Early syphilis and the skeletal system

Eleven patients with early syphilis were selected at the University Dermatology Clinik in Frankfurt/M, and bone scintigraphy was performed to check for bone lesions as sign of a systemic character of the disease. The 99mTc-methylene diphosphonate scintigrams were compared with those in a control group of 50 patients. Focal hot spots indicating early metabolic changes in bone were found in all 11 patients with early syphilis. The difference between the two groups was statistically significant. The most frequent sites of hot spots were the joints of the palmar and plantar first digits. Foci were also found at the tibial tuberosities. The results support the hypothesis that reactive focal osteitis is caused by penetrating treponemes in the very early stages of syphilis. Also, we can confirm the high sensitivity of bone scintigraphy for the early detection of metabolic changes in bone compared with conventional X-ray images.