Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations

Watts, Paula J.; Greenberg, Harry; Khachemoune, Amor

doi:10.1111/ijd.13206

Cited by 21 publications

(17 citation statements)

References 50 publications

(78 reference statements)

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“…First, among the MSM population there is a high risk of transmission ( Jansen et al, 2015 ; Schumacher et al, 2013 ). In addition to this, anal syphilis may pose an additional diagnostic challenge since ulcers are painless and inconspicuous and therefore making it more likely for the disease to progress into its secondary and tertiary stages ( Watts, Greenberg, & Khachemoune, 2015 ). It is important to identify the factors that are associated with HIV/syphilis co-infection in order to increase understanding of this phenomenon and to inform appropriate public health interventions.…”

Section: Discussionmentioning

confidence: 99%

Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador

et al. 2016

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There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.

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Section: Discussionmentioning

confidence: 99%

Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador

et al. 2016

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“…This is a 15.1% increase from 2013 and 40% increase from 2010 with a case rate of 6.3 cases per 100,000 population. An increase in prevalence has been noted in other countries as well, including India, Spain, and Canada (5–7). …”

Section: Discussionmentioning

confidence: 92%

“…It is important to elicit a detailed sexual history on patients to identify potential high-risk behavior. In addition, health initiatives that focus on disease prevention in MSM would help combat the largest at-risk population (1, 2, 5, 8, 13). …”

Section: Discussionmentioning

confidence: 99%

“…The Jarisch–erxheimer reaction, a well-known complication of syphilis, is an acute febrile reaction with associated headache and myalgias that occurs in 10–35% of treated patients. It is theorized to be due to an immunological response to exposed treponemal antigens and typically evolves within the first 24 h after initiating treatment in early stage syphilis (5, 9, 10). …”

Section: Discussionmentioning

confidence: 99%

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Syphilis: an atypical case of sepsis and multiple anogenital lesions in secondary syphilis

Smith

Dhillon

Cotter

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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The incidence of syphilis has historically been cyclical in nature, often in relation to the rise and fall of public health initiatives directed toward eradication along with social attitudes toward sexual practices. The incidence of syphilis has increased by 15% in the last 6 years in the United States, with similar increases worldwide. Herein, we present an atypical case of syphilis presenting with severe septic shock and multiple anogenital lesions in an immunocompetent host. A 22-year-old male with no significant past medical history presented with fevers, chills, sore throat, diaphoresis, and diarrhea. He was febrile, tachycardic, hypotensive, and unresponsive to fluid resuscitation requiring short-term vasopressor support. Physical exam revealed diffuse lymphadenopathy; lower extremity macular rash involving the soles of the feet; papular non-pustular lesions on the scrotum; and a 0.5 cm non-tender irregular, healing lesion on the shaft of the penis. Laboratory analysis was significant for leukocytosis and elevated creatinine. Serum screening rapid plasma reagin was positive, and further testing revealed a titer of 1:32, with confirmation via fluorescent treponemal antibody absorption test. The patient was diagnosed with secondary syphilis, which was determined to be the underlying etiology of the sepsis as all other serological evaluations were negative. He was treated with penicillin G benzathine 2.4 million units intramuscular and supportive management, with improvement of symptoms. The patient engaged in high-risk sexual behaviors, including prior unprotected sexual contact with males. New research indicates that up to one-third of patients may present with atypical cutaneous manifestations, as demonstrated by this patient. It is important for physicians to familiarize themselves with the varied clinical presentations of syphilis, which include multiple anogenital lesions and tender primary lesions in primary or secondary syphilis.

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“…These lesions are highly infectious. Primary syphilis of the oral cavity, however, may pass unnoticed by both patient and physician and the untreated lesion will heal regardless of treatment [25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Secondary Syphilis Presenting as Glossodynia, Plaques en Prairie Fauchée, and a Split Papule at the Oral Commissure: Case Report and Review

Eyer-Silva

Freire²,

Horta-Araujo³

et al. 2017

Case Reports in Medicine

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Syphilis has been coined “the great imitator” due to its extreme heterogeneity of presentation and mimicry of other conditions. Therefore, it is essential that physicians be familiar with the full spectrum of its manifestations. Syphilis may also lead to oral lesions that, occasionally, are unaccompanied by concomitant tegumentary findings. Such patients will pose unique diagnostic challenges. We report the case of a 45-year-old HIV-infected male patient in whom secondary syphilis presented with burning mouth and dysgeusia that progressed to glossodynia and odynophagia. Examination revealed painful, shallow erosions on the posterior aspect of the tongue, in a pattern of plaques en prairie fauchée. A painful split papule (fausse perlèche or false angular cheilitis) was also present in the left commissure. There were no cutaneous lesions. The oral lesions were considered highly suggestive of secondary syphilis. A novel VDRL assay (which was previously negative) yielded a titer of 1/128. Complete clinical remission was rapidly achieved after initiation of penicillin therapy. A comprehensive review of the literature on oral manifestations of syphilis is offered.

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Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations

Cited by 21 publications

References 50 publications

Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador

Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador

Syphilis: an atypical case of sepsis and multiple anogenital lesions in secondary syphilis

Secondary Syphilis Presenting as Glossodynia, Plaques en Prairie Fauchée, and a Split Papule at the Oral Commissure: Case Report and Review

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