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Background: The prevalence of syphilis is increasing in the United States. The emergency department (ED) is an important setting to screen and treat underserved populations. To tailor testing protocols to the local population, we aimed to identify risk factors for syphilis positivity in ED patients.Methods: We performed a retrospective analysis of ED patients who were screened for syphilis between November 2018 and August 2020. Patients were screened for Treponema pallidum antibody using a multiplex flow immunoassay, and positive results were confirmed by rapid plasma reagin or T. pallidum particle agglutination. Risk factors for new syphilis diagnoses were identified using multiple logistic regression.Results: We screened 1974 patients for syphilis (mean age, 37 ± 16 years; 56% female). We identified 201 patients with new infections without previous treatment. Independent risk factors for a new diagnosis of syphilis included housing status (undomiciled, 23% [60 of 256]; domiciled, 9% [133 of 1559]; adjusted odds ratio [aOR], 1.9 [95% confidence interval {CI}, 1.2-3.0]), history of HIV (positive, 44% [28 of 63]; negative, 9% [173 of 1893]; aOR, 5.8 [95% CI, 3.0-11.2]), tobacco use (positive, 15% [117 of 797]; negative, 4% [29 of 665]; aOR, 2.4 [95% CI, 1.5-3.9]), and illicit drug use (positive, 14% [112 of 812]; negative, 8% [52 of 678]; aOR, 2.2 [95% CI, 1.0-2.5]).Conclusions: Undomiciled housing status, history of HIV, history of tobacco use, and history of illicit drug use were independently associated with a new diagnosis of syphilis in the ED. Broadening targeted syphilis screening algorithms beyond sexually transmitted disease-related complaints could help identify new syphilis cases for treatment. [ABSTRACT FROM AUTHOR]

Background: Epileptic seizures were noted as one of the most overlooked manifestations in syphilis; therefore a few clinicians are concerned about the relationship between epilepsy and syphilis. Our study sought to clarify the prevalence and clinical features of epileptic seizures in patients with syphilis.Methods: We retrieved relevant articles from different databases, using the keywords "syphilis and epilepsy" and then performed statistical analysis to characterize the relationship between these diseases.Results: Forty one articles were included in this study: eight described the prevalence of syphilis and epilepsy and the remaining 33 were case reports on syphilis with epileptic seizures. The meta-analysis included 1252 patients with syphilis. The pooled estimate of proportion of prevalence (95% confidence interval) was 0.1384 (0.0955-0.2005), and the proportion and heterogeneity showed different degrees of change among three subgroups. The systematic review included 46 cases of syphilis with epileptic seizures. Thirty two (80%) patients had motor seizures, among whom 20 (62.5%) had tonic-clonic seizures. In addition, 30 (75%) patients had impaired awareness and 18 (45%) had status seizures. Twenty five (62.5%) patients were 35-55 years of age, and 77.5% of the included patients were men. Thirty seven (97.4%) patients were seizure-free after anti-syphilis treatment.Limitations: Research in this field has been conducted for a relatively short period and publication bias may exist. Furthermore, some patients with syphilis and epileptic seizures may not have received a clear diagnosis.Conclusion: The proportion of prevalence was 0.1384. Most of the included patients were 35-55 years of age and had impaired awareness and motor seizures. Many patients with syphilis and epileptic seizure showed full recovery or the development of minor neurological sequelae, and nearly all patients were seizure-free after timely anti-syphilis treatment. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment has been reported in people living with HIV‐1 (PLWH) with prior syphilis, while PLWH who present with incident syphilis have reduced blood CD4 T‐lymphocyte and elevated HIV‐1 RNA levels. However, the clinical, virological and neurocognitive effects of syphilis during acute HIV‐1 (AHI) remain unknown. Methods: Pre‐antiretroviral therapy laboratory outcomes and neurocognitive performance in a four‐test battery in the SEARCH10/RV254 AHI cohort were compared according to syphilis status, determined by serum Treponema pallidum haemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL) and syphilis treatment history. Impaired cognitive performance was defined as having z‐scores ≤ −1 in at least two tests or ≤ −2 in at least one test. Results: Out of 595 AHI participants (97% male, median age of 26 years and estimated duration of HIV‐1 infection of 19 days), 119 (20%) had history of syphilis (TPHA‐positive), of whom 51 (9%) had untreated syphilis (TPHA‐positive/VDRL‐positive/without prior treatment). Compared with those without syphilis (TPHA‐negative), individuals with untreated syphilis had higher CD8 T‐lymphocyte levels but not higher plasma HIV‐1 RNA or lower CD4 T‐lymphocyte levels. Taking into account estimated duration of HIV‐1 infection (P < 0.001), and later Fiebig stages (III–V) (P < 0.001), those with untreated syphilis had higher CD8 T‐lymphocyte levels (P = 0.049). Individuals with any syphilis (TPHA‐positive), but not untreated syphilis, had higher odds of impaired cognitive performance than those without (P = 0.002). Conclusions: During AHI, individuals with any history of syphilis (TPHA‐positive) had poorer cognitive performance than those without syphilis. However, syphilis was not associated with worsened HIV disease measures as described in chronic infection. [ABSTRACT FROM AUTHOR]

