Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe.

The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: ‐The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) ‐The development of dual treponemal and non‐treponemal point‐of‐care (POC) tests ‐The progress in non‐treponemal test (NTT) automatization ‐The regular episodic shortage of benzathine penicillin G (BPG) in some European countries ‐The exclusion of azithromycin as an alternative treatment at any stage of syphilis ‐The pre‐exposure or immediate post‐exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.

† Gummatous syphilis: 22 typical nodules/plaques or ulcers; † Neurosyphilis: ocular, auricular, meningovascular, parenchymatous (general paresis, tabes dorsalis); asymptomatic (abnormal cerebrospinal fluid [CSF]); † Cardiovascular syphilis: aortitis-asymptomatic, angina, aortic regurgitation, stenosis of coronary ostia, aortic aneurysm (mainly thoracic). Epidemiological monitoring of infectious syphilis: all patients with primary, secondary and early latent syphilis should be reported to their National Syphilis Surveillance System and these national programmes should report to the European Surveillance of STI (ESSTI) network of the ECDC, if they are within the European Union. 1

Scabies is caused by Sarcoptes scabiei var. hominis. The disease can be sexually transmitted. Patients' main complaint is nocturnal itch. Disseminated, excoriated, erythematous papules are usually seen on the anterior trunk and limbs. Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulphur 6-33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight). Partner management needs a look-back period of 2 months. Screening for other STI is recommended. Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces. Written information should be provided to suspected cases.

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Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.

Syphilis diagnosis is based on clinical observation, serological analysis, and dark-field microscopy (DFM) detection of Treponema pallidum subsp. pallidum, the etiological agent of syphilis, in skin ulcers. We performed a nested PCR (nPCR) assay specifically amplifying the tpp47 gene of T. pallidum from swab and blood specimens. We studied a cohort of 294 patients with suspected syphilis and 35 healthy volunteers. Eighty-seven of the 294 patients had primary syphilis, 103 had secondary syphilis, 40 had latent syphilis, and 64 were found not to have syphilis. The T. pallidum nPCR results for swab specimens were highly concordant with syphilis diagnosis, with a sensitivity of 82% and a specificity of 95%. Reasonable agreement was observed between the results obtained with the nPCR and DFM methods (kappa ‫؍‬ 0.53). No agreement was found between the nPCR detection of T. pallidum in blood and the diagnosis of syphilis, with sensitivities of 29, 18, 14.7, and 24% and specificities of 96, 92, 93, and 97% for peripheral blood mononuclear cell (PBMC), plasma, serum, and whole-blood fractions, respectively. HIV status did not affect the frequency of T. pallidum detection in any of the specimens tested. Swab specimens from mucosal or skin lesions seemed to be more useful than blood for the efficient detection of the T. pallidum genome and, thus, for the diagnosis of syphilis.

HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.