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PubMed1985

[Early manifestations of neuromeningeal syphilis. Review of the literature apropos of 3 severe forms].

We report 3 cases of severe syphilitic neuro-meningitis during the secondary stage: acute transverse dorsal myelitis with permanent paraplegia in a 17 year old teenager (case no. 1), uveo-meningitis with intracranial hypertension and diminished vision in a 52 year old woman (case no. 2), lower medulla lesion in a 46 year old man (case no. 3). The diagnosis was based upon highly positive serological tests for syphilis, associated with a compatible clinical context and meningitis in CSF specimens. Treatment was successful in cases nos. 2 and 3, unsuccessful in case no. 1 due to the irreversible character of the medullar lesions. Based on these 3 cases, the following points are discussed: the relatively atypical clinical character in the current context, the difficulties of the diagnosis, and the treatment regimens recommended for neurological syphilis. Despite the rarity of such cases, their extreme severity early in the secondary stage strongly implies the necessity for prevention by detecting and treating early syphilis. Attention is drawn upon the importance of doing serological tests for syphilis when presented with any atypical neurological situation.

Adolescent↗
PubMed1995

Cerebrospinal fluid treponemal antibodies in untreated early syphilis.

OBJECTIVE: Examine prevalence and diagnostic utility of cerebrospinal fluid (CSF) treponemal antibodies in early syphilis. DESIGN: Comparison study. SETTING: Sexually transmitted diseases clinic. PATIENTS: Forty patients with untreated early syphilis who underwent lumbar puncture. Fifteen were human immunodeficiency virus seropositive. MEASUREMENTS: Cerebrospinal fluid cell count, protein, VDRL test, and antibodies to Treponema pallidum by microhemagglutination test for T pallidum (MHA-TP) and fluorescent treponemal antibody absorption test (FTA-ABS); albumin ratio; and IgG index. RESULTS: Cerebrospinal fluid cell count was not available for one sample, and this patient was excluded from analysis. Of 39 patients, eight (21%) had reactive CSF-VDRL (definite neurosyphilis). Eleven (28%) had mildly elevated cell count or protein concentration, but nonreactive CSF-VDRL (possible neurosyphilis). Twenty had normal cell count and protein concentration, and non-reactive CSF-VDRL (normal). Cerebrospinal fluid MHA-TP and CSF FTA-ABS were reactive in all eight with neurosyphilis. Cerebrospinal fluid MHA-TP was reactive in seven (70%) of 10 with possible neurosyphilis and in six (32%) of 19 with normal CSF. Cerebrospinal fluid FTA-ABS was reactive in four (36%) of 11 with possible neurosyphilis and in five (28%) of 18 with normal CSF. A reactive CSF treponemal test was associated with higher mean CSF cell count and reactive CSF-VDRL. CONCLUSION: When criteria to define neurosyphilis depend on cell count or CSF-VDRL reactivity, the sensitivity of CSF treponemal antibodies is high. Nonreactive CSF treponemal tests may help to exclude a diagnosis of neurosyphilis in patients with early syphilis.

Antibodies, Bacterial↗
PubMed1976

Syphilis surveillance. Failure to screen in a university hospital.

Of 5,954 adult inpatients consecutively discharged from a university hospital during a three-month period, only 8.4% had serologic tests for syphilis performed during hospitalization. The testing rate was 20.1% on patients admitted to a medical teaching service and 1.4% on a surgical teaching service. In patients tested, a positive rapid plasma reagin test result was obtained in 6.2% and the diagnosis was confirmed by further testing, but effective therapy was not always given. On 9 of 30 patient records listed syphilis as a diagnosis on discharge. We conclude that serologic testing for syphilis is routinely omitted in the evaluation of hospitalized patients; even when tests are positive, the results are often ignored.

Adult↗
PubMed1978

Bell's palsy and secondary syphilis: CSF spirochetes detected by immunofluorescence.

Although Bell's palsy is usually idiopathic, occasional cases may have an identifiable infectious cause. When facial paralysis results from syphilis, it usually develops during the tertiary meningovascular stage. We report a 30-year-old man with secondary syphilis who developed facial paralysis associated with acute syphilitic meningitis. Spirochetes were identified in the cerebrospinal fluid by immunofluorescence using standard reagents from the fluorescent treponemal antibody absorption (FTA-ABS) test. Patients with Bell's palsy should be screened for syphilis with a blood FTA-ABS test, and treatment with corticosteroids should be considered only after an infectious cause has been excluded.

