Summary Objective  To document the manifestations of syphilis among patients with concurrent HIV infection over a 12‐month period. Method  Descriptive, cross‐sectional, hospital‐based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark‐field microscopy were undertaken to confirm diagnosis where serologic (non‐treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x‐ray, mantoux and purified protein derivative (PPD) status taken. Results  Thirty‐one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months ± 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD) – particularly genital ulcers – while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non‐reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. Conclusion  Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.

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Summary Sera from thirteen patients with tropical eosinophilia had IgE levels of 7000–56,000 μ/ml, unrelated to the level of eosinophilia or the duration of symptoms. They are the richest source of polyclonal IgE we have encountered.

Summary In a double blind trial of nasal spray of sodium cromoglycate (DSCG) for hay fever, fifteen of twenty‐three patients taking the drug were helped, compared with thirteen of twenty‐three receiving placebo—a statistically insignificant difference. Serum levels of IgE were raised in thirty‐eight of forty‐four patients examined. There was no significant difference between preseasonal and seasonal serum IgE levels in either of the DSCG or the placebo group. Serum IgE levels were significantly higher in the patients showing peripheral blood or nasal secretion eosinophilia during the hay fever season. There was no significant difference in the frequency of nasal secretion eosinophilia between those taking DSCG and those taking placebo. It is concluded that DSCG spray does not affect serum IgE levels or eosinophilia of either peripheral blood or nasal secretions under the conditions applying in this trial. Neither was DSCG significantly better than placebo in controlling symptoms.

Summary Twenty‐two patients with severe hay fever unrelieved by antihistamines in previous years were slowly hyposensitized with alum‐precipitated pyridine grass pollen extracts. Their responses were objectively assessed as very good (55%), good (18%) or improved (23%). Two mechanisms were detected: (i) an increase in serum blocking activity in 59% and (ii) the prevention in 59% of the serum IgE elevation expected in the pollen season.