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Background The global resurgence of syphilis necessitates vaccine development. Methods We collected ulcer exudates and blood from 17 participants with primary syphilis (PS) and skin biopsies and blood from 51 patients with secondary syphilis (SS) in Guangzhou, China, for Treponema pallidum subsp pallidum (TPA) quantitative polymerase chain reaction, whole genome sequencing (WGS), and isolation of TPA in rabbits. Results TPA DNA was detected in 15 of 17 ulcer exudates and 3 of 17 blood PS specimens. TPA DNA was detected in 50 of 51 SS skin biopsies and 27 of 51 blood specimens. TPA was isolated from 47 rabbits with success rates of 71% (12/17) and 69% (35/51), respectively, from ulcer exudates and SS bloods. We obtained paired genomic sequences from 24 clinical samples and corresponding rabbit isolates. Six SS14- and 2 Nichols-clade genome pairs contained rare discordances. Forty-one of the 51 unique TPA genomes clustered within SS14 subgroups largely from East Asia, while 10 fell into Nichols C and E subgroups. Conclusions Our TPA detection rate was high from PS ulcer exudates and SS skin biopsies and over 50% from SS blood, with TPA isolation in more than two-thirds of samples. Our results support the use of WGS from rabbit isolates to inform vaccine development. [ABSTRACT FROM AUTHOR]

Pati Aji Achdiat,1 Raka Ghufran Wibowo,1 Ranisa Larasati,1 Rasmia Rowawi,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email pati.aji.achdiat@unpad.ac.idAbstract: Sexual abuse is any non-consensual sexual act or behavior using force, with significant concern in “men who have sex with men” (MSM), and younger individuals. The incidence of sexually transmitted infections (STI) is also prevalent in the cases of sexual abuse in this population, showing the need for comprehensive medical and psychological intervention. This study presents a case of a 15-year-old Indonesian MSM adolescent who experienced three forced sexual intercourse with a mid-thirties male friend 6 months before the consultation. Psychological evaluation showed signs of moderate depression, then the patient reported erythematous macules and collarettes on the palms and soles. These symptoms appeared 1 month before consultation, without associated pain or pruritus. Additionally, moist, skin-colored verrucous papules and plaques were observed in the perianal area, along with a history of unintentional weight loss. The Kinsey score was calculated as three, showing bisexuality. Testing confirmed positive results for both HIV and syphilis, leading to the secondary diagnosis. The patient tested negative for additional STI and was treated with benzathine benzylpenicillin G 2.4 million international unit (IU) and antiretroviral therapy. After one month, the skin lesions improved and the patient was referred to the psychiatric department for psychological treatment. Syphilis and HIV are the predominant infections, showing the critical necessity of administering appropriate medical treatment, such as antiretroviral therapy and comprehensive STI management, with psychological assessment and management to enhance the psychological well-being of sexually abused individuals.Keywords: bisexual, human immunodeficiency virus, Indonesian, men sex with men, secondary syphilis, sexual abuse

This report details a case of neurosyphilis manifesting as concurrent ocular and otosyphilis, an uncommon presentation of the disease. Here, we describe the diagnosis and treatment of a 27-year-old immunocompetent Caucasian male who presented with uveitis and tinnitus. Physical exam was consistent with uveitis and audiometric testing revealed bilateral sensorineural hearing loss. Serum rapid plasma reagin (RPR) was reactive at 1:512 with a follow-up cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test likewise reactive at 1:2, confirming neurosyphilis. The patient was treated with intravenous penicillin G with improvement of symptoms and with subsequent improvement of serum and CSF RPR. However, he ultimately represented with recurrent symptoms and fluctuating serum RPR levels, necessitating repeat treatment and ongoing clinical monitoring. Neurosyphilis can occur at any point during the course of a syphilis infection and may present with a variety of nonspecific findings. This case documents a particularly uncommon instance of simultaneous ocular and otosyphilis, a presentation of neurosyphilis that has only been described a handful of times.