Abstract: Among 865 adults with early syphilis considered for a multicenter treatment trial, 234 (27%) were excluded before enrollment because of bacterial sexually transmitted infection coinfection. Coinfection with Neisseria gonorrhoeae (29%), Chlamydia trachomatis (22%), or both (23%) was common. Study findings highlight the need for comprehensive bacterial sexually transmitted infection screening in patients with syphilis. [ABSTRACT FROM AUTHOR]

Background: Septic cardiomyopathy has been observed in association with influenza, indicating that not only bacteria but also other infective agents can cause this condition. There has been no systematic study as to whether Treponema pallidum infection induces septic cardiomyopathy, and we are the first to report this possibility.Case Presentation: We report two cases of a 48-year-old man and a 57-year-old man who were diagnosed with syphilis-related septic cardiomyopathy. The diagnosis of cardiomyopathy was made based on elevation of cardiogenic markers and decrease in ejection fraction evaluated by echocardiography. Screen for infective pathogens was negative except for syphilis, which supported our diagnosis. The two patients recovered following effective anti-syphilis treatment and advanced life support technology. Syphilis serology became negative after treatment.Conclusion: Syphilis has the potential to cause septic cardiomyopathy. Clinicians should consider Treponema pallidum in cases of septic cardiomyopathy with unknown pathogens. However, the specific pathophysiological mechanism of syphilis-associated septic cardiomyopathy has not been elucidated, and more specific studies are needed. [ABSTRACT FROM AUTHOR]

A 30-year-old female patient presented with bilateral anterior nodular sclerokeratitis and multiple erythematous skin lesions involving the face, trunk, arms, and legs. The patient had a history of temporary relief with steroids, however the lesions recurred. A dermatology consultation was sought and the patient was diagnosed to have syphilis, consequent to which she was started on benzathine penicillin and showed a dramatic improvement in both skin and ocular lesions. A high index of suspicion for syphilis should be kept in mind for patients presenting with nodular scleritis to initiate timely and appropriate management with penicillin. [ABSTRACT FROM AUTHOR]

With a resurgence of syphilis with human immunodeficiency virus (HIV) infection in last few years, various ocular manifestations of syphilis have been described in literature. This case report described an HIV-positive patient on anti-retroviral therapy who was diagnosed and treated for posterior uveitis secondary to ocular syphilis in the recent past presented to our clinic with cystoid macular edema (CME). CME, which did not respond to periocular corticosteroid, resolved with intravitreal sustained release dexamethasone implant. There was a recurrence CME 9 months later and repeat injection of intravitreal implant showed complete resolution. A long-term follow-up did not reveal reactivation of the infection with intravitreal corticosteroid. Intravitreal sustained release dexamethasone implant can be an effective treatment for refractory CME in patients with regressed syphilitic uveitis. [ABSTRACT FROM AUTHOR]

A case study of a 58-year-old woman is presented, who was hospitalized for vision loss in the right eye, acute progressive vision loss in the left eye, headaches, and rashes. A year later, the patient was reported with persistent pain in both eyes and waxing and waning redness of the eyes, blurry vision, and photophobia.

