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Syphilis is caused by infection with the spirochetal bacterium Treponema pallidum subsp. pallidum. It was first recognized in the late 15th century. Since 2000, the incidence of sexually acquired syphilis has increased substantially in the developed world, with men who have sex with men and persons living with HIV infection disproportionately affected. Clinical manifestations of syphilis are protean and often include mucocutaneous manifestations. The first article in this continuing medical education series reviews historical aspects, microbiology, epidemiology, and clinical manifestations of sexually acquired syphilis., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Secondary syphilis has a wide spectrum of clinical and histologic manifestations., Objective: We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings., Methods: In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present., Results: The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%)., Limitations: This was a retrospective review., Conclusion: The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Sexually transmitted diseases (STDs) continue to be a global epidemic with significant risk of morbidity/mortality for the fetus. STDs with prominent cutaneous findings including condylomata acuminata, genital herpes infections, and syphilis are reviewed. Important clinical cutaneous findings help aid early diagnosis and facilitate treatment. Condylomata acuminata have the potential of causing cervical cancer, anogenital cancer, and oropharyngeal cancer. Significant advances have been made in human papilloma virus vaccinations and treatment. Genital herpes infection can produce significant physical and emotional distress to the patient and significant potential harm to the fetus. Early clinical recognition of STDs and their appropriate management is critical.

Syphilis is back since 2000. Early syphilis comprises primary syphilis, secondary syphilis and early latent syphilis (less than 1 year duration). During early phases of syphilis, patients are more contagious and neurologic complications are rare. Early neurosyphilis are mostly represented by uveitis or cranial nerves lesions. Treatment of non-neurologic syphilis are based on intramusculary injection of benzathine-penicilline G: one injection in case of early syphilis, three injections in case of late syphilis. The follow-up after treatment is based on clinical evolution and the titer of VDRL. Intravenously infusion of penicillin G is the only treatment recommended for neurosyphilis., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Venereal syphilis is a multi-stage, sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum (Tp). Herein we describe a cohort of 57 patients (age 18-68 years) with secondary syphilis (SS) identified through a network of public sector primary health care providers in Cali, Colombia. To be eligible for participation, study subjects were required to have cutaneous lesions consistent with SS, a reactive Rapid Plasma Reagin test (RPR-titer > or = 1 : 4), and a confirmatory treponemal test (Fluorescent Treponemal Antibody Absorption test- FTA-ABS). Most subjects enrolled were women (64.9%), predominantly Afro-Colombian (38.6%) or mestizo (56.1%), and all were of low socio-economic status. Three (5.3%) subjects were newly diagnosed with HIV infection at study entry. The duration of signs and symptoms in most patients (53.6%) was less than 30 days; however, some patients reported being symptomatic for several months (range 5-240 days). The typical palmar and plantar exanthem of SS was the most common dermal manifestation (63%), followed by diffuse hypo- or hyperpigmented macules and papules on the trunk, abdomen and extremities. Three patients had patchy alopecia. Whole blood (WB) samples and punch biopsy material from a subset of SS patients were assayed for the presence of Tp DNA polymerase I gene (polA) target by real-time qualitative and quantitative PCR methods. Twelve (46%) of the 26 WB samples studied had quantifiable Tp DNA (ranging between 194.9 and 1954.2 Tp polA copies/ml blood) and seven (64%) were positive when WB DNA was extracted within 24 hours of collection. Tp DNA was also present in 8/12 (66%) skin biopsies available for testing. Strain typing analysis was attempted in all skin and WB samples with detectable Tp DNA. Using arp repeat size analysis and tpr RFLP patterns four different strain types were identified (14d, 16d, 13d and 22a). None of the WB samples had sufficient DNA for typing. The clinical and microbiologic observations presented herein, together with recent Cali syphilis seroprevalence data, provide additional evidence that venereal syphilis is highly endemic in this region of Colombia, thus underscoring the need for health care providers in the region to be acutely aware of the clinical manifestations of SS. This study also provides, for the first time, quantitative evidence that a significant proportion of untreated SS patients have substantial numbers of circulating spirochetes. How Tp is able to persist in the blood and skin of SS patients, despite the known presence of circulating treponemal opsonizing antibodies and the robust pro-inflammatory cellular immune responses characteristic of this stage of the disease, is not fully understood and requires further study.

