Lesions Of Syphilis Research Articles

ORAL MANIFESTATIONS OF SYPHILIS: AN EPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL

<h3>Objectives</h3> This study is an epidemiologic survey of cases of syphilis diagnosed from oral manifestations. <h3>Study Design</h3> The medical records of patients with oral lesions of syphilis treated at a stomatology service in southern Brazil were reviewed. <h3>Results</h3> A total of 109 cases were selected in which there was laboratory confirmation. The mean age of the patients was 34.4 years and, of these, 51% were men. In 105 cases, the disease was diagnosed in the secondary stage; in 3 cases, the disease was in the primary stage and, in 1 case, in the tertiary stage. The 3 cases of primary syphilis presented as single and ulcerated nodules and the case of tertiary syphilis as a necrotic lesion in the palate. In 86% of cases of secondary syphilis there were multicentric oral lesions, with the labial mucosa and the tongue being most affected. In most cases these lesions presented as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%). In 91.7% of cases painful symptoms were reported. <h3>Conclusions</h3> Considering the significant increase of syphilis incidence, dentists should recognize its oral manifestations because early diagnosis can minimize the risks of complications and transmission.

Clinical and laboratory aspects of condylomata lata lesions of syphilis

ObjectivesCondylomata lata are a less common but distinctive syphilitic lesion. Variable theories as to their nature and origin exist. The aim of this study was to determine the clinical and...

Anal and oral detection of Treponema pallidum in men who have sex with men with early syphilis infection

ObjectivesWe aimed to characterise patterns of anal and oral detection of Treponema pallidum among men who have sex with men (MSM) with early syphilis.Methods200 MSM with serologically confirmed primary, secondary...

Treponema pallidum delays the apoptosis of human polymorphonuclear neutrophils through the intrinsic and extrinsic pathways

Treponema pallidum is a “stealth pathogen” responsible for infectious sexually transmitted diseases. Although neutrophils are usually present in skin lesions of early syphilis, the role of these cells in T. pallidum infection has barely been investigated. Neutrophils are short-lived cells that undergo constitutive apoptosis, and phagocytosis usually accelerates this process. Here, we demonstrated that human polymorphonuclear neutrophils (hPMNs) could phagocytose T. pallidum in vitro. An unexpected discovery was that T. pallidum inhibited hPMNs apoptosis markedly in an opsonin-independent manner. Furthermore, this phenomenon was not affected by bacterial viability, as detected by annexin V, morphology studies, and TUNEL staining. Exploration of the underlying mechanism showed that expression of the cleaved forms of caspase-3, −8, and −9 and effector caspase activity were diminished significantly in T. pallidum-infected hPMNs. T. pallidum also impaired staurosporine- and anti-Fas-induced signaling for neutrophil apoptosis. Of note, these effects were accompanied by inducing the autocrine production of the anti-apoptotic cytokine IL-8. Taken together, our data revealed that T. pallidum could inhibit the apoptosis of hPMNs through intrinsic and extrinsic pathways and provide new insights for understanding the pathogenicity mechanisms of T. pallidum.

Syphilis in pregnancy

Congenital syphilis is showing a rising trend globally. Materno-fetal transmission of syphilis can be prevented by ensuring early diagnosis and prompt treatment of infected pregnant women. The risk of transmission from mother to child is directly related to the quantity of Treponema pallidum in the maternal circulation. Maximum number of the organisms is seen in early syphilis. Hence, early syphilis in mother (in comparison to late syphilis) places the baby at a higher risk for congenital syphilis. Amniocentesis and cordocentesis may help in the prenatal detection of congenital syphilis. Ultrasonography and Doppler studies supported by serological tests, and polymerase chain reaction, and dark field microscopic examination of the specimen from suspected lesions of early syphilis of mother may help to diagnose congenital syphilis prenatally. Benzathine penicillin G in appropriate dose is the ideal drug for syphilis in pregnancy, except for neurosyphilis for which the drug of choice remains crystalline penicillin.

Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study

BackgroundSerology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and...

Exploring the attitudes of men who have sex with men on anal self-examination for early detection of primary anorectal syphilis: a qualitative study

BackgroundStudies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis.MethodsIn this qualitative study, 20 MSM over 18 years of age were purposively sampled from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically.ResultsFour major themes and 12 sub-themes were generated from the study: (1) reasons for performing anal self-examination, (2) preferred educational resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination. Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal self-examination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources.ConclusionOur study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more confidence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining efficacy. The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM.