A 31-year-old male patient presented with sudden onset loss of vision in the left eye. Ocular examination revealed significant vitritis with chorioretinitis lesion in the posterior pole. Subsequent investigations revealed positive human immunodeficiency virus (HIV) and syphilis serology; chest imaging revealed active pulmonary tuberculosis. Polymerase chain reaction from aqueous aspirate was positive for Mycobacterium tuberculosis. There was complete resolution of the lesions following antisyphilitic medications, antitubercular therapy along with highly active antiretroviral therapy. Syphilis and tuberculosis coinfection in a previously unknown HIV patient is rare but can occur. It is worthwhile to look for multiple coinfections in HIV patients. [ABSTRACT FROM AUTHOR]

Summary: The incidence of syphilis is increasing, and it typically presents in patients with known risk factors, often to genitourinary physicians. Patients presenting to a dermatologist or ophthalmologist will more likely have secondary syphilis, with the potential for having the associated complications. Early recognition is therefore vital to limit both the disease and risk of further contact spread. In this review, we include two case histories demonstrating the value of recognizing oral signs. Additionally, we review the currently accepted diagnostic and therapeutic recommendations. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55-year-old man with Crohn's disease who was brought to the infectious disease clinic of a hospital due to a mass on the right side of the face where diagnosis of HIV-1 infection was seen. An enlarged lymph node with florid follicular and paracortical hyperplasia was seen in the patient's histopathological examination of the biopsy specimen. The clinical course of the patient appeared to be similar to that of Burkitt's lymphoma.

Introduction: We present a case of membranous nephropathy associated with a secondary syphilis infection in a patient with HIV. Case Presentation: A 37-year-old white man with HIV who was receiving highly active antiretroviral therapy presented to the Emergency Department with 6 weeks of rectal pain. He had a CD3-CD4 count of 656 cells/mm3 and an undetectable viral load. On admission, he was found to have an anal ulcer, a serum creatinine of 1.4 mg/dL (baseline 0.7 to 1.0 mg/dL), elevated transaminases, positive rapid plasmin reagin, and a urine protein/creatinine ratio revealing nephrotic-range proteinuria. Renal biopsy demonstrated membranous nephropathy with features suggestive of a secondary cause. Our patient was treated with penicillin for secondary syphilis, with normalization of renal function, resolution of the nephrotic syndrome, and improvement of his elevated transaminases. Discussion: This case is a reminder that patients with HIV are not infrequently coinfected with Treponema pallidum and that secondary syphilis can have systemic manifestations, including elevated transaminases and nephrotic syndrome. Prompt diagnosis and treatment will result in resolution of these problems. [ABSTRACT FROM AUTHOR]

Background: The treatment failure and reinfection rates among syphilis patients are high, and relevant studies in China are limited. The aim of this study was to detect the rates of treatment failure and reinfection after syphilis treatment and to explore the potential associated factors.Methods: We conducted a longitudinal cohort study in a sexually transmitted disease clinic, the Department of Dermatology and Venereology in Nanshan Center for Chronic Disease Control. Serological testing was performed at baseline and throughout the 2-year follow-up for syphilis patients. To identify potential predictors of treatment outcomes, multivariate logistics analyses were utilized to compare the demographic and clinical characteristics of patients with serological failure/reinfection to those with serological cure/serofast.Results: From June 2011 to June 2016, a total of 1133 patients were screened for syphilis. Among the 770 patients who completed the 2-year follow-up, 510 first-diagnosed patients were included in the final analysis. Multivariate logistics analysis revealed the stage of syphilis (secondary syphilis VS. primary syphilis: adjusted odds ratio, 3.50; 95% confidence interval, 1.11-15.47; p = 0.04), HIV status (positive VS. negative: adjusted odds ratio, 3.06; 95% confidence interval, 1.15-8.04; p = 0.02) and frequency of condom use (always use VS. never use: adjusted odds ratio, 0.28; 95% confidence interval 0.08-0.75; p = 0.02) were significantly associated with the serological outcome.Conclusions: The clinical implications of our findings suggest that it is very important to perform regular clinical and serologic evaluations after treatment. Health counseling and safety education on sex activity should be intensified among HIV-infected patients and secondary syphilis patients after treatment. [ABSTRACT FROM AUTHOR]

The article reports on the dermoscopy of Biett's sign and differential diagnosis with annular maculo-papular rashes with scaling.

Syphilis is a chronic infection caused by the spirochete Treponema pallidum. The wide range of clinical presentations of secondary syphilis has given it the nickname of "the great imitator". Erythroderma is a generalized inflammatory reaction of the skin secondary to a wide variety of causes; however, it is not considered a common cutaneous manifestation of syphilis. Here, we presented the case of a 74-year-old Hispanic man who presented to our clinic with a history of chronic recurrent erythroderma. His medical history was not relevant except for previous unprotected sexual intercourses. Extensive work up to determine the cause of erythroderma was performed, resulting in positive for syphilis infection. Subsequent treatment of syphilis infection resulted in erythroderma remission. [ABSTRACT FROM AUTHOR]

