Natural history of primary syphilis: clinical and serological aspects of chancre concurrent with Follmann's balanitis / Evolução natural dos aspectos clínicos e sorológicos de um caso de cancro duro concomitante com balanite de Follmann

Introduction: Primary syphilis is classically represented by a hard chancre, but other rare forms such as Follmann's balanitis are occasionally described. Objective: To show an iconography of the clinical presentations of the classic hard chancre and Follmann's balanitis, in parallel with the serological results in the course of diagnosis and treatment. Methods: Descriptive case report of a patient of an outpatient clinic for sexually transmitted infections in a tertiary hospital in the city of São Paulo, SP, Brazil. Conclusion: Syphilis lesions acquire different clinical expressions according to the natural evolution of the disease. Recognizing these presentations, as well as knowing how to interpret the serological results, is essential for the diagnosis and adequate treatment of the infection.

Introdução: A sífilis primária é representada classicamente pelo cancro duro, porém outras formas raras, como a balanite de Follmann, são ocasionalmente descritas. Objetivo: Apresentar uma iconografia dos estágios evolutivos da lesão clássica de cancro duro e da balanite de Follmann em paralelismo com os resultados sorológicos no curso do diagnóstico e do tratamento. Métodos: Relato descritivo evolutivo de paciente atendido em ambulatório de atendimento de infecções sexualmente transmissíveis de hospital terciário da cidade de São Paulo (SP), Brasil. Conclusão: As lesões da sífilis adquirem expressões clínicas diversas conforme a evolução natural da doença. Reconhecer essas apresentações, bem como saber interpretar os resultados sorológicos, é fundamental para o diagnóstico e o tratamento adequado da infecção.

The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre / 中国医学科学杂志(英文版)

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

Predictors of pathological response and clinical outcome following chemoradiation for locally advanced rectal cancer - a systematic review / Preditores de resposta patológica e de outcome clinico após quimioradioterapia neoadjuvante para cancro do reto localmente avançado - uma revisão sistemática

Abstract Background: Colorectal cancer is one of the most common types of cancer and is associated with a high lethality rate. Treatment is multidisciplinary, and neoadjuvant chemoradiation is recommended in locally advanced rectal cancer. About 15% of patients answer favorably to neoadjuvant chemoradiation, so it is important to determine the predictors of response. Objective: To review the results of studies that analyzes the predictors of complete pathological response to neoadjuvant chemoradiation in patients with locally advanced rectal cancer. Search methods: We searched for eligible articles in data bases Pubmed and Scopus, between the 12th and the 20th of March 2020. The following key words were used: "predictors of response", "chemoradiation" and "locally advanced rectal cancer". Selection criteria: Inclusion criteria: Studies including patients with locally advanced rectal cancer, patients receiving neoadjuvant chemoradiation as treatment, studies including predictors of response to neodjuvant chemoradiation, overall survival as an outcome and regarding language restrictions, only articles in English were accepted, only studies published until the 31st of December 2019 were accepted. Main results: Fourteen studies fulfilled the inclusion criteria. Thirteen are cohort studies and one is a clinical trial. Four groups of predictors were defined: blood markers, tumors, histopathological and patients' characteristics. Author's conclusions: During the analysis of the articles, there were several predictors identified as potential candidates for clinical practice, such as high pre neoadjuvant chemoradiation Carcinoembryonic Antigen levels and small post neoadjuvant chemoradiation tumor size. Nevertheless, it is difficult to make definitive conclusions about the most reliable predictors. That is why it is crucial to initiate further studies with standardized cut-off values and a methodology homogenization.

