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22 patients with treated latent syphilis were studied by the method of anticomplementary activity. The patients did not have any antecedent of primary or secondary muco-cutaneous lesion or any other clinical or humoral manifestation of other diseases. The presence of circulating immune complexes with statistical significance were shown in 14 cases. Syphilis in this period is considered as an immuno reactive disease, obliging to periodic clinical and specialized laboratory controls.

The evoked potentials visual and auditory are studied in 43 patients with latent syphilis without previous mucocutaneous lesions. Twenty nine of them had not received treatment, and 14 due to their positive serology were treated with benzathine penicillin. At the visual potential evoked there were no abnormalities but in 20 cases evoked auditive potential were abnormal. This findings suppose the existence of subclinical neurological indicates the existence of lesions in almost 50% of the cases of this period of syphilis. All these patients had positive circulate immune complexes and normal cerebro-spinal fluid. The neurological alteration consists in a lesion of the cerebral trunk. According to these results the auditory potential evoked test is very important. The authors doubt on the efficacity of the benzathine penicillin in this period of syphilis.

Introduction: Syphilis is a systemic disease caused by Treponema pallidum. Humans are the only hosts, and the incubation period lasts from 9-90 days. Currently it can be divided into congenital or acquired. This division is due to the moment in which the infection occurred. Congenital Syphilis- when the infection happens during the prenatal period, whereas acquired, when the infection took place in the period after birth. In early acquired syphilis the I and II stages can be distinguished as well as early latent syphilis. As defined, early latent syphilis includes an acquired infection up to 1 or 2 years back, depending on the guidelines. Late syphilis however includes: late latent syphilis, tertiary syphilis, late cardiovascular syphilis, late neurosyphilis. Congenital syphilis has also been divided into early (which includes the first 2 years) as well as late, which is characterised by signs of congenital syphilis, the so-called stigmata of congenital syphilis constituting the untreated infection during the fetal stage or the infancy stage. Aim of the Study: The aim of our study is to divert the attention to one of the sexually transmitted diseases, which despite the downward trend at the end of the 20th century, rebounded at the beginning of the 21st century, especially among men who have sexual contact with other men. We paid attention to the symptoms accompanying this disease, also in the context of congenital syphilis, as well as the different methods of pharmacological treatment according to European guidelines. Materials and methods: Reviewed literature available at scientific articles , Google Scholar using keywords: “syphilis – epidemiology”, “syphilis treatment”, “symptoms of syphilis”, as well as European guidelines regarding the treatment of syphilis.

Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The syphilis is an infectious and systemic disease caused by the Treponema pallidum bacteria whose main way of transmission is the unprotected sexual intercourse. Objective: To characterize prisoner patients with syphilis according to clinical and epidemiological variables. Methods: An observational, descriptive and cross-sectional study was carried out from January, 2016 to December, 2020, of 66 men confined in Mar Verde Penitentiary Center in Santiago de Cuba who were diagnosed with syphilis. In statistical data processing, Fisher-Irving's exact test and chi-squared test of independence were applied to evaluate the association between the qualitative variables. Results: In the series there was a prevalence of the diagnosis of latent syphilis (100.0 %), as well as the 25 to 34 age group (33.3 %) and the basic secondary school level (77.3 %). Most of the prisoners didn't have history of sexually transmitted diseases (90.0 %), they got infected inside the prison (74.2 %), were multirreoffenders (45.5 %) and didn't enjoy marital relationships (74.2 %). Conclusions: In Cuba syphilis is an important health problem in the penitentiary centers as in other countries, where a rigorous control of sexually transmitted diseases could contribute to reduce its incidence.

ABSTRACT OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments’ percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms’ data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.

