Syphilitic Chancre Research Articles

Primary Syphilis Presenting as Bilateral Nipple-areola Eczematoid Lesions

Primary syphilis caused by Treponema pallidum usually develops in the genital region after sexual contact as syphilitic chancres. However, syphilitic chancres can also occur in extragenital regions, including sites of lips, tongue, palate, conjunctiva, neck, breasts, abdomen, intrascapular region, arms, palms, fingers, and thighs with an estimate of incidence ranging from 2% to 31% (1). Solitary syphilitic chancre occurring on the nipple region has been described scarcely in the literature (2–6). Herein, we describe a case of primary syphilis occurring on both nipple-areolas as eczematoid lesions in a male patient, which may be underreported.

Primary syphilitic chancres on arms, fingers and hands: more common than reported

Primary syphilitic chancres on arms, fingers and hands: more common than reported

A Disconnect between the Neurospirochetoses in Humans and Rodent Models of Disease

The human spirochetal diseases share many clinical similarities despite their diverse epidemiology. Syphilis is a sexually transmitted infection, whereas the leptospiroses and the borrelioses are zoonoses. The clinical similarities among the spirochetoses include a relapsing-remitting course of infection. The recurrent pattern of illness has three invariant features that are shared by all human spirochetoses. Entry of spirochetes is achieved through breaks in the skin or through mucous membranes. Cutaneous lesions such as the syphilitic chancre or the erythema migrans of Lyme disease constitute the earliest manifestations of these two diseases. In all three spirochetoses, there is dissemination to distant organs through tissues, blood, and other fluids. Late disease, often with intervening relapses and latent periods, can involve one or more organ systems. The spirochetal diseases also share tropisms for skin, nervous system, and heart and arteries. The neurotropism of spirochetes is evident in syphilis, the human borrelioses (Lyme disease and relapsing fevers), and in leptospirosis. Spirochetes enter the central nervous system (CNS) very quickly. Their ability to cause neurological disease may be dependent on the virulence of the infecting strains and on the development of an inflammatory response. Yet, most of the current animal models for the spirochetoses either do not recreate the manifestations of the neurological spectrum or require special manipulations to establish infection (Figure 1). Thus, a major challenge for experimental approaches to the human neurological manifestations of the spirochetoses has been an inability or difficulties in reproducing all or some aspects of the human disease in animal models. Figure 1 Summary of animal models for the neurospirochetoses.

Bilateral nongranulomatous anterior uveitis associated with chancre of the tongue: initial presentation of syphilis

BackgroundThis paper reports the case of a pleomorphic manifestation of syphilis, a reemerging sexually transmitted disease.FindingsA 51-year-old male presented with bilateral nongranulomatous anterior uveitis associated with an isolated syphilitic chancre of the tongue that was successfully treated with parenteral benzathine penicillin.ConclusionSyphilis has the potential to lead to any type of intraocular inflammation. A careful review of the symptoms is useful for the detection of extraocular signs of syphilitic infection.

Case Report: Papillary-Areola Complex Lesions. How To Solve Them?

INTRODUCTION: our daily practice in those public- privates services show us an approach sometimes inadequate for the diagnosis and treatment of the lesions of the papillary-areola complex (MAC), Among the differential diagnoses found on the skin, for example nipple eczema, psoriasis, superficial basal cell carcinoma, melanoma (when pigmented), papillary adenoma, adenoma seringomatoso, syphilitic chancre, scabies, Bowen s disease, Paget s disease. Clinical aspects often can be mistaken, delaying an appropriate treatment for that patient. REPORT: female patient, 42 years old, white, born in Rio de Janeiro, teacher. Menarche at 10 years; child 3, with pruritus and hyperemia periareolar on the left breast, with three years of evolution that did not improve with any anti-inflammatory drugs and antibiotics. The papilla area had mild hyperemia associated with complaints of itching. He had no palpable nodules or spontaneous nipple discharge. A mammogram showed pleomorphic microcalcifications, occupying the central area; and one dense area, irregular, measuring 11 mm in the subareolar region of the left breast. Rating BIRADS 4C. Excised biopsy of the papilla was performed with a diagnosis of Paget s disease of the breast. A simple mastectomy was the surgical choice because of associated pleomorphic microcalcifications. The pathology evaluation was conclusive for infiltrating ductal breast carcinoma with areas of comedo type necrosis, free surgical margins. Commitment of the nipple skin with an appearance of Paget s disease of the breast. DISCUSSION: The differential diagnosis of different lesions of MAC and its forms of treatment should be carefully recognized, as well as different forms of therapeutic approaches.

Primary syphilitic chancre on the upper arm in an HIV-1-infected patient

A 32-year-old HIV-infected man presented with an ulcerating skin lesion with indurated borders on the upper right arm. Both dark-field microscopy and syphilis serology confirmed the diagnosis of primary syphilis. Extragenital syphilitic chancres are uncommon but nevertheless have to be kept in mind as they often delay diagnosis.