Congenital syphilis (CS) is a preventable disease. Nevertheless, since the year 2000, there has been an upward trend in incidence in Spain, similar to what has occurred in other European countries. We present a case of early congenital syphilis showing the classical features of the disease, in which skin lesions gave the clue that led to the diagnosis.

Diagnosis and treatment of syphilis are challenging because of its variable clinical presentation and course and the lack of definitive tests of cure after treatment. This review of the most recent literature on the epidemiology, clinical manifestations, current diagnosis, and treatment of syphilis is focused toward clinicians who treat patients with this disease. Syphilis coinfection with human immunodeficiency virus is emphasized because it is increasingly common in the United States and affects the initial presentation, disease course, diagnosis, and treatment of syphilis. Of particular consequence is the effect of human immunodeficiency virus on the clinical diagnosis, prevalence, and course of neurosyphilis, one of the most serious consequences of syphilis infection.

Endemic treponematoses are present in inter-tropical countries in Africa, America, Indonesia and Papua New Guinea. Epidemiology and transmission of the disease are well known. After eradication in some countries after mass treatment in 1950-60, a resurgence of endemic treponematoses has been reported since 1980-90. We present 2 cases of endemic syphilis from the dermatology unit of the Maputo hospital, the first to be described in Mozambique. The endemic syphilis was probably facilitated by the social conditions induced by the Mozambican civil war between 1975 and 1993.

After a marked decline in the number of syphilis cases in the context of AIDS prevention campaigns, a significant increase has been observed in states of the former Soviet Union since 1994. In recent years, outbreaks have also been reported in the US, Canada, and several European countries. The current epidemic in the US and in different parts of Europe has largely involved men who have sex with men, many of whom are infected with HIV. Since a misdiagnosis of syphilis can have serious consequences for the patient and also for pregnancies and newborns, clinicians should be aware of the many manifestations of syphilis and difficulties in the diagnosis and management of the disease. Younger clinicians in particular are no longer familiar with the diverse clinical symptoms and the complex diagnostics of syphilis. Patients co-infected with HIV may present with atypical clinical manifestations and laboratory test results. Furthermore, through its association with an increased risk of HIV infection, syphilis has acquired a new potential for morbidity and mortality, and the diagnosis of syphilis should be routinely considered in patients with uveitis, sudden deafness, aortic thoracic aneurysm, or pregnancy. Only a minority of syphilis infections are detected in the primary stage. This may be because of atypical locations and, occasionally, atypical morphology of the lesions; however, it may also be because of the difficulty of detecting the pathogen. In the secondary stage, which is clinically extremely diverse, the diagnosis is confirmed serologically. There is a need for increased awareness of the symptoms and signs of acute infections, together with a willingness to consider the diagnosis of syphilis in patients with vague symptoms. An increasing number of diagnostic tests (both specific and nonspecific) are now available. However, in the absence of clinical symptoms or in cases with a low titer or inconsistent test results, diagnosis of syphilis can be difficult or even impossible. Treatment and follow-up should follow current guidelines designed for the involved area. In this article, the cutaneous manifestations of syphilis and their diagnostic and therapeutic management are described in detail.

The clinical manifestations of syphilis are variable in appearance and have been described for centuries. The disease has been arbitrarily divided mainly into three stages. Uncommon presentations of syphilis in adults include (a) primary syphilis-atypical forms of chancre vary in size, shape, morphology, and color. Small ulcus durum is single or multiple, grouped, or herpetiform. Giant necrotic and phagedenic chancres are resolved with scar formation. In intratriginous areas, ulcus durum is rhagadiform, linear, "rocket type," or bilateral. (b) Secondary syphilids include macular (roseolas, leukomelanoderma), papular (small miliar or lichenoid, or with large size-lenticular or nummular), papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, and others; there are also mucosal lesions, loss of the hairs, and alteration of the nails. (c) Tertiary syphilis occurs decades after infection in three main forms: gummatous, cardiovascular, and neurosyphilis (asymptomatic, meningeal, meningovascular, and parenchymatous-such as general paresis or tabes dorsalis). Early recognition of the clinical manifestations of syphilis is important for the start of treatment, recovery of patients, and the prevention of the spread of disease.

