Signs Of Secondary Syphilis Research Articles

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...

Easy to get, but not always easy to treat - Clinical and serological failure with Azithromycin in Syphilis: Time to adapt national guidelines?

Background Data since 2014 has shown a rise in the incidence of Syphilis especially amongst heterosexuals. In national guidelines, Macrolides remain an alternative treatment option although their efficacy has been long disputed. We describe a case of a patient with clinical and serological failure with Azithromycin treatment. Methods A 46 year old female presented with painful genital ulceration confirmed as primary syphilis. Sexual transmission infection testing was negative. She described an allergy (rash) to Amoxicillin and was given Doxycycline 100mg twice daily for 14 days. On day 5 she developed an urticarial rash and was changed to Azithromycin, 2g stat and 500mg daily for 10 days. Results There was initial serological response in her rapid plasma reagin (RPR) to 1:2 from 1:8 at 1 month, but at 5 months an RPR of 1:64 was seen with signs of secondary syphilis - a rash and a sore mouth. Re-infection was ruled out, she was re-treated with Azithromycin and her RPR reduced to 1:2, but she had a persistent macular rash. Following review by Infectious Diseases, 14 days of intravenous Ceftriaxone 1g daily was given. On day 10, her RPR rose to 1:64 but 3 months after fell to 1:4 and has been serofast since without further signs of Syphilis. Conclusion Patients treated with Macrolides should be closely monitored. Consideration should be given for desensitisation in patients with reported Penicillin allergy. As with pregnancy, consideration should be given to the removal of Azithromycin as an alternative treatment in national guidelines.

Condyloma Latum on the Lower Lip as an Isolated Manifestation of Secondary Syphilis – a Case Report

Abstract Oral lesions are described in all stages of syphilis, except in the latent stage. During the secondary stage of infection, oral lesions, saliva and blood of infected person are very contagious. The aim of this case report was to point to the secondary syphilis in differential diagnosis of oral diseases. A 30-year-old homosexual man presented with a three-week history of a painless verrucous lesion on his lower lip. Physical examination revealed a hypertrophic painless papillomatous lesion on the lower lip. The lesion was partly split with peripheral fissures. There were no generalized lymphadenopathies and no evidence of systemic disease. Further examination showed no other mucous membrane or cutaneous lesions elsewhere on the body. The external genitalia were normal. The patient was HIV-negative and otherwise healthy. A review of his medical history was significant for previous well documented treatment of anal chancre, which was successfully commenced at our Institute in 2010. It also revealed a history of a single unprotected receptive oral sex with an unknown partner 3 months before the onset of lesion. The diagnosis of condyloma latum on the lower lip was considered on clinical grounds. Laboratory findings, including complete blood count and blood chemistry were within normal limits. The VDRL (venereal disease research laboratory) test was positive with a titre of 1 : 128. Treponema pallidum hemagglutination assay (TPHA) was positive. HIV serology was non-reactive. The final diagnosis of solitary condyloma latum on the lower lip, as the only sign of secondary syphilis, was confirmed by positive results of routine serologic tests for syphilis. The patient was diagnosed with secondary syphilis and treated with a single intramuscular injection of benzathine penicillin, 2.4 million units. The lesion regressed completely within 2 weeks. Three months later the VDRL titer had fallen to 1 : 8 and HIV serology remained negative. Polymorphic oral manifestations in syphilis indicate that this disease should not be overlooked in the differential diagnosis of not only benign, but even malignant oral lesions. In conclusion, as far as the world literature available to us is concerned, this would be the first report of isolated solitary condyloma latum on the oral lip that, in the absence of any other clinical signs or symptoms of the disease, led to the diagnosis of secondary syphilis.

