Units Of Benzathine Penicillin Research Articles

Syphilitic Unorthodoxy: A Case of Lues Maligna in a Human Immunodeficiency Virus-negative 28-year-old Filipino Male

Lues maligna, also known as malignant syphilis, is an uncommon variant of syphilis at the secondary stage – more commonly reported in immunocompromised patients or those with concomitant human immunodeficiency virus (HIV) infection. In this report, we present a case of a 28-year-old HIV-negative male with a 9-month history of multiple, well-defined, irregularly-shaped, erythematous papules, and small plaques evolving to ulcerated plaques and nodules with crusts, associated with pain, pruritus, and episodes of fever, arthralgia, and weight loss. Positive treponemal and nontreponemal tests, aided by histopathologic findings consistent with syphilis led to the diagnosis of lues maligna. Significant improvement of lesions was noted with 3 weekly doses of 2.4 million units of benzathine penicillin G. For patients presenting with painful and pruritic erythematous ulcerated plaques with crusts associated with systemic symptoms, and with a significant sexual history despite testing negative for HIV infection, a high index of suspicion for uncommon presentations of other sexually transmitted infections such as syphilis could aid in early diagnosis and subsequent treatment.

A Case of Oropharyngeal Syphilis.

We present a case of a 50-year-old male who complained of a sore throat persisting for 2 months. Upon physical examination, multiple mucous patches were observed in the oropharynx region, but no skin lesions were found. Fiberoptic laryngoscopy confirmed these findings. The Treponema pallidum particle agglutination test and toluidine red unheated serum test (TRUST) were positive with a titer of TRUST 1:64. The patient admitted to engaging in extramarital sexual activities with several females but no males. Based on the clinical manifestations and laboratory test results, a diagnosis of secondary syphilis of the oropharynx was established. He was treated with 2.4 million units of benzathine penicillin G by intramuscular injection once a week for 3 weeks. After 1 month, the lesions completely disappeared without any symptoms. The titer of TRUST reduced to 1:2 in 1-year follow-up. This report aims to enhance physicians' understanding and recognition of oropharyngeal syphilis, enabling timely diagnosis and effective management.

An Atypical Cutaneous and Histopathological Manifestation of Secondary Syphilis in an HIV-Positive Male: A Case Report

We present an atypical case of secondary syphilis concomitant with condyloma lata in an HIV-positive male. The patient presented with lesions on his lateral neck, soles, and palms. Spirochetes were examined on the biopsy of the palm, consistent with secondary syphilis, but not on the biopsy from the neck. The lesion on the neck was diagnosed as an evolving secondary syphilis lesion due to the extent of the lymphoplasmacytic infiltration, presence of acanthosis and epidermal hyperplasia, the accompanying diagnosis of secondary syphilis on the palm, the patient’s history of HIV, and the related diagnosis of condyloma lata on the dorsal shaft of the penis. Following this diagnosis, the patient was referred to an infectious disease specialist who treated him with a single intramuscular injection of 2.4 million units of benzathine penicillin, per CDC guidelines. This case highlights the importance of clinicians taking into consideration a variety of factors when diagnosing and treating cutaneous disorders with a broad-spectrum differential diagnosis, particularly in at-risk individuals.

Toxinogene Corynebacterium diphtheriae-surinfectie van een chronisch ulcus

Toxigenic Corynebacterium diphtheriae superinfection of a chronic ulcer This article describes the medical history of a 92-year-old Congolese woman with a chronic ulcer on the right inner ankle, present since childhood after scratching small bumps. After returning from a holiday in Congo, the patient had a swollen right lower leg and the ulcer had become remarkably painful. Corynebacterium diphtheriae was cultured from a wound culture and toxin production was demonstrated by a PCR and an immunoprecipitation test (Elek test). Cutaneous diphtheria, usually caused by C. diphtheriae or C. ulcerans, has been on the rise in recent years, primarily due to frequent travelling to endemic areas and migration. The patient was initially treated with azithromycin for 2 weeks, whereafter a control culture showed no evidence of C. diphtheriae. Given the persistent pain symptoms, azithromycin was continued for 2 more weeks. The patient had received only 1 documented vaccine and was thus incompletely vaccinated against diphtheria. A nasopharyngeal carrier status could not be demonstrated. Contact isolation is strongly recommended in patients with toxigenic skin diphtheria since they form a reservoir for secondary transmission with the risk of respiratory diphtheria. Unprotected contacts with the wound exudate should be treated prophylactically with azithromycin 500 mg once a day for 3 days or a single intramuscular administration of 1.2 million units of benzathine-penicillin. Despite large-scale vaccination programs against diphtheria, a physician should include cutaneous diphtheria in the differential diagnosis in case of a non-healing ulcer with a grayish attachment.