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Background Histologic and serologic studies suggest the induction of local and systemic Treponema pallidum -specific CD4+ T-cell responses to T. pallidum infection. We hypothesized that T. pallidum -specific CD4+ T cells are detectable in blood and in the skin rash of secondary syphilis and persist in both compartments after treatment. Methods Peripheral blood mononuclear cells collected from 67 participants were screened by interferon-γ (IFN-γ) ELISPOT response to T. pallidum sonicate. T. pallidum -reactive T-cell lines from blood and skin were probed for responses to 89 recombinant T. pallidum antigens. Peptide epitopes and HLA class II restriction were defined for selected antigens. Results We detected CD4+ T-cell responses to T. pallidum sonicate ex vivo. Using T. pallidum -reactive T-cell lines we observed recognition of 14 discrete proteins, 13 of which localize to bacterial membranes or the periplasmic space. After therapy, T. pallidum -specific T cells persisted for at least 6 months in skin and 10 years in blood. Conclusions T. pallidum infection elicits an antigen-specific CD4+ T-cell response in blood and skin. T. pallidum -specific CD4+ T cells persist as memory in both compartments long after curative therapy. The T. pallidum antigenic targets we identified may be high-priority vaccine candidates. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Dermatovenereology is the property of Xi'an Jiaotong University Periodicals Center and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Syphilis and HIV are diseases that can be transmitted through sexual contact. Bisexual groups have a higher potential for HIV and syphilis transmission. In syphilis patients who have been infected with HIV, secondary syphilis often occurs along with primary syphilis, which can be found 2-3 times more often than in those who are not infected by HIV. Case: A 24-year-old male with HIV who is a bisexual man, complained chancre on his scrotum and on the tip of the penis that was painless and also has condyloma lata around the anus. Dermatological examination revealed multiple papules, patches, and plaques. The serological results for VDRL and TPHA were reactive. Histopathology examination of skin plaque suggests secondary syphilis. The Patient was diagnosed with overlapping primary-secondary syphilis and given therapy with single-dose intramuscular injection of benzathine penicillin G. Discussion: Bisexual groups have a higher potential for HIV and syphilis transmission. In HIV patients, primary and secondary syphilis often overlap. This was due to changes in the immune system causing the spread of Treponema pallidum more quickly and slowing the healing of primary lesions. Conclusion: Overlapping of primary and secondary syphilis in bisexual patients with HIV is common; in addition, the appearance of skin lesions in secondary syphilis can resemble other diseases, so confirmation by histopathology examination needs to be done.

Sexually transmitted diseases/infections (STDs/STIs) are one of major public health concern, and syphilis in today’s era is not an uncommon diagnosis. The rising trend of syphilis cases can be attributed to changes in sexual practices such as individuals being engaged in oro-genital or anogenital sex, having multiple sexual partners, increase in men having sex with men, HIV co-infection, and drug abuse. Syphilis mimics many other diseases, and diagnosis can be delayed if the clinician is not aware of varied presentations. Often, unusual mucocutaneous manifestations have fascinated dermatologists, leading to diagnostic difficulties. In today’s era, cases of secondary and latent syphilis are being more commonly encountered than those of primary syphilis. Herein, we emphasize on varied mucocutaneous manifestations of secondary syphilis among young individuals. We would like to highlight the need for the implementation of sex education among adolescents/young adults to prevent STDs/STIs.

Over the past decade, there has been a significant increase in cases with syphilis and HIV coinfection. Concordant infection with HIV can alter the clinical course and response to treatment in syphilis. Variable and unusual presentations of syphilis in HIV disease can make early diagnosis and treatment challenging. We, herein, report four cases of atypical manifestations of syphilis in patients with HIV coinfection. [ABSTRACT FROM AUTHOR]

Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.

Abstract Background Syphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis. Case presentation A virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully. Conclusion This case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.

The non-treponemal tests like VDRL and RPR hold an important place in the diagnosis of syphilis. In many countries, these tests are used for screening, with positive results being subsequently confirmed by treponemal or specific tests like TPHA or FTA-ABS. Recent observations of low-titer VDRL or RPR positivity (

Introduction: Secondary syphilis is well-known for its protean cutaneous manifestations and therefore very easy to be misdiagnosed. Aim: The current study was to observe the frequency of histopathological features characterizing secondary syphilis, and summarize the diseases most likely to be misdiagnosed. Material and methods: In this study a total of 129 pathological specimens from 114 patients with biopsy-proven secondary syphilis were retrospectively analysed and categorized according to clinicopathologic characteristics. The frequency of histopathological features characterizing secondary syphilis were analysed by comparison with clinical features. Results: We found that in a single sample there is at least one feature or at most 13 features exist concurrently, and most demonstrated between 5 and 9 diagnostic features. Plasma cells (97.6% overall vs. 94.0% < 6 features), endothelial swelling (86.8% vs. 74.0%), epidermis hyperplasia (73.6% vs. 62.0%) especially irregular acanthosis, lymphocytes infiltration (71.3% vs. 52.0%) and interstitial patterns (69% vs. 72.0%) were the most common findings in all cases as well as in cases with < 6 features. Granulomatous inflammation is an uncommon histopathologic pattern in secondary syphilis (12.4%). The rash morphologies of our biopsies mainly manifesting as macules and maculopapules were more likely to have 6 or fewer features, which were not only easily misdiagnosed for pityriasis rosea, tinea and erythema multiforme, but also mostly taken from the trunk and genitalia. Atypical morphologies can be combined with plasma cell infiltration and T. pallidum immunohistochemical stain to confirm the diagnosis. Conclusions: In this study plasma cells from superficial and deep perivascular distribution to nodular infiltration were a crucial clue for diagnosis of secondary syphilis. [ABSTRACT FROM AUTHOR]

