Lesions Of Secondary Syphilis Research Articles

Early Syphilis Presenting as Thickened Penile Plaques With an Embedded Recurrent Ulcer (Chancre Redux): A Case Report

Introduction: The manifestations of syphilis are varied, and serology can establish the diagnosis early, especially in rare cases. We report a case of chancre redux (a rare recurrence of primary syphilis), which was embedded within a secondary syphilitic penile skin plaque. There were missed opportunities at earlier diagnosis as serology for syphilis was not ordered. Case presentation: A 56-year-old man presented with thickened penile plaques for five months. He reported a small penile ulcer approximately one month prior. There was no history of other skin lesions or rash. However, clinically there was an asymptomatic, indurated ulcer embedded within a plaque which was swab-positive for syphilis by PCR. A punch biopsy of a plaque was spirochaete-positive using an immunoperoxidase stain. The patient’s lesions resolved three weeks after treatment with intramuscular benzathine penicillin. Discussion: Uncommonly reported even in the preantibiotic era, chancre redux is now rare. The ulcer usually recurs at or near the site of the original chancre, and has similar morphological features. The skin lesions of secondary syphilis can exhibit remarkable morphological variety. The most common skin manifestation, a generalized macular rash, was not present at any time in this case. Rather, there were only a couple of nonspecific penile plaques. If biopsy is performed, histologic findings are variable, though typically the inflammatory infiltrate includes plasma cells. A special immunoperoxidase stain can highlight spirochaetes in biopsy sections. Conclusion: This case highlights the importance of considering syphilis in the differential diagnosis of persistent, atypical penile lesions and underscores the need for appropriate serological testing in such instances.

Painful facial, oral, and genital ulcers

Painful facial, oral, and genital ulcers

Are we moving from symptomatic to asymptomatic syphilis: A retrospective analysis.

Syphilis remains a global health problem with recent reports of resurgence from various parts of the world. We undertook this study to analyze the current epidemiological and clinical trends of syphilis in our part of the country. To analyze the changing trends in clinical presentation of syphilis and the current status of HIV/AIDS-syphilis co-infection in our area. This is a hospital-based retrospective analysis of records of sexually transmitted disease (STD) patients enrolled in "Suraksha clinic" in the department of Skin and VD at a Tertiary Care Hospital in North India. Patient records were analyzed from January 2018 to December 2021. The demographic, clinical, and serological profiles of patients were assessed to study the percentage of syphilis patients attending the STD clinic and their clinical presentations. A total of 7153 patients were enrolled in the"Suraksha clinic" from January 2018 to December 2021, these included the venereal disease patients (3137) and nonvenereal disease patients (4016) who were registered for HIV and venereal disease research laboratory (VDRL) screening from the dermatology outpatient department. Out of 3137 sexually transmitted infection (STI) patients, 139 patients tested positive for VDRL. Treponema pallidum hemagglutination was found positive in 137 patients and negative in two patients. Hence, 137 patients were confirmed syphilis cases, constituting 4.36% of total STD cases in our STI clinic in 4 years. Out of 137 patients, 2 (1.45%) presented with primary chancre, 6 (4.37%) with lesions of secondary syphilis and 129 (94.16%) were found serologically reactive without any symptoms or clinical signs, i.e., in latent syphilis. Our records also showed 14 (10.21%) cases of HIV and syphilis co-infection. In our study, a remarkable rise in the number of patients in the latent syphilis stage is observed over primary and secondary syphilis stage. This signifies the persistence of syphilis in subclinical phase in the community and unfortunately, it goes unnoticed. These could be "warning signs" for changing disease pattern of syphilis in India and points toward hidden resurgence of syphilis as being reported in various parts of the world. To actively look for these "hidden cases," there is a need to strengthen "Suraksha clinics." VDRL testing should be mandatory along with routine testing in all patients visiting the hospital irrespective of their disease. We also propose for the central registration of syphilis patients on lines of HIV-infected patients' registry.

The Biett Collarette as an Important Dermascopic Finding of Secondary Syphilis

Syphilis is a sexually transmitted infection that presents with cutaneous manifestations during the disease course. The lesions seen in secondary syphilis can manifest differently in each individual and resemble lesions seen in other conditions; thus, making the diagnosis difficult in some circumstances. The lesions in secondary syphilis can be distinguished by a peripheral scale surrounding each lesion, known as a Biett Collarette. This unique finding can be visualized better via dermoscopy. Given this historically hard to diagnose condition, looking for the Biett Collarette can aid providers in diagnosing secondary syphilis. We encourage providers to look for this finding when presented with a vague maculopapular rash with secondary syphilis on the differential.

