Secondary Syphilis Presenting Research Articles

Syphilitic Stomatitis: Raising Awareness on an Often-Overlooked Presentation of Secondary Syphilis.

Syphilis is a resurgent infection with increasing prevalence, and its manifestations in the secondary stage of the disease are general and non-specific, being able to affect every organ system.The oral mucosa may be involved at any stage of the disease and the tongue, often a neglected organ, can be particularly affected and should be routinely observed.The internist, integrating a cornerstone speciality able to manage and diagnose systemic diseases, must be aware of the individual aspects of the physical examination, notably the appreciation and interpretation of each clue and sign found.

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

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

An Uncommon Presentation of Secondary Syphilis.

Syphilis is a chronic venereal disease caused by Treponema pallidum (TP). Destructive arthritis is rare in its primary and secondary stages but can occur in the tertiary stage and its congenital form.

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study.

Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

Malignant secondary syphilis presenting with rupioid lesions and moth-eaten alopecia.

Malignant secondary syphilis presenting with rupioid lesions and moth-eaten alopecia.

Secondary syphilis presenting as pulmonary nodules A case report and review of the literature

Secondary syphilis presenting as pulmonary nodules A case report and review of the literature

P30 An unusual infective cause of inflammatory arthritis

P30 An unusual infective cause of inflammatory arthritis

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

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

Secondary Syphilis: Pathophysiology, Clinical Manifestations, and Diagnostic Testing

The subspecies T. pallidum pallidum is the cause of the most infamous sexually and congenitally transmitted disease, syphilis. This disease has an estimated incidence of six million infections every year. Multiple studies have noted that the prevalence of syphilis has been steadily increasing worldwide in recent decades, especially among MSMs and HIV-positive patients. Clinically, syphilis presents in four stages with multiple different clinical manifestations. In this paper, we examine the current literature to determine the history and progression, pathogenesis, clinical features, and testing of secondary syphilis. Secondary syphilis is a stage of the disease with the most exuberant local and systemic clinical manifestations. The basis of the pathogenesis of SS underscores the unique mechanisms by which Treponema pallidum utilizes to escape immune recognition while simultaneously induces inflammation. SS can affect multiple organ systems and become more than just an STD. The most common presentation of secondary syphilis is rash, which manifests as a copper-colored maculopapular lesion on the trunk, palms, and soles. Although the RPR, VDRL, and FTA-ABS tests are perhaps the most commonly used diagnostic tools for syphilis and make up the traditional and reverse algorithms, there are other methods, including morphology and immunohistochemistry.

The oral presentation of secondary syphilis among men: the evolving interplay between syphilis, HIV and prophylactic strategies

Syphilis has been intricately linked with HIV because of shared transmission pathways and because these infections promote each other’s transmission. In addition, HIV infection may change the clinical presentation and management of syphilis lesions. Initially, the HIV epidemic had improved safe sex practices among men who have sex with men (MSM), but subsequent effective treatment and prophylaxis strategies, have resulted in behavioural disinhibition and a resurgence of syphilis. Here, we report on three cases of oral secondary syphilis and explore the relationship between oral syphilis and sexual practices, HIV and prophylactic measures that MSM employ. Three men, who presented to the University of Pretoria Oral Health Centre (UPOHC), complaining of oral lesions, were diagnosed by histopathology with secondary syphilis. The clinical appearance of the lesions, HIV status, treatment and prophylaxis employed by the men were documented. The clinical presentation, sexual practices, HIV status and prophylactic measures among these men differed and demonstrate the complexity of oral secondary syphilisdiagnosis and management.Syphilis presents variably in the oral cavity, and this may be linked to the sexual practices and HIV status of the patient.