Predominantly sexually transmitted infections (STIs) continue to be of concern to physicians. Particularly interesting are cases of combined STIs. Patients infected with human immunodeficiency virus (HIV) and other diseases pose the most challenging diagnostic and treatment scenarios. Venereologists observe severe manifestations of chronic dermatoses in individuals with HIV infection, atypical courses of other infections, and lack of response to conventional treatment methods. This study focuses on monitoring HIV-infected patients with syphilis during their hospitalization in the venereology department of the V.G. Korolenko Clinic, a branch of the State Budgetary Healthcare Institution Moscow Research and Practical Center for Dermatovenerology and Cosmetology. The study presents a differential diagnosis of secondary syphilis manifestations in these patients and discusses the peculiarities of the disease course.

Retno Hesty Maharani,1 Tomi Nugraha,1 Endang Sutedja,1 Kartika Ruchiatan,1 Hermin Aminah Usman,2 Pati Aji Achdiat1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62 81322750101, Email pati.aji.achdiat@unpad.ac.idAbstract: Syphilis is a sexually-transmitted disease with various clinical stages. Secondary syphilis manifestations may mimic other skin lesions. Patient co-infected with Human Immunodeficiency Virus (HIV), with CD4 cell counts of 200– 499 cells/mm3, often manifests an atypical cutaneous lesion, which may also occur as nodular or ulcerative lesions. Generalized nodulo-ulcerative lesions without systemic symptoms in secondary syphilis patients with HIV co-infection are rarely reported. A 22-year-old man presented with generalized asymptomatic multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs. His lesions spread progressively without the presence of any prodromal symptoms or adenopathy. He was previously diagnosed with HIV and is currently on antiretroviral medications, with a CD4 cell count of 388 cells/μL. His venereal disease research laboratories (VDRL) result was reactive (titer of 1:256). His Treponema pallidum hemagglutination assay (TPHA) result was also reactive (titer of 1:10,240). A skin biopsy was performed from the nodulo-ulcerative lesion on his back. Hematoxylin-eosin staining revealed a hyperplastic epidermis, a massive influx of plasma cells, and lymphocyte infiltration into the deep dermis, especially in the peri-adnexal, peri-vascular, and peri-muscular regions. The patient was diagnosed with secondary syphilis with HIV co-infection. He had no previous history of drug allergy. A single dose of 2.4 million units of benzathine penicillin G was administered. Almost all the lesions became hyperpigmented macules after two weeks and resolved completely after one month. His VDRL titer declined to 1:32 after three months. The various atypical lesions of secondary syphilis may lead to misdiagnosis and delayed treatment. The presence of multiple asymptomatic nodulo-ulcerative lesion without prodromal symptoms may indicate the presence of secondary syphilis, notably in patients co-infected with HIV. Therefore, knowledge of atypical cutaneous manifestations of secondary syphilis is warranted in order to treat patients accordingly.Keywords: secondary syphilis, human immunodeficiency virus, nodulo-ulcerative lesions

Background. Syphilis is one of the important blood transfusion disease that has 3 stages and characterized by latency phase. The goal of this study is detection of demographic categories related to syphilis and cell-mediated immunity in denotation of gamma interferon. Methods. The study was done in the main blood bank in Thi-Qar province-Iraq during the period from January 2020 to December 2021, the demographic data including age, gender, address and occupation. The infection was diagnosed by using TPHA technique, while gamma interferon concentration was detected by ELISA technique according to the manufacturer instruction. Results. The study record low level of syphilis (0.5438%) among blood donors, high significant differences in the parameters of study, the age group 31-40 revealed high percent of infection (44%) and high percent of infection occur in male (99.7%). Also, high significant differences were recorded in distribution of infected donors according to occupation, where gainers (72.5%) represent the most infected group than others and the blood donors that inhabits urban area (70.19%) were most exposed to syphilis infections than those in rural areas. The IFN-γ level was high significance in the infected donors (19.651±9.009) when compared with the controls under (p value= 0.000). Conclusion. In brief, syphilis has low prevalence among blood donors in Iraqi community, with significant differences among categories of demographic data. The study revealed strong cell-mediated immune response in infected blood donors characterized by high levels of gamma interferon.

