Clinical Expression of Secondary Syphilis in a Patient with HIV Infection

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 histopathological study of secondary syphilis

Objectives To study the histology of the skin lesions of secondary syphilis. Background Secondary syphilis is becoming less prevalent in developed countries and clinicians not familiar with the condition may resort to biopsy to elucidate the nature of a rash. It is therefore important that Dermatopathologists are aware of the histological features of secondary syphilis. Design Patients with secondary syphilis, who attended clinics held by one of us during a 10 year period and who consented to biopsy, were studied. Subjects Twenty-eight individuals. Methods Skin biopsies of representative lesions. Routine histological processing. Results The most common finding was that of an erythema multiforme pattern of papillary oedema and perivascular lympho-histiocytic infiltration (19 cases including the 2 men with HIV infection). The tissue reaction was mild in patients with macular lesions. Focal lichenoid tissue reaction (4 cases), a pseudolymphomatous appearance (1 case), and granuloma formation (3 cases) were noted in other patients. The histology of a condyloma latum was typical. Conclusions Our study serves to emphasise the importance of clinicopathological correlation in the assessment of a skin rash and to remind pathologists of secondary syphilis as an aetiological factor in macular and papular skin lesions. The mimicry of several other conditions confounds the specificity of the changes and shows that syphilis is a theoretical candidate in considering the aetiology of the changes seen. Careful scrutiny of all the histopathological features may permit a relatively refined differential diagnosis to be established and, either prospectively or retrospectively, alert the clinician to the appropriate additional investigative techniques which will allow a sound diagnosis to be attained.     

Miliary pustular syphilid

A case of secondary syphilis is presented in which a dramatic generalized eruption of pustules and an elevated temperature were prominent features. Biopsy of the skin lesions showed dermal granulomata, which are occasionally seen in the papulopustular lesions of secondary syphilis. The classification of pustular syphilids is reviewed.     

Extensive nodular secondary syphilis

An indigent male patient presented with a widespread nodular eruption involving the torso and limbs. The differential diagnosis included nodular secondary syphilis, Kaposi's sarcoma, sarcoidosis, and lymphoma. Investigation confirmed secondary syphilis with positive cerebrospinal fluid serologic findings. Penicillin therapy produced a Jarisch-Herxheimer reaction despite pretreatment to diminish this. Discussion on the clinical features and treatment of syphilis is presented.     

Primary and secondary syphilis, 20 years'' experience. 2. Clinical features.

The notes of 946 patients with primary and 854 with secondary syphilis were retrospectively reviewed. Of the 184 heterosexual men with primary syphilis, 182 (99%) had chancres affecting the penis, compared with 467 (64%) of the 728 homosexual men (p less than 0.0001). Anorectal chancres occurred in 249 (34%) of homosexual men. The commonest features of secondary syphilis included a rash, lymphadenopathy, and mucous patches of the mouth or genital area. Hepatitis, meningitis, other neurological problems, iridocyclitis, and periostitis were all exceptionally rare. The clinical features of primary and secondary syphilis do not appear to have changed in recent years.     

梅毒125例临床分析

目的 了解梅毒多变的临床特点,进一步认识该疾病.方法 对125例梅毒患者的临床资料进行分析.结果 梅毒硬下疳可多发,少数可以留疤,除生殖器外还可以发生在乳房.病例中一患者因乳房赘生物并逐渐破溃而就诊,临床拟诊寻常疣、湿疹、帕哲特病待排,病理诊断为亚急性炎症,然患者血清学检查显示RPR1:64( )及TPPA阳性.二期梅毒疹可表现为银屑病样疹、环形红斑、脓疱、扁平湿疣等,其发疹部位可在躯干、掌跖部,也可在头面部.皮疹可与硬下疳重叠出现(13.2%).结论 梅毒临床表现多样化,因此须多加注意.     

Malignant syphilis in an HIV-infected patient

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection may change the classic clinical course of syphilis and increase the incidence of a subtype of secondary syphilis named malignant syphilis. A homosexual patient with HIV infection consulted us about a one-month history of general malaise and widespread cutaneous ulcerative lesions, some with thick hemorrhagic crusts. Serology for syphilis was positive at high titers. Based on clinical, histological and serological findings, a diagnosis of malignant syphilis was made and the patient started treatment with penicillin G benzathine with progressive resolution of lesions. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous lesions.     

