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The case of a young man with condylomata lata in the toewebs of both feet is presented. Treponema pallidum was identified in these lesions. Examination two weeks after intramuscular injection of 2.4 X 10(6) units of benzathine penicillin showed resolution of the lesions on the toewebs.
A pregnant women with secondary syphilis received appropriate therapy with penicillin in the last trimester of pregnancy. At delivery, her titre had fallen fourfold, and the baby had a non-reactive cord blood titre at birth. However, the treatment failed to prevent infection in the infant, and the baby had developed signs of congenital syphilis at 10 weeks of age. The definition of "adequate therapy" of pregnant women is unclear, and recent guidelines are contradictory. Therefore, literature that pertains to penicillin therapy in pregnancy is reviewed, and new guidelines for therapy proposed.
BACKGROUND: The clinical diagnosis of primary and secondary syphilis can be difficult because of the wide variability of lesions. The available laboratory tests (dark-field microscopy and direct fluorescent antibody) require specialized microscopes and skilled technicians, and serologic tests are insensitive in early infection. METHODS: Dark-field microscopy and monoclonal antibody staining were compared to a new solid-phase enzyme-linked immunosorbent assay (Visuwell test) for detection of T. pallidum in lesion exudate of 188 patients with genital lesions. RESULTS: Sixty-four patients (34%) had lesions of early syphilis diagnosed by either dark-field, monoclonal antibody staining, or both. The Visuwell test and dark-field examination were positive in 52 (81.3%) and 55 (85.9%) of the 64 patients, respectively, whereas the monoclonal antibody staining technique demonstrated the presence of T. pallidum in 59 (92.2%) of the 64 patients. The Visuwell test gave a negative result in 111 of 124 patients who had negative dark-field and direct fluorescent antibody test results (89.5% specificity). CONCLUSIONS: The Visuwell test is an alternative method for evaluating genital ulcers but is less sensitive and specific than existing tests.
BACKGROUND: Metropolitan Nashville, Tennessee experienced a syphilis epidemic from 1996 to 1998. GOAL: This study describes the syphilis epidemic during this period. DESIGN: Descriptive analyses of syphilis surveillance data (1988-1998) were performed, with emphasis on the current epidemic (1996-1998), and were stratified by age, gender, race, and census tracts. RESULTS: Five features were observed regarding the 1996 to 1998 syphilis epidemic: (1) males and females were almost equally affected, with a delay in diagnosis in female patients; (2) the 30-39-year age group was most affected; (3) the 15-19-year age group had the highest percentage increase in incidence; (4) African Americans were the most affected population subgroup; and (5) downtown Nashville and the surrounding areas were most affected. CONCLUSION: Although talk of eradicating syphilis has surfaced nationally, Nashville has continually faced syphilis as a public health problem. During each of the past 3 years (1996-1998), the incidence of syphilis in this community has reached epidemic proportions.
BACKGROUND: Condylomata lata of the toe webs are uncommon manifestations of secondary syphilis. Considering the recent decline in the incidence of syphilis in the United States, such lesions are likely to present infrequently. In some cases, this phenomenon may be the only physical sign of syphilis; therefore, it is important that a high index of suspicion is maintained when evaluating toe web lesions in patients at epidemiologic risk for syphilis. GOALS: A case of secondary syphilis presenting solely with interdigital condyloma lata in the toe web spaces is reported, and similar cases reported in the literature are reviewed. STUDY DESIGN: This article documents the diagnosis of secondary syphilis based on a positive serology in conjunction with the development of interdigital condyloma lata as the only physical finding suggestive of lues. RESULTS: The latter lesions resolved after appropriate, adequate antibiotic therapy. CONCLUSIONS: A case of condylomata lata of the toe webs without other pertinent physical findings is presented. Analogous to lesions typically seen in the anogenital region, moist exophytic toe web plaques may represent condyloma lata and thereby be a sign of secondary syphilis. The differential diagnosis includes tinea pedis, erythrasma, macerated corns, verrucae, and several tropical mycoses (chromomycosis, mycetoma).
