This was a study of monkeypox-infected patients in a tertiary care center in Spain describing the epidemiologic, clinical, and microbiologic features of 49 patients.

Background Syphilis is a sexually transmitted infection (STI) caused by the pathogen Treponema pallidum. Its incidence is increasing in our country, especially among men who have sex with men (MSM). Serological tests are still the most widely used technique for diagnosis. The need for an early diagnosis has prompted the introduction of fast techniques, such as Treponema pallidum detection by polymerase chain reaction (PCR) on mucocutaneous samples. The objective of this work is to analyse the sensitivity of this technique in a series of patients diagnosed with syphilis at our centre. Methods Retrospective review of all cases diagnosed with syphilis at our centre between May 2017 and May 2021. Results A total of 203 cases of syphilis were diagnosed with serologic tests: 33% were primary syphilis and 53.1% secondary syphilis. PCR for Treponema pallidum was performed in 117 (57,6%) cases. The sensitivity was highest (95,2%) when performed on samples from mucocutaneous ulcers in primary syphilis. This value decreased to 69,4% in secondary syphilis, although there were variations between the types of samples. Conclusions The PCR test has a high diagnostic value when performed on ulcer exudates in patients with primary syphilis. Its most relevant advantages in clinical practice are the possibility of an early diagnosis before serological tests during the window period, the ability to confirm reinfections in patients with persistent positivity of reaginic antibodies and a history of treated syphilis. Nevertheless, given that a negative PCR test may not rule out infection by Treponema pallidum, serologic tests are still necessary for everyday practice.

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Importantly, we suspect lower 1-year readmission rates associated with these hospitalizations are related to more accurate differentiation and effective treatment of infectious and pseudoinfectious inflammation. Histopathologic analysis and tissue culture may improve management by providing alternative diagnoses or organisms for targeted antibiotic therapy. 5 Limitations of this study include unintentional exclusion of encounters classified as organism specific diagnosis (e.g. histoplasmosis, blastomycosis), confirmed pseudocellulitis (e.g. erythema nodosum, allergic contact dermatitis), and hospitalizations classified by diagnosis with greater priority (e.g. sepsis).Additionally, all patients in this study received a dermatology consult which may select for complex and atypical cases. Prospective research on this subject is needed to better characterize the role and potential benefit of histopathology and tissue cultures in patients with SSTIs and analyze potential confounding factors such as length of time from admission to biopsy and relative complexity of cases between biopsy and non-biopsy encounters.This study uniquely demonstrates skin biopsies are associated with a lower risk of 1-year rehospitalization among hospitalized patients with SSTIs, warranting further research to explore contributing factors such as improved diagnostic accuracy.

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