within controlled clinical settings, greater efforts are required to explore Strep A transmission in naturalistic settings.IMPORTANCEStreptococcus pyogenes remains a significant driver of morbidity and mortality, particularly in under-resourced settings. Understanding the transmission modalities of this pathogen is essential to ensuring the success of prevention methods. This proposed paper presents a nascent attempt to determine the transmission potential of Streptococcus pyogenes nested within a larger controlled human infection model.

Prevalencia de sífilis en gestantes atendidas en el Hospital Regional de Pedro Juan Caballero, en 2022

Introduction: Syphilis is a common pathology in our population, its early diagnosis is important to avoid complications in pregnant women and newborns since it can trigger serious complications in them. Objective: Determine the prevalence of syphilis in pregnant women treated at the Regional Hospital of Pedro Juan Caballero in the year 2022. Materials and methods: Descriptive, observational, cross-sectional study, where 5940 clinical records of pregnant women were analyzed at the Pedro Juan Caballero Regional Hospital in the period 2022, the study variables were sociodemographic aspects, gynecological-obstetric history and treatment. Results: Of the 5940 records analyzed, we found 74 patients with gestational syphilis, which corresponds to a prevalence of 1.24%, the most frequent age group was between 21 and 30 years in 45%, 80% of pregnant women with syphilis come from In the urban area, the diagnosis of gestational syphilis was made in 45% in children under 12 weeks of gestation and in relation to treatment, 66% of cases received 3 doses of benzathine penicillin.

A rare case report of bilateral vestibulopathy due to otosyphilis.

Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are rare. A 39-year-old male was referred to our medical center due to vertigo, persistent dizziness and gait disturbance for 2 months. Bilateral vestibulopathy due to otosyphilis was considered in this case, as confirmed through analyses of vestibular function, laboratory tests, and penicillin treatment. The patient was was treated with a high dose of penicillin G (24 × 106 IU/d) for 14 days. The patient's symptoms had improved greatly following treatment, with dizziness and gait disturbance having completely resolved at 3 months following hospital discharge. Bilateral vestibulopathy should be considered when evaluating patients with acute or subacute persistent dizziness. Clinicians should also be aware of the potential for otosyphilis among patients who report BVP.

Actinomycosis presenting as a nasopharyngeal mass: A case report

Actinomycetes are predominantly pathogenic bacteria that lack aerial hyphae and do not form spores. They are generally anaerobic or facultative anaerobic Gram-positive bacteria, belonging to the prokaryotic group. Actinomycetes are widely distributed in nature, similar to other bacteria, and are mostly saprophytic, with a few being parasitic. They are named as such due to their colony's radial form. The symptoms and signs of actinomycosis are atypical and rarely manifest in the nasopharynx. Consequently, it can be challenging to distinguish actinomycosis from nasopharyngeal carcinoma, making diagnosis difficult. Histopathology is usually relied upon for diagnosis, although culture may pose challenges. Fortunately, actinomycetes are highly sensitive to penicillin. Therefore, timely treatment with high doses of penicillin is crucial for successful recovery. In this case study, we present the details of a 53-year-old female patient with no history of mucosal damage or tooth decay but with a previous partial thyroidectomy. The patient experienced recurring neck pain accompanied by progressive limitation of neck movement. Nasopharyngoscopy revealed the presence of a smooth-surfaced mass. Subsequent biopsy, clinical imaging, microbiological analysis, and histological findings confirmed the diagnosis of actinomycosis.Following a comprehensive treatment plan involving a combination of penicillin and doxycycline for a duration of two months, the disease was successfully eradicated.

The effect of acute and chronic harmaline administration on penicillin induced epileptiform activity in rats

Aim: The electrophysiological impact of short-term and long-term harmaline treatment on the penicillin G-induced epileptic model in rats was examined in this study. Methods: Eighty-four adult male Wistar rats were randomly assigned to two groups: one received a single dose of harmaline, and the other received repeated doses of harmaline. Each group was further divided into six subgroups based on the dose of harmaline (0, 10, 50, or 100 mg/kg) or penicillin (control or sham). The electrophysiological data were collected using electrocorticography and analyzed using PowerLab Chart v.8 software. The statistical analysis included the latency, frequency, and amplitude of the spike-wave discharges. The serum levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) were measured using the ELISA method to assess the antioxidant effects of harmaline. Results: The results showed that both acute and chronic harmaline treatment increased the seizure threshold in a dose-dependent manner (p

