The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre / 中国医学科学杂志(英文版)

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.

Establishment and preliminary application to diagnose primary syphilis of Tp0259-PCR / 国际检验医学杂志

Objective To explore the significance of established Tp0259-PCR in diagnosing primary syphilis.To provide basis for establishing new PCR diagnosis method of Treponema pallidum.Methods Specific primers were designed by the gene sequences of Tp0259 which was obtained from Genbank.Tp0259-PCR was established under the optimization reaction condition.Using the new construction of amplification method to detect the common pathogenic microorganism in urinary and reproductive tract infec-tion.42 clinical secretion specimens suspected primary syphilis were tested by Tp0259-PCR.Serum specimens from the same pa-tients were tested by TPPA.Results Only specific amplicons could be found in amplifying the Treponema pallidum by Tp0259-PCR.The detection rate was 73.8% using Tp0259-PCR which was apparently higher than 57.1% using TPPA(P <0.05 ).The specificity of the established method was 100% comparing with TPPA.Conclusion The established method of Tp0259-PCR has high sensibility and specificity.This method might be better than serological method in diagnosis of primary syphilis.but its clinical diagnosis value need to be repeatedly verified by more clinical specimens.

Clinical manifestations of primary syphilis in homosexual men

At the beginning of a new millennium, syphilis incidence has been increasing worldwide, occurring primarily among men who have sex with men (MSM). The clinical features of primary syphilis among MSM is described, a case-note review of the primary syphilis (PS) patients who attended the Institute of Skin and Venereal Diseases. The diagnosis was assessed based upon the clinical features and positive syphilis serology tests. Among 25 patients with early syphilis referred during 2010, PS was diagnosed in a total of 13 cases. In all patients, unprotected oral sex was the only possible route of transmission, and two out of 13 patients had HIV co-infection. Overall, 77% of men presented with atypical penile manifestation. The VDRL test was positive with low titers. The numerous atypical clinical presentations of PS emphasize the importance of continuing education of non-experienced physicians, especially in countries with lower reported incidence of syphilis.