In recent years, the literature has been discussing the issues of diagnosis and managing damaged eye patients who suffer from syphilis/HIV coinfection. We present a clinical case of syphilitic uveitis in the patient’s third reinfection of syphilis, which occurred during a long-term HIV infection. The causes for insufficient treatment effectiveness are analyzed.

Dan Li,1 Ming Zhang,1 Jilai Yin,2,&ast; Kai Chen1,&ast; 1Department of Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan Province, People’s Republic of China; 2Department of Laboratory, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Kai Chen, Department of Dermatology, The Fifth People’s Hospital of Hainan Province, No. 8 Longhua Road, Longhua District, Haikou, Hainan Province, 570206, People’s Republic of China, Email bladetruth@126.com Jilai Yin, Department of Laboratory, the First Affiliated Hospital of Hainan Medical College, No. 31, Longhua Road, Haikou, Hainan Province, 570100, People’s Republic of China, Email 187295067@qq.comAbstract: A 18-year-old male presented with ulcers of lips and tongue and erythema of trunk of more than a month duration. Laboratory examinations for syphilis showed that TRUST (+) 1:32, TPPA (+), and HIV antibodies were negative. Combined with his case history and signs, he was diagnosed with secondary syphilis with chancre of lips and tongue and was cured by injecting benzathine penicillin 2.4 million U into gluteal muscles on both sides once a week for three times. After a month, the erythema and chancre disappeared. Three months later, the TRUST test was positive, the titer was 1:8, and the TPPA was positive.Keywords: chancre, secondary syphilis

Syphilis, a disease caused by the bacteria Treponema pallidum, has a multitude of clinical manifestations and is classified into primary syphilis, secondary syphilis and tertiary syphilis, based on clinical presentations and the time elapsed since the primary infection. The secondary stage of the disease can affect multiple organs and systems, and some of these involvements may be general and non-specific, justifying its name as ‘the great imitator’. We present a case of a 30-year-old woman with a history of painful neck lymph nodes with progressive enlargement, persistent headache, weight loss, myalgia and alopecia. During investigations, stomatitis on the dorsal face of the tongue developed. A secondary study showed serum positive for rapid plasma reagin (RPR) and T. pallidum haemagglutination (TPHA), negative RPR in cerebrospinal fluid and normal MRI, thus the diagnosis of secondary syphilis was made. The patient was treated with a single dose of penicillin with complete resolution of symptoms. The case highlights the need for an exhaustive clinical examination, especially in cases presenting with non-specific and general symptoms, and raises awareness for this disease which has increased its prevalence in the last decades.

Abstract is missing (Short communication)

Cong You,1 Kun Wang,1 Mingyi Liao,1 Luying Zhang,1 Mintong He,1 Xiaoying Ye,1 Yongzhang Qin,2 Tao Yang1 1Department of Dermatology and Venereology; Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China; 2Department of Endocrinology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of ChinaCorrespondence: Tao Yang, Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China, Tel +8618720732351, Email danny20021068@sina.comAbstract: Condylomata lata are flat-topped, moist papules or plaques usually found in the anogenital area as cutaneous manifestations of secondary syphilis. Here, we present a unique case of a solitary interdigital condyloma latum of secondary syphilis in a 16-year-old female sex worker without other cutaneous findings. Sexual contact history, histopathology, including direct detection of Treponema pallidum, and serological tests were essential for the diagnosis of this case. The patient reached serological cure with two doses of intramuscularly delivered penicillin G benzathine. Owing to the dramatic rise in the incidence of primary and secondary syphilis, medical workers should be aware of the atypical skin manifestations of secondary syphilis in adolescents who are at risk of acquiring sexually transmitted diseases to avoid the progression to late syphilis and further transmission to sexual partners.Keywords: interdigital condyloma latum, secondary syphilis, female adolescent

The article discusses a rare case of secondary syphilis presenting as an arthropod bite-like eruption in an immunocompetent patient. The patient initially had pruritic tan macules on the trunk and extremities, which were misdiagnosed as an arthropod assault. However, further evaluation revealed the presence of secondary syphilis, confirmed by laboratory tests and immunohistochemical staining. The patient was successfully treated with penicillin G, highlighting the importance of considering syphilis in cases of atypical cutaneous eruptions. [Extracted from the article]