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.

Posterior Subhyaloid Precipitates: ‘KPs’ of the Posterior Segment

ABSTRACT Purpose: To describe the course of posterior subhyaloid precipitates (PSPs) accompanying active retinitis. Methods: Retrospective study of three retinitis cases associated with PSPs and literature review. Results: Cases 1 and 2 were Toxoplasma retinochoroiditis. Case 3 had bilateral retinitis post-febrile illness. PSPs were yellowish-white spherical lesions seen in the presence of partial posterior hyaloid detachment (PVD) in the retro-hyaloid space lining the inferior PVD margin. In all 3 cases, PSPs resolved during treatment for primary disease. Resolution of PSPs preceded resolution of retinitis. Literature review revealed similar lesions in CMV retinitis and syphilis in addition to Toxoplasma retinochoroiditis. Conclusion: PSPs were seen in the presence of active retinitis and partial PVD when inflammatory aggregates gravitate inferiorly in the subhyaloid space. They were observed during active retinitis and their resolution preceded the resolution of retinitis, thus providing a potential marker for disease resolution.

Oral manifestations of syphilis: an epidemiological study in southern Brazil.

Syphilis is an infectious, sexually transmitted disease with varied oral manifestations, that can mimic other lesions. This study aimed to conduct an epidemiological survey of cases of syphilis, diagnosed from oral manifestations, establishing the sociodemographic profile of patients and clinical characteristics of oral lesions. The medical records of patients with oral lesions of syphilis acquired were reviewed, and 109 cases were selected. The mean age of the patients was 34.4years and, of these, 51% were male. In 105 cases, the disease was diagnosed in the secondary stage; in three cases, in the primary stage; and, in one case, in the tertiary stage. The cases of primary syphilis presented as single and ulcerated nodules, and the case of tertiary syphilis, as a necrotic lesion in the palate. In 86% of cases of secondary syphilis, there were multicentric lesions, presenting as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%), mostly affecting the labial mucosa and tongue. In 91.7% of cases painful symptoms were reported. Considering the increase in syphilis, it is extremely important that dentists recognize its oral manifestations, because early diagnosis and treatment can minimize the risks of complications and transmission.

Natural history of primary syphilis: clinical and serological aspects of chancre concurrent with Follmann’s balanitis

Introduction: Primary syphilis is classically represented by a hard chancre, but other rare forms such as Follmann's balanitis are occasionally described. Objective: To show an iconography of the clinical presentations of the classic hard chancre and Follmann's balanitis, in parallel with the serological results in the course of diagnosis and treatment. Methods: Descriptive case report of a patient of an outpatient clinic for sexually transmitted infections in a tertiary hospital in the city of São Paulo, SP, Brazil. Conclusion: Syphilis lesions acquire different clinical expressions according to the natural evolution of the disease. Recognizing these presentations, as well as knowing how to interpret the serological results, is essential for the diagnosis and adequate treatment of the infection.

Primary syphilis lesion characteristics, serological response and management in HIV-positive and HIV-negative men who have sex with men.

The characteristics and serological responses of primary syphilis are not completely understood. We aimed to describe the characteristics, the serological responses and presumptive treatment of primary syphilis in HIV-positive and -negative men who have sex with men (MSM). We conducted a retrospective review of microbiological and demographic information from MSM presenting with primary syphilis. There were 111 cases of primary syphilis in MSM, the median age was 46 (IQR = 37-53years) and 40 (36%) were living with HIV. Fifty percent of MSM presented with painful lesions and 14% with extra-genital lesions. Extra-genital lesions were significantly more likely to be painful than non-genital lesions (OR 4.72; 95%CI = 1.25-17.83, p = 0.02). Overall, a reactive serological response demonstrated a sensitivity of 80% (57/71) compared with Treponema pallidum PCR. Serology was more sensitive in MSM with no previous syphilis (OR = 3.38, 95%CI = 1.00-11.43, p < 0.05). MSM presenting with painless lesions were more likely to be treated presumptively (OR = 3.39, 95%CI = 1.38-8.33, p < 0.002). There were no differences in the characteristics, serological responses or management according to HIV status. Fifty percent of MSM with primary syphilis presented with painful lesions; extra-genital lesions are more likely to be painful than genital lesions, serology is positive in 80% and there were no differences between HIV-positive and -negative MSM. Understanding the characteristics of primary syphilis will underpin public health campaigns.