2889. One vs Three Weekly Doses of Benzathine Penicillin G for Treatment of Early Syphilis in Persons with and without HIV: A Multicenter Randomized Controlled Trial (RCT)

Abstract Background Syphilis rates in the United Stated (U.S.) have increased steadily for over a decade. Despite over 75 years as the drug of choice for syphilis treatment, controversy persists on optimal duration of therapy with benzathine penicillin G (BPG) for persons with early(primary, secondary, and early latent) syphilis, particularly for persons co-infected with HIV. Given the ongoing national shortages of BPG, optimizing duration of therapy is an urgent concern. Methods We conducted a multicenter RCT comparing a single intramuscular (IM) injection of BPG, 2.4 million units to BPG administered for three successive weeks for treatment of early syphilis in persons with and without HIV. The primary outcome of the study was a > 4-fold decline in RPR titer measured at 6 months. Intention to treat (ITT) and per protocol analyses were performed and were similar. ITT analyses are presented here. Results A total of 249 persons with early syphilis were enrolled at 10 participating sites. Most (97%) participants were were categorized as male sex, black race (62%), and 153 (64%) were living with HIV. The syphilis stage distribution was 19% primary, 47% secondary, and 33% early latent and did not differ significantly by HIV status. Serologic response (> 4-fold decline in RPR titer) at 6 months was 76% (95% Confidence Interval (CI) 0.68-0.82) in the single dose group and did not differ significantly from the three-dose group (70%, 95% CI 0.61-0.77). There were no treatment failures (> 4-fold increase in RPR titer). Among persons with and without HIV there was no significant difference in RPR response at 6 months: 76% in the single-dose group vs. 71% in the 3-dose group (95% CI 0.05-0.17). Most participants experienced mild to moderate local injection site pain and tenderness. Conclusion Treatment of persons with early syphilis with more than a single dose of 2.4 million units of BPG offers no therapeutic benefit irrespective of HIV infection status and was associated with increased rates of injection site discomfort. Disclosures Edward W. Hook, III, FIDSA, GARPD (Global Antibiotic Resistance Program: Advisor/Consultant|Talis Biomedical: Advisor/Consultant|VISBY Diagnostics: Advisor/Consultant Candice J. McNeil, MD, MPH, BARDA/GSK: Grant/Research Support|Becton Dickinson: Grant/Research Support|Cepheid: Grant/Research Support|Gilead: Grant/Research Support|Hologic: Grant/Research Support|Lupin: study product Julia C. Dombrowski, MD, MPH, Hologic: Grant/Research Support|Mayne Pharmaceuticals: Grant/Research Support

Strangles in a stallion in southeast Nigeria: clinical and pathological report

ABSTRACT. Streptococcus equi subspecies equi is the causative agent of strangles, a highly contagious mucopurulent upper respiratory tract infection of horses. This report describes the clinicopathologic findings of a fatal case of pulmonary form of strangles in a two-and-half-year-old stallion presented at a Veterinary Teaching Hospital in Southeast Nigeria. Treatment was attempted in quarantine using high doses of procaine penicillin; but it was unsuccessful. The clinical signs observed in the affected horse include a left unilateral supra-orbital swelling containing purulent matter, which progressed to a chronic intractable exudative pus. Anaemia with leukocytosis (due to neutrophilia) were observed in the haematologic parameters. Gross and histologic lesions were multifocally extensive abscessing necrotic lymphadenitis and bronchopneumonia with inflammatory oedema and infiltrate of polymorphonuclear leukocytes.

Secondary Syphilis in a 43-Year-Old Adult Man

We report a case of secondary syphilis simulating Gibert's pityriasis rosé. The patient was a 43-year-old adult with no previous history of syphilis. Erythematous circumscribed plaques were located on the abdomen, back and limbs, with characteristic palmar-plantar involvement. Histological examination was non-specific. Diagnosis was based on the positivity of treponemal tests. The patient's condition improved after administration of two doses of benzathine penicillin.