2221. Use of PCR and MLST analysis to establish Treponema pallidum as the cause of a painful oral lesion

Abstract Background A syphilitic chancre is described classically as a single, indurated, and painless ulcer at the site of Treponema pallidum inoculation. Methods We present a 39-year-old heterosexual, monogamous, HIV-negative woman with a painful tongue lesion of one month’s duration. To exclude a malignancy, a biopsy was performed. Results Histopathology showed intense inflammatory reaction, and T. pallidum immunocytochemistry demonstrated a high density of spirochetes in the subepithelial connective tissue. Subsequent testing revealed a reactive anti-T. pallidum IgG EIA and an RPR titer of 1:8. PCR amplification and multi-locus sequence typing (MLST) confirmed that the visualized spirochetes were T. pallidum. This particular MLST strain pattern has been identified twice before and named ST-109; however, no clinical information is available. Diagnosis and appropriate treatment were delayed since syphilis was not suspected initially. When the results became available, the patient was treated with 2.4 million units of benzathine penicillin given IM with complete resolution of the lesion. The male partner, who reported no symptoms, had a positive T. pallidum EIA with an RPR titer of 1:64 and was also treated with penicillin. Within four months, a woman from an adjacent town presented to urgent care with three perineal severely painful lesions, testing negative for HIV, Herpes Simplex Virus (HSV) by PCR of an ulcer swab, and chlamydia and gonorrhea on a urine sample by a NAAT. The anti-T. pallidum EIA was reactive, and the RPR titer was 1:4. The lesions resolved with IM penicillin treatment. Conclusion The observations reported here indicate that a subset of early syphilis cases may present with painful lesions. Despite the commonly held belief that syphilitic chancres are painless, several case series have reported tender lesions, single or multiple, without evidence of concurrent HSV infection to explain the pain. This is the first PCR and MLST sequencing analysis of a T. pallidum strain within a painful chancre. Given the rise in the number of cases of syphilis in the USA, it is essential that clinicians be aware of this atypical presentation. It remains to be determined whether such painful lesions are only associated with certain T. pallidum genotypes. Disclosures All Authors: No reported disclosures.

An Unusual Cause of Acute Gastroenteritis, Ascites, and Eosinophilia in a 29-Year-Old Woman

An Unusual Cause of Acute Gastroenteritis, Ascites, and Eosinophilia in a 29-Year-Old Woman

Malignant Syphilis as an Initial Presentation of HIV Infection: A Case Report

Abstract Introduction : Malignant syphilis (MS) is a rare and severe variant of secondary syphilis that is frequently associated with HIV infection. The clinical impact of HIV and syphilis co-infection is bidirectional, and the presence of MS is associated with acute HIV infection. Clinically, MS is characterized by nodular and ulcerative lesions affecting the trunk and extremities, which are covered with thick crusts. The treatment of choice for MS remains benzathine penicillin G. Herein, we report a case in which MS was the initial presentation of HIV infection. Case presentation : A 35-year-old male patient came with the chief complaint of extensive erythematous nodular rash for the past one month, with notable ulceration on some lesions with annular configuration along with fever and malaise. Based on the abovementioned clinical, laboratory, and histopathologic findings, the patient was diagnosed with MS and HIV. The diagnosis was established based on histopathological examination and syphilis serological testing. Discussion : Cutaneous disorders are a frequent presenting feature of HIV infection. The clinical manifestations of syphilis in immunosuppressed patients are often severe and/or atypical. The patient was then treated with weekly intramuscular administration of 2.4 million units of benzathine penicillin G for 3 weeks and achieved rapid and significant clinical improvement, with no Jarisch-Herxheimer reaction. Conclusion : Co-infection with syphilis and HIV alters the course of both diseases, and most HIV-infected patients with syphilis have typical disease manifestations associated with decreased CD4+ T-cell counts.

Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM. Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

Usefulness of New Automated Treponemal Tests in the Diagnosis of Early Syphilis: A Series of 15 Cases

BackgroundSyphilis is a sexually transmitted infection caused by Treponema pallidum, subspecies pallidum. As these bacteria are difficult to culture, syphilis must be diagnosed by serologic testing. The introduction of automated treponemal tests has led to changes in the traditional diagnostic algorithm for syphilis, which began with a nontreponemal test. We present 15 cases of primary syphilis detected using these new tools and review the microbiologic techniques used for the diagnosis of early syphilis. Material and methodsWe examined all cases of syphilis diagnosed in our department between January 2013 and September 2018 and selected patients with negative nontreponemal (rapid plasma reagin [RPR]) tests. ResultsOf the 158 patients diagnosed with syphilis during the study period, 15 had a negative RPR test, and 14 of them had a positive treponemal test. Fourteen of the patients were men and ages ranged from 22 to 60 years. Polymerase chain reaction was used to detect T pallidum in the lesion exudate from 8 patients and was positive in all cases. The 15 patients were treated with a single injection of 2.4 million units of benzathine penicillin G. ConclusionChemiluminescence immunoassays and T pallidum automated enzyme-linked immunoassays are useful in the diagnosis of early syphilis, and we believe that they should be adopted as screening tools given their diagnostic sensitivity, speed, and low cost.

Utilidad de las nuevas pruebas treponémicas automatizadas en el diagnóstico de la sífilis precoz. A propósito de 15 casos

BackgroundSyphilis is a sexually transmitted infection caused by Treponema pallidum, subspecies pallidum. As these bacteria are difficult to culture, syphilis must be diagnosed by serologic testing. The introduction of automated treponemal tests has led to changes in the traditional diagnostic algorithm for syphilis, which began with a nontreponemal test. We present 15 cases of primary syphilis detected using these new tools and review the microbiologic techniques used for the diagnosis of early syphilis. Material and methodsWe examined all cases of syphilis diagnosed in our department between January 2013 and September 2018 and selected patients with negative nontreponemal (rapid plasma reagin [RPR]) tests. ResultsOf the 158 patients diagnosed with syphilis during the study period, 15 had a negative RPR test, and 14 of them had a positive treponemal test. Fourteen of the patients were men and ages ranged from 22 to 60 years. Polymerase chain reaction was used to detect T pallidum in the lesion exudate from 8 patients and was positive in all cases. The 15 patients were treated with a single injection of 2.4 million units of benzathine penicillin G. ConclusionChemiluminescence immunoassays and T pallidum automated enzyme-linked immunoassays are useful in the diagnosis of early syphilis, and we believe that they should be adopted as screening tools given their diagnostic sensitivity, speed, and low cost.

Alternative Treatments for Syphilis During Pregnancy.

Alternative Treatments for Syphilis During Pregnancy.

The Benzathine Penicillin G (BPG) Reformulation Preferences Study - Samoa

Abstract Acute Rheumatic Fever (ARF) is an autoimmune condition caused by untreated group A streptococcal (GAS) infection of the upper respiratory tract (and possibly skin). Multiple or severe attacks of ARF can cause cardiac damage known as rheumatic heart disease (RHD). In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities is one of the highest in the world, usually affecting children and young adults. The most effective recommended management for ARF requires monthly intramuscular injections of 1.2 million units of Benzathine Penicillin G (BPG) known as secondary prophylaxis (SP) for 10 years or more. The goal of SP is to prevent GAS infections that may lead to the recurrence of ARF. Even with these monthly BPG injections, adherence to SP schedules are usually low due to the frequency and duration of injection, pain and access to proper and timely healthcare. A less painful and longer acting BPG formulation would ideally help prevent recurrence of ARF and improve compliance rates to this schedule with improved understanding of barriers and novel approaches to BPG delivery urgently needed. To better understand the BPG reformulation preferences of children/teens currently receiving monthly BPG intramuscular injections, and that of their families and healthcare providers who administer BPG, three software applications will be developed from pre-existing applications that have been optimized for use in target populations in New Zealand. This will be the first time software applications have been used to collect qualitative and quantitative data on individual preferences for BPG formulations and dosing regimens in Samoa.

Serological response to therapy following retreatment of serofast early syphilis patients with benzathine penicillin.

