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A 46-year-old man presented with a rapidly growing, verrucous penile mass with bilateral inguinal lymphadenopathy, clinically consistent with locally advanced penile carcinoma. He had no history of sexually transmitted infections and negative rapid plasma reagin (RPR) testing. Biopsy demonstrated no malignancy, but immunohistochemistry revealed Treponema pallidum. He was diagnosed with tertiary syphilis and penile gumma. He was treated with penicillin G, though the gumma showed minimal response and surgical extirpation was recommended. This case highlights the limitations of traditional RPR-first screening in syphilis and underscores the importance of a broad differential diagnosis when addressing penile masses.

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We investigated cancer risk among individuals with a prior bacterial sexually transmitted infection (STI) diagnosis using a retrospective cohort study of all Albertan residents diagnosed with chlamydia, gonorrhea, or syphilis during 2000-2014, that was then linked to the Alberta Cancer Registry. Follow-up started 5 years from their first bacterial STI diagnosis and continued until the first instance of a cancer diagnosis, death, or the study end date (December 31, 2019). Internal comparisons between the bacterial STI groups were undertaken using adjusted hazard ratios, while sex-specific standardized incidence ratios (SIRs) were calculated to compare cancer risk with the Alberta general population. The likelihood of developing cancer was largely comparable within the bacterial STI cohort, though head/neck cancer was more common after only gonorrhea exposure, and lung cancer was more common after only syphilis exposure. When compared with the general population, statistically significant SIRs were observed among females for cervical cancer (SIR = 1.9, 95%CI = 1.5, 2.3) and thyroid cancer (SIR = 0.8, 95%CI = 0.6, 0.9); females exposed to chlamydia with other STIs, or gonorrhea with other STIs, were also 3.2- and 2.9-times more likely to develop colon cancer, respectively. In males, statistically significantly associations were identified for cancer overall (SIR = 1.1, 95%CI = 1.0, 1.2) and Hodgkin lymphoma (SIR = 1.8, 95%CI = 1.0, 2.9); males exposed to chlamydia only were also 1.5- and 1.6-times more likely to develop prostate and testicular cancer, respectively, while males exposed to only syphilis were 2.4-times more likely to develop lung cancer. Our findings are consistent with common bacterial STIs being correlates of risk of certain cancers, although the possible etiologic mechanisms may be indirect.

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BACKGROUND: People of Asian ethnicity represent one of the fastest-growing populations in the United States and may experience unique social and cultural challenges to accessing sexual healthcare. This analysis explores disparities in annual sexually transmitted infection screening and diagnosis rates per person-year between Asian and non-Asian people with human immunodeficiency virus in Washington, District of Columbia (DC). METHODS: Using District Columbia cohort data, a longitudinal study of people living with human immunodeficiency virus receiving care in Washington, DC, we analyzed people with human immunodeficiency virus aged 18 or older with at least 1 year of follow-up between 2018 and 2023. Logistic regression was used to examine differences in sexually transmitted infection screening and diagnoses between Asian and non-Asian participants, while linear trend analyses were used to assess changes in the number of screenings and diagnoses between Asian and non-Asian participants. RESULTS: Among 8679 eligible participants, 0.88% (n = 76) were Asian. No significant differences in total sexually transmitted infection screenings or diagnoses were observed. However, Asian participants had higher screening rates per person-year for pharyngeal and urogenital gonorrhea, pharyngeal chlamydia, and syphilis. Chlamydia incidence was higher among Asian than non-Asian participants. Over 30% of both groups met the annual screening recommendation during the study period. CONCLUSIONS: Asians had comparable screening rates to non-Asians, but the small sample size limited the generalizability of our findings. Nonetheless, this study helps address an existing gap in the literature on Asian sexual health. Larger studies with detailed ethnic and social data are needed to deepen our understanding of sexual health service use within Asian communities.