The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.

In recent years a rising incidence of syphilis has been observed, especially in the population of homosexual men. Because of altered sexual behavior in terms of increased promiscuity paralleled by decreased use of condoms and the fact that a syphilis infection increases the susceptibility to HIV coinfection, the incidence of HIV is also rising once again in this population. In patients with HIV coinfection, the course of syphilis is often atypical or dramatic. Stage-specific features suggesting coinfection include prolonged primary ulcers persisting well into the secondary stage, numerous atypical cutaneous findings in the second stage and a rapid progression from stage to stage. The diagnosis of syphilis may be more difficult because of false positive or false negative serological findings in patients with HIV coinfection. Whether or not the CNS is more often involved is this patient group has not been established by prospective studies and remains controversial. However, WHO and CDC recommendations include evaluation of the CSF in HIV-infected patients with either late syphilis or when the time course is unknown period. There is worldwide agreement on the therapy of syphilis in patients with HIV coinfection. Patients with early syphilis should be treated with 2.4 benzathine penicillin i.m. once or twice; patients with late syphilis, twice or three times. Patients presenting with clinical or serological signs of neurosyphilis require 18-24 million IU penicillin i.v. daily for at least 2 weeks.

After a decade of unprecedented declines, incidence of early-stage syphilis in the United States and Europe has increased significantly since 2000. These cases have occurred at disproportionately elevated rates among people infected with HIV. Speculation continues as to whether the clinical spectrum of syphilis is qualitatively different among those individuals who are HIV infected. Recent data suggest that individuals who are immune compromised because of HIV have a higher likelihood of developing neurosyphilis. Recommendations for treatment of syphilis remain the same for patients with and without HIV.

During the 1990s, no studies of various clinical presentations of syphilis have been published in the indexed literature. However, a change in the clinical profile of secondary syphilis was expected during the last decade with the rapid spread of the HIV epidemic. The objective was to study the mucocutaneous manifestations of secondary syphilis in patients attending the STD clinic at the Postgraduate Institute of Medical Education & Research Chandigarh, India, during the last decade and to compare them with other similar studies published during the 1980s. All patients who were diagnosed with secondary syphilis in our STD clinic from 1990 to 1999 were examined and investigated. Serological response was measured at 3, 6, 9, 12, and 24 months post-treatment or until serological negativity was reached. Fifty-three patients (males = 34, female = 19) during this period were found to have secondary syphilis. The most common symptoms were as follows-skin rash 38 (71.7%), lymphadenopathy 26 (49%), persistent chancre 4 (7.5%), nodular syphilides 2 (3.8%), lues maligna 2 (3.8%), patches in the oral mucosa 6 (11.3%), condylomata lata 14 (26.4%), split papules 2 (3.8%). Five patients had a thin and conspicuous genital scar of the healed primary chancre. Three patients were HIV seropositive (1 patient each with lues maligna, lichenoid, and nodular syphilides). With the spread of the HIV epidemic, atypical muco-cutaneous manifestations of secondary syphilis may be seen more frequently than before and may pose problems in diagnosis. In the present study, six patients had atypical manifestations, and three of them were HIV seropositive.

Background: Metropolitan Nashville, Tennessee experienced a syphilis epidemic from 1996 to 1998., Goal: This study describes the syphilis epidemic during this period., Design: Descriptive analyses of syphilis surveillance data (1988-1998) were performed, with emphasis on the current epidemic (1996-1998), and were stratified by age, gender, race, and census tracts., Results: Five features were observed regarding the 1996 to 1998 syphilis epidemic: (1) males and females were almost equally affected, with a delay in diagnosis in female patients; (2) the 30-39-year age group was most affected; (3) the 15-19-year age group had the highest percentage increase in incidence; (4) African Americans were the most affected population subgroup; and (5) downtown Nashville and the surrounding areas were most affected., Conclusion: Although talk of eradicating syphilis has surfaced nationally, Nashville has continually faced syphilis as a public health problem. During each of the past 3 years (1996-1998), the incidence of syphilis in this community has reached epidemic proportions.

