Chancro luético multiple / Multiple syphilitic chancre

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Update on syphilis and pregnancy.

While the origins of syphilis remain unknown, it has long been recognized as an infectious entity with complex pathophysiology. In this review, we highlighted the epidemiology and risk factors associated with syphilis. The incidence of syphilis in most populations showed a consistent upward trend until the 1940s with the introduction of penicillin as the preferred treatment. The emergence of congenital syphilis and vertical transmission has been a direct result of heterosexual syphilis transmission. We also explore the microbiology and pathogenesis of Treponema pallidum as it directly correlates with its route of transmission and infectivity. The clinical features are best categorized into stages (primary, secondary, early, and late latent and tertiary). The primary stage presents as a characteristic chancre and inguinal adenopathy, while the secondary "bacteremia" stage has a predilection to dermatologic manifestations and constitutional symptoms. The latent phase of syphilis witnesses a quiescent period with variable relapse of symptoms and finally, one-third of untreated patients undergo tertiary syphilis years after the initial infection characterized by severe neurologic or cardiovascular symptomatology. We will also review the data collected for congenital syphilis from the CDC as this can manifest with stillbirth, neonatal death, and nonimmune hydrops. The diagnosis of syphilis focuses on a combination of nontreponemal and treponemal antibody tests with the CDC recommending a traditional algorithm from screening to confirmation. However, other agencies have recently adopted the reverse testing algorithm which has outperformed the traditional algorithm in certain populations. We finally focus on syphilotherapy and monitoring response to treatment with a specific emphasis on pregnancy. Birth Defects Research 109:347-352, 2017. © 2017 Wiley Periodicals, Inc.

Primary chancre in the rectum: an underdiagnosed cause of rectal ulcer.

We report the case of a 35-year-old homosexual man with previous history of HIV, with primary chacre in the rectum. We believe this paper is significant because the diagnosis of rectal ulcer is more common in recent years, however rectal syphilis is a poorly recognized entity, especially with primary chancre formation.

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.

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.

[A focal infiltration in the upper lobe of the right lung as a manifestation of the initial stage of secondary syphilis].

Among sexually transmitted diseases, the incidence of primary and secondary syphilis has substantially increased in Russian Federation within the recent years. Modern clinicians, acquainted only with conventional dermatovenerologic symptoms of the disease, are less aware of rare manifestations of syphilis as a generalized infection. A rare case of syphilis with infiltrative pulmonary lesion is discussed in the article; the attention of practitioners is drawn to "unusual" manifestations of syphilis.

Reactivación de la sífilis en Málaga / Revival of syphilis in Malaga

Introducción. En nuestro medio, la sífilis, aunque no ha dejado de presentarse en ningún momento, era realmente rara en los últimos años. Queremos, sin embargo, llamar la atención sobre su reciente reactivación con ciertas peculiaridades de presentación. Pacientes y métodos. Se estudian las características de 12 casos de sífilis diagnosticados en nuestro servicio de dermatología entre junio y diciembre de 2004. Resultados. De los 12 pacientes, con edades comprendidas entre los 20 y 48 años, sólo una era mujer, y seis eran homosexuales. Cinco de éstos y un heterosexual estaban, además, infectados por el virus de inmunodeficiencia humana. Tres pacientes fueron diagnosticados en el período primario, mientras que los otros nueve mostraban alteraciones propias del secundarismo, aunque cinco de ellos no tenían conciencia de haber tenido chancro ni adenopatías. La serología fue clave en el diagnóstico dada la gran variedad de manifestaciones clínicas y todos respondieron bien al tratamiento penicilínico. Conclusión. Conviene realizar serología luética en pacientes con cuadros sospechosos de sífilis secundaria, especialmente en pacientes homosexuales y portadores de anticuerpos frente al virus de inmunodeficiencia humana

Introduction. In our milieu, syphilis has been truly rare in recent years, although it has never ceased to be present. However, we would like to draw attention to its recent revival, presenting with certain peculiarities. Patients and methods. The characteristics of 12 cases of syphilis diagnosed in our dermatology department between June and December 2004 were studied. Results. Only one of the 12 patients, whose ages ranged from 20 to 48, was female, and six were homosexual. Five of the latter and one heterosexual were also infected with the human immunodeficiency virus. Three patients were diagnosed in the primary stage, while the other nine showed alterations characteristic of the second stage, although five of them were not aware of having had chancres or adenopathies. Serology tests were key to the diagnosis, because of the great variety of clinical manifestations. All of the patients responded well to penicillin treatment. Conclusion. Luetic serology should be performed in patients with symptoms that suggest secondary syphilis, especially in homosexuals and those who are HIV positive

["Lues maligna" in a female patient with diabetes]. / "Lues maligna" bei insulinpflichtigem Diabetes mellitus.