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Background: Syphilis can present with diverse clinical manifestations, earning the name "great imitator." Malignant syphilis (MS) is a rare, severe form of secondary syphilis, typically reported in immunocompromised patients, particularly those living with HIV. However, MS can occasionally occur in immunocompetent individuals, posing diagnostic challenges due to its atypical presentation. Methods: A case report is presented alongside a PubMed literature search using the terms "(malignant syphilis OR lues maligna) AND (immunocompetent) AND (case report OR case series)." No language or temporal restrictions were applied, yielding 18 relevant publications. Results: A 60-year-old HIV-negative man presented with fever, weight loss, papular lesions, and a single ulcer on the sternum. Serology was positive for syphilis, and PCR confirmed T. pallidum DNA in the lesion. Treatment with a single intramuscular dose of benzathine penicillin G led to prompt clinical and serological improvement. Literature review (n = 18) showed that MS in immunocompetent patients affects both sexes (55% male; mean age 37.1 years), often presents with ulceronodular or rupioid crusted lesions, and frequently involves systemic symptoms. Molecular diagnostics were rarely reported, with most diagnoses relying on histopathology and serology. Treatment with benzathine penicillin G was effective in all cases, and full recovery was achieved. Conclusions: MS can occur in immunocompetent, HIV-negative individuals without obvious risk factors. Clinicians should maintain a high index of suspicion in cases of systemic, cutaneous, or ocular manifestations suggestive of MS. Molecular assays can facilitate diagnosis and prevent unnecessary invasive procedures. Benzathine penicillin G remains the treatment of choice, demonstrating high therapeutic effectiveness. MS should be considered in the differential diagnosis of ulcerative or nodular dermatoses, regardless of immune status.

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Background: Cardiovascular syphilis (CVS) is a rare but severe manifestation of tertiary syphilis, often remaining clinically silent until life-threatening complications develop. Syphilitic aortitis can lead to aneurysmal degeneration, most commonly involving the ascending aorta and aortic arch. Despite advances in public health, the global resurgence of syphilis has renewed concern about its cardiovascular sequelae and the need for diagnostic vigilance. Case Report: We describe a 59-year-old male with systemic hypertension and a remote smoking history, who was largely asymptomatic except for mild exertional dyspnea (New York Heart Association Class II). During routine preoperative evaluation for noncardiac surgery, imaging revealed a giant aortic arch aneurysm measuring 114 × 94 × 93 mm, with associated dilatation of the ascending and descending aorta. Serologic testing confirmed syphilitic infection, and syphilitic aortitis was identified as the underlying etiology. After the completion of benzathine penicillin therapy, the patient underwent successful replacement of the ascending aorta and entire aortic arch under deep hypothermic circulatory arrest with selective antegrade cerebral perfusion. The supraaortic trunks were reimplanted en bloc using the island technique. Postoperative recovery was complicated by pleural effusion and transient neurological symptoms, both of which were managed conservatively, with full resolution. At two-month follow-up, the patient had returned to normal daily activities with preserved functional capacity. Conclusion: This case illustrates an atypical, arch-predominant presentation of CVS diagnosed incidentally in the contemporary era. It emphasizes the need to consider infectious etiologies, particularly syphilis, in patients with nonatherosclerotic or unusual aortic aneurysm patterns. Early recognition, appropriate antimicrobial therapy, and timely surgical intervention are essential to prevent catastrophic outcomes. The ongoing resurgence of syphilis underscores the importance of maintaining clinical awareness of this "forgotten disease," especially in patients with atypical aortic pathology.

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Syphilis, known for its varied presentations, often mimics other conditions, posing diagnostic challenges. Secondary syphilis can rarely manifest as generalised lymphadenopathy, resembling lymphoproliferative disorders. A male in his late 20s presented with appetite loss, bilateral painless lymphadenopathy and hepatosplenomegaly. Initial investigations suggested a lymphoproliferative disorder. Biopsy revealed dermatopathic lymphadenopathy. Detailed sexual history confirmed syphilis, treated with benzathine penicillin, resolving symptoms and lymphadenopathy. Diagnostic delay occurred due to an incomplete sexual history. Syphilis should be considered, even without typical cutaneous manifestations. Similar cases highlight syphilis's resemblance to malignant lymphoma. Comprehensive patient education and a multidisciplinary approach are vital. Early diagnosis and treatment are essential for optimal outcomes.

