ABSTRACT
Abstract Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
ABSTRACT
Objetivo: Describir tres situaciones clínicas en las que se presentan distintas manifestaciones bucales para una misma entidad patológica. En los tres casos la sospe- cha diagnóstica de sífilis primaria se basó en la presencia de una adenopatía. Los estudios de laboratorio permitieron confirmar el diagnóstico de sífilis. Por su polimorfismo y variabilidad clínica en sus diferentes etapas evolutivas, la sífilis es descripta clásicamente como "la gran simuladora". Este artículo propone que la presencia de adenomegalias características puede ser una clave para orientar el diagnós- tico de la patología, lo cual no ha sido aún reportado en la literatura. Casos clínicos: Se presentan tres casos clínicos de pa- cientes que acudieron a una consulta estomatológica privada y al Servicio de Estomatología del Hospital Alemán de Bue- nos Aires. Los tres acuden con signos y síntomas diferentes, pero compartiendo la presencia de adenopatías múltiples, en las que se destaca un elemento ganglionar más voluminoso (AU)
Aim: To describe three clinical cases that present dif- ferent oral manifestations for the same pathological entity. In all three cases, the suspected diagnosis of primary syph- ilis was based on the presence of an adenopathy. Labora- tory studies confirmed the diagnosis of syphilis. Due to its polymorphism and clinical variability in the different evo- lutionary stages, syphilis is classically described as "the great simulator". This article proposes that the presence of characteristic adenomegalies can be a key to guide the di- agnosis, which has not yet been reported in the literature. Clinical reports: Three clinical cases of patients who attended a private stomatology consultation and the Stoma- tology Service of the Hospital Alemán de Buenos Aires are presented. The three patients showed different signs and symptoms but shared the presence of multiple adenopathies with a more voluminous ganglial element (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Oral Manifestations , Sexually Transmitted Diseases, Bacterial , Lymphadenopathy , Argentina , Signs and Symptoms , Treponema pallidum/pathogenicity , Dental Service, Hospital , Diagnosis, DifferentialABSTRACT
Summary@#Secondary syphilis is a rare infectious sexually transmitted disease caused by Treponema pallidum in present era. It affects skin as well as other organs of the body. We hereby present a case of an adult male who presented with a one-month history of multiple brownish red maculopapular lesions all over the skin of the body involving the palms, soles, oral cavity and genitalia. His serology was positive for HIV, VDRL and TPHA with a low CD4 count. The patient was treated with three weekly doses of parenteral Benzathine penicillin G, antiretroviral therapy and podophyllin for condyloma acuminata to which he responded well.
Subject(s)
Sexually Transmitted Diseases , Neurosyphilis , Condylomata AcuminataABSTRACT
Introduction: Primary syphilis is classically represented by a hard chancre, but other rare forms such as Follmann's balanitis are occasionally described. Objective: To show an iconography of the clinical presentations of the classic hard chancre and Follmann's balanitis, in parallel with the serological results in the course of diagnosis and treatment. Methods: Descriptive case report of a patient of an outpatient clinic for sexually transmitted infections in a tertiary hospital in the city of São Paulo, SP, Brazil. Conclusion: Syphilis lesions acquire different clinical expressions according to the natural evolution of the disease. Recognizing these presentations, as well as knowing how to interpret the serological results, is essential for the diagnosis and adequate treatment of the infection.
Introdução: A sífilis primária é representada classicamente pelo cancro duro, porém outras formas raras, como a balanite de Follmann, são ocasionalmente descritas. Objetivo: Apresentar uma iconografia dos estágios evolutivos da lesão clássica de cancro duro e da balanite de Follmann em paralelismo com os resultados sorológicos no curso do diagnóstico e do tratamento. Métodos: Relato descritivo evolutivo de paciente atendido em ambulatório de atendimento de infecções sexualmente transmissíveis de hospital terciário da cidade de São Paulo (SP), Brasil. Conclusão: As lesões da sífilis adquirem expressões clínicas diversas conforme a evolução natural da doença. Reconhecer essas apresentações, bem como saber interpretar os resultados sorológicos, é fundamental para o diagnóstico e o tratamento adequado da infecção.
Subject(s)
Humans , Balanitis , Syphilis , Chancre , Sexually Transmitted Diseases , Diagnosis , InfectionsABSTRACT
As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Subject(s)
Humans , Male , Female , Ulcer/therapy , Sexually Transmitted Diseases, Viral/epidemiology , Chancroid/therapy , Sexually Transmitted Diseases/therapy , Genitalia/pathology , Brazil/epidemiology , Herpes Genitalis/therapy , Lymphogranuloma Venereum/therapy , Syphilis/therapy , Clinical Protocols , Granuloma Inguinale/therapyABSTRACT
Resumo As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.
Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
Resumen El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.
Subject(s)
Humans , Chancroid , Sexually Transmitted Diseases , Ulcer , Brazil/epidemiology , Sexually Transmitted Diseases/therapy , Sexually Transmitted Diseases/epidemiology , GenitaliaABSTRACT
Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.
Subject(s)
Female , Humans , Male , Chancre/diagnosis , Nipples , Skin , Syphilis/diagnosisABSTRACT
Resumen Introducción: Las enfermedades de transmisión sexual se definen como un grupo de infecciones causadas por diversos agentes que se adquieren durante las relaciones sexuales. Éstas además suelen generar manifestaciones en boca. Objetivo: Determinar las lesiones características en cavidad bucal de enfermedades de transmisión sexual. Materiales y métodos: Estudio descriptivo transversal, con 37 pacientes que asistieron a los servicios de Estomatología de la Universidad de Buenos Aires, Universidad de Cartagena y el Hospital Alemán en Buenos Aires durante 2015 y 2016. Se realizó historia clínica completa con pruebas Venereal Disease Research Laboratory (VDRL) y Fluorescent Treponemal Antibody Absortion (FTA-ABS) en pacientes con presunción de sífilis. Además de análisis histopatológico y Reacción en Cadena de la Polimerasa (PCR) en pacientes con presunción de Virus de Papiloma Humano (VPH). Resultados: El promedio de edad de los pacientes fue de 38 años, predominó el sexo masculino. El 54,1% fueron diagnosticados con sífilis y la lesión más encontrada en estos fue la pápula. El 45,9% restante fueron diagnosticados con VPH, la lesión predominante en estos fue la verrugosidad. Conclusiones: El odontólogo debe contribuir en la detección temprana de enfermedades de transmisión sexual identificando manifestaciones de éstas en boca; con el fin de evitar su evolución y prevenir su transmisión.
Abstract Introduction: Sexually transmitted diseases are defined as a group of infections caused by various agents which are acquired during sexual intercourse. They also tend to generate manifestations in the mouth. Objective: To determine the typical lesions in oral cavity of sexually transmitted diseases. Materials and methods: A descriptive transversal study was conducted with 37 patients who attended the stomatology services of the University of Buenos Aires, University of Cartagena and the Aleman Hospital in Buenos Aires during 2015 and 2016. A complete clinical history was carried out with Venereal Disease Research Laboratory (VDRL) and Fluorescent Treponemal Antibody Absortion (FTA-ABS) tests in patients with presumption of syphilis. In addition, histopathological analysis and Polymerase Chain Reaction (PCR) was made in patients with presumption of Human papillomavirus (HPV). Results: The average age of the patients was 38, where male sex predominated. 54.1% were diagnosed with syphilis and the most found lesion in them was the papule. The remaining 45.9% were diagnosed with HPV, the predominant lesion in them was a wart. Conclusions: The dentist should contribute to the early detection of sexually transmitted diseases by identifying manifestations of these in the mouth in order to prevent their evolution and prevent their transmission.
Subject(s)
Humans , Oral Medicine , Sexually Transmitted Diseases , Chancre , Internal Medicine , Papillomavirus Infections , Syphilis , Syphilis SerodiagnosisABSTRACT
Objective To investigate the expression of TP 0155 mRNA in rabbits with early infection of Treponema pallidum ( T.pallidum ). Methods Three New Zealand white rabbits were subcutaneously injected with T.pallidum Nichols Seattle strains.Each rabbit was inoculated at ten sites with 106 T.pallidum/site.Skin lesions at the primary stage of syphilis were observed at different time points. Biopsy from one of the lesions was obtained from each rabbit every three days for detection of TP 0155 mRNA and house keeping gene TP 0574 mRNA.TP0155 plasmid standard was constructed by molecular cloning technique , and the quantitative PCR was used to continuously detect the expression of TP 0155 mRNA and TP0574 mRNA from lesion at different time points.Kruskal Wallis test and Bonferroni method were used to analyze the data.Results On d6, red papules appeared on the dorsal skins of rabbits ,there were ulcers in the center of the lesions on d19,presenting typical appearance of syphilis chancre.On d24 the scab of ulcer became smaller; on d25 the rabbits showed disseminated secondary syphilis , which became smaller and disappeared on d30.The copy numbers of TP0155 plasmid standards were 7.48 ×109 copies/μL.There were significant differences in expression of both TP 0155 mRNA and TP0574 mRNA at different time points (χ2 =32.756 and 52.344,both P<0.01).The expression levels of TP0155 mRNA and TP0574 mRNA increased in the early stage, and both reached the peak at d15 (both P<0.05), and then rapidly declined. There were significant differences in normalized TP 0155 mRNA ( TP0155 ×1000/TP0574 mRNA ) at different time points(χ2 =19.758,P<0.05),which reached the peak on d24 and d30,respectively (all P<0.05).Conclusion The level of TP0155 mRNA increases with the disappearance of chancre and secondary syphilis lesions , suggesting that TP0155 might be involved in immune escape of T.pallidum.
