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PubMedDate not supplied

The origin of syphilis. Clinical and epidemiologic considerations on the Columbian theory.

It is an unpleasant vogue of our day to soil the image of outstanding personalities. Christopher Columbus is blamed for the crimes and cruelties that were committed in the New World after his landing in San Salvador as well as for the import of syphilis from West India to Europe. Attempts to trace the origin of the pandemic of syphilis at the verge of the fifteenth century concluded with the myth that the disease was contracted in Haiti by members of Columbus' crew who later joined the army of Charles VIII of France and participated in the siege of Naples. The surrender of the town on February 22, 1495, at 4 pm (natal hour of syphilis) was followed by orgies, which led to infection of all participants, particularly of all soldiers, who then spread the disease on their journey back to France. This story is refuted on the ground of epidemiologic and clinical facts. Most of the crew of Columbus' first trip joined the admiral in his second expedition, too, left Europe on February 24, 1494, and did not return before June 11, 1496 (87 days, or 12.4 weeks). With not more than approximately 10 persons arriving in Naples for such a short stay, an endemic of syphilis of such grave proportions could not have occurred. The disease has an incubation period of 4 weeks and a contagiosity rate of approximately 30%. In addition, 2 years and 47 days had passed between the departure from Haiti and the arrival in Naples.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease Outbreaks↗
PubMed1996

Outbreak of primary and secondary syphilis--Baltimore City, Maryland, 1995.

From 1993 to 1995, the number of primary and secondary syphilis cases reported in Baltimore City (1990 population: 736,014) increased 97%, from 179 to 352 cases per year (Figure 1). To identify potential reasons for this increase, CDC, in collaboration with the Baltimore City Health Department (BCHD) and the Maryland Department of Health and Mental Hygiene, analyzed data about primary and secondary syphilis cases during 1992-1995 and about temporal trends in factors that may affect syphilis rates (e.g., partner-notification results, access to medical care, and community illicit-drug use). In addition, data were analyzed from the two public sexually transmitted disease (STD) clinics in Baltimore City. BCHD collects demographic data for all cases of reported syphilis among patients who reside in Baltimore City and attempts to interview and provide partner notification and treatment for these patients. This report summarizes the results of the analysis, which suggest the outbreak has been associated with decreases in partner notification and health department clinical services and a substantial increase in community cocaine use.

Adolescent↗
PubMed1996

Syphilis: an old disease with modern health concerns.

Syphilis is an old disease with modern health challenges for clinicians. This article discusses the various clinical manifestations and stages of syphilis, reviews interpretation of the reactive syphilis serology, and summarizes syphilis treatment recommendations from the Centers for Disease Control 1993 sexually transmitted diseases treatment guidelines.

False Positive Reactions↗
PubMed1996

[Normotensive hydrocephalus as a manifestation of meningovascular syphilis].

Progressive general paralysis, tabes dorsalis and meningovascular syphilis are different manifestations of tertiary syphilis. The clinical picture of meningovascular syphilis is of a subacute or chronic meningeal syndrome. It may be associated with focal neurological signs of cerebral arteritis. Inflammation of the leptomeninges may impede circulation of the cerebrovascular fluid at different levels, giving rise to noncommunicating, or exceptionally to communicating hydrocephalus. Diagnosis of this depends on the clinical signs and neuro-imaging changes. We present the case of a man with meningovascular syphilis who developed clinical signs of normotensive hydrocephalus.

Brain↗
PubMed1997

Syphilis in pregnancy.

Syphilis in pregnancy remains a problem despite the availability of adequate diagnostic tests and years of penicillin therapy. During pregnancy, syphilis is compounded by its occurrence among populations that under-use the health care system and by its association with cocaine use and infection with HIV. The potentially devastating effect of syphilis on the fetus and attendant adverse outcomes on the pregnancy continue to make syphilis a global problem of major medical and public health consequences.

Female↗
PubMed1997

The Tuskegee Syphilis Study and women's health.

In May 1997, President Bill Clinton apologized for the Tuskegee Syphilis Study. The President's action underscores that in the 25 years since its public revelation, the study has moved from a singular historical event to a powerful metaphor that symbolizes racism in medicine, misconduct in human research, the arrogance of physicians, and government abuse of black people. The Tuskegee Syphilis Study also has implications for women's health. Discussion of the study usually ignores its impact on the wives of the victims. In addition, African-American women may be more reluctant to participate in clinical trials because of the shadow cast by the syphilis study and other incidents of medical abuse. Finally, the Tuskegee Syphilis Study reminds us that the battle against racism must be an integral part of the campaign to improve women's health.