Some syphilitic patients remain in a serologically positive state after the recommended therapy. Although we often retreat patients in clinical practice, the optimal treatment protocol remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We examined rapid plasma reagin serological test results of 70 serofast early syphilis cases who were retreated with 2.4 million units of benzathine penicillin weekly for 3 weeks. Serological retreatment success was defined as a minimum 4-fold decrease in baseline rapid plasma reagin test antibody titre within 6 months. Thirty-four (48.6%) of the patients who failed to achieve serological cure at 6 months after initial therapy achieved serological cure at 12 months. Patients who had higher non-treponemal titres at baseline and at 6 months were more likely to exhibit serological cure after retreatment than those with lower titres. Our results suggest that the incremental benefit of retreating serofast patients with early syphilis is moderate, considering the almost 1:1 ratio of serological response to serofast state at follow-up.

The amount of penicillin needed to prevent mother-to-child transmission of syphilis.

Syphilis is unique among sexually transmitted diseases in that it remains curable (with minimal reports of resistance) with a single dose of penicillin, formulated for this purpose as long-acting benzathine penicillin.1,2 Pregnant women with untreated syphilis experience adverse birth outcomes in over half of untreated pregnancies. These outcomes include stillbirth, organ deformities, prematurity and neonatal death.3 The World Health Organization (WHO) estimates that 930 000 pregnant women have probable active syphilis (transmissible during pregnancy) annually which results in approximately 350 000 adverse birth outcomes per year.4 Most maternal syphilis cases and adverse pregnancy outcomes occur in low- and middle-income countries, and more than half occur in sub-Saharan African countries.4 WHO estimates that global syphilis prevalence is 0.5% (95% uncertainty interval, UI: 0.4–0.6%) which corresponds to a global incidence of 5.6 million (95% UI: 4–8 million) syphilis cases per year among people aged 15–49 years.5 From these estimates, it is possible to calculate the amount of penicillin needed for syphilis treatment on a global scale. However, the difference between the global needs and what is currently produced is not possible to quantify as there is no global monitoring of availability. In May 2016, benzathine penicillin was recognized by the 69th World Health Assembly as an essential medicine that has been in short supply for several years. These shortages have affected treatment and prevention of congenital syphilis.6 A lack of benzathine penicillin can result in pregnant women with syphilis receiving ineffective or no treatment.7–10 Benzathine penicillin is a generic injectable with very few global manufacturers and is therefore at high risk for inventory stock out and shortages at the point-of-care. WHO has received reports of stock outs of benzathine penicillin from antenatal care representatives and providers in high morbidity countries from three WHO regions.11 Shortages during 2015 and 2016 at the manufacture and supply levels have been reported in the region of the Americas.12–14 An estimated 5.6 million doses of 2.4 million units of benzathine penicillin are needed annually to treat all syphilis cases.5 Of these, 930 000 doses are needed to treat pregnant women with syphilis early in pregnancy to prevent all cases of congenital syphilis.4 These separate estimates indicate an acute need for expanded access to benzathine penicillin in countries with high rates of adult syphilis and ongoing improvements in syphilis screening during antenatal care. WHO advocates use of these estimates in discussions at the manufacture and distribution levels to ensure a reliable supply of benzathine penicillin in all countries with cases of adult syphilis. Global demand for this formulation of penicillin has not been consistently and adequately quantified. Many people with syphilis do not develop pathognomic signs or symptoms and do not receive a diagnosis because they are unaware of infection or are unable to access health care and/or diagnostic tests. Therefore, these estimates of penicillin requirements are greater than the number of adults who will have been diagnosed with syphilis. These estimates do not include the treatment of congenital syphilis in infants as such regimens require different doses of aqueous, procaine, or benzathine penicillin formulations.1,2 As a result of increasing need and reported shortages, and in response to the directives from the 69th World Health Assembly, WHO, in partnership with other stakeholders, is doing a market analysis that will include evaluation of production, demand, supply and procurement practices at manufacture, country and regional levels. Results of this analysis will be used to further refine estimates of benzathine penicillin demand, improve availability and develop interventions to improve supply management and procurement. WHO’s plan for the elimination of mother-to-child transmission of HIV and syphilis includes targets of 95% of pregnant women receiving antenatal care and receiving syphilis testing during antenatal care, and 95% of women diagnosed with syphilis during pregnancy being treated.15 Elimination targets for syphilis are achievable given that benzathine penicillin, the only recommended treatment for syphilis occurring in pregnant women, can cure maternal syphilis and prevent adverse birth outcomes related to congenital syphilis if provided early in pregnancy.1,2 Countries seeking to expand and improve prenatal care, reduce adverse pregnancy outcomes, and achieve congenital syphilis elimination targets must have access to a secure supply of benzathine penicillin. Equally, manufacturers need a reasonable global needs estimate as part of the business case required to justify any changes to their manufacturing processes. These WHO estimates of penicillin needs can be used along with estimates of demand to adapt manufacturing practices to expand access to benzathine penicillin.

