Syphilis: The International Challenge of the Great Imitator
Section snippets
The many faces of syphilis
During the secondary stage, there is rapid reproduction and spread of the spirochetes consequential to intensive clinical manifestations. Patients may experience a range of constitutional symptoms, such as malaise, appetite loss, fever, headache, stiff neck, lacrimation, myalgias, arthralgias, nasal discharge, and depression. There is multiorgan involvement of the skin, oral cavity, genitalia, central nervous system, eyes, and visceral organs. Among these symptoms, skin eruptions proved to be
Diagnostic and serologic tests
Darkfield examination and a direct fluorescent antibody test of lesion exudates or tissue are the definitive methods for diagnosing early syphilis. A presumptive diagnosis is made with the use of two types of serologic tests: nontreponemal tests (eg, Venereal Disease Research Laboratory [VDRL] and rapid plasma reagin [RPR]), and treponemal tests (eg, fluorescent treponemal antibody absorbed and T. pallidum particle agglutination). The use of only one type of serologic test is insufficient for
Therapeutic options
Syphilis is a disease of considerable health magnitude and has devastating untoward health effects if left untreated. It is avoidable. It is treatable with the use of effective antibiotics.
The design challenge for syphilis elimination is not only to efficiently pursue the riddance of T. pallidum. There should be an intense call for a clinical network of physicians and other sexual health service providers to be at the center of syphilis and sexually transmitted infection (STI) surveillance to
Follow-up guidelines
The Centers for Disease Control has set up guidelines regarding follow-up of patients in different stages of syphilis (Table 2).
Management of sex partners
Persons exposed sexually to a patient who has syphilis in any stage should be evaluated clinically and serologically. They should be treated with a regimen based on the following recommendations [10]:
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Persons who were exposed within 90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sexual partner who might be infected even if seronegative; therefore, such persons should be treated presumptively.
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Persons who were exposed more than 90 days before the diagnosis of
Summary
Syphilis has been a source of social stigma, morbidity, and mortality for centuries. Although the introduction of penicillin in the 1940's contributed much to the decrease in epidemiology, statistics show that it is still a menace to our society.
Syphilis is a rare occurrence in children; therefore, a diagnosis of syphilis in a child warrants an investigation of sexual abuse. Emphasis that this disease is as damaging to the soul as it is to the body, especially in the case of a minor, is vital.
Acknowledgment
The authors thank Dr. Gertrude P. Chan, Section Head of Dermatology at the Research Institute for Tropical Medicine–Department of Health, Philippines and the resident physicians for the assistance with photograph collection.
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Histologic features of secondary syphilis: A multicenter retrospective review
2015, Journal of the American Academy of DermatologyOral syphilis: Report of three cases and characterization of the inflammatory cells
2015, Annals of Diagnostic PathologyCitation Excerpt :In the present study, the efficacy of this drug was demonstrated by the administration of a weekly dose of 2.4 million units (IM) and the observation of complete remission of the lesions after the first dose. However, the patients should be followed up by serologic testing at 6 and 12 months posttreatment [11]. Syphilis has important implications for clinicians because manifestations can occur in the mouth and perioral region and primary and secondary lesions are highly contagious.
Clavi syphilitici-an unusual presentation of syphilis
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