Importance: Screening for syphilis infection is currently recommended for high-risk individuals, including those with previous syphilis infection, an infected sexual partner, HIV infection, or more than 4 sex partners in the preceding year.Objective: To update a 2004 systematic review of studies of syphilis screening effectiveness, test accuracy, and screening harms in nonpregnant adults and adolescents.Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews through October 2015 and Ovid MEDLINE (January 2004 to October 2015), with updated search through March 2016.Study Selection: English-language trials and observational studies of screening effectiveness, test accuracy, and screening harms in nonpregnant adults and adolescents.Data Extraction and Synthesis: One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria.Main Outcomes and Measures: Transmission of disease, including HIV; complications of syphilis; diagnostic accuracy; and harms of screening.Results: No evidence was identified regarding the effectiveness of screening on clinical outcomes or the effectiveness of risk assessment instruments; the harms of screening; or the effectiveness of screening in average-risk, nonpregnant adolescents or adults or high-risk individuals other than men who have sex with men (MSM) or men who are HIV positive. Four non-US studies indicated higher rates of syphilis detection with screening every 3 months vs 6 or 12 months for early syphilis in HIV-positive men or MSM. For example, there was an increased proportion of asymptomatic, higher-risk MSM in Australia (n = 6789 consultations) receiving a diagnosis of early syphilis when tested every 3 months vs annually (53% vs 16%, P = .001), but no difference among low-risk MSM. Treponemal and nontreponemal tests were accurate in asymptomatic individuals (sensitivity >85%, specificity >91%) in 3 studies but required confirmatory testing. Reverse sequence testing with an initial automated treponemal test yielded more false reactive test results than with rapid plasma reagin in 2 studies, one with a low-prevalence US population (0.6% vs 0.0%, P = .03) and another in a higher-prevalence Canadian population (0.26% vs 0.13%).Conclusions and Relevance: Screening HIV-positive men or MSM for syphilis every 3 months is associated with improved syphilis detection. Treponemal or nontreponemal tests are accurate screening tests but require confirmation. Research is needed on the effect of screening on clinical outcomes; effective screening strategies, including reverse sequence screening, in various patient populations; and harms of screening. [ABSTRACT FROM AUTHOR]

Syphilis is caused by the spirochete bacterium Treponema pallidum and can be transmitted both sexually and from mother to child. T pallidum can infect any organ and produces a clinical disease with a relapsing and remitting course. It is not hard to see, therefore, why it is often described as the great mimic. In this review, we provide an update of modern syphilis epidemiology, clinical presentations, and testing and treatment strategies. [ABSTRACT FROM AUTHOR]

Substantial increases in syphilis during 2008-2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis ≤1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008-2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%-69.2%) diagnosed with secondary syphilis (range: 36.2%-52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p < 0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008-2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical characteristics and surgical management of rhegmatogenous retinal detachment (RD) in patients with acute syphilitic panuveitis.Methods: Retrospective case series and comprehensive literature review.Results: Including present and previously reported cases, we identified 11 eyes in 8 patients with acute syphilitic panuveitis that developed a rhegmatogenous RD. Seven of 11 eyes (63.6%) were repaired with a combined scleral buckling, vitrectomy, and endolaser photocoagulation surgery; 1 eye (9.1%) was repaired with scleral buckling only; and 2 eyes (18.2%) with vitrectomy only. Cryotherapy was used to treat a giant retinal tear in 1 eye (9.1%). Four eyes (36.4%) redetached and 3 underwent a second vitrectomy surgery.Conclusions: Although uncommon, rhegmatogenous RD can occur in patients with moderate to severe acute syphilitic panuveitis. We believe scleral buckling, vitrectomy, endolaser photocoagulation, and silicone oil tamponade give the best chance for successful retinal reattachment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the rates and types of sexually transmitted infections (STIs) in patients infected with the human immunodeficiency virus (HIV) attending a public STI clinic in Miami, Florida as compared with HIV-uninfected patients attending the same clinic.Methods: This was a retrospective review of medical records of individuals attending the Miami-Dade County Health Department STI clinic from March 2012 to May 2012. Demographic and clinical information was abstracted and transferred to an electronic database. Consecutive age-matched HIV-infected and HIV-uninfected patients were identified during the study period. Demographics, risk factors, and history and rates of STIs for HIV-infected and HIV-uninfected patients and for those with newly diagnosed and previously diagnosed HIV infection were compared.Results: A total of 175 medical records were reviewed (89 HIV-infected patients and 86 HIV-uninfected patients). The median age was 37 years. A history of STIs, including syphilis, was more common in HIV-infected than in HIV-uninfected patients. Individuals with a prior diagnosis of HIV were more likely to be older (older than 37 years of age, χ(2) = 15.3, P < 0.01), male (χ(2) = 4.74, P = 0.05), to have a new STI (χ(2) = 5.83, P = 0.01), to have a new diagnosis of syphilis (χ(2) = 5.15, P = 0.01), and to be under medical care (χ(2) = 31.19, P < 0.001) than those newly diagnosed as having HIV.Conclusions: HIV-infected individuals who attended this urban STI clinic had high rates of new and past STIs, suggesting the persistence of high-risk sexual behaviors. STI clinics could be a premier site to identify individuals with HIV and high-risk sexual behaviors who could benefit from additional targeted interventions. [ABSTRACT FROM AUTHOR]

