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Increases in the prevalence of syphilis, along with difficulties in recognizing its various clinical presentations, make it an elusive diagnosis. A primary asymptomatic chancre may go unnoticed. Secondary syphilis rash can masquerade as numerous dermatological conditions. Latent syphilis is asymptomatic. Tertiary syphilis can affect the cardiovascular and neurological systems. Failure to correctly diagnose syphilis in its earlier stages leads to dissemination of infection to sexual partners. A positive screening nontreponemal test is confirmed with a treponemal test. Treatment response is monitored by serologic titers. Sexual contacts must be treated. Diagnosis, treatment, and management are presented for 4 stages of syphilis.

Although primary syphilis generally involves the genitalia, literature reports that 12% of chancres are extragenital, with the anus and oral cavity as the most frequent locations. We present hereby a case series of four chancres of the finger observed at the sexually transmitted infection centre of Milan between 2010 and 2021.

A systematic review of case reports and series of oral syphilis found that the most affected anatomical site was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). Supplemental digital content is available in the text., Rapid emergence of syphilis and oral sexual behaviors has focused attention on oral syphilis, and published reports of cases with oral syphilis have increased in the recent decades. We performed a systematic literature review by searching articles from PubMed, EMBSE, and Google Scholar, looking for case reports or series that would potentially have the clinical characteristics and outcomes for each individual case with oral syphilis. A total of 145 cases with the infection, from 95 studies, were identified to include in our review. Two main clinical phenotypes (ulcerative lesions and mucous patches) appeared to be of particular relevance to oral manifestations. A solitary ulcer was mostly manifested as the lesion of primary syphilis (91.7%) preferentially located on the upper lip, tongue, palate, and buccal mucosa. The most affected anatomical site in the patients with single location involved was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). It is concluded that oral syphilis has its predominant clinical phenotypes although it can manifest in diverse manners.

Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers.a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement.Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales.hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría.la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

BACKGROUND: Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of “the great imitator,” oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS: A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS: We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS: Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.

In the previous meeting, I had the honor to present to a respected society a patient with primary and multiple chancre of the vagina, sexually inoculated.

The article presents clinical cases of syphilitic infection from our own practice, which were not recognized by doctors of related specialties at the early stages of the development of the disease. In the first observation, the manifestations of syphilis were regarded as a surgical pathology in the patient, which entailed surgical intervention, which was not necessary as such. The following clinical case demonstrates lesions of the mucous membranes in syphilis, mistakenly recognized by the therapist as streptococcal angina. The atypical hard chancre in the final observation disorientated the surgeon, that led to a delay in the correct diagnosis and, accordingly, in the appointment of adequate treatment. Regardless of the specialty, everyone should not forget about the variety of manifestations of syphilis in all periods. The lack of alertness among doctors of related specialties contributed to the delayed diagnosis and the appointment of specific anti-syphilitic therapy.

Syphilis, a sexually transmitted disease, can be categorized as acquired syphilis and congenital syphilis, manifesting diverse lesions involving multiple sites. Oral manifestations at the primary stage of acquired syphilis are usually characterized by its short period and non-specific varied presentations. And oral ulcers as initial and the only presentation of syphilis oral lesions are infrequent and occur in less than 2% of patients. Because of its transient nature and variable manifestations which could mimic other oral ulcerative lesions, oral syphilis presenting as sole ulceration at early stage can be easily neglected and rather difficult to diagnose. Herein, we report a 35-year-old female patient manifested a sole atypical ulceration on her upper lip for approximately 1 month. We highlighted the importance of early and accurate diagnosis, focused on the characteristics of oral chancre, and gave an insight to the differential diagnoses, which would be enlightening and useful in clinical practice.

Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The primary stage of the disease (the chancre) mainly involves the genital areas. Extragenital areas are involved in 5%-14% of cases, many of which occur in the oral cavity. Among the extragenital locations, the lip is the most frequent; however, despite this, published cases of the chancre of the lip are few. We present a case of a chancre presenting on the lip of a nonimmunocompromised 55-year-old male patient with immunohistochemical confirmation.