Acquired Syphilis by Nonsexual Contact in Childhood.

Children may acquire syphilis by nonsexual contact as a consequence of close and repetitive contact with mucosal or skin lesions of people with active syphilis. Prospective cohort study of pediatric patients with acquired syphilis by nonsexual contact. Demographics, clinical findings, posttreatment serology development and general laboratory data were collected. Sexual transmission was ruled out after a careful medical and psychosocial evaluation of the patient and his/her family. Twenty-four patients were included in the study. Mean age at diagnosis was 4.2 years old. All of them came from overcrowded households with poor hygiene conditions. The most frequent reason for consultations was secondary syphilis skin lesions (79.2%). The psychosocial evaluation of children and their families did not reveal signs of sexual abuse in any of the cases. Seventy-eight families and their cohabitants were evaluated, 23 (29.5%) resulted positive for rapid plasma reagin and treponemal test of hemagglutination; 60.9% of the cases were asymptomatic. The symptomatic relatives showed lesions of secondary syphilis. A sustained fall on nontreponemal antibodies titer (rapid plasma reagin) was observed after treatment, becoming negative in 6/24 (25%) cases within 12 months posttreatment. Following evaluation, it was considered that sexual abuse was unlikely. However, if examination and psychosocial evaluation do not support it, other ways of transmission must be considered. Overcrowded and poor household conditions boost the risks for nonsexual treponema transmission. An infected member of the family or a caretaker are a particular risk to an infant due to common practices such as using saliva to moisten the rubber nipples of the milk bottles or trying the food temperature using the lips before feeding the infants.

Treponema pallidum detection in lesion and non-lesion sites in men who have sex with men with early syphilis: a prospective, cross-sectional study

Syphilis transmission is increasing, and precisely how Treponema pallidum is transmitted sexually from person to person is unclear. We aimed to determine the frequency of T pallidum shedding from potentially asymptomatic sites and the stage of infection at which shedding is most frequent in men who have sex with men (MSM), who have been disproportionately affected by syphilis. We did a prospective, cross-sectional study in MSM recruited from Melbourne Sexual Health Centre (Melbourne, VIC, Australia). Men were eligible if they were aged 18 years or older, reported sex with men during the past 12 months, and had laboratory confirmed primary, secondary, or early latent syphilis, consistent with Australian definitions. Primary and secondary syphilis lesions were swabbed and non-lesion samples were collected via oral rinse, oral cavity swab, anal canal swab, urine, and semen. Samples were tested for T pallidum using PCR assays targeting polA (lesion and non-lesion samples) and 47 kDa (non-lesion samples only) gene targets. The primary outcome was the proportion of men with T pallidum detected from potentially asymptomatic sites-namely, the mouth, anus, urethra, and semen. Between Nov 30, 2015, and May 23, 2019, 246 MSM were screened for inclusion, of whom 200 had serologically confirmed early syphilis and were included in the study: 54 (27%) of 200 had primary syphilis, 93 (47%) had secondary syphilis, and 53 (27%) had early latent syphilis. T pallidum DNA was detected in 48 (24%; 95% CI 18·3-30·5) of 200 men by oral rinse or oral lesion swab, or both, of whom 24 had no oral lesions. Oral T pallidum detection was most frequent in those with secondary syphilis compared with those at other stages of disease (41 [44%] of 93 vs seven [7%] of 107; p<0·0001), and in men with rapid plasma reagin titres of 1/64 or higher compared with those with lower titres (37 [32%] of 117 vs 11 [13%] of 83; p=0·0026). T pallidum was detected by anal canal swab or anal lesion swab, or both, in 45 (23·0%; 95% CI 17·3-29·5) of 196 men with available samples, of whom ten had no anal lesion. Furthermore, T pallidum was detected in urine samples of 12 (6·1%, 3·2-10·3) of 198 men and in semen samples from six (12·0%, 4·5-24·3) of 50 men who provided samples. Among the 93 men with secondary syphilis, 69 (74%) had T pallidum detected at any site, and 24 (26%) had detection at two or more separate sites. Among the 54 men with primary syphilis, 49 (91%) had T pallidum detected at any site, and 11 (20%) had detection at two or more separate sites. Among the 53 men with early latent syphilis, four (8%) had T pallidum detected at any site and none had T pallidum detected at two or more separate sites. Unrecognised oral and anal shedding of T pallidum occurs in MSM with early syphilis, most frequently in those with secondary syphilis, suggesting secondary syphilis is the most infectious stage and that earlier detection and treatment of syphilis to prevent progression to the secondary stage might improve syphilis control. Future research is needed to ascertain the contribution of shedding of T pallidum from non-lesion sites to transmission of syphilis. Australian National Health and Medical Research Council.