Objectives: Sexually transmitted infectious (STI) colitis often raises concern for inflammatory bowel disease (IBD). In this study, we compare histologic features of IBD with STI colitis caused by syphilis and lymphogranuloma venereum.Methods: The STI colitis group included 10 unique colorectal biopsy specimens in patients with clinically confirmed syphilis and/or lymphogranuloma venereum. The STI biopsy specimens were compared with patients matched for age, sex, and site with Crohn disease (n = 10) or ulcerative colitis (n = 10). All IBD controls had an established history of IBD (up to 276 months of follow-up, mean follow-up = 102 months).Results: Discriminating features (P < .05) of STI colitis included its exclusive identification in human immunodeficiency virus-positive men who have sex with men, anal pain, and anal discharge. STI colitis contained the triad of (1) minimal active chronic crypt centric damage, (2) a lack of mucosal eosinophilia, and (3) submucosal plasma cells, endothelial swelling, and perivascular plasma cells. Nondiscriminating features (P > .05) included rectal bleeding, endoscopic appearance, skip lesions, ulcerations, aphthoid lesions, granulomata, foreign body giant cells, neural hyperplasia, fibrosis, and lymphoid aggregates.Conclusions: While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis. [ABSTRACT FROM AUTHOR]

A 36-year-old man with a history of chronic HIV infection had 3 weeks of generalized weakness; examination revealed a maculopapular rash on his arms and torso and patchy hair loss on his scalp. His CD4+ cell count was 820/μL and his HIV viral load was undetectable. What is the diagnosis and what would you do next? [ABSTRACT FROM AUTHOR]

Objective: Obtaining gestational syphilis prevalence and congenital syphilis incidence data in the city of Cali, Colombia during 2010. Materials and methods: This was a descriptive, cross-sectional study. The study population consisted of pregnant women who had attended prenatal control sessions and given birth in Cali and whose maternal and perinatal results were known. Patients whose epidemiological data had not been properly recorded were excluded. The clinical sociodemographic characteristics of pregnant women suffering from gestational syphilis were determined. Gestational syphilis prevalence and congenital syphilis incidence in Cali during 2010 were estimated. Results: Gestational syphilis prevalence for Cali was 1.4% and congenital syphilis incidence was 2.5 per 1,000 live births during 2010; 35% of women having positive serology had not received suitable treatment. Conclusions: Gestational syphilis prevalence was greater than expected, in view of available PAHO data. [ABSTRACT FROM AUTHOR]

Objective: Evaluating the effect of an educational intervention aimed at healthcare personnel regarding adherence to gestational syphilis (GS) and congenital syphilis (CS) management guidelines, early and suitable reporting of cases of GS and CS and their perception about using a rapid point-ofcare test for diagnosing syphilis. Materials and methods: An intervention study was carried out involving before and after measurement. Population: staff working in first-level healthcare centres in a rural area attending the population of Turbo located in Colombia's Caribbean region, close to Panamá, during 2008. Such intervention consisted of training healthcare staff, delivering printed material and providing a rapid point-ofcare syphilis test. How effectively the healthcare staff had acquired such knowledge and the effect of the training given on attending patients was evaluated regarding adherence to the guidelines, notification and workers' perception of using the rapid test. Information was directly obtained from the healthcare staff and the clinical histories of females attending the programme. Statistical analysis: A Wilcoxon signed-rank test was used for evaluating changes when scoring the test of their knowledge (before/after). A Chi2 test was used for evaluating changes in percentages regarding fulfilling the recommendations (statistical significance was fixed at 5%). Results: 533 clinical histories were evaluated and 129 people were trained. Reporting GS cases in Turbo improved significantly (8% vs 48%; p = 0.01), as well as the healthcare personnel's level of knowledge (p = 0.002), the search for (18% vs 53%; p = 0.001) and treatment of contacts (10% vs 29%; p = 0.034) and suitable treatment of the new-born (47% vs 85%; p = 0.03). Healthcare personnel had a favourable opinion about the rapid syphilis test. Conclusions: Training orientated towards resolving local problems improves the quality of healthcare attention provided for pregnant females and newborns babies suffering syphilis. [ABSTRACT FROM AUTHOR]