A case of secondary syphilis presenting with optic neuropathy

A case of secondary syphilis presenting with optic neuropathy

Intraoral Presentation of Secondary Syphilis: Case Report and Literature Review

<h3>Introduction</h3> Syphilis is a well-documented disease caused by infection with the spirochete <i>Treponema pallidum</i>. Syphilitic infec- tion progresses through three distinct phases: primary, secondary, and tertiary. Each stage is defined by a unique set of clinical features. <h3>Materials and Methods</h3> A 50-year-old male patient was referred to the Columbia University Oral Pathology clinic for evaluation of painful oral lesions of several months duration. Prior to his presentation, the patient was seen by his primary care physician who ordered routine bloodwork and screening for sexually transmitted infections; all results were unremarkable. On intraoral examination, the patient had lesions involving the lower labial mucosa, right ventral tongue, and the right buccal mucosa. All lesions were similar in appearance: predominantly tan-white with an erythematous border and central ulceration. The lesions ranged from 0.6 to 1 cm in size and were slightly firm to palpation. A representative biopsy was performed of the right buccal mucosal lesion. <h3>Results</h3> On routine histologic examination the specimen consisted of soft tissue covered by benign-appearing stratified squa- mous epithelium with a dense superficial and perivascular plasma cell infiltrate within the connective tissue. Based on the inflammatory pattern and the patient's clinical presentation, there was an elevated suspicion for spirochete infection. <i>T. pallidum</i> stain was performed and highlighted spirochete microbes. <h3>Conclusions</h3> Based on the microscopic and clinical findings the patient was diagnosed with secondary syphilis. Though the features of syphilis have been well-studied, intraoral manifestations of the disease are rare. Typically, serologic testing is used for diagnosis, however these tests lack 100% sensitivity and specificity resulting in false negatives in a subset of patients. The accuracy of this testing is also known to decrease with repeat infection, as was later discovered to be the case in this patient. Therefore, biopsy and adequate suspicion for infection are necessary for diagnosis in some cases.

Secondary Syphilis Presenting as Recurrent Oral Mucocutaneous Lesions.

Secondary Syphilis Presenting as Recurrent Oral Mucocutaneous Lesions.

Isolated plantar keratoderma with uveitis: A rare presentation of secondary syphilis in an HIV-negative male.

Isolated plantar keratoderma with uveitis: A rare presentation of secondary syphilis in an HIV-negative male.

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

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

Psoriasiform syphilis: A challenge.

Syphilis is one of the greatest masqueraders in dermatology, like mycosis fungoides or sarcoidosis. In fact, secondary syphilis can simulate different dermatological conditions, not only clinically but also histopathologically. A 34-year-old Brazilian man from Manaus (Amazonas) attended our Department complaining for 2 weeks of asthenia, weight loss and multiple asymptomatic disseminated erythematous papules and scaly plaques with well-defined borders and a tendency to confluence were observed on the trunk, neck and extremities, clinically similar to psoriasis guttata. The skin biopsy and laboratory tests disclosed secondary syphilis and the patient was treated with intramuscular benzathine penicillin with prednisolone, with a complete resolution.Psoriasiform syphilis, which imitates psoriasis, was well known by old dermatologists and was called syphilide psoriasiforme or psoriasis syphilitique. Psoriasiform syphilis is one of the atypical presentations of secondary syphilis and dermatologists should be aware of psoriasiform syphilis in order not to improperly treat syphilis patients with immunosuppressive drugs; also, pathologists should be aware of secondary syphilis histopathological features.

Syphilis Diagnosis and Treatment: State of The Art

The present review summarises the current knowledge in the field of syphilis diagnosis and treatment, along with epidemiologic and historical data. A literature search was conducted in PubMed and Google Scholar, using the search terms “syphilis”, “diagnosis”, “dermoscopy”, “management AND treatment”, “laboratory tests AND syphilis”, and “primary OR secondary OR tertiary OR congenital syphilis”. A total of 55 out of 100 papers were included in this review. An overview of the different clinical presentation of primary, secondary, tertiary, and congenital syphilis, with particular attention to dermatologic signs and dermoscopic examination, is provided. The panorama diagnostic procedures are illustrated, along with their accuracy and recommendation. Treatment and management options of patients at different syphilis stages are provided and discussed according to the referring guidelines. The dermatologist can play a key role in providing the early and correct diagnosis and setting up in the proper management of patients with syphilis infection.

A rare case of secondary syphilis presenting with extensive cutaneous nodules and generalised lymphadenopathy

Syphilis is an infectious disease caused by the spirochete Treponema pallidum. Syphilis is divided into clinical stages including primary, secondary, latent and tertiary syphilis. Secondary syphilis can present with various mucocutaneous lesions and multisystem involvement. Since it can mimic many other diseases, syphilis is known as ‘the great imitator'. However, secondary syphilis with nodular lesions is very rare. Moreover, nodular secondary syphilis can be misdiagnosed as syphilitic nodules of the tertiary stage. Hereby, we report an unusual presentation of secondary syphilis characterized by extensive erythematous nodules and generalised lymphadenopathy in an immunocompetent 39-year-old Caucasian male patient.

S2430 Syphilis, the Great Imitator: A Case Report on Secondary Syphilis Presenting as Hepatitis

S2430 Syphilis, the Great Imitator: A Case Report on Secondary Syphilis Presenting as Hepatitis

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

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