Isolated oral “Snail track ulcers” as a manifestation of secondary syphilis

Syphilis is an infectious disease which is sexually acquired or vertically transmitted. Oral lesions in secondary syphilis are common in association with general symptoms and cutaneous eruptions. However, exclusive oral manifestations are uncommon as seen in our case. The patient responded to injectable benzathine penicillin with clearing of all lesions.

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.

Atypical secondary syphilis presentation in a patient with human immunodeficiency virus infection: a case report

IntroductionUntreated syphilis may lead to severe complications. This infection has recently re-emerged in developed countries with a high number of cases coinfected with human immunodeficiency virus. In these patients, the skin lesions of secondary syphilis can be very atypical.Case presentationWe report the case of a 38-year-old Bulgarian homosexual man who was coinfected with human immunodeficiency virus and syphilis. His skin contained multiple extensive necrotic lesions with abundant purulent secretion that covered his face, lips, scalp, and torso. Initial clinical diagnoses included varicella pustulosa and staphylococcal dermatitis. Human immunodeficiency virus infection in our patient had been established 2 years earlier in prophylactic studies, but had not been treated. Due to lack of penicillin, he was successfully treated with ceftriaxone, and the skin lesions underwent complete reversal. He also began antiretroviral therapy, which resulted in a significant effect on his immune status. Three months after the onset of antiretroviral therapy, he also achieved optimal viral suppression.ConclusionThis case emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of any inflammatory cutaneous disorder in individuals infected with human immunodeficiency virus.

MLST typing of Treponema pallidum subsp. pallidum in the Czech Republic during 2004-2017: Clinical isolates belonged to 25 allelic profiles and harbored 8 novel allelic variants

A recently introduced Multilocus Sequence Typing scheme for Treponema pallidum subsp. pallidum was applied to clinical samples collected from 2004 to 2017 from the two largest cities (Prague and Brno) in the Czech Republic. Altogether, a total of 675 samples were tested in this study and 281 of them were found PCR-positive for treponemal DNA and typeable. Most of the typed samples (n = 281) were swabs from primary or secondary syphilis lesions (n = 231), and only a minority were whole blood or tissue samples (n = 50). Swab samples from patients with rapid plasma regain (RPR) values of 1–1024 were more frequently PCR-positive (84.6%) compared to samples from patients with non-reactive RPR test (46.5%; p-value = 0.0001). Out of 281 typeable samples, 136 were fully-typed at all TP0136, TP0548, and TP0705 loci. Among the fully and partially typed samples, 25 different allelic profiles were identified. Altogether, eight novel allelic variants were found among fully (n = 5) and partially (n = 3) typed samples. The distribution of TPA allelic profiles identified in the Czech Republic from 2004 to 2017 revealed a dynamic character with allelic profiles disappearing and emerging over time. While the number of samples with the A2058G mutation was seen to increase (86.7% in 2016/2017), the number of samples harboring the A2059G mutation was found to have decreased over time (3.3% in 2016/2017). In addition, we found several allelic profile associations with macrolide resistance or susceptibility, the gender of patients, as well as patient residence.

IFNγ Enhances CD64-Potentiated Phagocytosis of Treponema pallidum Opsonized with Human Syphilitic Serum by Human Macrophages.

