Intramuscular Injection Of Benzathine Penicillin Research Articles

Local anaesthetic to reduce injection pain in patients who are prescribed intramuscular benzathine penicillin G: a systematic review and meta-analysis

Three to 4-weekly intramuscular injections of benzathine penicillin G (BPG) for a prolonged period (e.g., 10 years, until age 40 years, or lifelong) are recommended for preventing group A streptococcal infections that cause recurrent acute rheumatic fever (ARF) and potential progression to rheumatic heart disease (RHD). The duration of treatment, frequency and local pain associated with BPG injections may lead to reduced compliance. Shorter courses of BPG are recommended for the treatment of syphilis and Streptococcal infections. We aimed to assess the effects of local anaesthesia in reducing injection pain in patients who are being treated with BPG. In this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Conference Proceedings Citation Index-Science and LILACS from database inception up to May 4, 2024, and performed additional searches for grey literature. Randomised controlled trials comparing BPG vs. BPG administered alongside local anaesthetics were included. Randomized controlled trials using BPG, irrespectively of indication, and testing any local anaesthetic agent for pain alleviation were considered eligible. We applied GRADE to assess the quality of evidence. Summary data were extracted from included trials. The primary outcome was injection pain, assessed through mean differences. A random-effects model was utilized to account for study heterogeneity. This study is registered with PROSPERO, CRD42022342437. Database searches identified a total of 3958 records, and 3 additional records were retrieved from grey literature searches. After removal of duplicates, screening of abstracts and full-text review, eight trials were included, combining a total of 489 patients (151 patients with RHD). Immediate pain level, as reported by patients, was of high intensity in most studies. Low intensity pain was still reported at 24h. Administration of lidocaine mixed with BPG was associated with a significant reduction in immediate post-injection pain (mean difference-3.84, 95% confidence interval-6.19 to-1.48, P=0.0001; 4 studies; I2=98%; GRADE: moderate quality), pain at 5 min (mean difference-2.85, 95% CI confidence interval-3.78 to-1.92, P<0.0001; 1 study; GRADE: moderate quality), and pain at 20 min (mean difference-1.85, 95% confidence interval-2.61 to-1.09, P<0.0001; 1 study; GRADE: moderate quality) on a 1 to 10 scale. One study assessed lidocaine cream applied to the skin prior to BPG injection and showed no significant reduction in injection pain (mean difference=-0.54, 95% CI confidence interval-1.17 to 0.09, P=0.13; 1 study; GRADE: low quality). Mepivacaine mixed with BPG in patients with syphilis showed a significant reduction of immediate post-injection pain (mean difference-2.19, 95% CI confidence interval-2.49 to-1.89, P<0.0001; 1 study; GRADE: moderate quality). Two studies assessed procaine mixed with BPG and reported: lower immediate pain levels or pain assessed at 1h (mean difference and 95% CI confidence intervals not provided, P=0.001 and P=0.008, respectively; 1 study; GRADE: low quality), or less immediate pain and pain at 24h on the buttock injected with procaine mixed with BPG (mean difference and 95% CI confidence intervals not provided, P<0.001 for both; 1 study; Grade: low quality). No severe adverse reactions were reported. In patients receiving intramuscular BPG injections, moderate quality quantitative evidence suggests that BPG injections diluted with lidocaine or mepivacaine may improve post-injection pain scores compared to BPG injections diluted with sterile water. Procaine may also have a benefit, but quality of evidence was lower. Most studies included small patient samples and assessed pain levels at different timepoints. Due to insufficient data we were not able to assess the impact of injection volume, and local anaesthetics' dose on pain intensity and duration of pain relief. WHO.

Insights into ocular syphilis in Nepal.