Adult↗
PubMed2006

[Plaques opalines: a rare form of secondary syphilis of the oral mucous membrane].

A 37 year old woman presented with a 4-month history of "plaques opalines" of the oral mucosa complaining of a rough feeling in her mouth and burning when swallowing. On the basis of clinical, histological and serological details and especially the presence of generalized indolent lymphadenopathy, the diagnosis of secondary syphilis was made. Although plaques opalines are a relatively rare manifestation of secondary syphilis, they can occasionally be the only sign and are important in the differential diagnostic considerations of gray-white mucosal lesions, especially with current continuing rise of syphilis incidence in Central Europe.

Adult↗
PubMed2006

[Syphilis].

The incidence of syphilis, an infectious disease caused by Treponema pallidum, is low worldwide. The knowledge of its symptoms is however important, since the infectivity is high and therapy is comparatively easy. The first feature of an infection is the chancre, which is nearly always located in the genital region. In half of the infected patients after 8-12 weeks, if untreated, a generalisation takes place, during which the bacteria affect all organ systems. At first the skin diseases are most prominent; in long-term disease (late syphilis) symptoms of the central nervous system and the cardiovascular system become more relevant. In the chancre the infectious agent may be proven natively, but not in a culture. At about 3-6 weeks after infection specific serum antibodies may be proven with very sensitive and specific methods. Mainly the TPHA and FTA tests are used. These tests allow a reliable diagnosis to be made also in cases with ambiguous clinical features. The treatment of syphilis is performed by using parenteral depot penicillins for 14 days. It may also be applied as post-exposure prophylaxis. Specifics of the course have to be take into consideration in cases of coexisting HIV infections and neurosyphilis. The disease has a favourable prognosis, when treatment starts early enough.

Anti-Bacterial Agents↗
PubMed1999

Haemophagocytosis in early congenital syphilis.

UNLABELLED: A previously healthy male infant developed hepatosplenomegaly, severe anaemia and thrombocytopenia 5 weeks after birth. Marked haemophagocytosis was present in the bone marrow. A typical maculopapular rash suggested early congenital syphilis. The diagnosis was confirmed by serology and by the presence of untreated syphilis in both parents. CONCLUSION: Syphilis needs to be excluded in infants suspected of haemophagocytic lymphohistiocytosis.

Biopsy, Needle↗
PubMed1989

Antenatal screening for syphilis at the University of Nigeria Teaching Hospital, Enugu, Nigeria--a six year survey.

Between January 1979 and December 1984, 29,083 out of 42,515 antenatal patients booking at the Antenatal Clinic of the Department of Obstetrics and Gynaecology of the University of Nigeria Teaching Hospital, Enugu, underwent full screening for syphilis. The results showed that 890 patients (3.06%) had positive VDRL test. Of those that reacted positively in the VDRL test, 103 (11.6%) had positive TPHA test. A prevalence rate of sero-positivity of 0.35% was obtained indicating a low incidence of syphilis in our pregnant women compared with results from other parts of Nigeria. A strong recommendation was made to treat all seropositive cases whether there was historical or clinical confirmation of syphilis or not.

Female↗
PubMed1985

Immunodiagnostic test for detection of serum antibody to Treponema pallidum (syphilis): fibronectin as a capture vehicle for treponemal adhesins.

Knowledge that Treponema pallidum adhesin proteins bind to host fibronectin (Fn) via ligand-receptor interactions has resulted in development of an ELISA for measuring specific antitreponemal antibodies in sera of syphilitic patients and infected experimental animals. As little as 50 ng of T. pallidum total protein extract added to Fn-coated wells permitted half-maximal levels of ELISA reactivity. Detection of serum antibody from intratesticularly infected rabbits occurred at dilutions greater than 1/100,000. Antibody titers in serum from patients with primary and latent syphilis were positive at 1/1 000 dilutions while serum samples from patients with secondary syphilis were reactive at 1/10,000. Furthermore, the ELISA proved useful for evaluating serum samples from individuals with other treponemal infections. Antibodies raised against the non-pathogenic spirochete, T. phagedenis biotype Reiter, were non-reactive with Fn-T. pallidum complexes. Also, Reiter treponemal proteins did not bind to Fn-coated wells. This ELISA using Fn as a capture vehicle for treponemal adhesin proteins was superior to 3 other routinely used tests for syphilis diagnosis.