Plasma Cell Balanitis Presenting in a Patient with a History of Syphilis

Plasma cell balanitis (PCB), also knows as Zoon balanitis, is a benign asymptomatic but chronic and erosive inflammatory condition of the glans penis and prepuce that generally affects uncircumcised men in later years. Clinical presentation involves a single, shiny, well defined reddish patch. We describe the first case of PCB ever reported in a patient with a previous history of syphilis, and include a review of the current literature. A 57-year-old Hispanic man with a remote history of syphilis presented with a 6-month nonhealing, granulating ulcer of the foreskin and glans penis that had been repeatedly mistaken for syphilis and treated unsuccessfully with circumcision 3 weeks previously. Biopsy of the glans penis demonstrated sections with denuded chronic granulation tissue showing a fibrotic stroma with numerous blood vessels and a mixed inflammatory infiltrate including scattered plasma cells. It is important to differentiate PCB from a syphilitic chancre in a patient presenting with a nonhealing penile lesion. This case report demonstrates that these entities may be seen in the same patient at different times.

Syphilitic chancre of the mouth

A 24-year-old man presented with a three-week history of a 1-cm painless, ulcerative lesion on his lower lip ([Figure 1][1]) and a three-day history of symmetrically distributed nonpruritic macules on his trunk ([Figure 2][2]) and limbs. He was HIV-negative and was otherwise healthy. He had

Syphilitic Chancre of the Tongue

A 41-year-old man presented with a 6-week history of a painful, nonhealing lesion on the dorsum of his tongue. Examination revealed an ulcer with a raised, indurated margin (Panel A). Malignancy and other infections were considered in the differential diagnosis. There was no lymphadenopathy on examination. A chronic inflammatory infiltrate with mature plasma cells and a granulomatous component was evident on incisional biopsy. Immunohistochemical staining for Treponema pallidum identified spirochetes in the granulation tissue overlying the ulcer, as well as in the walls and lumen of the capillaries at its margin (Panel B, arrows). A strongly positive treponemal antibody absorption . . .

Cell and Tissue Interactions of Treponema pallidum in Primary and Secondary Syphilitic Skin Lesions: An Ultrastructural Study of Serial Sections

There are limited reports on the ultrastructure of syphilis skin lesions. The aim of this study has been to perform an electron microscopic investigation of the morphology and the tissue distribution of treponemes in primary and secondary cutaneous lesions. Three cases of primary syphilitic chancre and one case of secondary syphilis were included. Prominent epidermal abnormalities in the primary chancre and a perivascular inflammatory infiltrate in the secondary lesion were found by light microscopy. Ultrastructurally, spirochetes were located mainly in the blood vessel walls and dermal tissue of the chancre lesions. In the secondary syphilis case, spirochetes were more abundant between epidermal keratinocytes. Most of them adjusted to the intercellular spaces. Occasionally, the electron microscopy images were highly suggestive of an intracellular location. Both the ultrastructural and immunohistochemical examination of the primary and secondary syphilis lesions showed a paradoxical distribution of the causative microorganisms compared to the light microscopic changes. In addition, the ultrastructural findings strongly suggest that Treponema pallidum subspecies pallidum invades tissues, not only through an intercellular, but also through a transcellular pathway.

Primary Syphilitic Chancre on the Hand With Regional Adenopathy

Primary Syphilitic Chancre on the Hand With Regional Adenopathy

Venereal and Endemic Treponematoses in the Developing World

This report provides an overview of the venereal (syphilis) and endemic treponematoses in the developing world. Endemic treponematoses predominantly affect children in the poorest rural communities of the tropic belt whereas syphilis is a universal disease that may affect newborns and sexually active persons of any age in any country of the world. The epidemiology clinical manifestations and treatment of venereal syphilis are discussed. Of special importance to this class of disease are its ocular manifestations due to the fact that treponematoses seem to be able to thrive in all layers of the eye including the retina and choroid. The prevalence of HIV infection and of syphilis is high in many countries of the developing world and syphilitic chancres like any genital ulceration increase the risk of acquiring and transmitting HIV. The diagnosis clinical features ophthalmologic manifestations and treatment for a variety of endemic treponematoses are discussed including pinta bejel and yaws. Finally the author suggests that the scarcity of information about syphilis and ophthalmology should motivate those in the field to further investigate ocular morbidity in patients with endemic treponematoses.

Mondor's disease of the penis associated with primary syphilis

A case of penile Mondor's disease associated with syphilitic chancre is reported. The aetiology and management of Mondor's disease is also discussed.

What Are The Ethical Considerations Surrounding a Minor's Request for Confidentiality?

What Are The Ethical Considerations Surrounding a Minor's Request for Confidentiality?