The nonvenereal treponematoses--yaws, endemic syphilis, and pinta--constitute a major health concern for many third world countries. These diseases are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Nonvenereal treponematoses differ significantly in their modes of transmission, epidemiology, and clinical presentation from venereal syphilis. Like venereal syphilis, they have a chronic relapsing course and have prominent cutaneous manifestations. Recently, several cases of imported yaws and endemic syphilis have been described in Europe. With the escalating U.S. military presence in many remote areas of the world and ever-increasing world-wide travel, the diagnosis of the nonvenereal treponematoses must be considered in appropriate clinical and historical situations.

A total of 1380 patients with syphilis were diagnosed and treated from January 1983 to December 1991 at the Department of Dermatology and Venereology at Leipzig University in West Saxon, Federal Republic of Germany where the population is 1.4 million. The incidence of syphilis increased gradually from 1983 to 1989 and then decreased again. The number of recent cases of syphilis was almost twice as high as latent syphilis cases (63:37%). The vast majority of cases suffered from early syphilis. In almost half the source of infection was casual contacts (44%); in one-third it was a stable partners (30%); about 6% were homosexuals and about 4% were prostitutes. Among the primary syphilis cases multiple chancres were seen in 16%. In 31% of cases, the ulcus durum was extragenital. Among the secondary syphilis cases macular and maculopapular exanthema were the commonest features (51%), followed by palmoplantar syphilis (5%), condylomata lata (5%), angina specifica (3%) and papular exanthema (3%). However, in 30% of the cases multiple skin features were observed. Secondary syphilis with persistent chancres were seen in 12%. Five percent of the patients were suffering from the second to the fifth reinfection in their life, and again 5% of the syphilis cases were detected during pregnancy. Only two patients had an HIV infection, 10% suffered from gonorrhea and 10% from trichomoniasis, 12% from chlamydial infection, 4% from genital warts and 8% from herpes simplex genitalis at the same time. The therapy of choice was penicillin. In 0.3% an allergy to penicillin was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervicouterine carcinoma is a public health problem in México, because of its high rate and mortality. In the present study, the frequency of flat condyloma was 11.06%. Association between dysplasia, cervicouterine carcinoma and flat condyloma was 67.2%. The risk of developing dysplasia or cervicouterine carcinoma if flat condyloma is present is 24%. Age and parity together with grade of lesion arte determinant to choice management. Malignancy must be discarded when a cervical lesion is diagnosed.

Since 1985, the number of primary and secondary (P&S) syphilis cases reported in the United States has been increasing. In 1990, 50,223 cases were reported, a 9% increase from 1989. The incidence of 20 cases per 100,000 persons, a 75% increase from 1985, is the highest since 1949. This report summarizes the incidence of P&S syphilis during 1990 and provides comparison data from 1981-1990.

We have considered all patients with positivity in the serological tests for syphilis admitted in our hospital since 1983. After grouping them according to the department, we have tried to show a connection between syphilis and principal disease.

The authors describe the epidemiological situation with regard to late syphilis in the period of 25 years with particular reference to the last decade (1965--1974). The activities of consultation services for late syphilis and their role in prevention of late organ involvement are discussed.

Seventy-nine cases of syphilis were the material of this study. Unusual presentations of primary syphilis were found in 42.5% of cases; explanations are given for these findings. Other aspects of the unusual presentations of the disease were studied with special stress on the occurrence of itching in the course of secondary syphilis. The authors emphasize that pruritus as a presenting symptom in the presence of skin lesion suggestive of syphilis should not blind the physician to the possibility that Treponema pallidum may be the etiologic agent.

The notes of 946 patients with primary and 854 with secondary syphilis were retrospectively reviewed. Of the 184 heterosexual men with primary syphilis, 182 (99%) had chancres affecting the penis, compared with 467 (64%) of the 728 homosexual men (p less than 0.0001). Anorectal chancres occurred in 249 (34%) of homosexual men. The commonest features of secondary syphilis included a rash, lymphadenopathy, and mucous patches of the mouth or genital area. Hepatitis, meningitis, other neurological problems, iridocyclitis, and periostitis were all exceptionally rare. The clinical features of primary and secondary syphilis do not appear to have changed in recent years.