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Background: Syphilis is characterized by diverse manifestations, including rare complications such as otosyphilis and malignant syphilis, particularly in immunocompromised individuals. Case Presentation: This study reported a case of a 40-year-old Human Immunodeficiency Virus (HIV)-positive male with bilateral sensorineural hearing loss (SNHL) and disseminated ulceronodular skin lesions. Serological testing confirmed active Treponema pallidum infection with a venereal disease research laboratory (VDRL) titer of 1:64. Dermatological results were consistent with malignant syphilis, a rare and aggressive variant of secondary syphilis. Audiological assessment showed mild bilateral SNHL, while cerebrospinal fluid analysis was insignificant. Although histopathological confirmation was not performed due to rapid clinical improvement, a presumptive diagnosis of otosyphilis was made. Treatment and Outcome: The patient was treated with intramuscular ceftriaxone 2 grams daily for 14 days as an alternative to penicillin due to accessibility constraints and preference. This led to complete resolution of hearing loss, regression of cutaneous lesions, and a significant clinical serological response, including VDRL seroconversion at 6 months. The treatment did not produce Jarisch-Herxheimer reaction, showing good tolerance and supporting ceftriaxone effectiveness as an alternative therapy in HIV-associated syphilis. Conclusion: This case study underscores the importance of early recognition and treatment of otosyphilis and malignant syphilis in HIV-infected individuals. Ceftriaxone may serve as an effective alternative regimen to penicillin, achieving both clinical and serological recovery. Moreover, routine screening for otologic symptoms in patient with syphilis is critical to prevent irreversible complications. The limitations include the absence of histopathology and CSF analysis conducted after therapy initiation.

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Syphilis is a sexually transmitted infection caused by Treponema pallidum It progresses through three clinical stages and shows various oral symptoms, mainly during the secondary stage. The disease can resemble other common oral mucosal conditions, such as infections with nonspecific pharyngitis, tonsillitis and laryngitis, as well as neoplastic and immune-mediated ulcers. This report discusses a heterosexual couple with rare manifestations of primary and secondary syphilis involving oropharyngeal lesions and an extragenital chancre, highlighting the diagnostic challenge and the importance of clinical awareness for early detection and treatment.

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Syphilis, caused by Treponema pallidum, is a re-emerging infectious disease with diverse clinical manifestations. While primary syphilis often goes unnoticed, secondary syphilis is characterized by systemic symptoms and variable skin lesions, earning it the epithet 'the great imitator'. Histologically, secondary syphilis typically shows a plasma cell-rich dermal infiltrate, whereas granulomatous inflammation is rare. This report describes a case of nodular secondary syphilis with granulomatous inflammation in a 22-year-old woman who presented with persistent erythematous nodules on the face. Initial mismanagement with corticosteroids delayed the diagnosis, which was later confirmed by histopathology and positive serologic tests. Treatment with benzathine penicillin G led to complete resolution of the lesions. The case highlights the importance of recognizing atypical presentations of syphilis, especially granulomatous forms, in the differential diagnosis. Serologic testing remains essential for confirmation, and benzathine penicillin is the treatment of choice for all stages of syphilis.

