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A man had widespread, noduloulcerative syphilitic lesions that appeared, chronologically, during the "secondary" stage of syphilis. There were no systemic manifestations of the disease, except for possible periostitis. The darkfield examination and spinal fluid examinations were negative for syphilis. It is suggested that the term "malignant" syphilis should be discarded in favor of nonduloulcerative cutaneous syphilis.
After declining steadily for 10 years, the number of reported cases of primary and secondary (P&S) syphilis more than doubled in New York City (NYC) from 117 in 2000 to 282 in 2001. The increases have occurred primarily among men who have sex with men (MSM). Of particular concern is the high proportion of syphilis cases among MSM who also have human immunodeficiency virus (HIV). This report summarizes 2001 P&S syphilis data for NYC and compares it with surveillance data for 1999 and 2000; findings indicate a substantial increase in the number of syphilis cases among MSM. These data suggest increases in high-risk sexual behavior among some MSM and underscore the importance of coordinating efforts between the MSM community public health officials, and health-care providers to strengthen HIV-prevention efforts.
OBJECTIVE: To injvestigate the cerebral blood flow of patients with early syphilis. METHODS: (99)Tc(m)-ECD as brain perfusion imaging agent was used in single photon emission computed tomography (SPECT) for 32 patients with early syphilis and 15 controls. Visual analyses were made on every BSPECT image. RESULTS: The 32 patients with early syphilis had general, patchy hypoperfusion of cerebral blood flow. Fourteen of the 32 patients had 48 episodes of marked patchy hypoperfusion of rCBF. The responsible areas of hypoperfusion in a patchy distribution involved the left frontal lobe (6 episodes), right frontal lobe (3), left parietal lobe (7), right parietal lobe (6), left temporal lobe (11), right temporal lobe (5), left occipital lobe (3), left basal ganglia (3), cerebellum (1), and nerve nuceus (1). No abnormality was found in the control group. CONCLUSIONS: Cerebral blood flow abnormalities exist in patients with early syphilis. General patchy hypoperfusion on SPECT imaging is common.
Ten years have elapsed since penicillin was introduced in the treatment of syphilis. In order to appraise recent trends in syphilotherapy in the world, WHO carried out a detailed study of treatment practices in early syphilis. A questionnaire was circulated to leading venereologists and clinics in the world, and 277 replies were received from 55 countries giving particulars of 294 schedules.A total of 65.3% of the participants used penicillin alone and 28.9% used it in combination with other drugs. In North America all clinics relied solely on penicillin as against 52.2% in Europe; and procaine penicillin G in oil with aluminium monostearate (PAM) was used in 91% of clinics in the Americas and Asia and in 60.6% of European clinics. The most common dosage of penicillin in all stages of early syphilis was 4.8-6.0 million units; but appreciably larger doses were used in Europe than elsewhere, some 39.4% of schedules using 10.8 million units or more. There were single instances of 36 million units being given. Consolidation treatment was given in none of the North American clinics; seldom in Asia; by about one-third of the participants in Central and South America; and, for secondary syphilis, in 59% of European schedules.This study shows that with intensive treatment with PAM the saving in drug cost to clinics over the classical courses of arsenic and bismuth may be as much as pound4 per case, but the overhead expenses are, of course, not reduced.
Analysis of data obtained in 25,787 Treponema pallidum immobilization tests in a ten-year period showed an increase in the incidence of biologic false positive (BFP) reactions for syphilis, and a decrease in the incidence of reactive TPI tests. The percentage of BFP tests increased from 54.2 per cent in 1953 to 70.7 per cent in 1962. Reaction to a standard serologic test for syphilis (STS) indicates only that the patient may have syphilis. A subsequent non-reactive TPI test remains the best procedure for ruling out a diagnosis of syphilis. Thus the clinician should be made more aware of the fact that a biologic false positive reaction strongly implies the existence of another disease, the cause of which should be investigated.
Congenital syphilis (CS) occurs when the spirochete Treponema pallidum is transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis during pregnancy can lead to stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities. This report summarizes 2002 CS surveillance data, which indicated that CS rates have decreased among all racial/ethnic minority populations and in all regions of the United States except the Northeast. To further decrease CS, collaborative efforts among health-care providers, health insurers, policymakers, and the public are needed to increase prenatal care and syphilis screening during pregnancy for women at risk for delivering infants with CS.
In 60 blood sera from syphilis patients the titers of IgG to T. pallidum antigens p17 and p41 were detected with the use of the test system based on the recombinant analogues of T. pallidum proteins. The study revealed that primary syphilis was characterized by considerable prevalence of IgG to protein p41 with the total antibody level being low, while early latent syphilis was characterized mainly by considerable prevalence of IgG to protein p17 in the presence of high titers of antibodies. In secondary syphilis the sera contained a high total antibody level and a wide range of IgG ratios to individual antigens. On the basis of the data obtained the dynamics of immune response to antigens p17 and p41 at the early stages of the disease was hypothetically plotted. The curves of antibody levels had a wave-like character with the phase shifts of peaks for individual proteins and very low antibody titers (less than 1:100) in the negative peak areas. Conclusions were made that it was necessary to use the mixture of antigens in the production of the test systems and, when designing reference panels of sera, to include sera with extremely low titers of antibodies to individual proteins.
