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Syphilis (lues) is a systemic bacterial disease transmitted mainly by sexual contacts and caused by Treponema pallidum subsp. pallidum . Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been increasing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 2 of recommendations discusses in detail clinical presentation, diagnostics, and treatment of neurosyphilis, syphilis in pregnancy and congenital syphilis.

Syphilis (lues) is a systemic bacterial disease caused by Treponema pallidum subsp. pallidum , which is mainly sexually transmitted or can be acquired by an unborn foetus via the placenta. Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been incresing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 1 of recommendations discusses in detail the clinical presentation, diagnostics, and treatment of early and late syphilis, excluding central nervous system syphilis and syphilis in pregnancy.

Introduction. Undiagnosed and untreated syphilis in pregnancy may result in subsequent complications: early fetal loss, stillbirth, low birth weight of infants and newborns with congenital syphilis. Objective. To analyze diagnostic and therapeutic dilemmas of positive results of serological tests for syphilis (STS) in pregnancy. Case reports. We present two cases of pregnant women, hospitalized in our department due to positive results of serological tests for syphilis, performed during the antenatal visit. On the basis of patients' history, physical examination and STS results, early latent syphilis was diagnosed in the first patient; biological false positive reactions were considered in the second one. Both patients received procaine penicillin treatment. Conclusions. Screening for syphilis in pregnancy as a part of antenatal care and appropriate treatment with penicillin are the most effective interventions to prevent complications of syphilis in pregnancy. It is also important to adapt modern European Guidelines for management of syphilis to Polish conditions.

Introduction . Chronic lymphedema, mainly due to total mastectomy with axillary lymph nodes dissection for breast cancer, can induce development of rare and highly malignant cutaneous angiosarcoma. This condition is called Stewart-Treves syndrome (STS). There are only about 400 cases of STS reported in the literature. The long-term prognosis is poor; 5-year survival is up to 10%. Limb amputation appears to be the treatment of choice. Objective . To present a case of Stewart-Treves syndrome with a fatal outcome, which developed 12 years after mastectomy with lymphadenectomy. Case report . A 65-year-old woman was admitted to our department for confluent purpuric macules, hemorrhagic blisters, and violaceous-black nodules, involving the whole left arm and forearm, with chronic severe lymphedema of the extremity. She had a history of left-sided breast cancer 12 years previously, treated with mastectomy with excision of axillary lymph nodes; subsequently, the failure of lymph drainage and lymph stasis developed. Histopathological examination of the tumor was consistent with angiosarcoma. The patient was disqualified from a surgical procedure due to the late stage of malignancy and died approximately a month later. Conclusions . Given unsatisfactory treatment options, the prevention of long-lasting lymphedema is crucial to improve prognosis of patients with breast cancer.