ABSTRACT
Rectal syphilis, known as a great masquerader, can be difficult to diagnose because of its variable symptoms. Gastroenterologists should be aware of the possibility of rectal syphilis when confronted with anorectal ulcers, and should gather a detailed history about sexual preferences and practices, including homosexuality. We report a case of primary rectal syphilis mimicking rectal cancer on radiologic imaging. In this report, we described the clinical, endoscopic, and radiologic features of this rare case.
Subject(s)
Humans , Male , Middle Aged , Rectal Diseases/diagnosis , Rectal Neoplasms/pathology , Syphilis/diagnosisABSTRACT
Primary syphilis affects the genital and, less frequently, the extragenital regions. Approximately two-thirds of extragenital chancres occur above the neck, and about one-half of these are seen on the lips, the perioral region, or in the oral cavity. We present a case of a 32-year-old woman with a 2-month history of discharging ulcers on both oral angles. She had a history of orogenital sexual contact. Serologic tests for syphilis was positive, particularly the VDRL (1:128), confirmed by TPHA. The biopsy specimen showed a predominant infiltration of plasma cells in the dermis. The skin lesions improved after 4 weeks treatment with doxycycline.
Subject(s)
Adult , Female , Humans , Biopsy , Chancre , Dermis , Doxycycline , Lip , Mouth , Neck , Plasma Cells , Serologic Tests , Skin , Syphilis , UlcerABSTRACT
A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.
Subject(s)
Adult , Humans , Male , Diagnosis, Differential , Rectal Diseases/complications , Rectal Neoplasms/pathology , Syphilis/complicationsABSTRACT
1. For our purpose, we adopted three serological procedures for the serological test for syphilis, namely: the Kahn standard flocculation test, the VDRL slide flocculation test, and the Kolmer complement-fixation test. Our reason for adopting them was to have a representative tube microscopic flocculation test, a slide microscopic flocculation test, and a complement-fixation test2. With the use of the 3 serologic procedures, the samples of sera from clinically diagnosed syphilitics of different stages of the disease gave positive reactions in 96.24 cases, doubtful reactions in 1.88 cases, and negative results in 1.88. Using the Kahn test, the VDRL test, or the Kolmer test individually, we observed doubtful results in 3.27, 2.28 and 9.11 of the cases: we obtained negative findings in 3.46, 4.65, and 11.95 of the cases respectively. This shows the advantage of using three serologic procedures over the routine use of one serologic test alone3. Based on our findings, the specificity of the Kahn standard flocculation test is 98.6; th VDRL slid flocculation test is 99.4; and the Kolmer complement-fixation test is 99.9. The sensitivity and specificity of the tests in syphilitics, and even in the different stages of syphilitic infections, are variableOur experience shows that the Kahn standard is the most sensitive, but the least specific. The Kolmer complement-fixation test, on the other hand, is the least sensitive, but the most specific. The VDRL slide-flocculation test stands uniformly halfway between the two, both in sensitivity and specificity. Because of this, we believe that, if one of these three procedures is to be adopted alone, the VDRL slide flocculation test should be given the preference. (Conclusions)
ABSTRACT
Electron mlactimpic studies were performed on three primary and two early secondary syphilitic lesions from three patients. AZ of these patients had both secondary syphilitic lesions and chancres. There was no difference in the morphology and location of treponemes in these patients as compared to those who had only a chancre or only a syphilid reported earlier. This study revealed that Treponema pallida were principally located in the intercellular space of keratinocytes and exhacellular space of the dermis. Furthermore, these organisms were observed within histiocytes, endothelial cells, fibroblasts, lymphocytes and even plasma cells. The plasma cells had well developed endoplasmic reticulum, and in some, dilatation of the endoplasmic reticulum was noted. Many t mponemes were demonstrated in and around blood vessels. The vascular endothelial cells were proliferating and the basement membranes were thick.