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Syphilis incidence has been rising worldwide over the last few decades, raising concern for a resurgence of tertiary complications. Syphilitic cardiovascular disease is a rare but serious manifestation of tertiary syphilis, formerly a major cause of aortitis and thoracic aortic aneurysms before the antibiotic era. This review provides an updated overview of syphilitic cardiac and vascular disease for the cardiology specialist. We will discuss the historical and epidemiological context of cardiovascular syphilis, including longitudinal preantibiotic era studies and contemporary case series. We outline the pathophysiology of syphilitic aortitis, highlighting mechanisms whereby Treponema pallidum infection causes obliterative endarteritis of the vasa vasorum, ischemic injury to the aortic wall, and resulting aneurysm formation with aortic valve and coronary ostia involvement. The clinical manifestations are presented, with emphasis on the triad of classic tertiary cardiovascular syphilis, which includes syphilitic thoracic aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. The diagnostic strategies are covered, including modern imaging findings (CT, MRI, echocardiography), serologic test algorithms for syphilis, and histopathologic features. Differential diagnosis is covered in depth, contrasting syphilitic aortitis with other causes of aortitis such as Takayasu arteritis, giant cell arteritis, and other infectious or idiopathic aortitides. Management principles are laid out, with antibiotic therapy and surgery as indicated for late disease. We also cover reported case outcomes and registry reports-including modern surgical series and a recent population-based study implicating syphilis in increased cardiovascular risk-and highlight prognosis with modern therapies. Syphilitic cardiac and vascular disease remains a relevant clinical entity-the "great imitator" of cardiovascular medicine-despite decreased incidence in the antibiotic. Early recognition of this treatable cause of aortitis is critical. Outcomes may be favorable with appropriate antibiotic treatment and early surgical repair of complications, but delayed diagnosis is perilous. Ongoing vigilance, research into optimal management, and public health measures to restrict syphilis are required to further reduce the impact of this disease.

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Background: Congenital syphilis rates have been increasing since 2012 and are associated with adverse health outcomes. There is variability in screening guidelines, and little is known about provider knowledge of them. The purpose was to assess the awareness and acceptability of prenatal syphilis guidelines among physicians. Materials and Methods: We cross-sectionally assessed prenatal provider (MD/DO; n = 201) awareness and adoption of national guidelines. Feasibility was assessed through the feasibility of the intervention measure, acceptability using the acceptability of the intervention measure, and appropriateness using the intervention appropriateness measure. Each measure included four items on a five-point Likert scale from strongly disagree (1) to strongly agree (5). The final analysis compared relative advantage, compatibility, complexity, observability, and trialability across the guidelines. Data analysis was completed in SAS v9.4, and this study was approved by the university's IRB. Results: Providers discussed (84%) and recommended (91%) prenatal syphilis screening to their patients. Providers (87%) were aware of their professional organizations' prenatal syphilis screening recommendations and utilized the American Academy of Pediatrics/American Congress of Obstetrics and Gynecology guideline (74%). Universal screening (62%), pregnancy trimester (54%), and professional organizations' recommended guidelines (54%) were associated with recommending syphilis screening to prenatal patients. The most important factor was universal screening (33%). The Centers for Disease Control and Prevention guideline had the highest mean relative advantage score (3.56, p = 0.020), and the United States Preventive Services Task Force guideline was viewed as significantly clearer (9.76) compared to the other guidelines (p = 0.007). Conclusions: Participants discussed and recommended prenatal syphilis screening to their patients despite variability in screening guidelines. Future studies should analyze guideline dissemination to fully understand the adoption process.

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BackgroundThe co-infection of human immunodeficiency virus (HIV) and neurosyphilis presents a significant clinical challenge due to the increased risk of opportunistic infections, including progressive multifocal leukoencephalopathy (PML).Case PresentationA 23-year-old unmarried male with an unprotected sexual history presented with progressive right upper limb weakness and slurred speech for 10 days. He was diagnosed with HIV and neurosyphilis co-infection, and neuroimaging/cerebrospinal fluid studies confirmed PML.ConclusionsThis case highlights the importance of screening for HIV and neurosyphilis in young patients with neurological symptoms and the need for awareness of opportunistic infections such as PML in immunocompromised individuals.