This study aims to elucidate the demographic characteristics, clinical features, diagnostic approaches, and medical management of patients with ocular syphilis, known as 'the great masquerader,' at a tertiary eye care center in Nepal. We conducted a retrospective review involving 15 eyes from ten patients with ocular syphilis treated at a uveitis referral center between 2020 and 2022. Lumbar puncture was performed if neurosyphilis was suspected. Treatment success was defined as the absence of ocular inflammation in both eyes and a decrease in Veneral disease research laboratory (VDRL) titres after completing therapy. A total of 15 eyes of 10 patients were diagnosed with syphilitic uveitis based on positive treponemal and non-treponemal serological tests. The mean age of the patient was 39.9years (range 22-54years) with an equal distribution between males and females. HIV coinfection was not found in any of the patients. Syphilitic uveitis was the primary presentation in nine patients (90%), while one patient presented with recurrent nodular scleritis. Ocular involvement was bilateral in 50% (5 patients). The mean duration between the initial symptom and the first presentation was 8.7weeks (range: 4days to 24weeks). The most common ocular findings was panuveitis (6 eyes). Eight patients with early syphilis received weekly intramuscular injections of benzathine penicillin G for 3 weeks whereas 2 patients with neurosyphilis were treated with intravenous ceftriaxone 1 gm twice a day for 14 days. Signs and symptoms of majority of patients improved with systemic therapy for syphilis. Syphilitic uveitis should be included in the differential diagnosis of any form of ocular inflammation.

Nursing Effects of Modified Intramuscular Injection Technique in Syphilis Treatment with Benzathine Penicillin

Nursing Effects of Modified Intramuscular Injection Technique in Syphilis Treatment with Benzathine Penicillin

Recurrent diabetic foot ulcer: An educational image and expert opinion

Background: The occurrence of diabetic foot ulcers is commonly attributed to factors including infection, diabetic neuropathy that are commonly associated poor control of blood sugar. History of foot ulcer is generally considered an important risk factor. Keywords: Richard Asher syndrome, Iraq. Patients and methods: The case of a diabetic and hypertensive male patient who had a history of previous foot ulcer, and developed a recurrence at the same site is described with emphasis on the current evidence-based therapeutic recommendations. Results: A 55-year diabetic hypertensive male who had a history of foot ulcer which healed completely after aggressive treatment before more than one year. The first ulcer was associated with clear evidence of infection with cellulitis and pus formation, but there was no evidence of gangrene. The first ulcer was treated successfully with antibiotic therapy followed by monthly intramuscular injection of benzathine penicillin. Topical treatment included topical antibiotic (fusidic acid) and topical dexpanthenol. Pentoxifylline was used instead valsartan to control hypertension and to improve peripheral vascular impairment. The patient also received alpha-lipoic acid supplementation. Few weeks before the occurrence of the second ulcer, the patient visited the practitioner of the organization who was working with, and for unclear reason, the doctor switched pentoxifylline with Coveram (Perindopril 10 mg + Amlodipine 10 mg). The ulcer was not associated with evidence of serious infection, and cellulitis like the first ulcer. However, the patient received oral antibiotics and topical therapies. To avoid injudicious frequent changes of antihypertensive medication, oral pentoxifylline was added in a dose of 400 mg daily. The second ulcer healed within one week. Conclusion: The medical treatment of the diabetic foot ulcer follows the principles of wound healing which include treatment of soft tissue infection, in addition to controlling factors more specifically related to diabetes such as neuropathy and peripheral vascular impairment. The current expert opinion suggests the use of monthly intramuscular benzathine penicillin, alpha-lipoic acid supplementation, and pentoxifylline in the long-term preventive therapies.