A large screen identifies beta-lactam antibiotics which can be repurposed to target the syphilis agent

Syphilis, caused by the spirochete Treponema pallidum subsp. pallidum (hereafter called T. pallidum), is re-emerging as a worldwide sexually transmitted infection. A single intramuscular dose of benzathine penicillin G is the preferred syphilis treatment option. Both supply shortage concerns and the potential for acquired antibiotic resistance further the need to broaden the repertoire of syphilis therapeutics. We reasoned that other β-lactams may be equally or more effective at targeting the disease-causing agent, Treponema pallidum, but have yet to be discovered due to a previous lack of a continuous in vitro culture system. Recent technical advances with respect to in vitro T. pallidum propagation allowed us to conduct a high-throughput screen of almost 100 β-lactams. Using several molecular and cellular approaches that we developed or adapted, we identified and confirmed the efficacy of several β-lactams that were similar to or outperformed the current standard, benzathine penicillin G. These options are either currently used to treat bacterial infections or are synthetic derivatives of naturally occurring compounds. Our studies not only identified additional potential therapeutics in the resolution of syphilis, but provide techniques to study the complex biology of T. pallidum—a spirochete that has plagued human health for centuries.

Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada.

Data were collected on the incidence and characteristics of stillbirths attributed to congenital syphilis (CS). Data were extracted on stillbirths in Edmonton Zone January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (one of whom was treated early in pregnancy and presumably reinfected), and one had a stillbirth in the week following one dose of benzathine penicillin G. Stillbirths due to CS were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.

Antibiotic exposure and risk of Parkinson's disease in the United Kingdom: A case-control study (P5-11.001)

<h3>Objective:</h3> To determine whether antibiotic or antifungal exposure increases the risk of developing Parkinson’s disease (PD). <h3>Background:</h3> A prior study suggested that adults who received &gt;1 course of anti-anaerobic or tetracycline antibiotics had an increased PD risk 10–15 years after exposure, while antifungal medication exposure was associated with an increased PD risk 1–10 years later. <h3>Design/Methods:</h3> A nested case-control study was used to examine the association between antimicrobial exposure with newly diagnosed PD using the Clinical Practice Research Datalink (CPRD), a primary care UK database. Each case was matched to up to 15 controls by age, year of registration, sex, and practice, at time of PD diagnosis (index date, ID). Number of prescribed antimicrobial courses was assessed 1–5, 5–10, and 10–15 years prior to ID. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) between antimicrobial exposure and risk of PD adjusted for relevant covariates. <h3>Results:</h3> We compared 19,022 PD cases to 120,447 matched controls. Exposure to one dose of penicillin 1–5 years prior to ID was associated with increased PD risk (OR 1.07, CI 1.0–1.13, p = 0.04), but reduced PD risk with exposure to &gt;2 penicillin doses (OR 0.92, CI 0.86–0.99, p = 0.02). Exposure to &gt;5 penicillin doses 1–10 years prior to ID was associated with reduced PD risk. Adjusting for multiple comparisons, there was a trend towards significance regarding reduced PD risk with exposure to &gt;5 penicillin doses 1–5 (p = 0.06) and 6–10 years (p = 0.09) prior to ID. A trend towards significance was found with exposure to &gt;2 doses of antifungals 1–5 years prior to ID and increased PD risk (p = 0.06). <h3>Conclusions:</h3> We found a borderline association between penicillin exposure and reduced risk of PD, but increased PD risk after antifungal exposure. <b>Disclosure:</b> Dr. Pal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint. Dr. Pal has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kyowa Kirin. Dr. Pal has stock in Baudax Bio. The institution of Dr. Pal has received research support from National Institutes of Health. The institution of Dr. Pal has received research support from Parkinson’s Foundation. Dr. Bennett has stock in Bristol Myers Squibb. Dr. Bennett has stock in Merck. Dr. Bennett has stock in Cigna. Dr. Bennett has stock in Organon. Dr. Roy has nothing to disclose. Dr. Nyandege has nothing to disclose. Dr. Mouradian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for HanAll Biopharma. Dr. Mouradian has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society for Experimental Neurotherapeutics. Dr. Mouradian has stock in Alnylam, Eli Lilly. The institution of Dr. Mouradian has received research support from NIH, Michael J. Fox Foundation for Parkinson’s Research; American Parkinson Disease Association. Dr. Mouradian has received intellectual property interests from a discovery or technology relating to health care. Dr. Mouradian has a non-compensated relationship as a Board of Directors with ANA that is relevant to AAN interests or activities. Dr. Gerhard has nothing to disclose. Daniel Horton has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Childhood Arthritis and Rheumatology Research Alliance. Daniel Horton has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pharmacoepidemiology &amp; Drug Safety. The institution of Daniel Horton has received research support from Danisco USA Inc. The institution of Daniel Horton has received research support from Childhood Arthritis and Rheumatology Research Alliance/Arthritis Foundation. Daniel Horton has received personal compensation in the range of $0-$499 for serving as a Consultant with US Food &amp; Drug Administration. Daniel Horton has received personal compensation in the range of $500-$4,999 for serving as a Guideline Development Team Member, Speaker with American College of Rheumatology.