Syphilis is a multi-stage, sexually transmitted disease caused by the spirochete Treponema pallidum (Tp). Considered broadly, syphilis can be conceptualized as a dualistic process in which spirochete-driven inflammation, the cause of clinical manifestations, coexists to varying extents with bacterial persistence. Inflammation is elicited in the tissues, along with the persistence of spirochetes to keep driving a robust immune response while evading host defenses; this duality is best exemplified during the florid, disseminated stage called secondary syphilis (SS). SS lesions typically contain copious amounts of spirochetes along with a mixed cellular infiltrate consisting of CD4+ T cells, CD8+ T cells, NK cells, plasma cells, and macrophages. In the rabbit model, Tp are cleared by macrophages via antibody-mediated opsonophagocytosis. Previously, we demonstrated that human syphilitic serum (HSS) promotes efficient uptake of Tp by human monocytes and that opsonophagocytosis of Tp markedly enhances cytokine production. Herein, we used monocyte-derived macrophages to study Tp–macrophage interactions ex vivo. In the absence of HSS, monocyte-derived macrophages internalized low numbers of Tp and secreted little cytokine (e.g., TNF). By contrast, these same macrophages internalized large numbers of unopsonized Borrelia burgdorferi and secreted robust levels of cytokines. Maturation of macrophages with M-CSF and IFNγ resulted in a macrophage phenotype with increased expression of HLA-DR, CD14, inducible nitric oxide synthase, TLR2, TLR8, and the Fcγ receptors (FcγR) CD64 and CD16, even in the absence of LPS. Importantly, IFNγ-polarized macrophages resulted in a statistically significant increase in opsonophagocytosis of Tp accompanied by enhanced production of cytokines, macrophage activation markers (CD40, CD80), TLRs (TLR2, TLR7, TLR8), chemokines (CCL19, CXCL10, CXCL11), and TH1-promoting cytokines (IL-12, IL-15). Finally, the blockade of FcγRs, primarily CD64, significantly diminished spirochetal uptake and proinflammatory cytokine secretion by IFNγ-stimulated macrophages. Our ex vivo studies demonstrate the importance of CD64-potentiated uptake of opsonized Tp and suggest that IFNγ-activated macrophages have an important role in the context of early syphilis. Our study results also provide an ex vivo surrogate system for use in future syphilis vaccine studies.

Nodular secondary syphilis in an immunocompetent woman: Case report and literature review

Abstract A 46-year-old woman presented with slightly itching, painless erythematous nodules on the face, neck, and genital area. Initial differential diagnoses included cutaneous lymphoma. We performed punch biopsy on her neck. In histopathology, interface dermatitis with some nodular infiltration of numerous neutrophils and plasma cells was observed, therefore, serologic tests for syphilis were performed. Owing to positive serologic test results and dramatically improved skin lesions after treatment with benzathine penicillin, nodular secondary syphilis was diagnosed. Nodular skin lesions in secondary syphilis are uncommon and often misleading. Our case suggests secondary syphilis should be considered in the differential diagnosis of nodular lesions.

Apport de la microscopie confocale par réflectance dans le diagnostic de syphilides ano-vulvaires, premier cas relaté

Herein we report the case of an 18-year-old pregnant patient presenting with plantar and ano-genital lesions of syphilis, pharyngitis, erythematosus and scalynasolabial intertrigo and angular cheilitis. In vivo reflectance confocal microscopy examination (Vivascope 3000®; Caliber Inc, Rochester, NY, USA, distributed in France by Mavig, Munich) of ano-genital lesions enabled us to identify hyper-reflective elongated rods in the papillary dermis suggesting spirochetes. The diagnosis was confirmed by TPHA and VDRL as well as immunohistological examination. We identified for the first time rod shaped structures in ano-genital lesions of secondary syphilis, regularly alternating hyper-reflective and non-reflective areas corresponding to helix-shaped treponemes visualized by darkfield microscopy, which may not be confused with other cell structures.

Oral Lesions as a Diagnostic Indicator of Secondary Syphilis

Syphilis is an infectious bacterial disease. Acquired primary syphilis presents as a hardened ulcer that arises at the contaminated site. Left untreated, the disease progresses to the secondary stage, presenting systemic signs and, in some cases, lesions in the oral mucosa. If it remains untreated, it can progress to the third stage, which can result in death. The aim of this study was to report a case of oral lesions of secondary syphilis and discuss their utility as diagnostic indicators. A 37-year-old White male presented with a 2-month history of painful ulcerated lesions that were red with a white center, located on the palate, labial commissure, and lateral border of the tongue, extending to the ventral surface of the tongue bilaterally. On the basis of laboratory test results, the patient was diagnosed with syphilis and was therefore referred for treatment.

