Syphilis Presenting Research Articles

Case Report: Osteomyelitis in a healthy patient: initial presentation of congenital syphilis with negative VDRL

Case Report: Osteomyelitis in a healthy patient: initial presentation of congenital syphilis with negative VDRL

Influence of gender on clinical presentation, management practices and outcomes of ocular syphilis

Ocular syphilis is a re-emerging inflammatory eye disease with a clear gender imbalance, disproportionately affecting men. We investigated the impact of gender on the presentation, management practices and clinical outcomes of this condition. Data generated from a study of patients consecutively diagnosed with ocular syphilis who attended a subspecialist uveitis service at one of four hospitals in Brazil over a 30-month period were disaggregated for analysis by gender. Two-hundred and fourteen eyes (161 men and 53 women) of 127 patients (96 men and 31 women) were included. Posterior uveitis was the most common presentation in both men and women (80.1% vs. 66.7%, p > 0.05), but men were significantly more likely to have vitritis as a feature of their disease (49.4% versus 28.8%, p = 0.019). Three eyes of women had nodular anterior scleritis (p = 0.015). Men were more likely to undergo a lumbar puncture to assess for neurosyphilis (71.9% vs. 51.6%, p = 0.048), but men and women undergoing a lumbar puncture were equally likely to have a cerebrospinal fluid abnormality (36.2% vs. 25.0%, p = 0.393). All patients were treated with aqueous penicillin G or ceftriaxone, and there was a trend towards more men receiving adjunctive systemic corticosteroid treatment as part of their management (65.2% vs. 46.7%, p = 0.071). There were no significant differences in the age of presentation, bilaterality of disease, anatomical classification of uveitis, initial or final visual acuity, and rates of ocular complications between men and women. Our findings indicate that ocular syphilis has comparable outcomes in men and women, but that there are differences in the type of ocular inflammation and management practices between the genders.

Clinical presentation of early syphilis and genomic sequences of Treponema pallidum strains in patient specimens and isolates obtained by rabbit inoculation.

The global resurgence of syphilis necessitates vaccine development. We collected ulcer exudates and blood from 17 primary syphilis (PS) participants and skin biopsies and blood from 51 secondary syphilis (SS) participants in Guangzhou, China for Treponema pallidum subsp. pallidum (TPA) qPCR, whole genome sequencing (WGS), and isolation of TPA in rabbits. TPA DNA was detected in 15 of 17 ulcer exudates and 3 of 17 blood PS specimens. TPA DNA was detected in 50 of 51 SS skin biopsies and 27 of 51 blood specimens. TPA was isolated from 47 rabbits with success rates of 71% (12/17) and 69% (35/51), respectively, from ulcer exudates and SS bloods. We obtained paired genomic sequences from 24 clinical samples and corresponding rabbit isolates. Six SS14- and two Nichols-clade genome pairs contained rare discordances. Forty-one of the 51 unique TPA genomes clustered within SS14 subgroups largely from East Asia, while 10 fell into Nichols C and E subgroups. Our TPA detection rate was high from PS ulcer exudates and SS skin biopsies and over 50% from SS blood, with TPA isolation in over two-thirds of samples. Our results support the use of WGS from rabbit isolates to inform vaccine development.

A Novel Treponema pallidum Subspecies pallidum Strain Associated With a Painful Oral Lesion Is a Member of a Potentially Emerging Nichols-Related Subgroup.

Early syphilitic lesions are typically painless; however, several recent case studies have included patients with tender lesions and no evidence of concurrent infections. Here we present the manifestations and serological and molecular findings of a patient from New York State with a painful tongue lesion. The diagnosis of syphilis was based on a combination of physical examination, serologic, pathologic, and immunohistochemical findings. DNA obtained from a formalin-fixed, paraffin-embedded biopsy was used to characterize the infecting pathogen using polymerase chain reaction, multilocus sequence typing, and whole-genome sequencing methods. Polymerase chain reaction and multilocus sequence typing of the biopsy specimen confirmed infection with T. pallidum subspecies pallidum ( T. pallidum ) of the Nichols cluster. Whole-genome sequencing analysis of this strain (herein called NYMC01) showed that it contained 17 unique single nucleotide variations and 4 more complex genetic differences; this novel genotype matched only 2 specimens, both from a patient in Seattle, Washington. The presence of this rare genotype in 2 geographically distinct locations suggests the potential emergence and spread of a new subgroup of the Nichols cluster. To our knowledge, this is the first genomic sequence obtained from a T. pallidum strain linked to a painful lesion, and the third description of whole-genome sequencing of T. pallidum from formalin-fixed, paraffin-embedded tissue. Analysis of additional specimens may reveal that the NYMC01-related genotype represents an emerging T. pallidum subgroup and may also aid in determining whether the painful clinical presentation of primary syphilis is related to specific T. pallidum genotypes.

Meningovascular Syphilis Presenting as Acute Ischemic Stroke in an HIV + Young Adult: A Case Report and a Brief Literature Review

Meningovascular Syphilis Presenting as Acute Ischemic Stroke in an HIV + Young Adult: A Case Report and a Brief Literature Review

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.

Exploring the use of ChatGPT in Reporting a Case of HIV, Syphilis, and Lyme Co-infection Presenting with Multiple Cranial Neuropathies (P5-7.003)

Exploring the use of ChatGPT in Reporting a Case of HIV, Syphilis, and Lyme Co-infection Presenting with Multiple Cranial Neuropathies (P5-7.003)

A diagnosis of syphilis following a radical circumcision for suspected penile cancer.