Adhesins, Bacterial↗
PubMed1993

Placental histopathology in syphilis.

Placental evaluation is important in congenital syphilis (CS) since clinical and serologic findings necessary to fulfill the diagnostic criteria of syphilis may be absent at birth, making early accurate diagnosis difficult. We examined 25 placentas from mothers with syphilis as confirmed by positive RPR rapid plasma reagin and fluorescent treponemal antibody absorption tests to determine which histopathologic features should raise the suspicion of CS. The 25 examined placentas were from 162 syphilitic mothers who delivered at our institution in 1990. Of the 27 infants delivered (including two pairs of twins), four were stillborn and three died at 1 day of age. Eleven of 23 liveborn infants fulfilled the Centers for Disease Control criteria of probable CS. Seven of the 25 placentas showed a well-defined constellation of histopathologic changes that included proliferative vascular changes, chronic villitis, relative villous immaturity, and, in six placentas, acute villitis. All seven of these placentas showed the presence of spirochetes by special stains. Six also had plasma cells in the basal decidua. Recognition of these placental changes, although nondiagnostic, should lead the pathologist to seek additional clinical history and ancillary tests. Placental histopathologic examination is an additional parameter to be considered in the diagnosis of CS.

Adolescent↗
PubMed1994

Asymptomatic congenital syphilis and auditory brainstem response.

Untreated congenital syphilis is a known cause of hearing loss. In order to ascertain if infants are at risk of hearing loss at birth, 75 neonates with serologic evidence of syphilis and APGAR scores greater than 9 at 5 min were examined by auditory brainstem response (ABR) audiometry. All of the infants had normal ABRs. Ophthalmologic examination revealed no evidence of interstitial keratitis. Lumbar puncture was attempted on all the neonates. Cerebrospinal fluid (CSF) was successfully obtained from 41 infants and revealed no abnormalities. This study demonstrates that asymptomatic infants with serologic evidence of syphilis do not require audiologic evaluation in the neonatal period.

Audiometry↗
PubMed1992

The hard penile circumferential fold as the presenting finding in primary syphilis: report of six cases.

BACKGROUND: Six patients with firm circumferential folds located in the balanic sulcus of the penis were studied. OBJECTIVE: The purpose of the study was to determine the origin of the lesions. METHODS: These patients were examined clinically, with dark-field examination when possible and with a serologic test for syphilis. RESULTS: All patients had reactive serologic tests for syphilis and had enlarged, firm, nontender, inguinal lymph nodes. CONCLUSION: Although we were unable to prove with certainty that the origin of these folds was syphilitic, all patients had clinical and serologic findings that supported the diagnosis of primary syphilis.

Adult↗
PubMed1995

Screening for syphilis in patients with carcinoma of the tongue.

The oral signs of syphilis have been comprehensively described and can be identified at each stage of the infection. Despite the historical recognition that inadequately treated or untreated syphilitic leukoplakia may undergo malignant transformation, many surgical units no longer routinely screen patients presenting with malignant or premalignant lesions. In this study, five of the 63 patients (8%) who presented with neoplasms of the tongue reacted to syphilis antibodies. These results indicate that syphilis is still prevalent in this group of patients and suggest that serological investigations may be warranted in the initial assessment of all patients with oral cancer.

Aged↗
PubMed2005

Phthisis bulbi caused by late congenital syphilis untreated until adulthood.

PURPOSE: To report a case of phthisis bulbi resulting from late congenital syphilis untreated until adulthood. DESIGN: Observational case report. METHODS: We report clinical and laboratory evaluations of a 43-year-old woman who presented with a palpebral ulcer of the right eye. RESULTS: The patient had a gummatous palpebral ulcer and a phthisis bulbi in the right eye and a gumma on the left eyelid. A silent interstitial keratitis of the left eye was detected. The patient had hearing loss in the right ear, her nose was missing, and her right leg had been amputated. Treponemal pallidum hemagglutination (TPHA) test was positive. Although we administered intensive oral penicillin, the clinical symptoms of the patient did not improve. CONCLUSIONS: This is a rare case of phthisis bulbi resulting from late congenital syphilis. We emphasize that treatment for late congenital syphilis must be carried out early and completely.