Syphilis has been resurgent in Australian cities for the last decade. The varied presentation of this infection requires the physician to consider syphilis in the differential diagnosis of a broad range of conditions. Most cases are in men who have sex with men, young people in remote Aboriginal communities, or travellers from high-prevalence countries. The diagnosis and staging of syphilis require a sexual history, physical examination and interpretation of serological and microbiological findings. Penicillin remains the mainstay of effective treatment and has been used successfully for over 65 years. Treatment failure is rare, whereas reinfection is common. The interaction of syphilis and human immunodeficiency virus is complex, but standard therapy remains curative, and lumbar puncture is rarely required. Regular testing of high-risk individuals, contact tracing with empirical treatment and serological follow up are important components of syphilis control. [ABSTRACT FROM AUTHOR]

The case of a congenital syphilis in a newborn is presented. The prevalence rate of this disease is around 5 to 100,000 neonates and 60% of them are asymptomatic. There is two clinical forms: early and late. The case here presented is an early case with the characteristic dermatological lesions in neonates. The treatment was a successful and after there was not any complications. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a Treponema pallidum polymerase chain reaction (PCR) test in the laboratory diagnosis of early syphilis in the United Kingdom.Subjects and Setting: Men and women attending genitourinary medicine clinics in England.Methods: A trial PCR service was offered for the analysis of swabs of ano-genital or oral ulcers suspected to be syphilitic in origin. Clinical details, results of treponemal serology, and other relevant laboratory tests carried out by the sending laboratories were obtained retrospectively by questionnaire.Results: Data from 98 patients, representing 100 episodes of ulceration, were analysed. The majority of patients (70) attended clinics in the Greater Manchester area. Eighty six patients were male and 58 were men who have sex with men (MSM), of whom 24 were HIV positive. PCR results agreed with the clinical diagnosis for 95 patients; samples from 26 patients were PCR positive and serologically diagnosed as primary (18) or secondary (8) syphilis, whereas 70 patients had PCR negative samples and were not diagnosed as having active syphilis. These data include two HIV positive patients who were PCR positive 12 and 21 days before their treponemal seroconversion. One positive PCR result was not supported by positive treponemal serology (this patient coincidentally received a 10 day course of co-amoxiclav 1 week after sampling). Three patients had negative PCR results but positive syphilis serology. The sensitivity, specificity, positive and negative predictive value for primary syphilis were 94.7%, 98.6%, 94.7%, and 98.6%, respectively, and for secondary syphilis these were 80.0%, 98.6%, 88.9%, and 97.2%, respectively.Conclusion: PCR is a sensitive and specific test for T pallidum, and an important adjunct to dark ground microscopy and treponemal serology in diagnosing infectious syphilis in the United Kingdom. [ABSTRACT FROM AUTHOR]

Topical antifungals had failed to improve the patchy hair loss on this patient's head. The pattern of the alopecia and a closer look at his history provided valuable diagnostic clues. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 34-year-old man with unilateral hearing loss and tinnitus in the left ear. Topics include patient reporting an erythematous papular rash on the trunk, neck, limbs, and palms as well as high fever and sore throat; and patient treated with intratympanic dexamethasone injections for 6 days with no significant change in the complaints or audiometry.