Syphilis continues to be a significant public health concern worldwide. The disease is endemic in many low- and middle-income countries, and rates have risen sharply in high-income countries over the last decade. The continued prevalence of infectious and congenital syphilis worldwide highlights the need for the development of an effective syphilis vaccine to complement public health measures for syphilis control. The complex, multi-stage course of syphilis infection necessitates a holistic approach to the development of an effective vaccine, in which immunization prevents both the localized stage of infection (typified by the highly infectious chancre) and the disseminated stages of infection (typified by the secondary rash, neurosyphilis, and destructive tertiary lesions, as well as congenital syphilis). Inhibiting development of the infectious chancre would reduce transmission thus providing community- level protection, while preventing dissemination would provide individual-level protection by reducing serious sequelae and may also provide community level protection by reducing shedding during secondary syphilis. In the current study we build upon prior investigations which demonstrated that immunizations with individual, well characterized T. pallidum TprK, TprC, and Tp0751 peptides elicits partial protection against infection in the animal model. Specifically, we show here that immunization with a TprC/TprK/Tp0751 tri-antigen cocktail protects animals from progressive syphilis lesions and substantially inhibits dissemination of the infection.

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Human African trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. It is caused by infection with protozoan parasites belonging to the genus Trypanosoma. They are transmitted to humans by tsetse fly (Glossina genus) bites which have acquired their infection from human beings or from animals harboring human pathogenic parasites. Tsetse flies are found just in sub-Saharan Africa though only certain species transmit the disease. We report a case of human African trypanosomiasis in a 28-year-old Indian female who had a travel history to sub–Saharan Africa, Uganda and she presented with a history of fever, body ache, headache, decreased oral intake, pain lower abdomen, swelling and discharge from forearm chancre since last 4-5 days. Peripheral smear showed heavy parasitemia by flagellated forms of Trypanosoma and the diagnosis of Trypanosoma brucei was given on Peripheral smear report. Serological testing was also done and a diagnosis of West-African trypanosomiasis was confirmed. The patient was successfully treated and made a good recovery. So West-African trypanosomiasis should be considered in the differential diagnosis with presentation of fever with chancre in every person with recent history of travel to African countries as it is universally fatal without treatment.

In the spring of 2018, necrotic and canker symptoms were observed on stems of young apple trees that were bench-grafted by growers on four rootstocks (EMLA 9, Supporter 4, M9-T337 and Pajam...

A man in his 50s was referred to hospital by his general practitioner with a suspected rectal lesion after rectal examination. He had also experienced intermittent constipation without rectal pain for five years, which he had managed with self-administered simple enemas once a week for the past three years, but these were not effective at relieving the constipation. He had a medical history of intolerance to penicillin. Full details of his sexual history could not be elicited. Digital rectal examination showed a non-tender rectal lesion of about 3 cm in diameter on the left side of the rectum; it had a smooth base, was slightly raised, and had indurated borders. Relevant laboratory test results are shown in table 1. View this table: Table 1 Relevant laboratory test results Magnetic resonance imaging showed irregular low rectal wall thickening (about 4 cm …

Cutaneous tuberculosis is caused by Mycobacterium tuberculosis with varied clinical features depending on the dissemination route and host immune status. Scrofuloderma is a type of cutaneous tuberculosis that often occurs in locations where there is an infected lymph node or bone underneath, whereas tuberculous chancre often appears in sites that are prone to trauma. Although several cases have been reported, the coexistence of more than one type of cutaneous tuberculosis is very rare. We report a 21-year-old immunocompetent male with a chronic nonhealing lesion on the left tibia followed by bilateral purulent ulcers on the submandibular area. Acid-fast bacilli examination was positive for M. tuberculosis, and the patient was diagnosed with tuberculous chancre and scrofuloderma, respectively. This case showed the importance of high clinical suspicion of cutaneous tuberculosis and the possibility of the coexistence of more than one type of cutaneous tuberculosis in order to avoid misdiagnosis and delay in treatment.

We describe a 17-year-old man who developed penile annular and scrotal eczematoid syphilids with penile chancre redux. Dermoscopy showed linear-irregular and hairpin vessels with white scales in annular lesions. Histopathology displayed psoriasiform hyperplasia with perivascular lymphoplasmacytic dermal infiltrate. Rapid plasma reagin and Treponema pallidumparticle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin.

Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.

