[Disseminated giant ecthymatous syphilid in secondary recurrent syphilis].
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Adult↗
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[Myoclonia and psoriasiform syphilids in a case of late syphilis].
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Aged↗
Photo quiz. Syphilis of the skin (nodular syphilids).
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AIDS-Related Opportunistic Infections↗
Mucocutaneous manifestations of secondary syphilis in north Indian patients: a changing scenario?
During the 1990s, no studies of various clinical presentations of syphilis have been published in the indexed literature. However, a change in the clinical profile of secondary syphilis was expected during the last decade with the rapid spread of the HIV epidemic. The objective was to study the mucocutaneous manifestations of secondary syphilis in patients attending the STD clinic at the Postgraduate Institute of Medical Education & Research Chandigarh, India, during the last decade and to compare them with other similar studies published during the 1980s. All patients who were diagnosed with secondary syphilis in our STD clinic from 1990 to 1999 were examined and investigated. Serological response was measured at 3, 6, 9, 12, and 24 months post-treatment or until serological negativity was reached. Fifty-three patients (males = 34, female = 19) during this period were found to have secondary syphilis. The most common symptoms were as follows-skin rash 38 (71.7%), lymphadenopathy 26 (49%), persistent chancre 4 (7.5%), nodular syphilides 2 (3.8%), lues maligna 2 (3.8%), patches in the oral mucosa 6 (11.3%), condylomata lata 14 (26.4%), split papules 2 (3.8%). Five patients had a thin and conspicuous genital scar of the healed primary chancre. Three patients were HIV seropositive (1 patient each with lues maligna, lichenoid, and nodular syphilides). With the spread of the HIV epidemic, atypical muco-cutaneous manifestations of secondary syphilis may be seen more frequently than before and may pose problems in diagnosis. In the present study, six patients had atypical manifestations, and three of them were HIV seropositive.
Adolescent↗
[The immediate results of treating patients with infectious forms of syphilis by the abbreviated single-course reserve method].
The results of rapid single-course oletetrine and tetracycline therapy of early syphilis are analyzed. The time of Treponema pallidum disappearance from syphilid discharge, of syphilid regression, and of the first negative results of the routine serologic tests, immunofluorescence 200/ABC and T. pallidum immobilization tests, as well as the blood serum tetracycline level indicate a high therapeutic efficacy of this method and recommend it for wide use.
Adult↗
[Syphilis. Clinical aspects of Treponema pallidum infection].
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.
AIDS-Related Opportunistic Infections↗
Syphilis: uncommon presentations in adults.
The clinical manifestations of syphilis are variable in appearance and have been described for centuries. The disease has been arbitrarily divided mainly into three stages. Uncommon presentations of syphilis in adults include (a) primary syphilis-atypical forms of chancre vary in size, shape, morphology, and color. Small ulcus durum is single or multiple, grouped, or herpetiform. Giant necrotic and phagedenic chancres are resolved with scar formation. In intratriginous areas, ulcus durum is rhagadiform, linear, "rocket type," or bilateral. (b) Secondary syphilids include macular (roseolas, leukomelanoderma), papular (small miliar or lichenoid, or with large size-lenticular or nummular), papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, and others; there are also mucosal lesions, loss of the hairs, and alteration of the nails. (c) Tertiary syphilis occurs decades after infection in three main forms: gummatous, cardiovascular, and neurosyphilis (asymptomatic, meningeal, meningovascular, and parenchymatous-such as general paresis or tabes dorsalis). Early recognition of the clinical manifestations of syphilis is important for the start of treatment, recovery of patients, and the prevention of the spread of disease.
AIDS-Related Opportunistic Infections↗
[Clinical and serological findings of syphilis in HIV-infected patients].
To identify the characteristic features of lues in patients infected with HIV, 402 HIV-positive patients were examined for serological and clinical signs of lues. 141 patients (133 male, 8 female, mean age 36 [18-69] years) had a positive lues serology. Treatment for lues was required in 20 of the 141 cases (14%). In ten patients (one case of lues I, nine cases of lues II) dermatological signs were predominant, macular exanthemas (n = 4) and palmo-plantar syphilides (n = 3) being most frequent. Three patients had seropositive latent lues. Eight patients presented with signs of an active neurolues (lues II: n = 1; lues III: n = 6; lues IV: n = 1). In three of the eight cases the serum FTA-ABS-IgM findings were negative. In these three patients the need for a specific treatment was realized only on the basis of cerebrospinal fluid (CSF) examination in conjunction with the clinical findings and the anamnesis. This result makes it very clear that indication for CSF puncture should be more liberal in some HIV infected patients. The markedly high proportion of cases of neurolues (40% of the luetic patients requiring treatment) is possibly due to reactivation of old lues infections.
AIDS-Related Complex↗
Late benign syphilis of the skin.
Two cases of late cutaneous syphilis are presented. After treatment for secondary syphilis in 1957 and retreatment for rising VDRL titers ten years later, one patient had developed a nodular syphilid. The other had several gummas. He had two quantitative nonreactive vDRL tests and a negative Treponema pallidum immobilization (TPI) test, but two reactive fluorescent treponemal antibody absorption (FTA-ABS) tests. Syphilis was suspected histologically and was confirmed by the specific serologic testing, the characteristic clinical presentation, and the prompt response to penicillin treatment. The clinical, serologic, histologic, therapeutic, and pathogenetic aspects of late benign syphilis of the skin are discussed.
Adult↗
Clinical survey of syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with special reference to the recent clinical manifestations and evaluation of IgM antibodies to Treponema pallidum.
One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA + IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.
Adolescent↗
Secondary syphilis mimicking borderline (BL) leprosy.