English

Background: Sexually transmitted diseases (STD) are an important public health problem because of their health, social and economic consequences. Situation of STDs in India is like tip of iceberg. Hence the present study was planned to know the prevalence of syphilis, gonococcal and human immunodeficiency virus (HIV) infection in Vidarbha region of India which is a central part of country. Materials and Methods: 400 patients attending sexually transmitted disease clinic of Indira Gandhi Medical College and Hospital Nagpur, Vidarbha having urogenital complaints and suspected of having sexually transmitted disease were randomly selected and divided kept into 2 groups. Group I comprised patients with genital ulcers and symptoms and signs of secondary syphilis while in group II patients with genital discharge and scrotal pain and swelling were kept. Results: Age group between 25 - 35 years is commonly affected with male to female ratio of 5.25:1. These are associated with high risk factors like contact with commercial sex workers (CSW) and heterosexuality. STDs found in decreasing order are Syphilis, Chancroid, Gonorrhoea, Candidiasis, Trichomoniasis and Granuloma inguinale. HIV seropositivity is also found high (7%). Conclusion: STDs continue to cause significant morbidity in this region. Commonest presentation is genital ulcer followed by genital discharge. There is a need of programs with an integrated approach, inducing behavioral change, promoting

Comment re: Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis

Dear Editor: We read with interest the paper by van der Vaart and colleagues [1] entitled “Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis,” and were struck by the similarity of the color fundus images of the two presented cases to the findings in Acute Syphilitic Posterior Placoid Chorioretinopathy (ASPPC) [2]. Our recently reported case series and comprehensive review of the literature concluded that ASPPC lesions, like the two presented, tend to be yellow-white, flat, round or oval-shaped, and often involving the macula [2]. While detailed descriptions of additional imaging studies were not presented by van der Vaart and associates, we have found ancillary imaging to be quite useful in the diagnosis of ASPPC [2]. Fluorescein angiography, for example, tends to show early hypofluorescence with progressive late hyperfluorescence, often with an irregular or ‘leopard skin’ pattern. Indocyanine green typically shows hypofluorescence corresponding to the macular lesion in both the early and late phases, although late hyperfluorescence can be observed as well. In the acute setting, Spectral Domain-Ocular Coherence Tomography (SD-OCT) tends to show some degree of disruption of the outer retinal hyper-reflective bands associated with the external limiting membrane, the photoreceptors, and/or the photoreceptorretinal pigment epithelium (RPE) junction. Irregular nodularity of the photoreceptor-RPE junction can also be observed. Lastly, enhanced depth imaging (EDI) OCT and B-scan ultrasonography show no thickening of the choroid or scleral in ASPPC, and effectively rule out choroiditis and scleritis as a cause of the lesion. All of these changes typically normalize completely following treatment with neurosyphilis doses of intravenous penicillin for 10 to 14 days. Given the diameter of the lesions presented by van der Vaart and colleagues, one would expect the choroid to be thickened if choroiditis were, in fact, the underlying cause. Perhaps this is what the authors intended when they wrote that the “granulomatous choroidal lesions were singular and rounded in appearance, with height noted also on OCT.” A more detailed description of findings noted on imaging studies performed by the authors would be of interest. It is noteworthy that both of the patients reported by van der Vaart and associates [1] did quite well following a 2week treatment with intravenous penicillin, despite the fact that one was infected by the human immunodeficiency virus (HIV; the status of the second patient was not reported). While a number of case reports and small clinic-based series have suggested that HIV co-infection can worsen the severity and/or outcome of ocular syphilis, our experience and The authors have no financial interest in any aspect of this manuscript and have full control of all primary data.

Moth-eaten alopecia: a sign of secondary syphilis

A 39-year-old man presented with a three-month history of progressive hair loss on his scalp. Five months earlier, he had a generalized rash that lasted for three weeks. He reported having sexual intercourse without condoms with multiple female partners, but he had no history of genital ulceration.