BackgroundSyphilis incidence has exponentially increased in recent decades, particularly among men who have sex with men (MSM). Primary syphilis is characterised by a chancre appearing at the site of Treponema pallidum (TP) inoculation. Atypical morphological variants of syphilitic chancre are frequent. Clinical suspicion must be confirmed either by the demonstration of TP within the lesion through direct tests, such as dark field microscopy (DFM) or T. pallidum nucleic acid amplification technique (TP-NAAT), or by serological tests.ObjectivesTo analyse the clinical features, the sexual behaviour and the role of diagnostic tests in a cohort of men with primary syphilis in Milan.MethodsEpidemiological, clinical and laboratory data of male patients with primary syphilis seen at the STI Center of the University of Milan between 2015 and 2019 were retrospectively evaluated. Diagnosis was confirmed by at least one positive diagnostic test of either DFM, TP-NAAT or serology.ResultsAmong a total of 244 patients, 160 (65.6%) were MSM and 32 (13.1%) were living with HIV. One hundred twenty-four (50.8%) patients had a clinically atypical chancre. Chancres were exclusively extragenital in 30 (12.3%) patients, with MSM being more commonly affected (MSM vs heterosexuals: 16.3% vs 4.8%, respectively; p=0.012), and anal region the most frequently involved site. Chancres were multiple in 68/242 (28.1%) patients and morphologically atypical in 76/244 (31.1%). Diagnosis was obtained by (1) both serology and direct methods in 158/244 patients (64.7%), (2) serology solely in 47/244 (19.3%) and (3) direct methods solely in 39/244 (16%). DFM yielded positive results in 83/139 (59.7%) patients, while TP-NAAT gave positive results in 114/121 (94.2%) patients.ConclusionsPatients with primary syphilis frequently present with morphologically atypical chancres. Furthermore, MSM commonly exhibit extragenital involvement. A combined diagnostic approach including both direct and indirect tests is needed.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The signs and symptoms of syphilis vary depending on which of the four stages it presents. The primary stage of syphilis classically presents with a painless ulcer (chancre). We report a case of the extragenital chancre on the nipple which is examined from skin biopsy and immunohistochemistry. This case showed that it is important to identify the special site’s pruritus erythema by pathology and serological examination.

14 Pág. (This article belongs to the Special Issue Integrating Science on Xanthomonas and Xylella for Integrated Plant Disease Management), Xanthomonas citri pv. citri (Xcc) and X. citri pv. aurantifolii (Xca) are causal agents of Citrus Bacterial Canker (CBC), a devastating disease that severely affects citrus plants. They are harmful organisms not reported in Europe or the Mediterranean Basin. Host plants are in the Rutaceae family, including the genera Citrus, Poncirus, and Fortunella, and their hybrids. In addition, other genera of ornamental interest are reported as susceptible, but results are not uniform and sometimes incongruent. We evaluated the susceptibility of 32 ornamental accessions of the Rutaceae family belonging to the genera Citrus, Fortunella, Atalantia, Clausena, Eremocitrus, Glycosmis, Microcitrus, Murraya, Casimiroa, Calodendrum, and Aegle, and three hybrids to seven strains of Xcc and Xca. Pathotyping evaluation was assessed by scoring the symptomatic reactions on detached leaves. High variability in symptoms and bacterial population was shown among the different strains in the different hosts, indicative of complex host–pathogen interactions. The results are mostly consistent with past findings, with the few discrepancies probably due to our more complete experimental approach using multiple strains of the pathogen and multiple hosts. Our work supports the need to regulate non-citrus Rutaceae plant introductions into areas, like the EU and Mediterranean, that are currently free of this economically important pathogen., This research was funded ORPRAMed Project on “Risk assessment of introduction of Xanthomonas citri subsp. citri through commercial trade of ornamental rutaceous plants in the Mediterranean basin”, ERA-NET ARIMNET 2-Call 2015.C.B., V.C. acknowledge the University of Catania for support under the projects “Investigation of phytopathological problems of the main Sicilian productive contexts and eco-sustainable defense strategies” (PIA.CE.RI. 2020–2022 Linea 2-Research Project MEDIT-ECO.); “Emergent Pests and Pathogens and Relative Sustainable Strategies” (Progetto di ricerca di Ateneo 2018-2020). O.P. and I.R. acknowledge the European Union (ERDF, EAFRD) and Réunion regional council for support