Malignant syphilis (MS) is a rare variant of secondary syphilis. Also known as rupioid syphilis, MS is characterized by the presence of multiple papules, papulopustules, black lamellate crust that may resemble an oyster shell, or nodules with ulceration lacking central clearing. MS is often associated with immunodeficiency and frequently co-occurs with HIV infection. We here report a case of MS in a patient with HIV infection. HIV infection can cause atypical clinical symptoms of syphilis. In this case, unlike previous cases, cutaneous lesions of MS were limited to the face, making the diagnosis challenging based on clinical findings alone. However, his laboratory findings, appearance of the Jarisch-Herxheimer reaction, and a dramatic response to antibiotic therapy are characteristic of MS, making the diagnosis even more certain. Our case suggests the importance of physicians considering the possibility of MS when observing black-crusted lesions.

Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Syphilis is a significant public health issue, notably in (HIV) positive patients. Due to the absence of pathognomonic signs in secondary syphilis and its ability to present and mimic a wide variety of clinical findings, it gained the name "the Great imitator '(mimicker).' Herein, we describe a case of a 51-year-old man who presented with acute painless loss of vision of the right eye preceded by a few erythematous plaques with thick scales over bilateral legs and multiple discrete and confluent scaly papules over the palms and soles. During the hospital stay, a diagnosis of non-arteritic anterior ischemic optic neuropathy (NAION) as a manifestation of neurosyphilis is made. To the best of our knowledge, this is the first reported case of NAION as the presenting symptom of neurosyphilis in secondary syphilis in an immunocompetent patient. [ABSTRACT FROM AUTHOR]

Introduction: The role of the host immune response could be critical in the development of Treponema pallidum (Tp) infection in individuals with latent syphilis. This study aims to investigate the alterations in T follicular helper T (Tfh) cell balance among patients with secondary syphilis and latent syphilis. Methods: 30 healthy controls (HCs), 24 secondary syphilis patients and 41 latent syphilis patients were enrolled. The percentages of total Tfh, ICOS+ Tfh, PD-1+ Tfh, resting Tfh, effector Tfh, naïve Tfh, effector memory Tfh, central memory Tfh, Tfh1, Tfh2, and Tfh17 cells in the peripheral blood were all determined by flow cytometry. Results: The percentage of total Tfh cells was significantly higher in secondary syphilis patients compared to HCs across various subsets, including ICOS+ Tfh, PD-1+ Tfh, resting Tfh, effector Tfh, naïve Tfh, effector memory Tfh, central memory Tfh, Tfh1, Tfh2, and Tfh17 cells. However, only the percentages of ICOS+ Tfh and effector memory Tfh cells showed significant increases in secondary syphilis patients and decreases in latent syphilis patients. Furthermore, the PD-1+ Tfh cells, central memory Tfh cells, and Tfh2 cells showed significant increases in latent syphilis patients, whereas naïve Tfh cells and Tfh1 cells exhibited significant decreases in secondary syphilis patients when compared to the HCs. However, no significant change was found in resting Tfh and effector Tfh in HCs and secondary syphilis patients or latent syphilis patients. Discussion: Dysregulated ICOS+ Tfh or effector memory Tfh cells may play an important role in immune evasion in latent syphilis patients. [ABSTRACT FROM AUTHOR]

We report a 22-year-old homosexual man, a known case of HIV-1 infection but non-compliant to medications, who presented with a 5-month history of progressive painless non-pruritic coin-shaped skin lesions and recent gradual bilateral blurring of vision. His history divulged a primary syphilitic event 1 year prior to the present clinical manifestations. Investigation led to the diagnosis of neurosyphilis with ocular involvement with concurrent signs of secondary syphilis. Treatment with aqueous crystalline penicillin G, ophthalmic steroid and tropicamide drops, and topical emollients resulted in significant clinical improvement of ocular symptoms and skin lesions. The diagnosis of neurosyphilis requires a high degree of clinical suspicion and should be included in the differential diagnosis of unexplained ocular symptoms, particularly in men who have sex with men and HIV-infected patients. This is necessary for the early diagnosis, appropriate management, and good outcome of these patients. [ABSTRACT FROM AUTHOR]