Case Report: Secondary Syphilis And Human Immunodeficiency Virus Coinfection

Introduction: Syphilis is a sexually transmitted infection that is chronically progressive, with a broad spectrum of active clinical and asymptomatic periods. A total of 80.6% of men with syphilis were Men Who Sex with Men (MSM), 47% of the population was coinfected with Human Immunodeficiency Virus (HIV). Case Presentation: Male, 23-yo, MSM, unmarried, HIV, complaining of red bumps and spots on the palms, soles, and upper arms since 4 days ago. One week earlier, he complained of sores in the genitals, which recurred 1 year ago and healed on their own. Dermatological examination revealed multiple erythematous patches and papules. The corpus penis, glans penis, and scrotum showed erosions and multiple ulcers with an erythematous-based, covered with yellowish crusts. VDRL and TPHA were reactive. The patient was diagnosed with secondary syphilis and treated with an intramuscular injection of benzathine penicillin 2.4 million IU once. A 1-month evaluation showed significant lesion improvement, VDRL titer 1:64. Evaluation of the 3rd and 6th months revealed a VDRL titer of 1:4. Conclusion: The clinical manifestations of syphilis patients with HIV coinfection are generally more atypical, aggressive, and overlap caused by changes in the immune system in HIV infection. Unsafe sexual behavior in MSM increases the transmission of syphilis infection. Diagnosis and therapy are generally the same. Men Who Sex with Men is a factor that allows the transmission of syphilis in HIV patients. Administration of benzathine penicillin injection once gave lesion improvement and significantly reduced VDRL.

Multimodal imaging in syphilitic retinitis with vasculitis in an immunocompetent patient

A 47-year-old male reported a sudden diminution of vision in the left eye for 1 month. Fundus examination showed dense vitritis, retinal hemorrhages around the disc with subretinal precipitates. Peripheral examination revealed snowball opacities. Multimodal imaging indicated syphilitic retinitis with vascular leakage. A complete systemic workup was performed to support the diagnosis. Intramuscular benzathine penicillin injection along with oral corticosteroids showed an excellent response as confirmed by the multimodal imaging. Syphilitic retinitis with vasculitis is uncommon and can occur in immunocompetent patients. Multimodal imaging can be used to demonstrate the extent of involvement and to monitor treatment response.

Secondary Syphilis During Pregnancy: The Importance of Screening and Clinical Management

Background: Syphilis is one of the most serious sexually transmitted diseases worldwide, and has tremendous consequences for the mother and her developing fetus if left untreated. The burden of morbidity and mortality due to congenital syphilis is high. Purpose: Screening and prompt to know the importance of treatment of syphilis during pregnancy. Case: A 32-year-old multigravida in 5 months of pregnancy presented with multiple raised lesions over her labia. It was accompanied by fluor and smelly fishy odor. There was no history of genital ulcers in either spouse and no history of sexual promiscuity. History of antenatal care in public health showed non-reactive status of HIV, syphilis and hepatitis B. Clinical examination revealed multiple flat, moist warts over her labia mayora and minora, and multiple roseola syphilitica on the plantar pedis sinistra. Darkfield microscopic examination presence spirochete, venereal disease research laboratory (VDRL) titer was 1:16 and T. pallidum particle agglutination assay (TPHA) titer was 1:2560. Obstetric ultrasonography examination was suggestive no mayor congenital abnormalities. Both of serology VDRL and TPHA were non-reactive in her husband. Significant of lesion improvement and decrease a fourfold titer serologic in VDRL (1:4) and TPHA (1:320) as follow-up 3 months after being treated with single intra-muscular injections of benzathine penicillin 2.4 million units. Discussion: Coordinated prenatal care and treatment are vital. It’s implemented before the fourth month of pregnancy to reduce vertical transmission and all associated side effects of congenital syphilis. Penicillin is highly efficacious in maternal syphilis and prevention of congenital syphilis. Conclusion: Universal screening and adequate pregnancy care must be a priority.