Introduction: Syphilis is one of the sexually transmitted infections which, surpassed only by HIV / AIDS, has had devastating effects on humanity and is still a health problem. Objective: To analyze the incidence of syphilis in Cienfuegos during the year 2013-2017. Method: A descriptive, retrospective study was conducted in a series of cases in PCHE (Provincial Center of Hygiene and Epidemiology of Cienfuegos), of patients diagnosed with syphilis in the period 2013 - 2017. The variables used were: age group, sex, behavior sexual, diagnostic classification by type of syphilis, risk factors and sexual orientation. Results: The most affected municipalities were Rodas and Aguada. The highest incidence was in 2013 (21.2%), although in the last two studied years there is no significant difference, with 162 patients in 2016 and 2017 (20.9%), demonstrating a high incidence of syphilis in the province. The prevailing age group was 25 to 59 years, with a total of 477 patients (61.7%), the male sex predominated with 482 patients (62.3%) over the female with 291 patients (37.6%). According to diagnostic classification by type, 395 (51%) corresponded to early latent acquired syphilis and symptomatic acquired 378 (49%). Regarding sexual behavior, it was found that heterosexuals contributed more cases, as well as non-use of the condom in terms of risk factors was the most frequent. Conclusions: There is a significant incidence of syphilis in the province. Early acquired latent syphilis prevails in males. The aim is to increase epidemiological surveillance even more in patients with risky sexual behavior.

Objetivo: Describir las características de los casos de sífilis en internos de prisiones. Material y Método: Estudio descriptivo de los casos confirmados de sífilis primaria, secundaria y latente precoz diagnosticados en prisiones españolas (2007-2008). Se recogieron variables sociodemográficas, clínicas y relacionadas con la transmisión en un cuestionario estandarizado cumplimentado por los médicos de los centros. Se obtuvieron distribuciones de frecuencia de las variables cualitativas y la media y desviación estándar para la edad. Se calculó la tasa de incidencia anual por mil internos. Para evaluar la asociación entre variables cualitativas se utilizaron las pruebas de ji-cuadrado y exacta de Fisher y la de U de Mann-Whitney para las cuantitativas. Resultados: Se identificaron 94 casos de sífilis (35,1% primaria, 20,2% secundaria y 44,7% latente precoz). La tasa de incidencia fue 0,9 y 0,7 casos/1.000 internos en 2007 y 2008, respectivamente. La mayoría de enfermos fueron hombres (90,4%), entre 31 y 40 años (30,9%) y extranjeros (52,1%). El 80,9% de los diagnósticos se realizaron por cribaje. Un 5,3% presentó coinfección con el VIH y el 16% refería haber tenido infecciones de transmisión sexual (ITS) previamente. El mecanismo de transmisión más probable fueron las relaciones heterosexuales (83,0%); la situación de riesgo más común para la adquisición de sífilis fue ser cliente de prostitución (39,4%). Conclusiones: La incidencia de sífilis en prisión es elevada. La oferta de screening de sífilis ha permitido detectar pacientes que no estaban siendo tratados y pone de manifiesto la importancia del sistema penitenciario en el control de las ITS.Objective: To describe the characteristics of cases of syphilis amongst prison inmates. Materials and Methods: Descriptive study. Confirmed cases of primary, secondary and early latent syphilis were identified in prisons in Spain during 2007-2008. Socio-demographic and clinical information, as well as variables related to transmission, was collected by the attending physicians in a standard form. Frequency distributions of each variable were performed. Annual incidence rates were calculated. To evaluate the association between qualitative variables, the χ² and Fisher's exact tests were used; the Mann-Whitney test was utilized to compare quantitative variables. Results: During the study period, 94 syphilis cases were identified (35.1% primary, 20.2% secondary and 44.7% early latent). The incidence rates were 0.9 cases/1000 prisoners in 2007 and 0.7 cases/1000 prisoners in 2008. Most cases were male (90.4%), between 31-40 years old (30.9%) and foreigners (52.1%). The majority of patients were diagnosed through screening (80.9%). Heterosexual contact was the most frequent transmission route (83.0%). Overall HIV prevalence was 5.3%, and 16.0% of the patients had a history of previous sexually transmitted infections (STI). Almost 40% of the cases reported being a client of a sex worker. Conclusions: Incidence of syphilis in prison is high. Many syphilis patients were detected through screening, highlighting the role of the Spanish prison health service in STI control.