A Young Man With HIV and Neurosyphilis Develops a Rare Fatal Brain DiseasePlain Language SummaryThis case study discusses a 23-year-old man who was diagnosed with both HIV and neurosyphilis and later developed a rare brain disease called progressive multifocal leukoencephalopathy (PML). Due to his weakened immune system from these infections, he experienced symptoms like arm weakness and slurred speech. The report emphasizes the importance of testing young people with neurological symptoms for conditions like HIV and neurosyphilis. It also highlights the need for healthcare providers to be aware of PML and other opportunistic infections in individuals with compromised immune systems. Early recognition and management of such cases are crucial for better patient outcomes.

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ABSTRACT: Granulomatous dermatitis within tattoos is most often attributed to pigment reactions, infection, or sarcoidosis. We report 2 patients of secondary syphilis presenting as granulomatous inflammation confined to black tattoo ink, an uncommon manifestation. Both patients demonstrated histologic features of granulomatous dermatitis with plasma cells, spirochetes confirmed by special staining, and complete resolution after penicillin therapy. These patients highlight syphilis as an important consideration in the differential diagnosis of papules within a tattoo.

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Objetivo: Identificar o conhecimento de graduandos de odontologia sobre a sífilis e suas repercussões orais. Metodologia: Estudo transversal, descritivo, cujo instrumento de pesquisa foi um formulário virtual constituído por perguntas claras e objetivas. Resultados: Cento e trinta e três voluntários participaram do estudo. Todos declararam saber o que é a sífilis e a grande maioria respondeu tratar-se de uma infecção sexualmente transmissível (IST). No entanto, quase 30% dos estudantes não souberam identificar o agente etiológico da doença e desconhecem o sítio extragenital de maior acometimento. Embora 94% dos graduandos afirmem poder ser a sífilis diagnosticada pelo cirurgião dentista, 43,2% não sabem como realizar o diagnóstico, e mais da metade desconhece o exame a ser solicitado. Setenta e quatro por cento dos estudantes que realizavam atendimento clínico não incluem na anamnese perguntas relacionadas às ISTs. Questionados sobre o conhecimento que tinham da doença, apenas 12,1% avaliaram como adequado e a maioria relatou não se sentir preparado para atender pacientes portadores da condição. Conclusão: Os estudantes de odontologia apresentam conhecimento limitado sobre a sífilis e suas manifestações orais, uma vez que se mostram inseguros em atender pacientes acometidos pela doença, insatisfeitos com o conhecimento que detêm e desconhecem características elementares da enfermidade... (AU)

Aim: To identify the knowledge of undergraduate dental students about syphilis and its oral repercussions. Methodology: A cross-sectional, descriptive study whose research instrument was a virtual form made up of clear and objective questions. Results: One hundred and thirty-three university students took part in the study. All said they knew what syphilis was and the vast majority said it was a sexually transmitted infection (STI). However, almost 30% of the students were unable to identify the etiological agent of the disease and were unaware of the extragenital site where it is most found. Although 94 per cent of undergraduates said that syphilis could be diagnosed by a dental surgeon, 43.2 per cent did not know how to make the diagnosis and more than half did not know which test to request. Seventy-four per cent of students who provide clinical care do not include questions related to STIs in their anamnesis. When asked about their knowledge of the disease, only 12.1 per cent rated it as adequate and the majority reported not feeling prepared to treat patients with the condition. Conclusion: Dental students have limited knowledge about syphilis and its oral manifestations, as they are insecure about treating patients with the disease, dissatisfied with their knowledge and unaware of the basic characteristics of the disease... (AU)