Neurosyphilis with optical involvement in an immunocompetent patient: a case report

BackgroundNeurosyphilis became a rare disease after the introduction of antibiotics. The resurgence of syphilis in association with human immunodeficiency virus infection in the past decades increased the incidence of this tertiary form of the disease. However, in immunocompetent patients neurosyphilis remains uncommon and accurate diagnosis is challenging as the clinical presentation is unspecific and the validity of supportive laboratory tests is unclear.Case reportWe describe the case of a 60-year-old man who presented with a 6-month clinical picture of depression-like symptoms and recent sudden unilateral blindness. Medical history uncovered a primary syphilitic event 20 years before. The investigation led to the diagnosis of neurosyphilis with optical involvement in a patient who did not present with any signs of secondary syphilis. Treatment with penicillin G and topical steroids resulted in significant clinical improvement and resolution of the visual loss.ConclusionIn the well-established natural history of syphilis, primary syphilis is almost always followed by manifestation of the secondary form, which in turn precedes a period of latency. This case emphasizes the need for a high index of suspicion of neurosyphilis in an immunocompetent patient with nonspecific neuropsychiatric manifestations and an atypical course of syphilis infection.

Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis

Syphilis is caused by the spirochete Treponemapallidum. The disease entity has long been known to be associated with ocular inflammation. With the development of appropriate therapy, its prevalence had gradually faded until the HIV epidemic. However, syphilis should remain an important consideration for many types of ocular inflammation because of its protean manifestations. They include disease of the cornea and ocular surface, posterioruveitis, optic nerve involvement, retinal vascular disease, retinal detachments, and others [1–6].Ocular syphilis remains a highly treatable illness, with intravenous penicillin G or intramuscular penicillin being the hallmarks of therapy [7]. We report two cases of syphilis presenting as solitary granulomas, to emphasize the relevance of consideration of this illness early in the diagnostic investigation for similar ocular signs.

Syphilitic Punctate Inner Retinitis in Immunocompetent Gay Men

To describe the features of an unusual syphilitic uveitis syndrome in a cluster of homosexual patients. Retrospective case series. Five consecutive patients diagnosed with syphilitic retinitis in our Melbourne uveitis clinic over a period of 8 months. The case notes of patients diagnosed with syphilitic retinitis were reviewed and the clinical features are presented and discussed. Description of retinal findings and documentation of any associated sequelae. All patients were homosexual men. Two were human immunodeficiency virus positive. None of the patients had been previously diagnosed with syphilis, although 3 presented with systemic symptoms and signs of secondary syphilis. All patients had marked anterior uveitis and vitritis. All patients had acute retinal arteriolitis and inner retinitis, with distinctive, inner retinal and preretinal white dots. These retinal findings were remarkably similar in all patients, and resolved with little or no sequelae after standard systemic treatment for syphilis, combined with oral prednisolone. Syphilitic retinitis may be an increasingly common clinical problem, reflecting the growing incidence of syphilis among homosexual men in Australia. Our patients showed stereotypical ocular and systemic features, which are useful in differentiating this condition clinically from other types of acute posterior uveitis, such as necrotizing viral retinitis. Proprietary or commercial disclosure may be found after the references.

Unsuspected Syphilitic Hepatitis in a Patient With Low-Grade Proteinuria and Abnormal Liver Function

A 25-year-old patient was found to have cholestatic liver enzyme abnormalities during assessment for asymptomatic low-grade proteinuria at the US Naval Hospital in Portsmouth, Virginia. These abnormalities persisted for a 6-month period, and an extensive workup, including viral serologic studies, rapid plasma reagin test, iron studies, ceruloplasmin, antimitochondrial, antinuclear, and anti-human immunodeficiency virus antibodies, endoscopic retrograde cholangiopancreatography, and liver biopsy, was unrevealing until serologic tests for syphilis were repeated to evaluate a new onset of urethral discharge. The patient had none of the more characteristic signs of secondary syphilis. The liver enzyme abnormalities rapidly resolved after treatment with penicillin. Syphilis remains the great impostor and still must be considered in the differential diagnosis of unexplained liver enzyme abnormalities, even in a patient with no symptoms or signs of early syphilis.