Secondary Syphilis and Human Immunodeficiency Virus (HIV) Co-infection in Men Who Have Sex with Men (MSM) with Triple Doses Benzathine Penicillin G Treatment: A Case Report

Background: World Health Organization (WHO) reported that there are 6 million new cases of syphilis worldwide per year. The incidence of syphilis in Indonesia has increased over the past few years, particularly among men who have sex with men (MSM). Purpose: To report a case of secondary syphilis with Human Immunodeficiency Virus (HIV) coinfection in MSM, thereby increasing understanding of high-risk sexual behavior among MSM. Case: A 26-year-old man with a chief complaint of rashes on both palms, soles of the feet, and face. The rashes spread with no itching, heat, or pain, which occurred two weeks ago. The patient was diagnosed with HIV in 2019. Physical examination found multiple violaceus macules with clear boundaries, 0.5–1 cm in size, covered with scales. Venereal Disease Research Laboratory (VDRL) serology titer was 1:16 and Treponema Pallidum Haemagglutination Assay (TPHA) was 1:20.480. The recent CD4 count was 440 with an undetectable HIV RNA viral load. Benzathine penicillin G 2.4 million units was given intramuscularly 3 times at 1-week intervals. The patient experienced clinical improvement and decreased VDRL and TPHA titers. Discussion: Syphilis patients with or without HIV would have similar clinical symptoms. However, syphilis patients with HIV tend to have more extensive lesions. The treatment option with three doses of benzathine penicillin G is still very effective in cases of syphilis with HIV. Conclusion: Syphilis has a higher incidence in MSM patients with extensive clinical manifestations of skin lesions. It can be observed in syphilis patients with HIV; therefore, close monitoring is needed.

Secondary syphilis with stage III HIV in an adolescent deaf male with a history of sexual relationship with men: a case report

Introduction: Syphilis is an infection caused by Treponema pallidum of the spirochaete family.&#x0D; Case: A 19-year-old Balinese came with a complaint of red spots on the palms of the hands and feet one month ago. The patient has a hearing disability and is currently enrolled in a special-needs school in Denpasar. VDRL examination with reactive results with titer 1:256 and TPHA reactive with TPHA titer 1:5120. The patient received benzathine penicillin G 2.4 million units intramuscularly. Significant improvement was obtained, and the serological test was decreased.&#x0D; Discussion: Syphilis transmits through sexual contact, vertically from pregnant women to their fetuses, through needle sharing. People with hearing disabilities and adolescents are considered vulnerable as objects of harassment and sexual violence.&#x0D; Conclusion: People with disabilities and adolescents are vulnerable to sexually transmitted diseases. Information on reproductive health and sexually transmitted diseases need to be more readily available for people with disabilities. Secondary syphilis therapy with a single dose of benzathine penicillin is effective from clinical or serological observations.

Congenital syphilis as the cause of multiple bone fractures in a young infant case report

BackgroundThe differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in 60–80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis.Case presentationThis 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made.We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF.On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings.ConclusionsWe present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy.