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.

Strategies of testing for syphilis during pregnancy.

Strategies of testing for syphilis during pregnancy.

Reduction in Mother-to-Child Transmission of Syphilis For 10 Years in Shenzhen, China

Untreated maternal syphilis can result in the fetuses being infected. Severe adverse pregnancy outcomes include stillbirth, perinatal death, low birth weight, and congenital syphilis (CS). The World Health Organization has already classified global elimination of CS as a priority. However, this preventable disease is still threatening people's health in the world. A Programme of Prevention of Mother-to-Child Transmission of Syphilis in Shenzhen was launched in 2002. All pregnant women in Shenzhen were screened for syphilis by serological methods at their first prenatal care visit. The infected individuals were treated with 3 weekly injections of 2.4 million units of benzathine penicillin. The babies were followed up until 18 months old to diagnose CS. Up to 2011, the Programme of Prevention of Mother-to-Child Transmission of Syphilis in Shenzhen screened 2,077,362 pregnant women and intervened in 7668 mothers infected with syphilis. The screened rate among pregnant women increased from 89.8% in 2002 to 97.4% in 2011. The proportion of those having adverse pregnant outcomes (including spontaneous abortion, premature delivery, and stillbirth) decreased from 27.3% in 2003 to 8.2% in 2011. The incidence of CS decreased from 115/100,000 in 2002 to 10/100,000 (live births) in 2011. In 2002, in the face of rising CS numbers, Shenzhen adapted a syphilis control program that involved cost-free testing for pregnant women, commitment and collaboration at multiple levels of the health system, and strong supervision and government guidance. Local program and surveillance data suggest that the program has been very successful in reducing CS incidence.