Using an Indigenous framework to contextualise Immunology education within the Health Sciences setting

Abstract Indigenous Māori and Pacific children and young people remain disproportionately affected by Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD), with rates in Aotearoa/New Zealand and the Pacific Region of significant concern. ARF is the body’s autoimmune response to an untreated Group A Streptococcal (GAS) throat or skin infection. If multiple or severe episodes of ARF occur and are left untreated, this can lead to permanent cardiac damage known as RHD. RHD remains a major cause of morbidity and mortality globally. In the absence of a GAS vaccine, the best recommended treatment and management approach consists of painful monthly intramuscular injections of Benzathine Penicillin G (BPG) administered to the upper thigh area, and given for at least 10 years or more. A new Penicillin for ARF/RHD prevention is urgently needed. The purpose of this work was to employ the use of an Indigenous Pacific framework within the undergraduate Health Sciences education setting to support learning and teaching efforts appropriate to vulnerable communities affected by ARF and RHD. The Talanoa approach was utilised within the classroom setting to support discussions relating to ARF and RHD and vulnerable communities that was appropriate and respectful to the Indigenous cultural setting. Well-received by students, this approach was not only applicable to the cultural setting for those communities affected by ARF/RHD in Aotearoa/New Zealand, but also helped with contextualisation, supporting courteous class discussions with relevant in-class learning opportunities and experiences. This work highlighted the importance of Indigenous frameworks for supporting Immunology education within the Health Sciences education setting.

Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. How to Cite this Article Pubmed Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Web Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. http://www.sysrevpharm.org/?mno=11016 [Access: March 29, 2021]. doi:10.31838/srp.2020.9.63 AMA (American Medical Association) Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Vancouver/ICMJE Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. (2020), [cited March 29, 2021]; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Harvard Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Turabian Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. 2020. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Chicago Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11 (2020), 452-457. doi:10.31838/srp.2020.9.63 MLA (The Modern Language Association) Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11.9 (2020), 452-457. Print. doi:10.31838/srp.2020.9.63 APA (American Psychological Association) Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63

Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial.

The aim of this study was to determine the effect of using three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures on patients' pain and satisfaction levels during intramuscular benzathine penicillin injection. A randomized controlled trial. The study population consisted of 91 patients who were prescribed intramuscular benzathine penicillin medication. The participants were stratified by gender and assigned to three groups (control, virtual reality and distraction cards groups). The visual analogue scale was used to assess pain and patient satisfaction. A one-way analysis of variance and Dunnett's post hoc tests were used to compare the pain and satisfaction levels by group. The mean pain was 6.67 (2.17) in the control group, 4.4 (2.71) in the distraction cards group and 4.93 (3.07) in the virtual reality group and the difference was statistically significant (F=5.84, p˂.01). The average of the satisfaction levels in the groups was 3.57 (2.23) in the control group, 7.13 (2.86) in the distraction cards group and 8.07 (2.55) in the virtual reality group. The difference between the satisfaction levels was statistically significant (F=25.77, p˂.01). The three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures were effective in reducing pain associated with intramuscular benzathine penicillin injection and increasing patient satisfaction. The results of this study will contribute to evidence-based nursing practices for the pain associated with intramuscular benzathine penicillin injection. NCT04420559.

Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

15119 Reducing the pain of intramuscular benzathine penicillin injection in syphilis by using 1% lidocaine as a diluent: A prospective, randomized, double-blinded trial study

Background: According to the Centers for Disease Control and Prevention 2015 sexual transmitted disease treatment guidelines, Benzathine penicillin G (BPG) is the recommended first-line treatment for the treatment of syphilis. In our general practice, using lidocaine as the diluent of BPG causes pain at the injection sites. This study aimed to compare the effect of BPG diluted in 1% lidocaine versus that diluted in sterile water on injection sites.

Nicolau syndrome after intramuscular benzathine penicillin injection

Abstract Background Nicolau syndrome is a rare, potentially severe complication that may occur after any drug injection, particularly after intramuscular, subcutaneous or intraarticular injection. The pathogenesis of the necrosis is not completely known, it's presumed that ischemic necrosis is induced by direct vascular injury, perivascular inflammation, and vascular constriction. Few case was reported since the first description by Freudenthal in 1924 and Nicolau in 1925. Case report we report two cases of Nicolau syndrome in the child after benzathine penicillin intramuscular injection in the thigh. The cases were complicated by a necrosis of the extremities and a Volkmann syndrome. Conclusion Nicolau syndrome is an uncommon iatrogenic ischemic necrosis of the skin and deeper tissue. It is reported to occur after intramuscular injection for certain drugs such as benzathine penicillin. The pathogenesis is unknown but embolic occlusion, inflammatory and physical obstruction of blood vessels have been suggested in our cases. There is no standard guideline for its management.