The diagnosis of secondary syphilis can be challenging for clinicians due to its diversified cutaneous presentations. This is particularly true for human immunodeficiency virus (HIV) coinfected patients, who may develop unusual clinical manifestations. We report a case of a 33-year-old male, with HIV-1 infection without treatment, who presented to the emergency department (ED) with a 3-month history of erythematous macules. In the week before presenting to the ED, the lesions had progressed to multiple generalized papulovesicles and papules with central necrosis and serohemorrhagic crust, some exhibiting a "collarette" scale. Nasal discharge, earache, and fever were also present. The clinical picture was compatible with the diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA). Complementary examinations confirmed the diagnosis of PLEVA-like secondary syphilis, and the patient was successfully treated with benzathine penicillin. Our case highlights the importance of being aware of this rare cutaneous presentation of syphilis. [ABSTRACT FROM AUTHOR]

Secondary syphilis is known as "The Great Imitator". It can mimic numerous diseases clinically and histologically, including erythema multiforme (EM). Coinfection with HIV often makes its manifestations more atypical leading to delays in diagnosis and therapy. A 34-year-old male-sex-male patient who had received coronavirus disease 2019 (COVID-19) vaccine 1 week earlier presented with complaints of slightly pruritic scaly erythematous targetoid plaques and erythematous macules on the trunk and extremities for 6 weeks. Histopathology examination showed basal cell vacuolar degeneration of the epidermis and lymphocytic infiltrates along the dermal-epidermal junction and superficial dermis, consistent with EM. Upon further investigation, syphilis and HIV serology were reactive (VDRL 1: 128, TPHA 1: 40960, CD4+ 461 cells/µl). Lesions improved significantly after a single dose of 2,4-million units of benzathine penicillin intramuscular injection. Secondary syphilis presenting as erythema multiforme (EM)-like eruptions is very rare. Physicians should be aware of this unusual presentation to prevent complications. [ABSTRACT FROM AUTHOR]

The diagnosis of syphilis can be challenging for dermatologists and dermatopathologists. In particular, secondary syphilis can have different clinical and histopathological presentations. A granulomatous tissue response is an unusual finding in secondary syphilis. We report the case of a 77-year-old man who presented with a 4-week history of non-pruritic generalised macules, papules, nodules and plaques. Histopathologically, there was a dense perivascular and periadnexal lympho-histiocytic dermal infiltrate with non-palisading and non-caseifying epithelioid granulomas and abundant plasma cells. The diagnosis of syphilis was confirmed by serology and immunohistochemical detection of Treponema pallidum in the biopsy specimen. A brief overview of the diagnostic role of immunohistochemistry is also provided, with particular emphasis on reported cases of granulomatous secondary syphilis. [ABSTRACT FROM AUTHOR]

The subspecies T. pallidum pallidum is the cause of the most infamous sexually and congenitally transmitted disease, syphilis. This disease has an estimated incidence of six million infections every year. Multiple studies have noted that the prevalence of syphilis has been steadily increasing worldwide in recent decades, especially among MSMs and HIV-positive patients. Clinically, syphilis presents in four stages with multiple different clinical manifestations. In this paper, we examine the current literature to determine the history and progression, pathogenesis, clinical features, and testing of secondary syphilis. Secondary syphilis is a stage of the disease with the most exuberant local and systemic clinical manifestations. The basis of the pathogenesis of SS underscores the unique mechanisms by which Treponema pallidum utilizes to escape immune recognition while simultaneously induces inflammation. SS can affect multiple organ systems and become more than just an STD. The most common presentation of secondary syphilis is rash, which manifests as a copper-colored maculopapular lesion on the trunk, palms, and soles. Although the RPR, VDRL, and FTA-ABS tests are perhaps the most commonly used diagnostic tools for syphilis and make up the traditional and reverse algorithms, there are other methods, including morphology and immunohistochemistry.

Background: World Health Organization (WHO) reported that there are 6 million new cases of syphilis worldwide per year. The incidence of syphilis in Indonesia has increased over the past few years, particularly among men who have sex with men (MSM). Purpose: To report a case of secondary syphilis with Human Immunodeficiency Virus (HIV) coinfection in MSM, thereby increasing understanding of high-risk sexual behavior among MSM. Case: A 26-year-old man with a chief complaint of rashes on both palms, soles of the feet, and face. The rashes spread with no itching, heat, or pain, which occurred two weeks ago. The patient was diagnosed with HIV in 2019. Physical examination found multiple violaceus macules with clear boundaries, 0.5–1 cm in size, covered with scales. Venereal Disease Research Laboratory (VDRL) serology titer was 1:16 and Treponema Pallidum Haemagglutination Assay (TPHA) was 1:20.480. The recent CD4 count was 440 with an undetectable HIV RNA viral load. Benzathine penicillin G 2.4 million units was given intramuscularly 3 times at 1-week intervals. The patient experienced clinical improvement and decreased VDRL and TPHA titers. Discussion: Syphilis patients with or without HIV would have similar clinical symptoms. However, syphilis patients with HIV tend to have more extensive lesions. The treatment option with three doses of benzathine penicillin G is still very effective in cases of syphilis with HIV. Conclusion: Syphilis has a higher incidence in MSM patients with extensive clinical manifestations of skin lesions. It can be observed in syphilis patients with HIV; therefore, close monitoring is needed.