The authors report a case of a 45 year old patient, negative VIH,with recurrent stroke, secondary to meningovascular syphilis andtherapeutic failure with ceftriaxone. The neurosyphilis is due to impairment of the nervous central system for the Treponema pallidumin any stadium of the condition, and includes both asymptomatic andsymptomatic forms of the infection. The forms of presentation arediverse and depend of the location and extension of the lesions. TheMRI shown multiple vascular injuries which reflects the impairment ofsmall blood vessels (Nissl arteritis) caused by the Treponema .Thecurrent recommendation of the treatment is with crystalline penicillin G intravenously 4 millions every 4 hours for 14 days. The evidence up to the present time in people’s positive VIH with latent syphilis with or without neurosyphilis treated with ceftriaxone has showned up to 23% of therapeutic failures. There is a lack of information in immunocompetent patients.

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.

Syphilis is an infectious disease caused by the spirochaete Treponema pallidum subsp. pallidum which is transmitted by sexual contact or vertical transmission during pregnancy. The incidence of syphilis has increased in the last years, mainly among men who have sex with men. Without treatment, the disease develops into different clinical stages, being able to present cardiovascular or irreversible neurological complications after a number of years. The disease is classified as early syphilis - primary, secondary and early latent syphilis (less than 12 months) - which is contagious, and as late syphilis - late latent and tertiary syphilis- which is rarely contagious. Diagnosis and management are often a challenge because of its diversity of manifestations and the difficulty of interpretation of serological tests. The treatment of syphilis is based on penicillin or doxycycline in allergic patients. Treatment failure because of resistance has been described with azithromycin. The follow up with a serological test is recommended in all patients with syphilis in order to ascertain cure after the treatment and to diagnose possible reinfections., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Syphilis is produced by Treponema pallidum, which is acquired mainly through sexual contact and transplacental, but can also be acquired by transfusion of contaminated human blood and direct accidental inoculation. The natural history of the infection is characterized by three symptomatic clinical stages: primary, secondary and tertiary syphilis; these last two are preceded by asymptomatic or latent stages of the disease: early latent syphilis and late latent syphilis. This report presents the epidemiological situation of syphilis in Chile up to 2016, using as a method the descriptive analysis of cases that entered surveillance. In the last 5 years the syphilis rate remained relatively stable between 22 and 24 cases per one hundred thousand inhabitants (habs). In 2016, 4,147 cases were reported, showing a rate of 22.8 per one hundred thousand inhabitants. In relation to age, the greatest risk was found in the group of 20 to 34 years. The year 2016 increased the gap between the sexes, by increasing the rate in men. According to geographical distribution, in 2016 the highest notification rates are presented in the regions of the extreme north and center of the country, with the highest risk being the regions of Tarapacá, Antofagasta and Valparaíso. Congenital syphilis showed a progressive decrease in the number of cases since 2012 (n = 39) to 2016 (n = 24), whose rate was 0.1 per thousand live births.