Resumo Introdução: O cancro colorretal é um dos cancros mais prevalentes em Portugal e tem associada uma alta taxa de letalidade. Atualmente, o tratamento é multidisciplinar, e a quimioradioterapia neoadjuvante está indicada no Cancro do Reto Localmente Avançado. Sabe-se que cerca de 15% dos doentes responde favoravelmente à quimioradioterapia neoadjuvante, sendo por isso importante determinar quais os preditores de resposta a este tipo de tratamento. Objetivo: Rever os resultados dos estudos que analisam os preditores de resposta completa à quimioradioterapia em pacientes com Cancro do Reto Localmente Avançado. Métodos de pesquisa: Pesquisamos artigos elegíveis nos bancos de dados Pubmed e Scopus, desde o dia 12 a 20 de Março de 2020. Foram utilizadas as seguintes palavras chave: "preditores de resposta", "quimioradioterapia neoadjuvante" e "Cancro do Reto Localmente Avançado". Critérios de seleção: Critérios de inclusão: Estudos que incluam pacientes com Cancro do Reto Localmente Avançad, pacientes sujeitos a quimioradioterapia neoadjuvante, preditores de resposta à quimioradioterapia, que avaliem a sobrevivência como outcome, escritos em inglês e publicados até dia 31 de Dezembro de 2019. Resultados principais: Catorze estudos preencheram os critérios de inclusão. De todos os artigos, treze são Cohort e um é Clinical Trial. Foram definidos quatro grupos de preditores: marcadores de sangue e caraterísticas do tumor, histopatológicas e dos pacientes. Conclusões dos autores: Durante a análise dos artigos, foram identificados vários preditores como potenciais candidates para a prática clínica, tais como o valor elevado de antigénio carcinoembrionário pré- quimioradioneoaajuvância e tamanho reduzido. Contudo, é arriscado elaborar conclusões concretas relativamente aos preditores mais confiáveis. Por isso, é crucial iniciar novos estudos com valores de cut-off estandardizados e métodos com maior homogeneidade.

Manifestaciones bucales de enfermedades de transmisión sexual identificadas en tres servicios de estomatología en Sur América / Oral manifestations of sexually transmitted diseases identified in three stomatology services in South America

Resumen Introducción: Las enfermedades de transmisión sexual se definen como un grupo de infecciones causadas por diversos agentes que se adquieren durante las relaciones sexuales. Éstas además suelen generar manifestaciones en boca. Objetivo: Determinar las lesiones características en cavidad bucal de enfermedades de transmisión sexual. Materiales y métodos: Estudio descriptivo transversal, con 37 pacientes que asistieron a los servicios de Estomatología de la Universidad de Buenos Aires, Universidad de Cartagena y el Hospital Alemán en Buenos Aires durante 2015 y 2016. Se realizó historia clínica completa con pruebas Venereal Disease Research Laboratory (VDRL) y Fluorescent Treponemal Antibody Absortion (FTA-ABS) en pacientes con presunción de sífilis. Además de análisis histopatológico y Reacción en Cadena de la Polimerasa (PCR) en pacientes con presunción de Virus de Papiloma Humano (VPH). Resultados: El promedio de edad de los pacientes fue de 38 años, predominó el sexo masculino. El 54,1% fueron diagnosticados con sífilis y la lesión más encontrada en estos fue la pápula. El 45,9% restante fueron diagnosticados con VPH, la lesión predominante en estos fue la verrugosidad. Conclusiones: El odontólogo debe contribuir en la detección temprana de enfermedades de transmisión sexual identificando manifestaciones de éstas en boca; con el fin de evitar su evolución y prevenir su transmisión.

Abstract Introduction: Sexually transmitted diseases are defined as a group of infections caused by various agents which are acquired during sexual intercourse. They also tend to generate manifestations in the mouth. Objective: To determine the typical lesions in oral cavity of sexually transmitted diseases. Materials and methods: A descriptive transversal study was conducted with 37 patients who attended the stomatology services of the University of Buenos Aires, University of Cartagena and the Aleman Hospital in Buenos Aires during 2015 and 2016. A complete clinical history was carried out with Venereal Disease Research Laboratory (VDRL) and Fluorescent Treponemal Antibody Absortion (FTA-ABS) tests in patients with presumption of syphilis. In addition, histopathological analysis and Polymerase Chain Reaction (PCR) was made in patients with presumption of Human papillomavirus (HPV). Results: The average age of the patients was 38, where male sex predominated. 54.1% were diagnosed with syphilis and the most found lesion in them was the papule. The remaining 45.9% were diagnosed with HPV, the predominant lesion in them was a wart. Conclusions: The dentist should contribute to the early detection of sexually transmitted diseases by identifying manifestations of these in the mouth in order to prevent their evolution and prevent their transmission.