We believe this to be the first report of coexisting polymerase chain reaction (PCR)-confirmed primary genital and ocular syphilis in a patient with penicillin allergy treated with doxycycline. The case examines the use of nonpenicillin and corticosteroid treatment of ocular syphilis and highlights the risk of eye involvement early in the disease process.

espanolLa sifilis es una infeccion bacteriana cronica causada por Treponema pallidum que se transmite fundamentalmente por via sexual. La enfermedad tiene importancia no solo clinica sino tambien de salud publica. Las manifestaciones clinicas son muy variadas y van desde una ulcera o chancro hasta lesiones cutaneas diseminadas, cardiovasculares, neurologicas, oftalmologicas o articulares. Ademas de la morbilidad que provoca, facilita la transmision de la infeccion por el VIH y puede generar secuelas en ninos nacidos de madres afectas. Sin tratamiento, la enfermedad progresa durante anos y puede provocar complicaciones neurologicas y cardiacas. A pesar de su antiguedad, los principios del tratamiento han permanecido estables durante decadas. El diagnostico y el manejo son en ocasiones complejos por la variedad de manifestaciones y la dificultad de interpretacion de las pruebas serologicas empleadas. La penicilina es el tratamiento de eleccion. La respuesta al tratamiento se determina en base a los cambios de los titulos de anticuerpos durante meses tras el tratamiento. EnglishTreponemal infections. Syphilis Syphilis is a chronic bacterial infection caused by Treponema pallidum and is essentially sexually transmitted. The disease is important clinically and in terms of public health. The clinical manifestations are very varied and range from an ulcer or chancre to disseminated skin, cardiovascular, neurological, ophthalmological and joint lesions. In addition to the morbidity caused by the condition, it facilitates HIV infection and can cause sequelae in children born of infected mothers. Untreated, the disease progresses for years and can cause neurological and cardiac complications. Despite their antiquity, the principles of treatment have remained the same for decades. Diagnosis and management can occasionally be complex due to the variety of manifestations and the difficulty in interpreting serological tests. Penicillin is the standard treatment. Response to treatment is determined based on changes in the antibody titres in the months after treatment.

Clinical Presentation A 38-year-old male patient presented to the local oral and maxillofacial surgery department with a 3-month history of a persistent ulcer on the left lateral border of the tongue. The ulcer had raised edges but was not painful to palpation. The patient was fit and well and a nonsmoker. Clinical photographs and an incisional biopsy were used to investigate the cause. Histology Histologic examination showed oral mucosa comprising parakeratinized, stratified squamous epithelium that centrally was ulcerated. A dense chronic inflammatory infiltrate dominated by plasma cells was identified within connective tissue extending into muscle. Numerous neutrophils were noted in the surface layers of the epithelium. The findings of special stains for fungal hyphae were negative; however, the finding of immunohistochemistry for Treponema pallidum was positive, highlighting the spirochete organisms. The lesion was diagnosed as a syphilitic ulcer. Further Investigations Following the histologic diagnosis, the patient was referred to the genitourinary medicine department for further investigations, including blood serology and definitive treatment. Discussion There has been a recent increase in the number of reported cases of syphilis. Primary presentation of the sexually transmitted disease is in the form a chancre, a solitary ulcer, at the site of infection. Although chancres typically present within the genital region, oral presentation is also possible and is perhaps overlooked as a differential diagnosis of ulceration within the oral cavity. We will discuss the case in detail, focusing on the clinical presentation, differential diagnoses, and treatment rationale.

While the origins of syphilis remain unknown, it has long been recognized as an infectious entity with complex pathophysiology. In this review, we highlighted the epidemiology and risk factors associated with syphilis. The incidence of syphilis in most populations showed a consistent upward trend until the 1940s with the introduction of penicillin as the preferred treatment. The emergence of congenital syphilis and vertical transmission has been a direct result of heterosexual syphilis transmission. We also explore the microbiology and pathogenesis of Treponema pallidum as it directly correlates with its route of transmission and infectivity. The clinical features are best categorized into stages (primary, secondary, early, and late latent and tertiary). The primary stage presents as a characteristic chancre and inguinal adenopathy, while the secondary "bacteremia" stage has a predilection to dermatologic manifestations and constitutional symptoms. The latent phase of syphilis witnesses a quiescent period with variable relapse of symptoms and finally, one-third of untreated patients undergo tertiary syphilis years after the initial infection characterized by severe neurologic or cardiovascular symptomatology. We will also review the data collected for congenital syphilis from the CDC as this can manifest with stillbirth, neonatal death, and nonimmune hydrops. The diagnosis of syphilis focuses on a combination of nontreponemal and treponemal antibody tests with the CDC recommending a traditional algorithm from screening to confirmation. However, other agencies have recently adopted the reverse testing algorithm which has outperformed the traditional algorithm in certain populations. We finally focus on syphilotherapy and monitoring response to treatment with a specific emphasis on pregnancy. Birth Defects Research 109:347-352, 2017. © 2017 Wiley Periodicals, Inc.