Extensive Deep Tissue Involvement in Nicolau Syndrome and Below-Knee Amputation: A Case Report and Literature Review.

Nicolau syndrome (NS) is a rare cutaneous drug reaction in response to injections administered via any route. Based on the available studies in the medical literature, NS presents as skin and subcutaneous fat necrosis, and typically, it does not cause severe complications such as acute limb ischemia or death. In this study, we report the case of a 6-year-old boy who received an intramuscular injection of benzathine penicillin G for the treatment of bacterial pharyngitis, and subsequently developed a severe case of NS, which eventually led to below-knee amputation of the right lower limb. Although a few approaches have been suggested for the management of NS, they might not be effective under certain circumstances. Early detection, close monitoring, and consistent interventions, such as surgical fasciotomy and debridement procedures, might be necessary in severe cases of NS.

Coincidence of Nicolau Syndrome and Rhabdomyolysis after Intramuscular Benzathine Penicillin Injection: A Case Report

Nicolau syndrome (NS) is a rare but well-known complication of intramuscular Benzathine Penicillin (BP) injection, manifesting by symptoms of livedoid discoloration of the skin, edema, as well as classical clinical features of myalgia, muscle weakness and pigmenturia immediately after intramuscular. NS or embolia cutis medicamentosa was first described in 1925 by Nicolau and Freudenthal following intramuscular injection of bismuth salt for the treatment of syphilis. Since then, a few cases have been reported both in adult and children.

Compartment syndrome and acute lower limb ischemia with paralysis complicating intramuscular benzathine penicillin injection

Nicolau dermatitis (ND) is a well-known but rare adverse drug reaction involving the skin and the subcutaneous and even muscle tissues at the site of intramuscular injection (IMI). Benzathine penicillin (BP) is the most frequent medication causing serious and acute complications such as limb ischemia, compartment syndrome (CS), and nerve paralysis. The subsequent damage to the lower limb (LL) might be due to microemboli, leading to progressive deterioration of the downstream tissue bed. We describe a 7-year-old boy with a diagnosis of ND after IMI of BP and diclofenac sodium to the medial mid-right thigh. Two days earlier, the patient seemed to experience an acute suppurative complication of circumcision and underwent the aforementioned treatment (September 15, 2018). The circumcision and injection of drugs were illicitly carried out by a nonmedical practitioner. The child complained of severe pain and disability of his right LL. On admission (September 16, 2018), he was found to have acute LL ischemia and CS with cyanosis, hypoesthesia and paresis. Fasciotomy was achieved and medical therapy with heparin, corticoid, and an antibiotic was made for 7 days. Postoperative periods were uneventful. Livedoid violaceous patch and erythematous plaque and ecchymosis have evolved progressively during 10th day, with formation of a diffuse necrotic spot before healing up within 2 months. The length of hospital stay was 10 days. The rehabilitation for walking was started 2 weeks after the operation. Between 6 and 12 months of follow-up, the motor deficit involved the entire LL and persisted despite the tremendous achievement of regular neuromuscular physiotherapy. The paralysis was considered permanent.

Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline

Nous décrivons le cas d'un enfant de 9 ans qui a présenté une ischémie aiguë sévère de membre dans un contexte de syndrome de Nicolau du membre pelvien gauche faisant suite à une injection intramusculaire glutéale de benzathine-pénicilline. Outre la rareté de l'ischémie aiguë de membre chez l'enfant, la particularité de ce syndrome de Nicolau compliqué associant une thrombose artérielle aiguë et d'une rhabdomyolyse sévère ayant conduit à une désarticulation de sauvetage de la hanche font l'intérêt de ce cas.