452例梅毒患者的临床分析

目的:了解梅毒的发病及临床特点,以探求及早控制本病的措施。方法:对本院1997年1月-2002 年12月间的452例梅毒患者的临床资料进行整理和临床分析。结果:452例梅毒中一期梅毒174例,占38.5%, 二期梅毒198例,占43.8%,一、二期梅毒共存者6例,占1.3%。潜伏期(隐性)梅毒74例,占16.4%。结论:正规足量的驱梅药物治疗,一期梅毒治愈恢复明显快于二期梅毒。     

梅毒、淋病和生殖道沙眼衣原体感染诊疗指南（2020年）

梅毒、淋病和生殖道沙眼衣原体感染是我国目前重点防治的性传播疾病。梅毒的临床表现复杂,按照其发病时间、临床表现及传染方式,可分为一期梅毒、二期梅毒、三期梅毒、神经梅毒、隐性梅毒及先天梅毒等。淋病和生殖道沙眼衣原体感染主要侵犯泌尿生殖道,其临床表现从无症状到伴发各种并发症,差别较大。这3种性病的诊断应依据流行病学史、临床表现及实验室检查结果综合判断后确定。应尽早、规范并按推荐方案进行治疗。治疗后应进行必要的随访。淋病的病原体耐药已经成为临床关注的问题。     

妊娠合并梅毒临床病例分析

目的：总结妊娠合并梅毒病例的临床特点及产前梅毒筛查情况，研究梅毒治疗时间对妊娠结果的影响。方法：对我院1998年4月—2002年4月间妊娠合并梅毒的病例进行回顾性分析。结果：妊娠合并梅毒病例30例，占住院分娩病例总数的0．49％。潜伏梅毒病25例，占83．3％；Ⅰ期梅毒、Ⅱ期梅毒及妊娠前驱梅治疗后血清固定的病例各占3．3％、6．7％、6．7％。晚期妊娠发现梅毒病例中，死胎或畸胎6例，先天性梅毒婴儿3例，远多于妊娠早期及中期发现梅毒的病例。结论：妊娠合并梅毒病例的临床表现以潜伏梅毒为主。治疗梅毒的时间对妊娠结局有一定影响。     

123例早期梅毒临床分析

目的观察早期梅毒的临床特点及疗效,为提高早期诊治水平提供科学依据。方法对123例早期梅毒患者的临床资料进行综合分析。结果本组病例中男性76例,女性47例。Ⅰ期梅毒53例,以外生殖器硬下疳为主;Ⅱ期梅毒67例,以掌跖暗红斑、扁平湿疣及玫瑰疹为主;潜伏梅毒3例,无皮疹。123例患者USR、Trust、TI'PA试验均为阳性(100%):使用苄星青霉素治疗梅毒血清试验阴转率达95.9%。结论早期梅毒临床表现多样性,易误诊。苄星青霉素是治疗早期梅毒的首选药物。     

Early diffuse alopecia in a neonate with congenital syphilis

Neonatal alopecia has been described in many circumstances but never as a part of the constellation of signs in congenital syphilis. Common clinical features of early congenital syphilis include hepatosplenomegaly, skeletal deformities, hematologic disturbances, and mucocutaneous features such as rhinitis and maculopapular rash. Syphilitic alopecia has previously been described only in conjunction with secondary syphilis. In this article, we describe the first occurrence of alopecia in a neonate with congenital syphilis.     

Clinical and microbiologic studies of genital ulcers in Kenyan women

The etiology of genital ulcers in women in tropical regions is poorly understood. Eighty-nine women, presenting to a sexually transmitted disease clinic in Nairobi (Kenya) with a primary complaint of genital ulcers, were evaluated prospectively in a clinical and laboratory study. A final etiologic diagnosis was possible for 60 (67%) of the women. Culture for Haemophilus ducreyi was positive for 43 women, eight had secondary syphilis with ulcerated condyloma latum, three had primary syphilis, one had both chancroid and syphilis, two had moniliasis, two had herpetic ulceration, and one had a traumatic ulcer. The clinical characteristics that best distinguished chancroid from secondary syphilis were ulcer excavation and a rough ulcer base. No etiologic diagnosis was established for 29 patients. However, the clinical and epidemiologic features of these patients suggested that they were similar if not identical to the patients with H. ducreyi culture-positive chancroid. Further studies are necessary to determine the etiology of ulcers in females in whom no pathogen was identified.     