Syphilis has re-emerged as a significant public health threat in recent years. While most cases of syphilis are currently diagnosed in low-income and middle-income countries, the incidence of syphilis has been increasing in Western industrialised countries since the 1990s, particularly among gay, bisexual and other men who have sex with men (MSM).1 Increased rates among heterosexuals in these countries have also been reported in more recent years, most often in marginalised populations.2 In England, there were 7982 diagnoses of syphilis during 2019, a 200% increase since 2010. Although three-quarters of cases were diagnosed in MSM, cases in heterosexual men and women have increased by 69% and 117%, respectively, between 2015 and 2019, and the number of cases of congenital syphilis (CS) has also increased.3 The underlying drivers of the increase in heterosexually acquired syphilis cases in England remain unclear. Syphilis is caused by Treponema pallidum subspecies pallidum and is typically transmitted by direct contact with an infectious lesion during sexual intercourse. The clinical presentation of syphilis is divided into three stages, primary, secondary and tertiary, and the first two are the most infectious stages. Typically, primary syphilis presents as a painless ulcer (chancre) which usually occurs in genital sites and resolves within 3 to 8 weeks. If left untreated, 25% of patients will develop secondary syphilis, a systemic disease characterised by fever, rash and lymphadenopathy. Secondary syphilis will resolve spontaneously in 3 to 12 weeks and all untreated cases will progress to latent (asymptomatic) infection, with one-third …

A 34-year-old woman managed at the department of skin and venereal diseases was diagnosised with primary syphilis (with gangrenisation and phagedenisation of the hard chancre) and HIV co-infection. In the nasolabial triangle area there was a large ulcerated defect of an irregular configuration and with dense crusts of brown-black colour, transiting to the nasal septum. The complete scarring of the chancre was observed on the 17th day. Complications of syphilis can have physical, psychological and social consequences and even lead to disability.

Background Syphilis causes considerable morbidity not only in adults but also in children. Unfortunately, acquired syphilis in children has not received due attention and remains a relatively ignored field. Methods This was a retrospective study, in which epidemiologic, clinical, and investigational data were analyzed from medical records of all sexually transmitted infection (STI) cases attending the STI clinic of Pt. B. D. Sharma, PGIMS, Rohtak from January 1992 to November 2018. Children of age ≤14 years with acquired syphilis were studied. Results Of 9138 STD cases registered from January 1992 to November 2018, 39 were children with acquired syphilis, of whom 22 were males and 17 were females. The majority were in 12-14 years age group (22 cases; 56.41%). A history of sexual abuse could be elicited in 10 patients. Three gave a history of voluntary sexual activity. Examination revealed secondary syphilis in 32, latent syphilis in 6 and only one case of primary chancre. Analysis of incidence of pediatric acquired syphilis cases over three-year intervals during the last 27 years indicated an initial decreasing trend followed by recent slight rise in last 3 years. Conclusion Social inhibitions and reluctance to report child sexual abuse may have led to an underestimate of actual prevalence. The prevalence in the 12- to 14-year age group may indicate emerging trends of promiscuous sexual behavior. The recent rising trend in occurrence of childhood acquired syphilis may mirror the recent resurgence of adult syphilis.

Syphilis and HIV infection share the same high-risk groups and transmission ways, so coinfection is common. Syphilis enhances the risk of the transmission and acquisition of HIV. The natural history and clinical manifestations of syphilis can be modified by concomitant HIV infection, which can rapidly progress from primary syphilis to tertiary syphilis. HIV infection can change the face of syphilis. In primary syphilis, chancre lesions can be multiple and larger; ocular syphilis can occur in early and late syphilis; malignant syphilis is more common in AIDS patients. The biological false negative of nontreponemal cardiolipin test is common in HIV/AIDS patients with syphilis. The incidence of neurosyphilis is significantly increased, while the diagnosis of neurosyphilis is difficult because of HIV infection.