A RETROSPECTIVE ANALYSIS OF 12 CASES OF ORAL SYPHILIS RECENTLY DIAGNOSED AT A SOLE INSITITUTION

Syphilis is an infectious disease caused by the bacterium Treponema pallidum and has 3 classically clinical stages. This disease may mimic several other more common oral mucosa lesions. This study aimed to describe the different oral manifestations of 12 patients diagnosed as having syphilis in the last few years at our institution. Eleven of the 12 syphilis cases presented lesions of secondary syphilis and 1 of primary syphilis. The diagnosis was made through biopsies or/and laboratory tests, and the treatment was conducted by intramuscular injections of benzathine penicillin G with good results. The patients' group examination confirmed the theory that syphilis may resemble several other diseases. Dental surgeons should be aware of the manifestations of oral syphilis, which might be very different from the classical description of mucous patches, to play a desirable key role on the diagnosis and control of this disease. Syphilis is an infectious disease caused by the bacterium Treponema pallidum and has 3 classically clinical stages. This disease may mimic several other more common oral mucosa lesions. This study aimed to describe the different oral manifestations of 12 patients diagnosed as having syphilis in the last few years at our institution. Eleven of the 12 syphilis cases presented lesions of secondary syphilis and 1 of primary syphilis. The diagnosis was made through biopsies or/and laboratory tests, and the treatment was conducted by intramuscular injections of benzathine penicillin G with good results. The patients' group examination confirmed the theory that syphilis may resemble several other diseases. Dental surgeons should be aware of the manifestations of oral syphilis, which might be very different from the classical description of mucous patches, to play a desirable key role on the diagnosis and control of this disease.

Group A Streptococcal Infection, Acute Rheumatic Fever and Rheumatic Heart Disease in the Solomon Islands

Abstract Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin) can trigger Acute Rheumatic Fever (ARF), an autoimmune condition if left untreated. Severe or recurrent attacks of ARF that also remain untreated, can lead to a type of permanent cardiac damage known as Rheumatic Heart Disease (RHD). RHD remains a significant cause of morbidity and mortality globally and is rare in developed countries. In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities remain one of the highest in the world, usually affecting children and young adults. Since a GAS vaccine remains unavailable, the most effective recommended treatment and management strategy to prevent further GAS infections that can lead to ARF and RHD constitute of painful monthly intramuscular injections of Benzathine Penicillin G (BPG). These BPG injections are administered for at least 10 years or more and are referred to as secondary prophylaxis (SP). Due to the pain, formulation and other issues associated with regular BPG injections, adherence to SP remains problematic globally. A new Penicillin that supports better adherence to SP is urgently needed. This work sought to further understand the local context in the Solomon Islands concerning GAS, ARF and RHD. Preliminary findings indicate very high ARF and RHD rates present in the local setting, in addition to issues with access to ARF/RHD prevention measures with BPG. An electronic database to monitor ARF and RHD as a national disease register will be of clinical relevance to the local setting in the Solomon Islands. Research efforts in the Pacific Region contributing towards the generation of a new Penicillin for BPG SP will be of benefit.

Needle temperature and pain perception in the treatment of rheumatic heart disease

Aim: Patients with rheumatic heart disease (RHD) are committed to lifelong secondary prophylaxis with antibiotics. The study was conducted to evaluate the effect of cold needle to decrease the pain associated with this injection. Material and methods: A randomised crossover single-blinded study was conducted among 100 patients receiving penicillin with room-temperature needle and cold needle (0–2oC) in random order. Pain was evaluated using numerical pain rating scale and bio-physiological measures. Results: There was a significant decrease in subjective pain score when cold needle was used as compared to room-temperature needle (3.37 ±1.75 vs 5.58 ±1.68, P≤0.0001). Conclusion: Cold needle decreased pain perception of patients receiving intramuscular injection of benzathine penicillin. Pain-reducing technique may be useful in improving compliance of patients receiving benzathine penicillin.