Black or African American↗
PubMed1997

[The impact of HIV infection on the incidence of syphilis and gonorrhea at a university hospital (1985-1994)].

Syphilis and gonorrhea are two sexually transmitted diseases (STD) which still persist in spite of the existence of effective treatment. In this paper the incidence of these two diseases was evaluated between 1985-1994, a decade during which the problem of HIV infection arose. Every patient who attended the STD Program at the Hospital and was suspected of having syphilis and/or gonorrhea was clinically evaluated and was subjected to the following tests: a) search for Neisseria gonorrhoeae (Ng) and penicinilase producers (PPNG) identification, b) search for Treponema pallidum (Tp) by darkfield microscopy, c) serological studies for syphilis. From 1985 to 1991 the average of positive cases for Ng was 14.8% while from 1992 to 1994 it was 4.0% (p < 0.0001) showing a dramatic decrease between 1991 and 1992. PPNG increased from 8.7% in 1985 to 44.6% in 1988 and then slowly decreased down to 26.9% in 1994. From 1985 to 1990 the average of positive darkfield examinations was 20.7% while from 1991 to 1994 it was 12.2% (p < 0.0001). Between 1985 to 1988 syphilis serological studies showed 45.7% positive cases dropping to 34.3% between 1989 and 1994 (p < 0.0001). HIV infection appearance had a wide repercussion throughout the world generating behavioral and sexual habit changes which have probably helped to prevent these two STD. Gonorrhea incidence was also influenced by the appearance of new effective treatments, even against PPNG, such as fluorated quinolones and third generation cephalosporines. The population studied belongs to the most crowded area in Argentina, so that these observations should not be extrapolated to the rest of the country.

Adolescent↗
PubMed1976

Hepatitis and bone destruction as uncommon manifestations of early syphilis. Report of a case.

We describe a patient with a painful lytic lesion of the clavicle and a granuloma of the liver in late secondary syphilis. The classic "moth-eaten" alopecia of the scalp as well as eyebrows and eyelashes suggested syphilis, although an initial false-negative VDRL test for syphilis (prozone phenomenon) caused a delay in diagnosis. Bone as well as liver involvement in early syphilis may be more common than previously recognized.

Adult↗
PubMed1996

[Malignant syphilis in human immunodeficiency virus infection].

INTRODUCTION: The associated infection with Treponema pallidum and human immunodeficiency virus (HIV) was responsible for the return of malignant syphilis. CASE REPORT: We report a case of malignant syphilis which revealed a HIV seropositivity. The lesions were typical. Serological features were in accordance with the diagnosis. A treatment with penicillin was prescribed and there was no relapse after five years. DISCUSSION: The diagnosis of malignant syphilis in a HIV positive patient may be difficult. The course of the disease may be serious and a prolonged treatment with high doses of penicillin is often necessary. The occurrence of the malignant syphilis in HIV positive patients is not fortuitous and seems to be related to an abnormal immunity.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment.

A retrospective questionnaire survey of a sample of 173 of the 360 cases of early congenital syphilis reported in 1972 revealed serious problems with diagnostic certainty, prevention, and treatment of congenital syphilis. Only 24 (13.9%) of the reported cases could be categorized as probably or definite cases based on criteria developed from a literature review. Forty percent of the mothers received no prenatal care and an additional 19% received no prenatal care until the third trimester. Initial and followup serologic testing was inadequate in those who received care. Eighty-three different penicillin treatment schedules were used in the treatment of 128 infants. Carefully reasoned diagnostic and therapeutic decision making about the management of congenital syphilis appears to be lacking.

Adolescent↗
PubMed1978

Venereal syphilis in tropical Africa.

A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin.

Humans↗
PubMed1986

Serological tests for syphilis in Saudi Arabia.