Objectives: To determine the etiology of genital ulcer disease (GUD) among patients attending sexually transmitted disease (STD) clinics in Pune, India, and to examine the relationship to HIV infection and compare the clinical diagnosis of GUD with the results of a multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum, herpes simplex virus (HSV), and Hemophilus ducreyi infection.Methods: Between June 20, 1994, and September 26, 1994, 302 patients with a genital ulcer were evaluated. Clinical etiology of GUD was based on physical appearance and microbiologic evaluations which included darkfield microscopy and serology for syphilis. Swabs of each genital ulcer were tested for HSV antigen by enzyme immunoassay (Herpchek; Dupont, Wilmington, DE) and processed in a multiplex PCR assay (M-PCR; Roche, Branchburg, NJ) for simultaneous detection of HSV, Treponema pallidum, and Hemophilus ducreyi.Results: Two hundred seventy-seven men and 25 women with a median age of 25 were evaluated. The seroprevalence of HIV was 22.2%. The etiology of GUD as determined by M-PCR was HSV (26%), H. ducreyi (23%), T. pallidum (10%), and multiple infections (7%); no etiology was identified in 34%. HIV seroprevalence was higher among those patients positive for HSV compared with other etiologies (OR = 2.1, CI: 1.2-3.7; p = 0.01). When compared with M-PCR, the Herpchek test was 68.5% sensitive and 99.5% specific. Darkfield detection for T. pallidum was 39% sensitive and 82% specific, in contrast to rapid plasma reagin and fluorescent treponemal antibody absorption test, which was 66% sensitive and 90% specific. Clinical diagnosis alone or in combination with basic laboratory tests showed poor agreement with M-PCR. [ABSTRACT FROM AUTHOR]

Hepatitis being first manifestation of secondary syphilis is rare. Here in we report a case of 39 years old male who was being treated for hepatitis and presented to us subsequently with itchy maculopapular rash. Venereal disease research laboratory (VDRL) titre was 1:16. Treponema pallidum hemagglutination assay (TPHA) was positive. He was treated with intramuscular Benzathine Penicillin. His hepatitis improved rapidly. [ABSTRACT FROM AUTHOR]

The article describes the case of a 62-year-old man with a two-week history of generalized weakness and a diffuse rash and was diagnosed of secondary syphilis.

The article presents a case study of a 25-Yyear old man presented to the Gastroenterology Clinic with history of fatigue, abdominal pain, and a change in bowel habits, and reported rectal pain, bleeding, and tenesmus, and diagnosis of infectious proctitis associated with syphilis and lymphogranuloma venereum was made.

The incidence of syphilis has consistently increased from 2000 to 2002. We report a case of acquired syphilis with symptoms of Tullio phenomenon in a patient concurrently diagnosed with HIV infection. The resurgence of syphilis in HIV-positive groups at high risk has public health implications for prevention of both diseases. [ABSTRACT FROM AUTHOR]

Objectives: Syphilis outbreaks have recently been reported in the United Kingdom, some of which have included cohorts of HIV positive individuals. As a result we commenced 3 monthly screening of syphilis serology (STS) for HIV positive patients having routine follow up blood tests. We assessed if there was an increased number of individuals being screened and also whether the screening programme was diagnosing early cases of syphilis.Methods: Data from a 1 year period following introduction of screening (May 2001) were analysed and compared with data from the same period last year. The case notes of patients with a positive VDRL were reviewed to establish, firstly, whether these represented new diagnoses and, secondly, whether patients were asymptomatic at the time of screening.Results: 2670 patients had at least one CD4 count measured in the period (surrogate for patients having routine bloods). Of these, 2266 patients had STS performed (85%). 38 patients had a positive VDRL. Of these, 20 were confirmed as having early syphilis which was asymptomatic at the time of screening. Six asymptomatic cases were also confirmed with newly positive TPPAs and a negative VDRL. These 26 asymptomatic cases represent 29% of all cases of early syphilis diagnosed in our department and 50% of cases in the HIV positive cohort.Conclusion: With intensive surveillance significant numbers of cases of asymptomatic early syphilis are being identified in a group of HIV individuals under routine follow up, at an earlier stage than would otherwise have been the case. This presents an opportunity to intervene not only to prevent clinical illness but also to institute infection control measures. [ABSTRACT FROM AUTHOR]

The presents case study of a 28‑year‑old man who was diagnosed with secondary syphilis which is a sexually transmitted diseases. Topics discussed include dermoscopic appearance of hyperkeratotic scalp lesions with an inner circular scaling edge inwardly oriented over a diffuse background with monomorphic dotted vessels; observation of secondary syphilitic maculo‑papular lesions using polarized dermoscopy; and observation of diffuse scaling of the scalp and macular alopecia.

The article presents case study of a young adult female who was diagnosed with secondary syphilis which is a sexually transmitted infection. Topics discussed include importance of dermoscopy in differentiating Biett's sign; use of qualitative medical test for Treponema pallidum; and use of Benzathine Penicillin for treatment of secondary syphilis.

A letter to the editor is presented which discusses the case study of a 24-year-old Chinese man suffering from warty mucosal lesions which is an oral condyloma lata of secondary syphilis.