Objetivo: Identificar los conocimientos de los estudiantes universitarios de Odontología sobre la sífilis y sus repercusiones orales. Metodología: Estudio descriptivo transversal cuyo instrumento de investigación fue un formulario virtual compuesto por preguntas claras y objetivas. Resultados: Ciento treinta y tres estudiantes universitarios participaron en el estudio. Todos dijeron saber qué era la sífilis y la gran mayoría afirmó que se trataba de una infección de transmisión sexual (ITS). Sin embargo, casi el 30% de los estudiantes no fueron capaces de identificar el agente etiológico de la enfermedad y desconocían el lugar extragenital donde se encuentra con mayor frecuencia. Aunque el 94% de los estudiantes universitarios afirmó que la sífilis podía ser diagnosticada por un cirujano dentista, el 43,2% no sabía cómo hacer el diagnóstico y más de la mitad no sabía qué prueba solicitar. El 74% de los estudiantes que prestan atención clínica no incluyen en la anamnesis preguntas relacionadas con las ITS. Cuando se les preguntó por sus conocimientos sobre la enfermedad, sólo el 12,1% los calificó de adecuados y la mayoría afirmó no sentirse preparada para tratar a pacientes con esta patología. Conclusión: Los estudiantes de Odontología tienen conocimientos limitados sobre la sífilis y sus manifestaciones orales, ya que se sienten inseguros a la hora de tratar a pacientes con la enfermedad, insatisfechos con sus conocimientos y desconocen las características básicas de la enfermedad... (AU)

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Sexually transmitted infections (STIs) continue to pose a major public health challenge and have profound social, economic and health impacts. These infections, which are caused by a variety of bacteria, viruses and parasites, are primarily transmitted through sexual contact, but can also be passed from mother to child during childbirth or through contaminated needles and blood products. Despite advances in medicine and public health, the prevalence of STIs continues to rise, fueled by factors such as stigma, limited access to sexual health services, and evolving pathogens. This review will examine the global burden of STIs and highlight their prevalence and impact on different populations. It will discuss some of the diagnostic challenges that hinder the effective management and control of these infections. It will also discuss the wider public health implications, including the economic costs, and identify emerging challenges and potential strategies to mitigate their impact.

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PURPOSE: Syphilis is a systemic sexually transmitted infection that often mimics autoimmune and neurological disorders, which can lead to diagnostic delays. We describe a series of four patients affected by ocular syphilis initially misdiagnosed as a systemic inflammatory condition to highlight the ophthalmologist's role in early detection and management, thereby preventing irreversible visual impairment. METHODS: We retrospectively reviewed four cases of ocular syphilis from 2022 to 2024, which were initially misdiagnosed as autoimmune or neurological diseases and thus inappropriately treated with immunosuppressive therapy. The patients underwent a full ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, fundus imaging, optical coherence tomography, and retinal angiography. Syphilis serologies were performed, and treatment included intravenous penicillin G or ceftriaxone (for penicillin-allergic patients). RESULTS: All patients tested positive for syphilis, with negative HIV screening. Initial misdiagnoses included systemic sarcoidosis, multiple sclerosis, psoriasis-like skin lesions, or unknown inflammatory conditions and were treated with unnecessary immunosuppressive therapy. Ocular findings varied from granulomatous panuveitis to retinal vasculitis, placoid chorioretinitis, and macular edema. Antibiotic therapy led to significant clinical improvement, but patients exhibited irreversible damage, such as decreased visual acuity, persistent color vision loss, retinal atrophy, and irreversible photoreceptor damage. CONCLUSION: Syphilis remains a great mimicker, frequently misdiagnosed as non-infectious systemic disease. Ophthalmologists play a critical role in identifying ocular manifestations and initiating appropriate serological testing. A delayed diagnosis increases the risk of irreversible damage. Given the rising incidence, greater awareness and interdisciplinary collaboration are essential to ensure timely diagnosis and management.

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Syphilis is a multi-system disease caused by Treponema pallidum. Apart from congenital syphilis, it is seen exclusively in sexually active populations, as it has a sexual route of transmission. Children experiencing sexual abuse can acquire syphilis. We report a 12-year-old male child who was a victim of sexual abuse and had presented with a perianal verrucous mass. Immediate surgical resection was opted for to relieve constipation caused by the obstructing mass. The case was managed under the POCSO Act 2012.