Adult↗
PubMed2005

Oral syphilis--re-emergence of an old disease with oral manifestations.

Three representative cases of oral primary syphilis are presented. We wish to highlight the resurgence of this disease, which has occurred recently in the western world, particularly in Europe and the United States of America. Since the initial presentation may be oral, it is important to include syphilis in the differential diagnosis of patients presenting to oral diagnostic clinics with atypical oral ulceration. Recent developments in the serological diagnostic tests and treatment are reviewed. Early diagnosis and treatment has significant implications, not only for the patient, but also for previous and future transmission to contacts. Early syphilis is a highly infectious disease in which the lesions heal spontaneously, despite inappropriate treatment which may appear curative, and yet the patient remains infectious. It is therefore important that clinicians maintain a high clinical index of suspicion and crucial that an accurate diagnosis be made at presentation.

Adult↗
PubMed1988

Ocular syphilis in patients with human immunodeficiency virus infection.

We diagnosed ocular syphilis in three homosexual men infected with human immunodeficiency virus (HIV). Ocular inflammation included uveitis, optic neuritis, and retinitis. Dermatologic and central nervous system manifestations of secondary syphilis were also present. The history of homosexuality was difficult to obtain. Concomitant infection with HIV may alter the course of syphilis, obscure the diagnosis, and impair the response to therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection.

PURPOSE: To describe dense vitritis as the primary manifestation of ocular syphilis in three human immunodeficiency virus (HIV)-positive patients and to determine the response of these patients to the established regimen for neurosyphilis. METHODS: Anti-Toxoplasma gondii IgM and IgG antibody titers, tuberculin skin test, chest radiograph, and serum angiotensin-converting enzyme level were obtained because tuberculosis, sarcoidosis, and toxoplasmosis were in the differential diagnosis. Two of the three patients were not known to have HIV infection at the time of initial examination and consented to HIV testing. Treponemal and nontreponemal tests were performed on serum and cerebrospinal fluid to establish a definitive diagnosis. Treatment for neurosyphilis was initiated, and daily ophthalmic examinations were performed, with careful attention to signs commonly associated with syphilitic eye disease. RESULTS: All three patients exhibited improvement in visual acuity and resolution of vitreous haze. There was no evidence of other signs of posterior uveitis. The one patient for whom there has been a 6-month follow-up showed no sequelae of his eye disease. CONCLUSIONS: Human immunodeficiency virus-positive patients with syphilis may present atypically dense vitritis. In these patients, vitritis may be the first manifestation of syphilis. The regimen for neurosyphilis provides effective therapy. Moreover, in some patients, syphilitic vitritis may be the initial manifestation of HIV disease.

Adult↗
PubMed1994

Treatment of asymptomatic congenital syphilis: benzathine versus procaine penicillin G therapy.

We compared the efficacy of two treatment regimens for asymptomatic congenital syphilis. Between June 1989 and July 1991, we prospectively and randomly assigned 169 patients to receive either one dose of benzathine penicillin G or procaine penicillin G for 10 days. There were no significant differences between the treatment groups in regard to birth weight, sex, race, gestational age, Apgar scores, infant or maternal rapid plasma reagin (RPR) titers, fluorescent treponemal IgM antibody, or maternal treatment. Patients were examined at 2 to 3, 6, and 12 months after treatment; treatment failure was defined as clinical signs or persistent laboratory evidence of congenital syphilis. Nine patients were removed from the study during the neonatal period, eight were lost to follow-up, and 152 patients were examined 2 to 3 months or more after treatment. Among these 152 patients, none had clinical evidence of congenital syphilis at follow-up, and all the patients tested at 2 to 3 months after treatment (68 in the benzathine penicillin G group and 61 in the procaine penicillin G group) had at least a fourfold decrease in RPR titers. The RPR became nonreactive in all but three of the infants (two in the procaine penicillin G group and one in the benzathine penicillin G group; all three were 2 to 3 months of age when last tested). We conclude that treatment failure did not occur with either regimen and that there was no significant difference in outcome between the two groups.

Female↗