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and has shown a significant increase in recent decades. It may be associated with other STIs such as soft chancre or chancroid, which is an uncommon infection in Brazil. The presence of ulcerated genital lesions is associated with a higher risk of HIV transmission. An accurate clinical and laboratory diagnosis of genital ulcer disease is essential for the appropriate treatment of pregnant women, in order to avoid congenital syphilis, a severe complication of mother-to-child vertical transmission. We report the case of a woman in the third trimester of pregnancy with Rollet’s mixed chancre and describe the clinical and laboratory diagnosis, as well as the treatment of these diseases in pregnancy. We emphasize the importance of training health professionals on early diagnosis and treatment in order to avoid mother-to-child transmission. Keywords: Chancroid, Syphilis, congenital, STI, Syphilis, Pregnancy

Background Effective syphilis control could be achieved by reducing its duration of infectiousness, for example, by identifying a higher proportion of cases at the primary stage. We hypothesised that men who have sex with men (MSM) who practice receptive anal intercourse (“bottoms”) are more likely to miss the primary stage and present with secondary syphilis, compared to MSM who practice exclusively insertive anal intercourse (“tops”). Methods This was a retrospective analysis of MSM diagnosed with either primary or secondary syphilis at Melbourne Sexual Health Centre between 2008 and 2017. We analysed associations between the stage of syphilis (primary vs secondary) and sexual behaviour data collected by computer-assisted self-interview (CASI). Results 559 MSM diagnosed with syphilis provided sufficient behavioural data for analysis, of whom 338 (60%) had primary syphilis and 221 (40%) had secondary syphilis. Among “tops”, 77% (95%CI 69–84) presented with primary syphilis and 23% (95%CI 16–31) presented with secondary syphilis. Whereas among “bottoms”, 54% (95%CI 49–59) presented with primary syphilis and 46% (95%CI 41–51) presented with secondary syphilis. Among those with primary syphilis, 247 (73%, 95%CI 68–78) had a penile chancre and 77 (23%, 95%CI 19–28) had an anal chancre. In multivariate logistic regression, “bottoms” were more likely to present with secondary syphilis than “tops” (aOR 3.90, p Conclusion “Bottoms” more often presented with secondary syphilis compared to “tops”, and most MSM who presented with primary syphilis had penile chancres rather than anal chancres. This suggests that MSM who have receptive anal intercourse may be more likely to overlook anal syphilis chancres, perhaps because these are located inside their anal canal. These men may benefit from additional strategies to improve the recognition of anal chancres. Disclosure No significant relationships.

Background A protective vaccine against Treponema pallidum subsp. pallidum (T. pallidum) would facilitate syphilis control at a global scale. We have identified three T. pallidum antigens that, when used separately as immunogens, either attenuate chancre development at the challenge site or pathogen dissemination. Here, we report protection induced by a vaccine desing composed of these three antigens + two custom adjuvants containing Natural or Synthetic TLR4 agonists and a natural Mincle agonist. Methods Recombinant TprK (aa 37–273), Tp0751 (aa 24–237), and Subfamily I Tpr (aa 23–351) peptides were emulsified in either adjuvant and used to immunize groups of eight rabbits. Immunized animals were challenged intradermally with 10^5 T. pallidum/site at 10 sites, along with eight unimmunized control animals. Lesion development was recorded daily and treponemal burden measured by darkfield (DF) microscopy and qPCR of lesion aspirates and biopsies. Dissemination to distant tissues was evaluated by qPCR and rabbit infectivity test (RIT). Results Compared to unimmunized, treponemal burden by DF in lesion aspirates at Day 19 was significantly lower in animals that received both Natural and Synthetic adjuvant groups. By qPCR, treponemal burden was significantly lower in the Natural group. At day 19 and 30, respectively, the proportion of lesions ulcerating was significantly lower in the Natural group, compared to Unimmunized. At day 30, the proportion of lesions ulcerating in the Natural group was significantly lower than in the Synthetic group. Mean lesion volume was smaller in immunized groups versus unimmunized on days 10–25 post-challenge. RIT indicated the lowest number of disseminated T. pallidum in rabbit tissues from the Natural group, followed by the Synthetic group, then the unimmunized group. Conclusion Immunization with the three-antigen cocktail significantly attenuates syphilis infection: enhancing T. pallidum clearance, promoting lesion healing, and reducing dissemination. In rabbits, Natural adjuvant was more effective than Synthetic adjuvant in inducing protective immunity. Disclosure No significant relationships.