Neurosyphilis Presenting as Primary Progressive Aphasia

Back to table of contents Previous article Next article LettersFull AccessNeurosyphilis Presenting as Primary Progressive AphasiaPanagiotis Ioannidis, M.D., Ph.D., Athanasios Lourbopoulos, M.D., Ph.D., Dimitra Mamouli, M.D., Eleni Polichroniadou, M.D., George Papadopoulos, M.D., and Dimitris Karacostas, M.D., Ph.D.Panagiotis IoannidisSearch for more papers by this author, M.D., Ph.D., Athanasios LourbopoulosSearch for more papers by this author, M.D., Ph.D., Dimitra MamouliSearch for more papers by this author, M.D., Eleni PolichroniadouSearch for more papers by this author, M.D., George PapadopoulosSearch for more papers by this author, M.D., and Dimitris KaracostasSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.neuropsych.13010018AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Primary progressive nonfluent aphasia (PPnfA) is an aphasic disorder that is classified in the spectrum of frontotemporal dementia diseases.1 It is characterized by disturbed grammatical comprehension and expression, as well as reduction of speech sound production. We present a adult man whose initial symptoms and signs were compatible with PPnfA in whom later work-up surprisingly unmasked neurosyphilis.Case ReportA 52-year-old normotensive native man was admitted from the outpatient memory clinic of our department for evaluation of speech difficulties that started 6 months earlier. His past medical history was otherwise unremarkable. Neurological examination revealed mild cogwheel rigidity, positive grasp reflexes, and bilateral Babinski signs. MMSE score was 28, and the Addenbrooke Cognitive Examination–Revised (ACE–R) test score was 74/100. He presented reduced verbal fluency, with word-finding difficulties. Brain MRI showed bilateral perisylvian cortical atrophy, more prominent in the left hemisphere (Figure 1), and routine EEG revealed theta-wave activity in the left frontotemporal area. Extensive serology and hematological tests were normal except for positive Venereal Disease Research Laboratory (VDRL) test (titer: 1/128). Subsequently, serum tests for rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were both positive, with RPR titer: 1/128. Spinal tap demonstrated clear CSF with 160 cells/mm3 (50% neutrophils), along with protein: 135 mg/dl, glucose: 28 mg/dl, and positive VDRL (1:16), RPR (1:32), and positive FTA-Abs.FIGURE 1. Neurosyphilis Patient’s MRI[A]: T1-weighted image with contrast medium; [B]: T2-weighted image shows ventricular enlargement due to parenchymal atrophy, incompatible with his age.The patient was treated with IV 4×106 units of penicillin administrated 6 times daily for 15 days and followed by 2.4 million units of benzathine penicillin 5 IM once a week for 3 weeks. A second spinal tap showed clear, acellular CSF, with protein 95 mg/dl, glucose 37 mg/dl, positive VDRL (1:8), and RPR (1:16).On follow-up 6 months later, a significant improvement of language production was observed; his ACE–R score was 92/100; MMSE score was 30; and the rest of the neurological signs remained unchanged.DiscussionNeurosyphilis can present with progressive cognitive deterioration accompanied by psychiatric manifestations,2 and it is considered one of the treatable and reversible causes of dementia.3 With the present progress of socioeconomic globalization, the spread of migration from developing countries, and the recently-published increasing spread of syphilis,4 we have to reconsider neurosyphilis even in immunocompetent adults. The correct diagnosis could be crucial because early therapy could dramatically affect prognosis.5 Also, our case was atypical because it presented with progressive aphasic disturbances resembling PPnfA. Had we omitted the special serological tests for syphilis, our case could had probably remained undiagnosed.In conclusion, syphilis should be included in the differential diagnosis of early-onset dementias, even if the initial symptoms and neuroimaging findings point toward a degenerative dementing process.Dept. of Neurology, AHEPA University Hospital, Aristotle University School of Medicine, Thessaloniki, Macedonia, GreeceCorrespondence: Dr. Ioannidis; e-mail: [email protected]grThe authors report no conflict of interest related to the present study.References1 Gorno-Tempini ML, Hillis AE, Weintraub S, et al.: Classification of primary progressive aphasia and its variants. Neurology 2011; 76:1006–1014Crossref, Medline, Google Scholar2 Nagappa M, Sinha S, Taly AB, et al.: Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital. Neuroradiology 2013; 55:379–388; available at doi: 10.1007/s00234-012-1017-9Crossref, Medline, Google Scholar3 Yu Y, Wei M, Huang Y, et al.: Clinical presentation and imaging of general paresis due to neurosyphilis in patients negative for human immunodeficiency virus. J Clin Neurosci 2010; 17:308–310Crossref, Medline, Google Scholar4 Mayer KH, Mimiaga MJ: Resurgent syphilis in the United States: urgent need to address an evolving epidemic. Ann Intern Med 2011; 155:192–193Crossref, Medline, Google Scholar5 Ghanem KG: Review: Neurosyphilis: a historical perspective and review. CNS Neurosci Ther 2010; 16:e157–e168Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByLanguage impairments and CNS infections: a review29 July 2021 | Aphasiology, Vol. 36, No. 10Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man1 June 2022 | Cognitive and Behavioral Neurology, Vol. 35, No. 2Current Infectious Disease Reports, Vol. 17, No. 5 Volume 26Issue 1 Winter 2014Pages E27-E28 Metrics PDF download History Published online 1 January 2014 Published in print 1 January 2014

Syphilitic balanitis of Follmann

Syphilitic balanitis of Follmann (SBF) is a rare condition that is considered as manifestation of primary syphilis. A 28-year-old heterosexual male patient was consulted for a diffuse indurated dark red erythema of the glans penis accompanied by bilateral inguinal lymphadenopathy. Serological tests for syphilis were found positive. Treatment consisting of a single intramuscular administration of 2.4 million units of benzathine-penicillin was followed by complete disappearance of erythema and induration of the glans within twoweeks. Syphilitic balanitis of Follmann presents with variable clinical appearances, and primary chancre may be absent, associated with, or occur after the balanitis. Usually the inguinal lymphadenopathy is present, and syphilitic serology is positive or is going to become positive. Treatment is identical to that of primary syphilis. The recrudescence of syphilitic infection requires exclusion of SBF from the diagnosis of balanitis.

O05.2 Measuring Syphilis: Quantitative PCR Can Be Used to Monitor Treatment Response

BackgroundThe humoral response to Treponema pallidum ( T. pallidum), which causes syphilis, is divided into ‘non-specific’ anti-lipid and specific anti-treponemal protein antibodies. A four-fold reduction in anti-lipid antibodies is used...