A young woman with syphilids resembling borderline lepromatous (BL) leprosy is being described. This is yet another addition to its already well-documented manifestations. The high prevalence of leprosy and syphilis augments the epidemiological significance of the case.
Adult↗
Clinical manifestations of secondary syphilis.
The results of a prospective study, aimed at having a fresh look at the clinical features of secondary syphilis in 89 patients, are presented. Eighty-one (91.0%) had syphilides, and of these, 24 (29.6%) had atypical morphology. Two or more groups of lymph nodes were enlarged in 60, and hepatosplenomegaly was seen in 20 (22.5%) patients. Condylomata data in atypical sites occurred in six patients. A total of 10 patients had alopecia on the scalp, and anterior uveitis was seen in 7 (7.9%). The clear CSF showed minimal elevation of lymphocytes in one of the 21 patients on whom lumbar puncture was performed and may, therefore, be considered unnecessary as a routine procedure. An awareness of the varied clinical presentations would assist in early diagnosis of the disease and help reduce its complications.
Adult↗
Alopecia syphilitica, a simulator of alopecia areata: histopathology and differential diagnosis.
Alopecia syphilitica (AS) may be "moth-eaten" or diffuse, clinically, and be confused with alopecia areata (AA) or other alopecias. The English language literature contains scant information regarding the histopathology of AS, and the resemblance between AS and AA has not been given adequate recognition. We report the histopathological findings of AS from nine patients with secondary syphilis and acute hair loss. The alopecia was moth-eaten in four patients and diffuse, but slightly moth-eaten, in five. Microscopically, the dermoepidermal interface was not involved. The numbers of hair follicles were diminished, with increased numbers of catagens and telogens. Lymphocytic infiltration was present around the hair bulbs and fibrous tracts in eight cases. Plasma cells were present in four biopsies. Other less common findings included lymphocytes in the isthmus, parabulbal lymphoid aggregates, and granulomatous infiltrate in the upper dermis. The findings, save for the follicular changes, resembled those of macular/maculopapular syphilides outside the scalp. With the follicular changes, the overall patterns resembled AA closely. The modified Steiner stain did not reveal spirochetes in any of our cases and failed to differentiate between AS and AA. Comparing the AS cases to 13 cases of AA, we found only a few differentiating features. The presence of peribulbal eosinophils strongly suggests AA. Without peribulbal eosinophils, the presence of plasma cells, abundant lymphocytes in the isthmus, or parabulbal lymphoid aggregates suggests AS.
Adult↗
Keratopustular variety of framboesiform syphilis: a case report.
An unusual form of secondary syphilis is presented, characterised by eruption of keratopustular syphilides which became confluent on the genitals and on other surfaces of the body. Histologically an intensive intraepidermal multilocular pustule formation was followed by equally intense but incomplete keratinisation. Abundant oozing lesions forced the patient to keep the genitals in a plastic bag which led to the formation of an uncommon, giant condylomatous surface covering the scrotum and penis.
Adult↗
Early varioliform syphilis. A case report.
A 25-year-old man developed a rare form of early syphilis with smallpox-like eruptions, mainly in the groins and axillae. Histological examination of the syphilids showed an unusual structure with an exceptional number of Treponema pallidum within the epidermis.
Adult↗
[Clinical analysis of 22 cases with syphilis racenta in Department of Dermatology, Nippon Medical School].
Forty-nine patients with syphilis were seen from January 1996, to June 2000 at the Dermatological Clinic of Nippon Medical School Hospital. The frequency of syphilis among all outpatients was 0.17%, and the number of male syphilis patients was almost twice that of female syphilis patients. Many sexual contacts (especially with female prostitutes) were considered to be the source of the infection in a large proportion of the syphilis patients. Chancres were observed in 50% of the 6 patients with primary syphilis. Macular or papular syphilide and psoriasis syphilitica were the most frequently observed symptoms in the patients with secondary syphilis. The Jarisch-Herxheimer reaction was observed in 18.8%. The titer of IgM-TPHA responded well to the therapy, and decreased or even disappeared after treatment. The titer of TPHA did not change markedly upon treatment. A retrospective study of syphilis from 1980 revealed that the incidence of syphilis, especially early infectious syphilis, in patients at our clinic has decreased markedly since 1991.
Adult↗
[A case of secondary syphilis simulating plasmocytoma].
A clinically unclear case is described of stomatitis with a long duration in a male of 28. Exfoliations in the region of the mouth angle were observed resembling pemphigus vegetans. Biopsy examination revealed a thick plasma cell infiltration which was considered to be an extramedullary plasmacytoma. However, a polyclonal composition of plasmacytes was found immunomorphologically producing immunoglobulins A, M and G with predominant production of IgG. This allowed rejection of neoplastic nature of the infiltrate, confirming its inflammatory origin and specific character. Serological tests (Wassermann, immunofluorescence test, in vitro immobilization test) confirmed the diagnosis of secondary recurring syphilis. Differential diagnosis of plasma-cell syphilid of skin and mucosal extramedullary plasmacytoma is under discussion.
Adult↗
[Acquired syphilis during human immunodeficiency virus infection. 6 cases].
We retrospectively studied the clinical, serological, bacteriological and histopathological data obtained in 6 HIV seropositive patients seen in our department from 1986 to 1989 for secondary syphilis. The clinical presentation was atypical in 4 of the 6 patients, with 2 palmoplantar keratodermas and 2 ulcerative syphilids. The diagnosis was made on darkfield examination in 2 patients, high titers of antibodies in 6 and histopathological examination (numerous plasma cells) in 4. All were cured with the classical penicillin therapy recommended for early syphilis.
Adult↗