An atypical early primary syphilis case presentation with multiple umbilicated papular lesions on the penis and a nonreactive syphilis serology was misdiagnosed as molluscum contagiosum. Over a period of eight weeks, prior to dermatologic consultation, the papules enlarged, ulcerated, and healed. New plaque and patch formation on the penis and scrotum led to a differential diagnosis of inverse psoriasis vs. syphilis. Histological examination of a shave biopsy specimen revealed numerous Treponema pallidum organisms and repeat syphilis serological test results confirmed a syphilis diagnosis. Lesions responded to treatment with benzathine penicillin. One must keep a high index of suspicion for syphilis in light of its diverse presentation and increasing incidence.

Background: Men who have sex with men (MSM) have frequent rectal infections. Although a large increase in incidence of syphilis has been reported in recent years, rectal chancre is a rare manifestation that can easily be neglected.Methods: We describe a male patient who had sex with men and presented with protracted chronic proctitis and scaly rashes. A diagnosis of HIV infection and early syphilis with syphilitic proctitis (rectal chancre) was confirmed by the findings of ulcerative proctitis under colonoscopy, the presence of Treponema pallidum in rectal ulcer biopsy specimens by immunohistochemistry, and positive serologic test results for human immunodeficiency virus type 1 (HIV-1) and syphilis.Results: Intramuscular benzathine penicillin G (2.4 million Units) given once a week for three consecutive weeks resulted in complete resolution of rectal and skin lesions. The patient also began regular anti-viral therapy against HIV infection.Conclusion: Immunohistochemical detection of Treponema pallidum in the primary infection tissue is a useful complement to serologic tests for the diagnosis of syphilis by clinical laboratories. Healthy and protective sexual behavior is advocated to avoid possible infections in MSM.

Syphilis is caused by infection with Treponema pallidum subsp. pallidum, a not-yet-cultivable spiral-shaped bacterium that is usually transmitted by sexual contact with an infected partner or by an infected pregnant woman to her fetus. There is no vaccine to prevent syphilis. Diagnosis and treatment of infected individuals and their contacts is key to syphilis control programs that also include sex education and promotion of condom use to prevent infection. Untreated syphilis can progress through four stages: primary (chancre, regional lymphadenopathy), secondary (disseminated skin eruptions, generalized lymphadenopathy), latent (decreased re-occurrence of secondary stage manifestations, absence of symptoms), and tertiary (gummas, cardiovascular syphilis and late neurological symptoms). The primary and secondary stages are the most infectious. WHO estimates that each year 11 million new cases of syphilis occur globally among adults aged 15-49 years. Syphilis has re-emerged in several regions including North America, Western Europe, China and Australia. Host-associated factors that drive the re-emergence and spread of syphilis include high-risk sexual activity, migration and travel, and economic and social changes that limit access to health care. Early, uncomplicated syphilis is curable with a single intramuscular injection of benzathine penicillin G (BPG), the first line drug for all stages of syphilis. Emergence of macrolide-resistant T. pallidum has essentially precluded the empirical use of azithromycin as a second-line drug for treatment of syphilis. Virulence attributes of T. pallidum are poorly understood. Genomic and proteomic studies have provided some new information concerning how this spirochete may evade host defense mechanisms to persist for long periods in the host.

Young olive trees showing wilting and trunk cankers were observed in an orchard in Antalya province, Turkey. The aerial symptoms associated with reddish brown cankers expanding from the root collar to the stem were leaf discolouration, defoliation, and twig dieback. A Phytophthora sp. was consistently isolated from necrotic root and crown tissues of symptomatic trees. The causal agent of the disease was identified as Phytophthora inundata by morphological characteristics and comparison of sequences of the Internal Transcribed Spacer (ITS) region. Pathogenicity of the isolates was tested by stem inoculation and soil infestation using olive saplings. At the end of the experiments, lesions developed on both stems and roots, and root weight reduction occurred. This is the first report of P. inundata causing disease of olive trees in Turkey.