LB1576. High Prevalence of Oral Treponema pallidum by PCR among US Adults with Early Syphilis

Abstract Background Treponema pallidum (T. pallidum) is transmitted from person to person by direct contact with widespread dissemination early after acquisition. Current syphilis diagnostic testing is limited to darkfield microscopy from visible lesions and serologic antibody detection. T. pallidum molecular diagnostics are urgently needed. Methods As part of a multicenter US syphilis treatment trial that completed enrollment in March 2022 (NCT 3637660), we randomized 249 adults with early syphilis infection to 1 vs 3 weekly doses of benzathine penicillin G to compare treatment response at 6 months. In a small substudy (n=32) presented here, consenting participants at the University of Alabama at Birmingham (UAB) and Emory University had pre-treatment oral (buccal mucosa and posterior pharynx) and lesion swab samples collected. Following DNA extraction, T. pallidum burden in samples was quantified by targeting the tp0574 gene. Syphilis was staged by experienced providers according to physical examination and serology. Results Study participants were men (100%) and most were living with HIV (91%) with mean CD4 count 477 cells/mm3. Syphilis stage was categorized as primary in 6 (19%), secondary in 18 (56%) and early latent in 8 (25%). Oral swab qPCR positivity rates were 17% in primary disease, 44% in secondary disease, and 63% in early latent disease (see Figure). Lesion PCR positivity was similar in primary and secondary syphilis (40% and 38.5%). Mean treponemal burden was highest on oral swabs of participants with early latent syphilis (13,128,969) and lesion swabs of participants with secondary syphilis (2,033,309). Conclusion Among adult males, many living with HIV, data suggest a role for oral and lesion swabs for the molecular detection of T. pallidum. Widespread availability of PCR, the relative ease of oral specimen collection, and the opportunity to directly demonstrate T. pallidum in persons with early latent syphilis suggest the opportunity for PCR testing to enhance and refine syphilis diagnostic testing. The elevated proportion of positive oral samples and significant organism burden in secondary and early latent syphilis is consistent with potential for transmission. Disclosures All Authors: No reported disclosures.

IS IT A HERXHEIMER REACTION OR ANAPHYLAXIS COMPLICATING USE OF PENICILLIN IN SYPHILIS TREATMENT?

<h3>Introduction</h3> Herxheimer reactions, similar to anaphylaxis, can occur after the first dose of penicillin and can be associated with dyspnea, hypotension, rash, vomiting and tachycardia. Herein we describe a case regarding a complication of syphilis treatment that was thought to be anaphylaxis, but further investigation suggested Herxheimer reaction. <h3>Case Description</h3> A 62-year-old man with a distant history of syphilis infection was seen by an outpatient ophthalmologist for 1.5 months of rapidly worsening vision in his right eye secondary to ocular syphilis. RPR testing was positive and the patient was directly admitted for treatment. The patient reported developing a reaction to penicillin more than thirty years prior which included vomiting, dyspnea, throat tightening, and a rash fitting the description of urticaria that was reflexively diagnosed as anaphylaxis at the time. Due to the 30-year history of penicillin allergy, the Allergy Immunology Service was consulted. The patient passed the indicated penicillin skin testing and challenge. On further evaluation, it was determined that he previously had rigors, fever, and chills, which were more compatible with Herxheimer Reaction. He was then started on penicillin G 4MU IV q4 hours. Fortunately, he did not develop an "ocular" Herxheimer reaction. <h3>Discussion</h3> Distinguishing anaphylaxis from a Herxheimer reaction in this patient is important for several reasons: (1) treatment can cause an ocular Herxheimer reaction, (2) avoidance of penicillin for 30 years may have led to delayed, more expensive, and less effective therapies, and (3) the cost of skin testing, challenge, and if-needed desensitization could have been avoided based on the history.