Syphilitic Chancres of the Mouth: Three Cases

Syphilitic Chancres of the Mouth: Three Cases

Multiple aphthoid syphilitic chancres of the oral cavity

We describe the case of a 31-year-old man who was affected by three asymptomatic, aphthoid, syphilitic chancres of the oral cavity. These lesions were accompanied by right latero-cervical and chin lymphadenopathy. The infection was previously diagnosed as aphthous stomatitis. The search for Treponema pallidum by means of darkfield microscope examination was positive. The patient was successfully treated with oral erythromycin ethylsuccinate. To our knowledge, this is the first case of multiple aphthoid syphilitic chancres of the oral cavity reported in the literature. We suggest that all patients with a recent history of painless ulcers in the oral cavity, accompanied by regional lymphadenopathy in which the clinical diagnosis has not been confirmed, should undergo a darkfield microscope examination.

Extragenital syphilitic chancre manifesting as a solitary nodule of the nipple

Journal of the European Academy of Dermatology and VenereologyVolume 20, Issue 7 p. 886-887 Extragenital syphilitic chancre manifesting as a solitary nodule of the nipple JY-Y Lee, Corresponding Author JY-Y Lee Department of Dermatology, College of Medicine, National Cheng Kung University, and * Corresponding author, Department of Dermatology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, 704 Tainan, Taiwan, tel. 886-6-2766180; fax 886-6-2004326; E-mail: yylee@mail.ncku.edu.twSearch for more papers by this authorM-H Lin, M-H Lin Department of Dermatology, College of Medicine, National Cheng Kung University, andSearch for more papers by this authorY-C Jung, Y-C Jung Department of Pathology, Sin-Lau Christian Hospital.Search for more papers by this author JY-Y Lee, Corresponding Author JY-Y Lee Department of Dermatology, College of Medicine, National Cheng Kung University, and * Corresponding author, Department of Dermatology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, 704 Tainan, Taiwan, tel. 886-6-2766180; fax 886-6-2004326; E-mail: yylee@mail.ncku.edu.twSearch for more papers by this authorM-H Lin, M-H Lin Department of Dermatology, College of Medicine, National Cheng Kung University, andSearch for more papers by this authorY-C Jung, Y-C Jung Department of Pathology, Sin-Lau Christian Hospital.Search for more papers by this author First published: 21 April 2006 https://doi.org/10.1111/j.1468-3083.2006.01560.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue7August 2006Pages 886-887 RelatedInformation

Evaluation of syphilis in patients with HIV infection in Nigeria

To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken. Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months +/- 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD)--particularly genital ulcers--while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.

Syphilis

Syphilis is a sexually transmitted infection by Treponema pallidum. Without antibiotic treatment syphilis lasts for several decades and may develop up to 4 different clinical stages. Usually, the disease begins with a distinct painless and indurated ulcer at the contact site: the primary chancre. An indolent regional lymph node swelling is usually associated with the syphilitic chancre. After spontaneous healing of the primary lesion and several weeks of latency, the clinical symptoms of secondary syphilis occur. Treponema pallidum bacteremia leads to common symptoms like fever and malaise, but also to a generalized lymphadenopathy, and a broad variety of lesions of the skin and mucosal membranes. Non-pruritic transient exanthems often involving palms and soles, condylomata lata, and a specific angina with mucous patches of the oral cavity are prominent signs. After several relapses, which are characterized by a decreasing intensity of clinical symptoms, secondary syphilis then resolves spontaneously. A second period of latency follows, lasting 3-12 years. Then the outcome of untreated syphilis becomes apparent: spontaneous healing by elimination/inactivation of the spirochetes (75%) or transition to tertiary syphilis (25%). Two kinds of granulomatous skin reactions are typical for tertiary syphilis: superficial nodular syphilids and gummas. The bones, as well as the cardiovascular and central nervous system, may also be involved. Finally, metasyphilis with severe and sometimes lethal neurological symptoms (tabes dorsalis, progressive paralysis) occurs 10 to 30 years after primary infection. Except for irreversible tissue destruction which occurs prior to therapy, all stages of syphilis can be cured completely.

Vulvar pathology

We evaluated the main causes of vulvar dermatoses; in 785 patients with a vulvar diseases who visited Ibn Rochd Hospital Centre, Casablanca between January 1991 and December 2002. The average age was 31 years [range 2 months to 81 years] ; 362 patients [41.52%] had vulvar pruritus, 273 patients [34.77%] had warts and 157 [20%] had one or more vulva ulcers. The most common infectious pathology was papillomavirus infection, found in 273 cases [34.77%], followed by vulvovaginal candidiases in 102 cases [12.99%], syphilitic chancre in 18 cases [2.29%] and herpes genitalis in 17 cases [2.16%]. The most common non-infectious pathology was vulvar dermatosis: 259 cases [32.99%] ; idiopathic pruritus vulvae: 61 cases [7.7%] ; and tumour-related conditions: 45 cases [5.6%]. The frequency of infectious conditions was over 50% and these were generally sexually transmitted infections.