A total of 6684 sera were initially screened for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Reactive sera from either or both these tests were tested for confirmation by the fluorescent treponemal antibody-absorbed (FTA-ABS) test. VDRL biological false positive reactors were detected in 0.5% of the total sera examined, with 0.4% and 0.8%, respectively, obtained in pregnant women and blood donors. Eight sera (0.1%) were found to be positive in the TPHA test alone. An overall positivity of 2.7% for syphilis was detected, with a 0.85% positivity in antenatal patients. Infection with T pallidum seemed to be more common in men than in women (1.6:1) and predominated in the age group 20-39 years. Serological testing of sera from 26 mother and infant pairs allowed one case of congenital syphilis to be detected by FTA-ABS (IgM) and identified VDRL biological false positivity in seven infants.

Adult↗
PubMed2006

[Late secondary syphilis with ulceration of the tongue during HIV coinfection: case report].

With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.

Anti-Bacterial Agents↗
PubMed2004

Syphilis in the HIV-infected patient: an update on epidemiology, diagnosis, and management.

After a decade of unprecedented declines, incidence of early-stage syphilis in the United States and Europe has increased significantly since 2000. These cases have occurred at disproportionately elevated rates among people infected with HIV. Speculation continues as to whether the clinical spectrum of syphilis is qualitatively different among those individuals who are HIV infected. Recent data suggest that individuals who are immune compromised because of HIV have a higher likelihood of developing neurosyphilis. Recommendations for treatment of syphilis remain the same for patients with and without HIV.

AIDS-Related Opportunistic Infections↗
PubMed1984

The clinical spectrum of syphilis in adolescence.

Syphilis, due to the spontaneous healing of the initial lesion, is often overlooked by adolescent patients. If undetected and untreated the condition may bring disastrous consequences. To investigate how syphilis first appears, we reviewed the medical history of 33 patients diagnosed from 1977 to 1981. The following main symptoms were found: typical chancre (9%), atypical chancre (9%), rash (45.5%), and marked lymphadenopathy (12%). Four patients were discovered only by a positive serology; four patients with low titers were discovered to have been previously treated and were monitored for evidence of cure. All patients had a positive RPR and FTA-ABS. Eleven patients (33%) had a concomitant venereal disease or a positive past history. A significant number (48%) were troubled, delinquent, or homosexual; 10% were victims of sex abuse. Contrary to general belief, most patients do not consult for a primary chancre. Instead, they present with a broad spectrum of clinical manifestations ranging from a variety of dermatologic signs to diverse degrees of lymphadenopathy, to being completely asymptomatic. Syphilis was not the initial diagnosis in over one-third of our patients. Those caring for adolescents should maintain a high index of suspicion for this disease.

Adolescent↗
PubMed2005

[Rash and nephrotic syndrome: consider syphilis].

INTRODUCTION: Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows. OBSERVATION: During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed after biopsy as membranous nephropathy. DISCUSSION: Membranous nephropathy is an immunological complication of secondary syphilis. Recovery usually follows treatment. It is often associated with signs that may erroneously suggest connective tissue disease.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Congenital syphilis after reactivation of "healed" maternal primary infection].

UNLABELLED: The congenital syphilis is an infectious fetopathy which is able to affect the whole organism. In most cases symptoms are not obvious before week fourth to twelve of life. The infection of the mother is the precondition for the child's disease. The placental transfer takes place after the fifth to sixth month of gestation. We report about an eight week old baby with congenital syphilis. The positive maternal laboratory findings in the 4th month of pregnancy have been interpreted as a completely cured earlier infection causing a sero scar. The diagnosis became evident by serological tests detecting reactivation of maternal infection in late pregnancy and the clinical signs of acute infection of the child. CONCLUSION: There is a high risk of reactivation of maternal syphilis in the third trimenon even if the mother does not show any symptoms. In this case further serological tests in the prenatal care and careful examination of the newborn must be initiated.

Female↗
PubMed1990

[Bone pain in adults as the first symptom of late congenital syphilis].

A 20-year-old woman developed multifocal bone pain. Diagnostic radiology revealed thickened periosteum, and syphilis serology was positive (T. pallidum haemagglutination test 1:5120). She also had discrete signs of congenital syphilis, with retinitis pigmentosa and Hutchinson's incisors. Skeletal scintigraphy demonstrated increased uptake even in radiologically unremarkable bones. The bone pain decreased after four-week administration of 1 M units of penicillin G daily. Scintigraphy one year later showed regression of the increased uptake, skeletal radiology did not reveal significant changes. This case shows that late manifestations of congenital syphilis still occur today. The stigmata of such an infection can be minute and easily missed. Skeletal scintigraphy is better for demonstrating active bone involvement than conventional radiology.

Adult↗