A 40-year-old female patient with diabetes mellitus presented with multiple erythematous ulcerated nodules and plaques predominantly on the trunk. A few months ago her partner had a small ulcer on the penis. She was HIV negative but showed markedly elevated syphilis serology titers (TPPA titer > 1:20.480, VDRL titer 1:128). The serum glucose levels exceeded 275 mg/dl. After exclusion of neurological involvement, we made the diagnosis of "lues maligna" arising in the setting of diabetes mellitus. The patient was treated with 2.4 million units benzathine penicillin intramuscularly weekly for three weeks. Simultaneously, diabetes therapy was improved with insulin injections. The syphilitic lesions cleared rapidly. In the follow-up VDRL titer was negative. "Lues maligna" is an unusual ulcerative variant of secondary syphilis which has been observed more frequently in HIV-infected patients in the last years. The occurrence of this aggressive variant in the clinical setting of diabetes mellitus is extremely rare.

Evaluation of syphilis in patients with HIV infection in Nigeria.

OBJECTIVE: To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Modification of syphilitic genital ulcer manifestations by coexistent HIV infection.

BACKGROUND: Conflicting data exist regarding whether HIV infection leads to changes in the clinical manifestations and severity of genital ulcer disease (GUD). GOAL: To determine the impact of HIV on the etiology and clinical severity of GUD. STUDY DESIGN: From July 1990 to July 1992, consecutive patients presenting to the two Baltimore City Health Department (BCHD) Sexually Transmitted Diseases clinics were approached as candidates for enrollment in a prospective study to determine factors associated with the transmission and acquisition of sexually transmitted diseases (STDs). RESULTS: Of the 1368 patients who presented to the BCHD, 214 (16%) had genital ulcerations: 160 (21%) of 757 men and 54 (9%) of 611 women. Among the patients with GUD who had undergone HIV testing, 28 (14%) of 204 were infected with HIV: 25 (17%) of 151 men and 3 (6%) of 53 women. Although both groups-those infected with HIV and those not infected with HIV--presented with GUD of similar duration (10 versus 11 days; P = 0.17), multiple lesions were found more frequently in men with HIV infection than in uninfected men: 87% versus 62% (P = 0.02). Although not statistically significant, GUD in men with HIV infection more often were deep (64% versus 44%, respectively) rather than superficial (36% versus 57%, respectively; P = 0.08), and larger (505 mm(2) versus 109 mm 2; P = 0.06). Primary syphilis caused more GUD among men with HIV infection than among uninfected men: 9 (36%) of 25 versus 24 (19%) of 126, respectively (P < 0.01). Secondary syphilis was diagnosed with concomitant GUD more frequently among men with HIV infection than among uninfected men: 3 (13%) of 25 versus 3 (2%) of 123, respectively (P < 0.01). CONCLUSIONS: In this study, patients who presented with GUD were more likely to be infected with HIV. A higher proportion of men with HIV infection had multiple lesions, and the lesions were more likely to be caused by syphilis.

Superimposed primary chancre in a patient with Adamantiades-Behçet's disease.

Adamantiades-Behçet's disease was diagnosed in a 42 year old Turkish patient with recurrent oral aphthae, genital ulcerations, papules, and sterile pustules, histologically presenting as cutaneous vasculitis, and intermittent arthritis with joint effusion particularly of the knees. Six months after initial improvement under treatment with colchicine 2 mg/day, a solitary genital ulcer with enlarged inguinal lymph nodes appeared and persisted for 7 weeks despite the continuation of colchicine treatment and the introduction of clindamycin 2 mg/day intravenously. The unusual persistence of the ulcer and the failure of clindamycin therapy led to further differential diagnostic considerations and the identification of primary syphilis. The genital lesion healed 4 weeks after initiation of treatment with tetracycline 2 mg/day by mouth for 15 days.