Graph: Figure 1: Papular-nodular rash on the forehead of a 37-year-old man with a history of HIV infection and previously treated syphilis, presenting with fever and hemoptysis, consistent with secondary syphilis with atypical rash and pulmonary involvement. The diagnosis of pulmonary syphilis is based on criteria proposed by Coleman and colleagues in 1983: radiographic evidence of pulmonary involvement; historical, physical examination and serological findings typical of syphilis; the exclusion of other pulmonary disease; and response to antisyphilis therapy.[3]. [Extracted from the article]

Background: Syphilis is a sexually transmitted bacterial infection of the spirochete, Treponema pallidum. While primary syphilis often involves genitalia, oral manifestations are observed in a subset of patients. These lesions are often associated with submandibular and cervical lymphadenopathy. This is a case report of a primary syphilitic lesion located on the hard palate of the oral cavity, with only a very few cases described previously.Case Presentation: We describe a rare case of syphilis in a 59-year-old African American man presenting with subjective fevers, chills, marked submental lymphadenopathy, a diffuse skin rash, and an ulcer of the hard palate.Conclusions: This case report demonstrates the importance of maintaining a high index of suspicion for syphilitic infection when a patient presents with nonspecific symptoms, a diffuse rash, and an oral lesion. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 65-year old acquired syphilis patient with anemia and leukoerythroblastic reaction which treated with ceftriaxone. Topics discussed include the long-term Human Immunodeficiency Virus (HIV) prophylaxis received by the patient due to his HIV-positive male partner, the evaluation of anemia where it showed abnormalities and the positive results from being treated with ceftriaxone.

Background: Ascertaining if the clinical and immunological response to repeat syphilis differs from that in initial syphilis may assist in designing optimal syphilis screening strategies and vaccine design.Methods: We prospectively recruited 120 patients with a new diagnosis of (baseline) syphilis. During a 24-month follow-up period, 11 of these patients had a further diagnosis of (repeat) syphilis. We conducted a paired comparison of their plasma cyto-chemokines at baseline and repeat syphilis.Results: Comparing to their baseline infection, paired analyses of the 11 individuals with repeat infections during follow-up revealed that these reinfections had lower concentrations of Interferon (IFN)α (0.8 [Interquartile range (IQR) 0.8-0.8 vs. 12.2 [IQR 1.6-24.2], P = 0.004) and Chemokine (C-C motif) ligand (CCL) 4 (0.9 [IQR 0.9-12.2 vs. 17.5 [IQR 4.9-32.8], P = 0.022].Conclusion: In this small study of 11 individuals, repeat syphilis was found to present with an attenuated immune response. The relevance of these findings to the design of optimal syphilis screening programs is discussed. [ABSTRACT FROM AUTHOR]

Background: Syphilis is a global health concern disproportionately affecting HIV-infected populations. In Alberta, Canada, the incidence of syphilis in the general population has recently doubled with 25% of these infections occurring in HIV-infected patients. The Southern Alberta HIV Clinic (SAC) and Calgary STI Program (CSTI) analyzed the epidemiologic characteristics of incident syphilis infections in our well-defined, HIV-infected population over 11 years.Methods: Since 2006, as routine practice of both the Southern Alberta Clinic (SAC) and Calgary STI Programs (CSTI), syphilis screening has accompanied HIV viral load measures every four months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were re-infected as evidenced by a four-fold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed.Results: Incident syphilis was identified 249 times in 194 HIV-infected individuals. There were 36 individuals with repeated infections (28.5% of episodes). Following a prior decline in annual incident syphilis rates, the rates have tripled from 8.08/1000 patient-years (95% confidence interval (CI): 4.14-14.75) in 2011, to 27.04 per 1000 person-years (95% CI: 19.45-36.76) in 2016. Half of the syphilis episodes were asymptomatic. Patients diagnosed with syphilis were twice as likely not to be taking ART and had a higher likelihood of having plasma HIV RNA viral loads > 1000 copies/mL (19%). Incident syphilis was seen predominantly in Caucasians (72%, P < 0.001), males (94%, P < 0.001) and men who have sex with men (MSM) as their HIV risk activity (75%, P < 0.001).Conclusions: We have highlighted the importance of a regular syphilis screening program in HIV-infected individuals demonstrated by increasing rates of incident syphilis in our region. Targeted preventative strategies should be directed towards HIV-infected populations identified at highest risk, including; MSM, prior alcohol abuse, prior recreational drug use and those with prior syphilis diagnoses. [ABSTRACT FROM AUTHOR]