Yuchen Li,* Ruxiao Nie,* Xianwei Cao, Chuan Wan Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chuan Wan, Department of Dermatology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People’s Republic of China, Tel +86-18070052970, Email chuanwan@ncu.edu.cnAbstract: Eosinophilic pustular folliculitis (EPF) is a rare, chronic, non-infectious inflammatory skin disease. Although the pathogenesis of EPF is unknown, eosinophilic pustular folliculitis may be associated with human immunodeficiency virus (HIV) infection, malignancies or syphilis. Here, we report the first case of EPF associated with syphilis, indicating that syphilis and EPF are correlated with T-helper type 2 immune responses. A 48-year-old man gradually developed erythema and pustules on the face, neck. Physical examination revealed multiple infiltrative red patches and plaques on the face, neck with tiny pustules. Skin biopsy results revealed that the dermal follicular sebaceous gland unit was infiltrated by a large number of neutrophils and eosinophils, forming eosinophilic microabscesses. Therefore, the patient was diagnosed with EPF associated with syphilis and received drug treatment. After the treatment, the pustules markedly decreased, leaving behind pigmentation. Furthermore, the patient is still being followed up.Keywords: eosinophilic pustular folliculitis, secondary syphilis, pathogenesis, T-lymphocyte immune response

Background: Syphilis is a treatable bacterial infection caused by Treponema pallidum. There has been a change in incidence of syphilis in various nations over the years. Aim: To study the epidemiological trends, demographic profile, high-risk behaviour, clinical pattern, and stage of syphilis over the last ten years in patients presenting to an STD clinic in a tertiary care hospital. Material and Methods: This was a retrospective observational study over ten years. Records of all confirmed syphilis cases were analysed in relation to demography and clinical profile. Results: There were a total of 3,110 STD patients among whom 31 cases (accounting for 0.99%) of confirmed syphilis were seen. There was a significant increase in cases in the last five years of study, especially in the last year. An increase in primary (PS) and secondary syphilis (SS) was observed. Males outnumbered females (3:1). Mean age of patients was 35.0 ± 11.53 years. Professionals were most common (22.6%) having syphilis followed by farmers (19.35%). A significant proportion (45.1%) of our patients were at least graduates. Unprotected sex was seen in all the patients followed by extramarital/premarital sex (71.35%). There were 16.12% of cases who had a history of paid sex and 9.7% were homosexuals. SS and latent syphilis were more common (38.7% each) than PS (19.35%). In PS single chancre and in SS truncal asymptomatic rash was the commonest clinical presentation. Limitation: Single-centre study, including only self-reported patients leading to a small sample size, is the major limitation of the study. Conclusion: The increased trend of primary and secondary syphilis in recent years highlights that there is a risk of an impending epidemic.

Introduction Co-infection of human immunodeficiency virus (HIV) with syphilis is common and has significant clinical consequences. HIV infection can change the course and clinical manifestations of syphilis, resulting in atypical syphilis. A rare feature of this infection is malignant syphilis, which frequently resembles other skin lesions and poses a challenge in diagnosis. This report aims to describe a case of malignant syphilis in an HIV-positive patient. Case report A 33-year-old man who has sex with men (MSM) came to the dermato-venereology outpatient clinic with chief complaints of ulcerative lesions on the face, trunk, arms, palms, and legs for the past two months. The patient complained of fever, chills, and decreased appetite two weeks prior to presentation. A dermatological examination showed numerous well-demarcated ulcerated plaques and nodules partially covered with crust. Reactive results were found on syphilis serologic tests with high titers. The test for HIV was reactive, with a CD4 cell count of 219 cells/mm³ . The patient was then diagnosed with malignant syphilis and received treatment in the form of benzathine penicillin injection 2.4 million units once a week for three consecutive weeks. After treatment, the skin lesions and syphilis serologic titer improved. Conclusions Secondary syphilis in patients with HIV infection may present as an atypical variant. As reported in this case, malignant syphilis should always be considered in the differential diagnosis when ulcerative and necrotic lesions are observed in individuals with HIV infection. [ABSTRACT FROM AUTHOR]

