Liver Disease Associated with Secondary Syphilis

Lee, Richard V.; Thornton, George F.; Conn, Harold O.

doi:10.1056/nejm197106242842508

Cited by 68 publications

(33 citation statements)

References 3 publications

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“…Laboratory findings show a modest increase in transaminases and bilirubin, and a marked increase in ALP. 3,4,12,16,17 The presence of spirochaetes in the liver tissue is diagnostic but difficult to demonstrate, as in our case, and it is likely due to technical factors in the storage and staining or to Kupffer cell phagocytosis. 8,12,15,19,21,29 Liver damage has also been described in HIV-positive patients with syphilis.…”

Section: Discussionmentioning

confidence: 64%

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

Noto¹,

Nonno

Licci

et al. 2008

Int J STD AIDS

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The incidence of syphilis has increased substantially over the past years, particularly in men who have sex with men. The clinical manifestations of syphilis are variable and liver involvement is uncommon, but may occur at any stage of the disease. We report a case of early syphilitic hepatitis (ESH) in an immunocompetent patient referring multiple bisexual exposures, who presented at admission with jaundice, tiredness, an ulcerated genital lesion and an increase of liver aminotransferases. During his hospital stay, he developed a skin rash, and serology for syphilis was found positive. Our case report strengthens the need to take into consideration the diagnosis of ESH in all patients with unexplained liver enzyme increase and epidemiological data of unsafe sexual exposures. Indeed, an early recognition of the clinical manifestations of syphilis can lead to a prompt treatment, and allows the prevention of the transmission of this disease to other individuals.

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Section: Discussionmentioning

confidence: 64%

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

Noto¹,

Nonno

Licci

et al. 2008

Int J STD AIDS

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“…25 Secondary syphilis may result in hepatitis; glomerulonephritis (mediated by antibodytreponeme complex deposition) and splenomegaly. [26][27][28] A small proportion of patients (1-2%) will develop neurological complications during secondary syphilis. 21 These are typically acute meningitis (headache, neck stiffness, photophobia, nausea) and cranial nerve palsies including eighth nerve palsy with resultant hearing loss and possible tinnitus.…”

Section: Acquired (Adult) Diseasementioning

confidence: 99%

UK national guidelines on the management of syphilis 2015

Kingston¹,

et al. 2015

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These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

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“…Localized inflammation of the oral cavity, tongue, and genital mucous membranes can cause mucous patches (66,204); infrequently, secondary syphilis can be accompanied by gastric and renal involvement and hepatitis (118,213). T. pallidum has been found in liver biopsy samples taken from patients with secondary syphilis (92,170), while glomerulonephritis resulting from immunoglobulin-treponeme antigen complexes deposited in the glomeruli appears to cause kidney damage (17,224,315). Nephrotic syndrome may also be present.…”

Section: Secondary Syphilismentioning

confidence: 99%

Biological Basis for Syphilis

2006

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SUMMARY Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum subsp. pallidum. Clinical manifestations separate the disease into stages; late stages of disease are now uncommon compared to the preantibiotic era. T. pallidum has an unusually small genome and lacks genes that encode many metabolic functions and classical virulence factors. The organism is extremely sensitive to environmental conditions and has not been continuously cultivated in vitro. Nonetheless, T. pallidum is highly infectious and survives for decades in the untreated host. Early syphilis lesions result from the host's immune response to the treponemes. Bacterial clearance and resolution of early lesions results from a delayed hypersensitivity response, although some organisms escape to cause persistent infection. One factor contributing to T. pallidum's chronicity is the paucity of integral outer membrane proteins, rendering intact organisms virtually invisible to the immune system. Antigenic variation of TprK, a putative surface-exposed protein, is likely to contribute to immune evasion. T. pallidum remains exquisitely sensitive to penicillin, but macrolide resistance has recently been identified in a number of geographic regions. The development of a syphilis vaccine, thus far elusive, would have a significant positive impact on global health.

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Liver Disease Associated with Secondary Syphilis

Cited by 68 publications

References 3 publications

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

UK national guidelines on the management of syphilis 2015

Biological Basis for Syphilis

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