Despite the long history of medical interest in syphilis and its effects on pregnancy outcome, many fundamental questions about the pathophysiology and treatment of syphilis during pregnancy remain unanswered. However, understanding has been advanced by recent scientific reports such as those which delineate the complete sequence of the genome of the syphilis spirochaete, provide a more precise description of fetal and neonate infection by use of rabbit infectivity tests and describe the gestational age distribution of fetal death secondary to syphilis. It appears that fetal syphilitic involvement progresses in a rather predictable fashion, and although there is disagreement about the optimal prenatal treatment regimen, programmatic efforts to prevent fetal death must provide seropositive pregnant women with a recommended treatment early in pregnancy, and certainly before the third trimester.
The prevalence of HIV has been continually increasing both in urban and rural Ethiopia. As yet, there has been no report on the magnitude of the problem in the elderly and rural population. This study assessed the seroprevalence of HIV and syphilis infection among 706 elderly and predominantly rural subjects in Northwest Ethiopia. Socio-demographic information was collected using a structured questionnaire. Venous blood was collected and the serostatus of HIV and that of syphilis were checked by ELISA and RPR, respectively. The total HIV-1 seroprevalence was 5% (35/706). Sex-specific prevalences of HIV for males and females were 5.6 and 4.7% respectively. A 4.2% difference in prevalence was observed by area of residence, which was statistically significant, P = 0.018. Only 6% of subjects positive for syphilis were also positive for HIV, while 4.9% of subjects negative for syphilis were positive for HIV. The data indicates that the prevalence of HIV among elderly people in Northwest Ethiopia was high. This indicates the importance of involving the elderly in HIV/AIDS prevention and control programs.
Denmark is currently experiencing an outbreak of syphilis that began in 2003 and has continued in 2004. Data from the national surveillance system show that most cases are in men who have sex with men (MSM), and that a large proportion of these patients are also HIV positive. The proportion of known HIV positive cases in MSM notified with syphilis during the outbreak has, however, not been significantly different from previous years. The majority of cases were reported from Copenhagen municipality, and 70% of the cases were acquired domestically. The outbreak does not seem to be affecting the age group under 20 years. We speculate that most of the MSM found with both syphilis and HIV were already HIV positive when they acquired syphilis infection.
OBJECTIVE: To analyze the clinical and pathological features of 40 patients with secondary syphilis. METHODS: A total of 40 cases of secondary syphilis confirmed by serology were collected during 1994-2004 and were first diagnosed on presentation with oral lesions. RESULTS: The white patch in oral mucosa was found in 32 cases with painless or slight pain in most cases. The most common site of the lesion was the tongue. The histological examination on eight cases was initially misdiagnosed as oral candidosis or lichen planus, but confirmed as syphilis after serology revealed nonspecific inflammation with intraepithelial microabscess and dense perivascular infiltration of lymphocytes and plasma cells in connective tissue. The symptoms showed dramatic improvement in 16 cases after benzathine penicillin treatment. CONCLUSIONS: The oral manifestations of syphilis have specific clinical and pathological feature and attention should be paid to the suspicious oral lesions when patients are first presented in a dental office.
Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus infections (TORCH) and syphilis were determined in order to assess the immune/susceptibility status in Jamaican pregnant women in 1986. The positive rates were 57% (T. gondii), 69% (rubella), 97% (CMV), 91% (HSV), and 4.9% (syphilis), respectively. The rate of reactivity for syphilis ranged from 2.1% in Kingston and St. Andrew to 7.3% in rural parishes. The seropositivity rate for rubella was over 50% in all parishes, the highest being 85% in St. Thomas. The seroprevalence of T. gondii was lowest in Trelawny (37.5%). There were no significant differences in seropositivity of CMV and HSV infections between women from various parishes. The importance of seroprevalence of the TORCH group of agents and syphilis on perinatal morbidity and mortality in Jamaican women is discussed, and appropriate recommendations for prevention and control of congenital infections in Jamaica are suggested.