The subspecies T. pallidum pallidum is the cause of the most infamous sexually and congenitally transmitted disease, syphilis. This disease has an estimated incidence of six million infections every year. Multiple studies have noted that the prevalence of syphilis has been steadily increasing worldwide in recent decades, especially among MSMs and HIV-positive patients. Clinically, syphilis presents in four stages with multiple different clinical manifestations. In this paper, we examine the current literature to determine the history and progression, pathogenesis, clinical features, and testing of secondary syphilis. Secondary syphilis is a stage of the disease with the most exuberant local and systemic clinical manifestations. The basis of the pathogenesis of SS underscores the unique mechanisms by which Treponema pallidum utilizes to escape immune recognition while simultaneously induces inflammation. SS can affect multiple organ systems and become more than just an STD. The most common presentation of secondary syphilis is rash, which manifests as a copper-colored maculopapular lesion on the trunk, palms, and soles. Although the RPR, VDRL, and FTA-ABS tests are perhaps the most commonly used diagnostic tools for syphilis and make up the traditional and reverse algorithms, there are other methods, including morphology and immunohistochemistry. [ABSTRACT FROM AUTHOR]

Case Presentation: A 40-year-old male presented the the emergency department (ED) due to a diffuse body rash after a sexual encounter. Examination revealed a maculopapular rash that included the palms and soles of the feet bilaterally. A rapid plasma reagin was positive, and the patient was treated with 2.4 million units of benzathine benzylpenicillin intramuscularly.Diagnosis: Secondary syphilis can mimic many disease processes but classically presents as a painless macular rash on the palms of the hands and soles of the feet. Diagnosis is based upon clinical examination coupled with serological testing. Emergency department management should include 2.4 million units of benzathine benzylpenicillin intramuscularly and mitigation strategies.

Xue Yang,1 Weigang Wu,2 Yongjie Wang,1 Wen Wu,1 Xia Huang,1 Li Xu3 1Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of China; 2Department of Infectious Disease, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, People’s Republic of ChinaCorrespondence: Li Xu, Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, People’s Republic of China, Email 419176498@qq.comAbstract: Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Here, we report a rare case of secondary pulmonary syphilis, which was diagnosed by metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid (BALF). Direct pulmonary involvement by T. pallidum was suggested by a positive mNGS result in BALF. One month after treatment with benzathine penicillin G (2.4 million units, three doses), a repeated CT scan showed the radiological resolution. To our knowledge, this is the first reported case of secondary pulmonary syphilis diagnosed by mNGS in BALF.Keywords: pulmonary, secondary syphilis, Treponema pallidum, mNGS

In immunocompromised conditions, latent syphilitic infection can lead to secondary syphilis. We present here a case of neurosyphilis (syphilitic meningomyelitis) in a kidney transplant recipient. Atypical presentation, the typical maculopapular rash, and a serological test all pointed to secondary syphilis. The scenario illustrates a crucial point: infections can go undetected, whereas a patient is on immunosuppressive therapy.

Although the incidence of syphilis reached a historic low in 2000, the number of incident cases has since increased in men and women across the USA. In 2019, men who have sex with men (MSM) accounted for 57% of all primary and secondary (P&S) syphilis cases, and about half of MSM with P&S syphilis are living with human immunodeficiency virus (HIV) infection. Days after infection, Treponema pallidum disseminates and invades tissues distant from the site of inoculation. Once the spirochete disseminates, the host develops an inflammatory response; diagnosis requires a high level of suspicion since syphilis may affect the skin, musculoskeletal, cardiovascular, and central nervous systems. We report a 61-year-old man with virally suppressed HIV infection who presented with polyarthralgia, chest pain, and weight loss, diagnosed with secondary syphilis, manifesting with ankle inflammatory arthritis and bone involvement, of the calvarium and manubrium. Early and late syphilis in adults can manifest with articular and periarticular pathologies, including inflammatory arthritis, tenosynovitis, periostitis, and myositis. Higher clinical suspicion is needed for prompt diagnosis of syphilis in patients who are at risk and suspected of having an autoimmune disease. This report includes a review of the musculoskeletal manifestations of syphilis. [ABSTRACT FROM AUTHOR]