IMPORTANCE OF INTRABUCCAL INJURIES IN SYPHILIS DIAGNOSIS: A CASE REPORT

Syphilis is a chronic bacterial infection caused by Treponema pallidum, with main routes of transmission through sexual contact or the congenital pathway. The objective of this study is to report the importance of knowledge of syphilis intraoral lesions for the diagnosis of this condition by the dentist. A 25-year-old female patient had a whitish plaque in the posterior region of the palate measuring approximately 1.5 × 2.0 cm associated with an erythematous area associated with discrete brownish maculae on the upper limb. Serologic tests Venereal Disease Research Laboratory and fluorescent treponemal antibody absorption were requested because of suspicion of syphilis, which were positive. After confirmed diagnosis, treatment with penicillin G benzathine 2.4 million IU, intramuscular in a single dose and in a single session was instituted. The progression of syphilis lesions may lead to worsening of the individual’s systemic condition. Thus, it is essential that the dentist be able to diagnose and treat this type of infection.

Overlapping Primary and Secondary Syphilis in Human Immunodeficiency Virus (HIV) Patient

ABSTRACTCoinfection between syphilis and Human Immunodeficiency Virus (HIV) could have varied clinical manifestations. Overlapping of syphilis stages is accounted for 25% of cases, attributable to the defect of the cellular and humoral immune response. We reported 55 years old man who was sexually active since 25 years ago via genito-genital, genito-anal, genito-oral routes, had multiple sexual partners both male and female, seldom used condom, and always being the insertive. Dermatological examination revealed alopecia non-scarring, a painless solitary ulcer on the collum penis, also multiple erythematous macules, patches, and plaques all over the body. Spirochaeta sp. was found from the base of the ulcer with a darkfield microscope. Histopathology examination revealed secondary syphilis lesion. Venereal Disease Research Laboratory (VDRL) 1:16, Treponema Pallidum Haemagglutination test (TPHA) reactive, HIV Determine rapid test reactive, and CD4 (Cluster of Differentiation 4) T-cell count 111 cells/ µL. He was treated with a single dose of benzathine penicillin G 2,4 million units intramuscular and antiretroviral drugs. On sixth month evaluation, VDRL was non-reactive, and CD4 T-cell count 325 cells/µL. This case shows that overlapping clinical manifestations of primary and secondary syphilis on HIV patients could occur with a good general condition. Immediate treatment of antibiotics for syphilis and antiretroviral could improve the clinical and serological conditions.Keyword: primary syphilis, secondary syphilis, HIVCorrespondence: nurul.laili.nahlia@gmail.com

Atypical manifestations of recent syphilis: study of 19 cases

BackgroundSyphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare. ObjectivesTo describe atypical penile manifestations in patients with early syphilis. MethodsThe present study reports patients who developed cord-like lesions on the penis. ResultsThe study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed. Study limitationsSmall number of patients included. ConclusionsIn view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.

Tinidazole: Another Therapeutic Option for Syphilis?

After the incidental observation of an almost complete resolution of maculopapular eruption in a patient having simultaneously secondary syphilis and trichomonas vaginalis infection, we extended the treatment with tinidazole (500 mg 4 times daily for 7 days) to 10 other early syphilis patients before the start of the conventional penicillin treatment. All patients showed marked improvement of their lesions in a few days. After the introduction of the conventional penicillin regimen, the lesions further improved and VDRL titers declined at least 4-fold within 6 months in all patients. Tinidazole is a 5-nitroimidazole derivative as well as metronidazole but with a longer plasma half-life. It is activated intracellularly by bacterial/parasitic enzymes to a redox cytotoxic intermediate that damages large protein molecules and inhibits repair and transcription of DNA affecting also the cell wall. With this action, tinidazole might also have a synergic action with penicillin and doxycycline, facilitating the entry of such drugs. It is possible that tinidazole has the same bactericidal action on spirochetes other than Borrelia, such as Treponema pallidum, explaining its rapid therapeutic action on the lesions of early syphilis. Whether this action could be confirmed by studies on larger series of patients, tinidazole might be considered in case of allergy to penicillin or other antibiotics usually prescribed in syphilis.

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.