OBJECTIVE: To study the rate of human immunodeficiency virus (HIV) seroconversion, HIV transmission and related risk factors among injecting drug users (IDUs) in an area of Sichuan province. METHODS: In November 2002, a community-based baseline survey was conducted to recruit 333 HIV-seronegative IDUs for a prospective cohort study in Xichang county of Sichuan province, China. Follow-up visits were carried out every 6 months to study the situation of drug use, sexual behaviors of the IDUs and blood specimens were collected to test for antibodies against HIV and syphilis. RESULTS: During a 24-month follow-up period, cohort retention rate and HIV incidence were 75.7% and 2.53 per 100 person-years [95% confidence interval (CI): 1.10-3.97)], respectively. Multivariate Poisson regression model showed that risk factors which were significantly associated with HIV seroconversion would include: ethnicity (RR = 12.42; 95% CI: 2.72-56.74, P = 0.0012) and needle or syringe sharing in the past 3 months (RR = 4.06; 95% CI: 1.29-12.81, P = 0.0168). Syphilis seroconversion in this cohort was 4.71 per 100 person-years (95% CI: 2.59-6.82). In multivariate Poisson regression being female (RR = 4.42; 95% CI: 1.78-10.99, P = 0.0014) appeared to be the only factor which was significantly associated with syphilis seroconversion. CONCLUSION: Our study results showed that there was a rapid transmission of HIV and syphilis among IDUs in Sichuan province, suggesting that effective intervention should be urgently taken.
During the last STDs'epidemic in Russia (1994 - 2004) over 2.7 min people have been infected with syphilis. At present the structure of syphilis morbidity is characterized by 37% of latent forms, including 1.5% late latency. The increased level of late latency may result from: an ever-growing number of those with asymptomatic syphilis; disorderly and self-dependent usage of antibacterial preparations; spread of the virus chronic infections (herpes, hepatitis B, C) altering the macroorganism immune response; alcohol and drug abuse which decreases the efficacy of specific therapy. In general, chronization of the syphilitic infection may be caused by antigenically inert treponemal cell surface; paucity of outer membrane protein; residence of treponemas within an immunoprotective niche; uncompleted phagocytosis of treponemes with macrophages. Syphilis remains an "infectio magna" and demands thorough attention to all diagnostic and therapeutic procedures on every stage of the disease.
Despite the dramatic rise in syphilis incidence in the United States, studies on recently acquired syphilis in persons more than 60 years of age remain rare. Thirty-five cases of primary, secondary, and early latent syphilis in individuals 60 years and older were identified in the city of Hartford, Conn, between 1985 and 1990. There were no cases of early syphilis in the elderly reported from 1985 to 1986, whereas there were 23 cases reported from 1989 to 1990. Thirty-three cases occurred in men and two cases occurred in women; 25 patients were black, five were white, and five were Hispanic. Ten men reported having more than one sexual partner within 2 months of their diagnosis; five of these 10 had sexual relations with a prostitute. Physicians who care for the elderly should perform a complete sexual history and counsel patients regarding high-risk sexual practices.
The Bureau of STD Control continues to combat NYC's epidemic of congenital syphilis. The demographic profile of this population has remained constant with only a clearer identification of previously reported risk factors: most notably poor prenatal care and substance abuse. There is a suggestion of a plateau having occurred in adult and congenital syphilis, possibly caused by saturation effect on the high-risk population. During the period 1989 through 1990, the rates for cocaine/crack use have remained relatively constant among mothers infected with syphilis. A recent study by the Division of Substance Abuse Services of New York State school-age children demonstrated a drop in cocaine use from 14% in 1983 to 6%. If a similar decline is seen in substance abuse in other age groups, the rate of congenital syphilis may diminish.
To evaluate the similarities and differences of antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE) and syphilis, we studied 20 SLE and 16 syphilis high titer IgG aPL sera for antibody isotype, avidity, phospholipid specificity, light chain and IgG subclass. Syphilis aPL had lower avidity, with kappa light chain and IgG1 and IgG3 predominance, in contrast to higher avidity, with lambda light chain and IgG2 and IgG4 predominance in SLE aPL. Phospholipid specificities were similar. SLE and syphilis aPL both recognize phospholipid epitopes but differ in important antibody characteristics.
Gonorrhoea and syphilis that belong to our oldest recognized sexually transmitted diseases (STD) are also the prototypes of curable STDs. After the discovery of the causative organisms, Neisseria gonorrhoeae in 1879 and Treponema pallidum in 1905, diagnostic tests were developed and by this, in conjunction with instituted regulations and legislation, means were created for public health authorities to collect statistical data. Sweden has fairly reliable statistics of both syphilis and gonorrhoea from 1912 and onwards, and these data show many interesting characteristics. Syphilis was prevalent in Sweden among both males and females during World War (WW) I and peaked in 1920 with an incidence rate of 150 and 75 per 100,000 population, respectively. The incidence figures fell rapidly after 1920 and reached a low of less than 30 cases per 100,000 in the mid 1920s, probably as a result of systemic treatment with Salvarsan in conjunction with vigorous contact tracing, two important measures to bring an infectious disease under epidemiological control. There was a slight increase of male syphilis in the late 1920s and early 1930s, and of both male and female cases during WW II which never reached the incidence figures of WW I. Penicillin was introduced in the mid 1940s for treatment and was proved superior to Salvarsan. The incidence figures have been very low ever since the early 1950s.(ABSTRACT TRUNCATED AT 250 WORDS)