Human macrophage polarization enhances opsonophagocytosis and inflammatory response of the stealth pathogen, Treponema pallidum

Human macrophage polarization enhances opsonophagocytosis and inflammatory response of the stealth pathogen, Treponema pallidum

Oral Ulceration: an Unusual Manifestation of Secondary Syphilis - a Case Report

The oral cavity is the most common extragenital site of infection. Oral lesions in secondary stage syphilis are particularly common when associated with general symptoms and cutaneous eruption. However, the exclusive oral localization, not associated with general manifestations, is uncommon. We report a case of a 27 year old male patient with isolated oral ulceration as the sole presentation of secondary syphilis. In contrast with the oral lesion of primary syphilis, which tends to be solitary, painless, indurated ulcers, oral lesions of secondary syphilis are typically painful, multiple and accompanied by a concomitant cutaneous eruption.

Case series of syphilis and HIV co-infections

Syphilis and HIV co-infection are indeed dangerous combinations. The present communication describes three different cases of syphilis and HIV co-infection in young men. The first case is a 25-year-old medical graduate with a primary and secondary syphilis lesions at time of presentation. The second case is a 24-year-old government officer with right eye posterior uveitis where the serology tests for syphilis were reactive. His HIV tests were also positive. The final case is a 25-year-old homosexual who was admitted to the medical ward because of Mycobacterium tuberculosis infection. The HIV and syphilis serology tests were noted to be positive.

Clinical Spectrum of Oral Secondary Syphilis in HIV-Infected Patients.

Background. Oral lesions may constitute the first clinical manifestation in secondary syphilis, but detailed descriptions in HIV-infected individuals are scarce. Objective. To describe the clinical characteristics of oral secondary syphilis in HIV-infected patients and its relevance in the early diagnosis of syphilis. Methods. Twenty HIV/AIDS adult subjects with oral secondary syphilis lesions presenting at two HIV/AIDS referral centers in Mexico City (2003–2011) are described. An oral examination was performed by specialists in oral pathology and medicine; when possible, a punch biopsy was done, and Warthin-Starry stain and immunohistochemistry were completed. Intraoral herpes virus infection and erythematous candidosis were ruled out by cytological analysis. Diagnosis of oral syphilis was confirmed with positive nontreponemal test (VDRL), and, if possible, fluorescent treponemal antibody test. Results. Twenty male patients (median age 31.5, 21–59 years) with oral secondary syphilis lesions were included. Oral lesions were the first clinical sign of syphilis in 16 (80%) cases. Mucous patch was the most common oral manifestation (17, 85.5%), followed by shallow ulcers (2, 10%) and macular lesions (1, 5%). Conclusions. Due to the recent rise in HIV-syphilis coinfection, dental and medical practitioners should consider secondary syphilis in the differential diagnosis of oral lesions, particularly in HIV-infected patients.

Nodular secondary syphilis simulating lepromatous leprosy

There are diverse skin manifestations of both leprosy and syphilis. These diseases can appear similar to many other dermatologic conditions as well as to systemic diseases with dermatologic signs. Nodular syphilis is an uncommon type of secondary syphilis. We present here a person from a leprosy-endemic area with diffuse nodular skin lesions of secondary syphilis who was initially suspected of having lepromatous leprosy.

Current status of acquired syphilis: A hospital-based 5-year study

Introduction:Prevalence of sexually transmitted infection shows regional variations. Though a rising trend of prevalence of viral STI s has been observed, syphilis still continues to remain a commonly diagnosed STI.Aim:To study the current status of acquired syphilis in a tertiary care hospital.Materials and Methods:Retrospective analysis of all the cases of acquired syphilis registered in our hospital from 2005 to 2009 was done. Complete epidemiological, clinical, and investigational data were recorded and assessed.Observation:Total of 570 cases attended the STI clinic from year 2005 to 2009. 42 (7.36%) cases were diagnosed as syphilis. There were 32 (74%) males and 11 (26%) were females. 25 (60%) were married. Only two patients were less than 15 years of age. Primary syphilis was diagnosed in 21 (50%), secondary in 10 (24%), and latent in 11 (26%) cases. Two (9.5%) of primary syphilis showed multiple chancre. Concomitant primary chancre and lesions of secondary syphilis were seen in 2 (20%) patients. Secondary syphilis presented as condyloma lata (50%), maculo-papular rash (40%), and lues maligna in one patient who was HIV positive. Mixed infection was diagnosed in eight patients of which herpes genitalis was the commonest. Two patients were serologically positive for HIV.Conclusion:Incidence of syphilis had shown a constant trend over last 5 years. In lieu of change in trends of sexual practices, condyloma was the commonest presentation of secondary syphilis. Pustular syphilis was observed in association with HIV and could be a marker of the immune-deficient state.