Background and Objective: To study the epidemiology, diagnosis, treatment strategies and perinatal outcomes of gestational syphilis., Patients and Method: We performed a retrospective study of 94 pregnant women with syphilis whose gestation and delivery were monitored in a Department of Obstetrics from 2002 to 2010 among a total of 85,806 births of women without syphilis in the same period., Results: The prevalence of gestational syphilis was 0.11%. Most of the women were foreign and the most prevalent type was late latent syphilis. Only 57 patients underwent right treatment despite adequate prescription. Maternal complications were confirmed in 31 pregnant women and 16 cases had fetal complications. We diagnosed 4 cases of neonatal syphilis, 3 of them with syphilitic meningitis, whose mothers had not completed the treatment correctly., Conclusions: The implementation of a mandatory syphilis serology in the pregnancy has enabled us to diagnose many cases of late latent syphilis. The successful completion of treatment must be ensured to prevent vertical transmission., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objective: To describe the characteristics of cases of syphilis amongst prison inmates., Materials and Methods: Descriptive study. Confirmed cases of primary, secondary and early latent syphilis were identified in prisons in Spain during 2007-2008. Socio-demographic and clinical information, as well as variables related to transmission, was collected by the attending physicians in a standard form. Frequency distributions of each variable were performed. Annual incidence rates were calculated. To evaluate the association between qualitative variables, the χ² and Fisher's exact tests were used; the Mann-Whitney test was utilized to compare quantitative variables., Results: During the study period, 94 syphilis cases were identified (35.1% primary, 20.2% secondary and 44.7% early latent). The incidence rates were 0.9 cases/1000 prisoners in 2007 and 0.7 cases/1000 prisoners in 2008. Most cases were male (90.4%), between 31-40 years old (30.9%) and foreigners (52.1%). The majority of patients were diagnosed through screening (80.9%). Heterosexual contact was the most frequent transmission route (83.0%). Overall HIV prevalence was 5.3%, and 16.0% of the patients had a history of previous sexually transmitted infections (STI). Almost 40% of the cases reported being a client of a sex worker., Conclusions: Incidence of syphilis in prison is high. Many syphilis patients were detected through screening, highlighting the role of the Spanish prison health service in STI control.

Introduction: In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience., Methods: We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006., Results: Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38 %) had a peripheral blood CD4 cell count CD4 + or= 1:32., Conclusion: In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups.

The non-treponemic fast detection test of plasmatic reagines (RPR) and the treponemic hemagglutination test of Treponema pallidum were used in the detection of infection due to T. pallidum in 60 males presenting HIV/AIDS infection with clinicoepidemiological diagnosis of syphilis. It was confirmed that 30% presented recently acquired symptomatic or latent syphilis and that 10% had markers of past treated infection or of late acquired latent syphilis, whereas in the other 60% no serological reactivity was detected. A seroprevalence study of reaginic antibodies was conducted by RPR in 59 HIV/AIDS females, using 67 women negative to this virus as controls. All of them had no symptoms compatible with the syphilitic infection. It was concluded that 20.3% and 11.9%, respectively, presented reactivity, which established a probable diagnosis of syphilis or a seroresistance to a previouos syphilis. These results showed a close association between syphilis and HIV/AIDS and that both diseases may coexist in a same patient.

A retrospective chart review of 439 pregnant women with positive syphilis serology detected with VDRL was made. One hundred twenty two women (27.7%), aged 17 to 43 years and with a gestational age ranging from 8 to 38 weeks, had false positive VDRL tests. None of these patients had a titer over 1:4 and 65% had a weakly reactive VDRL. Forty percent of women were diagnosed as having an early latent syphilis and 20% as late latent syphilis. Due to the high frequency of these later diagnoses in women with VDRL titers below 1:2, with no risk factors and negative sexual partners, post partum follow up is essential to detect cases with false positive FTA-ABs tests.

Although it was common in the preantibiotic era, paroxysmal cold hemoglobinuria (PCH) is now an exceptional condition. A 34-year-old female with anemia and episodic hemoglobinuria provoked by cold is reported. The laboratory studies suggested intravascular hemolytic anemia, and the Donath-Landsteiner test showed a biphasic IgG hemolysin with anti-P specificity. This finding and the evidence of latent syphilis were diagnostic of PCH. Penicillin therapy suppressed the hemolytic episodes, although the Donath-Landsteiner test is still positive. It is concluded that PCH is still an exisiting disease which should be considered in the differential diagnosis of episodic hemoglobinuria.

With the acquisition of specialized laboratory techniques, as the determination of serum immune complexes and the auditory evoked potentials, which bring new knowledge, the study of syphilis must be reviewed, in particular the classification of the evolution periods. The authors consider latent syphilis and neuro-syphilis. Based on these facts the new ways of treatment as well as the evolution control must be revised. These test should always be performed in order to determine exactly the syphilis period of the patient.