Multiple Oral Syphilitic Chancres in a Homosexual Man / 대한피부과학회지

No abstract available.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de transmisión sexual y VIH/VIH avanzado. No. 07 / Protocol of the National Epidemiological Surveillance System for sexual transmission and advanced HIV / HIV. No. 07

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. En el presente protocolo se incluirán tres elementos: La vigilancia en poblaciones clave será centinela Se instituirá la vigilancia para la población general a través de Epiweb La vigilancia de la mujer embarazada para la prevención y eliminación de la transmisión materno infantil de la sífilis congénita, a través de Epiweb

Chancre Presenting as Nipple Eczema / 대한피부과학회지

No abstract available.

Use of FTA elute card impregnated with cervicovaginal sample directly into the amplification reaction increases the detection of human papillomavirus DNA

This study aimed to evaluate the use of the FTA elute cardTM impregnated with cervicovaginal sample directly in the PCR amplification for detection of HPV-DNA. The results were compared to a reference technique. This method was more efficient than the protocol indicated by the manufacturer, identifying 91.7% against 54.2% of the positive samples.

Painful Nodular Chancre of the Lower Lip / 대한피부과학회지

No abstract available.

Doenças sexualmente transmissíveis na mulher: como abordar? / Sexually transmitted diseases in women: how to broach them?

O presente estudo visou realizar uma revisão sistemática da literatura em relação à abordagem das mulheres com doenças sexualmente transmissíveis (DST). As síndromes clínicas abordadas abrangeram uretrites, cervicites, corrimento vaginal e úlceras genitais. A propedêutica indicada incluiu exames diretos e bioquímicos, métodos sorológicos, microbiológicos e de biologia molecular. O tratamento foi recomendado de acordo com o diagnóstico sindrômico ou etiológico, de acordo com a disponibilidade de exames complementares. Além disso, incluiu-se também a abordagem de parceiros, gestantes e mulheres coinfectadas pelo HIV.

This paper presents a systematic literature review on the management of women with sexually transmitted diseases (STD). The clinical syndromes discussed were urethritis and cervicitis, vaginal discharge and genital ulcers. Complementary studies included direct examination and biochemical reactions, serology, microbiological and molecular biology methods. The treatment was recommended in accordance with syndromic or etiologic diagnosis and with the availability of complementary examinations. Moreover, the approach towards partners, pregnant women and HIV co-infected women was also included.

A Case of Primary Syphilis on Both Oral Angles / 대한피부과학회지

Primary syphilis affects the genital and, less frequently, the extragenital regions. Approximately two-thirds of extragenital chancres occur above the neck, and about one-half of these are seen on the lips, the perioral region, or in the oral cavity. We present a case of a 32-year-old woman with a 2-month history of discharging ulcers on both oral angles. She had a history of orogenital sexual contact. Serologic tests for syphilis was positive, particularly the VDRL (1:128), confirmed by TPHA. The biopsy specimen showed a predominant infiltration of plasma cells in the dermis. The skin lesions improved after 4 weeks treatment with doxycycline.

Actitudes terapéuticas manejo sindrómico de las infecciones de transmisión sexual / Therapeutic attitudes: syndromic handling of sexually transmitted infections

En el presente artículo tratamos acerca de los gérmenes causantes de las infecciones de transmisión sexual (ITS), sus manifestaciones clínicas y revisamos los nuevos tratamientos; en especial, el llamado Manejo Sindrómico que es tratar con antibióticos combinados los síntomas de las ITS con el fin de combatir a los agentes causales más frecuentes.

The current article is about causing germs of Sexually Transmitted Infections (STI), its clinical manifestations and to review the new treatment concepts; moreover, the so called syndromic management that is to treat with combined antibiotics the STI symptoms so as to fight the biggest causations.(au)

MRI of Neurosyphilis Presenting as Mesiotemporal Abnormalities: a Case Report

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.

An Unusual Case of Luetic Lymphadenitis as a Solitary Submandibular Mass / 대한이비인후과학회지

Syphilis, a chronic systemic infection caused by Treponema pallidum, is usually sexually transmitted and characterized by episodes of active disease interrupted by a latent period. After an incubation period of averaging 2-6 weeks, a primary syphilis with a firm, non-tender chancre appears, often associated with regional lymphadenopathy. Secondary syphilis shows localized or diffuse mucocutaneous lesions and generalized non-tender lymphadenopathy. In about onethird of untreated cases, the tertiary stage appears, characterized by progressive destructive mucocutaneous, musculoskeletal or parenchymal lesions, aortitis or symptomatic central nervous system diseases. Without serological testing, the precise diagnosis is very difficult. In fact, it has often been called the great imitator because it was often confused with other disease. We report a very unusual case of luetic lymphadenitis presented as a solitary submandibular mass.