Intradermal infection of rabbits with Treponema pallidum imitiates rapid and active cellular response at the site of injection. During the first 2 weeks following infection, there is a marked increase in the numbers of organisms at the site of infection. Systemic dissemination of treponemes occurs during the early stage of infection, presumably before the immune response is fully mobilized. The mononuclear infiltration, which is apparent at the lesion site one week postinfection, becomes more pronounced at 2 weeks. The infiltrating cells are predominantly T lymphocytes and macrophages. By 4 weeks postinfection, most of the organisms have been cleared from the primary site; however, low numbers of treponemes survive locally and in distant tissues. Thus, whereas infection with T. pallidum appears to activate immune mechanisms which are capable of clearing most of the organisms from the primary lesion, some organisms are able to evade these mechanisms and persist in vivo.
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Although penicillin still remains highly effective for syphilis, concerns have been raised that current regimens may be inadequate for the treatment of early syphilis. We report the failure of benzathine penicillin in the treatment of secondary syphilis. Extensive tracing of sexual contact history failed to identify sources of possible reinfection; therefore, we believe that this case represents a treatment failure and an ensuing relapse of secondary syphilis.
A young woman with syphilids resembling borderline lepromatous (BL) leprosy is being described. This is yet another addition to its already well-documented manifestations. The high prevalence of leprosy and syphilis augments the epidemiological significance of the case.
We report a case of HIV infection with herpes simplex, syphilis, and condyloma acuminatum in a 66-year-old heterosexual man. The patient was an asymptomatic carrier (group II) of HIV infection. Herpes simplex on his penis was controlled by aciclovir. Secondary syphilis was treated with penicillin G, after which skin lesions disappeared. These four diseases were all sexually transmitted diseases (STD). One should consider the possible existence of other STD in similar cases.
There are increasing reports of unusual clinical features and atypical courses of syphilis in patients with acquired immunodeficiency syndrome. Recently, we had the opportunity to study an HIV-positive female patient with strong manifestations of secondary syphilis. The case is discussed together with the implications of secondary syphilis in her concomitant ocular affliction. Moreover, we comment on the clinico-therapeutic controversies brought about by the association of infection with Treponema pallidum and HIV.
A rare case of secondary syphilis showing mucous patches on the hard palate is reported. A 31-year-old male had two erosive patches which were slightly raised on his hard palate. A linear lesion was also present on the inside of his right alveolar process. Many red-brown macules on his abdomen and bilateral inguinal lymphadenopathy accompanied these symptoms. The serological tests for syphilis were positive: VDRL test 1:512, TPHA test 1:20,480, and IgM-FTA-ABS test 1:40. Immunohistochemical staining with rabbit monoclonal antibody to Treponema pallidum by the biotin-streptoavidin system detected treponemal organisms in the paraffin-embedded specimen from his mucous patch. A diagnosis of secondary syphilis was made, and he was given amoxicillin (AMPC) at 750 mg per day for 4 weeks. His eruptions, including the mucous patch, healed in a week.
Lues maligna, which is characterized by noduloulcerative lesions, is a rare form of secondary syphilis. It is mainly seen in either HIV-infected or malnourished patients suffering from a depression in immunity. We presented a chronic alcoholic, HIV negative male patient with noduloulcerative lesions diagnosed as lues maligna based on his skin eruptions, results of serologic tests, and, histopathologic findings. We believe that chronic alcoholism could be the cause of immunosuppression in our case and wanted to emphasize the possibility of an association between lues maligna and chronic alcoholism.
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The histological appearances found in biopsies from fifty-seven patients with secondary syphilis have been correlated with the clinical morphology of the eruptions. Considerable variation of histological pattern was encountered, and the frequency with which some of the classically described changes were found to be absent or inconspicuous is stressed. Of particular interest were the findings that, in nearly one-quarter of the biopsies, plasma cell infiltration was either absent or very sparse, and that vascular damage was seen in less than half. Where present, the vessel changes were almost entirely confined to swelling of the endothelial cells. Proliferation of the endothelial cells was most uncommon. The epidermis was very frequently involved in the inflammatory process. Exocytosis, spongiosis, parakeratosis, and acanthosis were the most frequent changes. No consistent histological difference between papular and papulo-squamous lesions could be found but macular lesions demonstrated more superficial and less intense dermal infiltration as well as less severe epidermal involvement. In late secondary lesions, the infiltrate became granulomatous, but in other respects the duration of the exanthem could not be correlated with the pathology. The differential diagnosis from pityriasis lichenoides and other inflammatory dermatoses is discussed and the value of histopathology in the diagnosis of secondary syphilis is emphasized.
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