We present a case of a 70-year-old gentleman who was referred to our tertiary 2-week-wait penile cancer clinic with a penile mass that was ulcerated, painful and discharging. This was suspicious for penile cancer and a radical circumcision was performed to remove the diseased foreskin en bloc with the lesion that was arising from the inner foreskin. Histopathology did not reveal cancer; however, we identified spirochaetes in keeping with syphilis. This was confirmed on serology. The patient was referred to the genitourinary medicine team and treated with antibiotics. This case demonstrates a rare presentation of genital syphilis in an elderly gentleman initially referred with concerns of penile cancer. Although, rare, especially in this age group, syphilis should be considered as a differential diagnosis in a patient presenting with an ulcerated, discharging, firm penile mass, especially given that the incidence of syphilis has been rising in recent years.

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.

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.

HIV Infection Modifies the Role of Prior Treponema pallidum Infection in the Clinical Presentation of Early Syphilis Among Adult Patients From Sexually Transmitted Infection Clinics in Peru.

We aimed to compare the clinical presentations (symptomatic vs. asymptomatic) with prior Treponema pallidum infection status (first infection vs. reinfection) among people with early syphilis. We used data from PICASSO, a cohort study in Peru that enrolled people with active syphilis from May 2019 to August 2021. Study participants had early syphilis and a prior syphilis serological test result within the prior 12 months to determine prior T. pallidum infection status. We calculated prevalence ratios (PRs) of symptomatic clinical presentation (primary or secondary syphilis) by prior T. pallidum infection status, stratified by HIV infection status. In addition, we explored the association of prior T. pallidum infection status and lesion presentation, stratified by primary and secondary syphilis cases, using the Fisher exact test. We include 84 T. pallidum reinfection cases and 61 first infection cases. We found increased frequency of symptomatic clinical presentation among first-infection cases (39% vs. 20%; PR, 1.94; P = 0.014). This association was stronger among persons living without HIV infection (38% vs. 7%; adjusted PR, 6.63; P = 0.001) in comparison to those living with HIV infection (45% vs. 34%; adjusted PR, 1.38; P = 0.458). Among secondary syphilis cases, more participants from the reinfection group reported that their lesions improved 1 week after treatment (100% vs. 29%, P = 0.045) compared with those with a first infection. Among the primary syphilis cases, all participants reported that their lesions improved 1 week after treatment. Prior syphilis was associated with a decreased prevalence of symptomatic reinfection, especially among persons not living with HIV infection.

51 - Diagnosis of bilateral papillitis as primary presentation of syphilis

51 - Diagnosis of bilateral papillitis as primary presentation of syphilis

Follmann balanitis - A very rare presentation of primary syphilis.

Follmann balanitis - A very rare presentation of primary syphilis.

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

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

A 61-Year-Old Woman with Ocular Syphilis Presenting As Floaters in Eye

A 61-Year-Old Woman with Ocular Syphilis Presenting As Floaters in Eye

Hypovolemic Shock Due to Lower Gastrointestinal Tract Bleeding Secondary to Primary Rectal Syphilitic Ulcer. Case Report and Literature Review

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, it has a well-defined course with several stages throughout its natural history ranging from primary to tertiary. Rectal syphilis is a rare syphilis presentation and can occur in both primary and secondary syphilis, either in a syphilitic ulcer or proctitis. It's generally doesn't have symptoms, however it can cause rectal bleeding that in most cases tends to be self-limiting. The diagnosis is established when it's possible with direct observation studies; However, in cases of concomitant contamination by spirochetes of the usual rectal flora, the sensibility and specificity of direct observation tests decreases, so the diagnosis requires an adequate clinical, serological and, if necessary, histopathological correlation. The treatment and follow-up is the same as in other syphilis types and depends on the time of evolution and specific conditions of the patient in question. We present the case of a male patient with primary rectal syphilis that during his course triggered a state of hypovolemic shock secondary to massive rectal bleeding.

Сase report of syphilitic hepatitis

Syphilitic hepatitis is a rare clinical presentation of syphilis and is easily misdiagnosed. However, clinical and histopathologic manifestations of Syphilitic Hepatitis can imitate other infectious and non-infectious diseases, and the diagnosis should be considered in patients with abnormal liver function tests. We present an unusual case of syphilitic hepatitis presenting with jaundice and abdominal bloating after treatment with benzylpenicillin, liver enzymes, and mucocutaneous findings improved.

Syphilis Resurrected: Case Series of Palmoplantar Secondary Syphilis.

Introduction Syphilis is a sexually transmitted infection caused by Treponema pallidum which has protean manifestations. The cutaneous presentation of syphilis can mimic many dermatologic conditions. Materials & methods With an aim to describe palmoplantar involvement in syphilis, a retrospective study of case series was done with 11 patients having palmoplantar skin lesions in syphilis within a period of two years. Only serologically confirmed cases were included. Results The prevalence of palmoplantar involvement in syphilis was 47.85% and all of them except one patient (congenital syphilis) were secondary syphilis. A major proportion of cases (72.8%) studied had no history or presentation of genital lesions. Biett's collar which is an indicator of palmoplantar syphilis was seen only in 45.5% of the cases. Conclusion The clinicians must be aware that palmoplantar skin lesions might be the only clinical presentation of syphilis and a high index of suspicion is needed to correctly diagnose and treat the condition in such a setting.

S2541 Navigating Uncommon Presentations of Colorectal Syphilis: Case Series and Literature Review

S2541 Navigating Uncommon Presentations of Colorectal Syphilis: Case Series and Literature Review

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