S3020 Hepatitis From a Sexually Transmitted Bacterial Infection

Introduction: Syphilis is a multisystemic, sexually transmitted infection (STI) that is caused by the spirochete Treponema pallidum. Hepatic involvement is rare. We present a patient who was diagnosed with syphilitic hepatitis (SH). Case Description/Methods: A 54-year-old male presented to the hospital with one week of sharp upper abdominal pain, jaundice, poor appetite, and a 25-lb. weight loss. He also reported multiple sexual partners and a rash that developed 2 months ago. Vital signs were within normal range. Physical examination revealed scleral icterus, a soft, non-tender abdomen, a plaque-like penile lesion and small, circular lesions on his palms and soles of feet. Laboratory studies revealed aspartate aminotransferase (AST) 164 U/L, alanine aminotransferase (ALT) 207 U/L, alkaline phosphatase (ALP) 1395 U/L, total bilirubin 5.6 mg/dL, gamma-glutamyl transferase 782 U/L. Hepatitis panel, acetaminophen and alcohol levels were negative. Chronic liver disease work-up was unremarkable. Treponemal antibody and rapid plasma reagin test were both positive. HIV test and cerebrospinal fluid venereal disease research laboratory (VDRL) test were negative. Abdominal ultrasound and CT scan of the abdomen were unremarkable. Magnetic resonance cholangiopancreatography was notable for hepatomegaly and hepatitis. Patient received 1 dose of penicillin G 2.4 million units intramuscularly with remarkable improvement in his symptoms and liver function tests. He was discharged home with close follow-up with gastroenterology and infectious disease. Discussion: SH occurs in 0.2-9.7% of patients with syphilis and is most commonly seen in the primary and secondary disease stages. Clinical manifestations include a maculopapular rash (involving the trunk, palms and/or soles of feet), fatigue, poor appetite, hepatomegaly and icterus. Liver function tests (LFTs) may reveal a marked increase in ALP and GGT in comparison to ALT and AST. SH is diagnosed with abnormal LFTs, serological evidence of syphilis, exclusion of other liver diseases and LFTs returning to normal after antibiotic therapy as in our patient. The histological features of SH include inflammatory infiltration of the bile duct and hepatic granulomas. Spirochetes are often difficult to identify in liver tissue. Penicillin is the mainstay of treatment. Clinicians should consider syphilitic hepatitis in a patient with abnormal LFTs (especially ALP) and a rash involving the palms and soles of feet in the appropriate clinical context.

Neurosyphilis masquerading as papillodema unmasked by tell-tale vitreous cells and peripapillary hemorrhages

A 35-year-old lady presented with headache and diminution of vision in both eyes for 30–35 days. She was being treated for idiopathic intracranial hypertension with documented high intracranial pressures. In view of the past history of positive blood RPR and the current picture of peripapillary hemorrhage along with papillodema and telltale vitreous cells, we suspected neurosyphilis and repeated Blood-CSF TPHA, both of which were positive. She was treated with a single dose of benzathine penicillin G 1.2 MIU I.M and tablet doxycycline 100 mg twice a day for 14 days, with oral acetazolamaide, to achieve resolution of symptoms and improvement of vision.

A Review on the Diagnosis and Treatment of Syphilis

Syphilis is a multi-phase sexually transmitted disease through contacting with a partner infected by syphilis or from a gravida to her newborn congenitally. The reappearance of syphilis is a severe public health concern, particularly because syphilis lesions would boost the chance of acquiring and spreading human immunodeficiency virus (HIV) infection. A dose of benzathine penicillin G (BPG) through intramuscular injection is the current treatment for syphilis, which is the optimal treatment for all stages of syphilis. Although some alternatives such as doxycycline and ceftriaxone are also evidently effective, the optimal therapy is still BPG, especially in latent syphilis and pregnancy. Because of the clinically significant azithromycin resistance, this second-line medication is no longer used routinely. Currently, macrolide resistance is the only antibiotic resistance with clinical evidence. Even though still no vaccine is published for syphilis, syphilis is a promising disease for vaccine development. The vaccine for syphilis is currently under research. This paper contained information about the pathological process, symptoms, diagnosis of syphilis, and effective treatment using antibiotics. The review also discussed future vaccine directions.

ORAL MANIFESTATION OF PRIMARY SYPHILIS

Syphilis is a bacterial infection caused by <i>Treponema pallidum</i>, which can be transmitted mainly through unprotected sexual contact or vertical transmission. This disease can manifest itself in the primary, secondary, and tertiary stages. The most important laboratory tests for diagnosis are treponemic and nontreponemic tests. A 23-year-old male patient attended the oral medicine clinic reporting an asymptomatic upper lip vermilion lesion. The physical examination revealed an ulcerated lesion with a clear base in the vermilion of the upper lip, on the right side, of approximately 1.0 cm. Clinically, the diagnostic hypothesis was chancre. Incisional biopsy and serological tests for syphilis and human immunodeficiency virus were performed. The histopathologic examination confirmed the diagnostic hypothesis, and the tests obtained positive results only for syphilis. Treatment was performed with a single dose of benzathine penicillin and the lesion regressed, testing negative in the Venereal Disease Research Laboratory after 3 months.