SECONDARY SYPHILIS: A CLINICOPATHOLOGIC STUDY

Background. With the resurgence of syphilis in the hiv era, a greater awareness of the clinicopathologic features of the disease is desirable. This report describes and correlates the clinical and histopathologic features of secondary syphilis seen at a teaching hospital in Delhi, India. Methods. Forty biopsies of mucocutaneous lesions from 31 consecutive patients with secondary syphilis, seen between September 1987 and January 1991, were studied and the histopathologic findings correlated with the clinical findings. Results. A spectrum of histopathologic changes ranging from a minimal infiltrate to granulomatous inflammation throughout the dermis was seen. The pattern of inflammation correlated well with the type of skin lesion, with macules showing the least and nodules the most prominent changes. The predominant cell type in the infiltrate was the mononuclear cell/lymphocyte. Plasma cells were seen infrequently. except in condylomata lata. Endothelial proliferation, the “classical” feature of the histopathology of syphilis was noted infrequently. Conclusions. The histologic manifestations of secondary syphilis appear to be as varied as the clinical ones. This calls for close interaction between the clinician and the pathologist to correlate the clinical, serologic, and histologic findings to establish the diagnosis of syphilis.     

梅毒患者病程中宿主的免疫学变化

目的 探讨梅毒螺旋体(TP)感染的不同病程与宿主免疫学变化的关系。方法 采用ELISA法分别检测一期和二期梅毒患者血清抗TP抗体的滴度(用活动指数AI表示)。MTT比色法测定一期和二期梅毒患者血清对脐带血淋巴细胞增殖反应的影响(用刺激指数SI表示)。ABC-ELLSA法分别检测一期和二期梅毒患者血清中细胞因子IL-2、IL-4含量。结果 二期梅毒患者抗TP抗体的活动指数(AI)显著高于一期梅毒(t=3.92,P<0.01)。一期和二期梅毒血清对脐带血淋巴细胞增殖反应的刺激指数SI显著低于无血清含PHA组(q₁=12.99,P₁<0.01。q₂=12.04,P₂<0.01),且二期梅毒血清SI亦显著低于一期梅毒(q=7.18,P<0.01)。一期梅毒血清中IL-2含量明显高于二期梅毒(t=3.50,P<0.05),IL-4含量与二期梅毒差异无显著性(t=1.31,P>0.05)。结论 抗TP抗体随着梅毒病程由一期向二期进展其滴度越来越高,但与体液免疫有关的细胞因子IL-4没有发生显著性变化;宿主感染梅毒螺旋体后,其细胞免疫功能受到明显抑制,且随着病程由一期向二期进展,其抑制现象越来越显著。     

Circulating immune complexes in primo-secondary and serological syphilis (author's transl)

Some clinical features of syphilis suggest that immune complexes may be a pathogenetic factor in the syphilitic lesions. Recently, circulating immune complexes have been reported in six patients with secondary syphilis by S?ling et al. In our study, the presence of circulating immune complexes was investigated in 42 patients with syphilis (primary, secondary, serological) by the method of C1q binding test. Elevated C1q binding activity was demonstrated in two-thirds of the patients with primo-secondary syphilis, with a significant difference between this group and the controls. Only two of the 21 patients with serological syphilis showed elevated C1q binding activity. Circulating immune complexes, often at moderates rates, appear very early and decrease rapidly during treatment. It was not possible to demonstrate a decline in serum complement in association with elevated C1q binding activity. During five Jarisch-Herxheimer reactions, no increase in circulating immune complexes has been noticed compared to pre-treatment values: this suggests that circulating immune complexes have no essential importance in this reaction. The characterization of the components of these circulating immune complexes by the previously described "radioimmunoprecipitation PEG assay" (RIPEGA) will enable us to state their specificity and to conceive their potential responsibility in some lesions of secondary syphilis, such as nephrotic syndrome.     

The dynamics of Treponema-specific blood immunoglobulins in early forms of syphilis

The study has involved 73 patients with syphilis, 31 female and 42 male ones, aged 18-42. Four of these suffered from primary seronegative, 14 from primary seropositive, 21 from secondary fresh, 22 from secondary recurrent, and 12 from early latent seropositive syphilis. Peripheral blood sera were under study. Treponema-specific antibodies of the IgM and IgG classes were titered by enzyme immunoassay. The detected changes in Treponema-specific immunoglobulinemia are in good correlation with clinical staged pattern of syphilis and antiinfectious immunity status.     

Clinical Survey of Syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with Special Reference to the Recent Clinical Manifestations and Evaluation of IgM Antibodies to Treponema pallidum

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA+IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.     

Pedal interdigital condylomata lata: a rare sign of secondary syphilis

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).     

Clinical Study on Syphilis in Abu Dhabi with Special Stress on the Unusual Presentation of the Disease

ABSTRACT: Seventy-nine cases of syphilis were the material of this study. Unusual presentations of primary syphilis were found in 42.5% of cases; explanations are given for these findings. Other aspects of the unusual presentations of the disease were studied with special stress on the occurrence of itching in the course of secondary syphilis. The authors emphasize that pruritis as a presenting symptom in the presence of skin lesion suggestive of syphilis should not blind the physician to the possibility that Treponema pallidum may be the etiologic agent.