Diagnóstico da sífilis a partir das manifestações bucais / Syphilis diagnosis through oral manifestation

A sífils é uma doença sexualmente transmissível causada pelo Treponema pallidium. Pode ser transmitida também pelas vias hematogênicas e materno-fetal. A sífilis primária é caracterizada pelo cancro, observado na mucosa bucal na forma de úlcera firme indolor. As placas mucosas representam a manifestação oral da sífilis secundária. A sífilis terciária é caracterizada pela formação de gomas que podem levar a perfuração do palato. O diagnóstico de sífilis deve ser baseado de acordo com o estágio da doença. O tratamento da sífilis consiste em antibioticoterapia. A sífilis pode ser diagnosticada a partir de lesões bucais, sendo portanto, de fundamental importância o conhecimento desta doença pelo cirurgião-dentista.

Sífilis: a gran simuladora / Syphilis: he Great Mimicker

Objetivo.El objetivo del presente trabajo es revisar la epidemiología, la clasificación clínica, el diagnóstico y el tratamiento de la sífilis. Materiales y métodos. Con las palabras clave sífilis, lúes enfermedades de transmision sexual, se buscó información en la bases de datos de Pubmed/Medline,Cochrane, SciELO, al igual que en referencias de artículos de revista y textos, principalmente, de los últimos cinco años. El resultado de esta búsqueda arrojó 179 referencias, de las cuales, se tomaron las 36 más relevantes, teniendo en cuenta, principalmente, metanálisis, artículos de revisión, actualizaciones, estudios aleatorios doble ciego y guías clínicas. Resultados. La sífilis primaria es la primera etapa, en la que se forman úlceras indoloras (chancros), 2 a 3 semanas después de la primera infección.Es posible que la persona no note las úlceras o algún otro síntoma, especialmente, si están ubicadas en el interior del recto o en el cuello uterino. Las úlceras desaparecen en un período de 4 a 6 semanas. La sífilis secundaria se presenta de 2 a 8 semanas después de la aparición de las primeras úlceras. Alrededor de 33% de los que no reciben tratamiento para la sífilis primaria, desarrolla esta segunda etapa. La etapa final de la sífilis es la llamada sífilis terciaria y en ella la infección se disemina al sistema nervioso, el corazón, la piel y a los huesos. Conclusión. El uso de preservativos es fundamental para disminuir notoriamente el riesgo de adquirir esta enfermedad. Una vez adquirida,se debe realizar un tratamiento efectivo con el fin de evitar complicaciones cerebrales, del sistema nervioso y cardiacas.

Objective. To describe the epidemiology, clinical classification, diagnosis, and treatment of syphilis. Materials and methods. Using syphilis, lues, and sexually transmitted diseases as key words, information was sought in the databases such as Pubmed/Medline, Cochrane, SciELO, as well as in journal articles and text references, mainly from the last five years. The result of this search yielded 179 references; the most relevant, 36, were taken for analysis, mainly metaanalysis, review or state of the art articles,and double-blinded, andomized studies and clinical guides. Results. Primary syphilis is the first stage of the infection, which causes painless ulcers 2 to 3 weeks after first infection. The infected person may not notice those lesions or any other symptoms, particularly if ulcers are located inside the rectum or the cervix. Ulcers disappear over a 4 to 6 week period. Secondary syphilis is presented from 2 to 8 weeks after the appearance of the first ulcers. About 33% of those who do not receive treatment for primary syphilis develop this second stage of the disease. The final stage of syphilis is called tertiary syphilis and infection may disseminate to the nervous system, the heart, the skin and the bones. Conclusion. Condom use is essential to reduce the risk of acquiring the disease.Once acquired, an effective treatment must be administered to prevent brain, heart and nervous system complications.

Uveíte e lesões primárias disseminadas na sífilis adquirida / Uveitis and primary lesions disseminated in syphilis

Introdução: a sífilis é uma doença infecto-contagiosa de transmissão sexual, ascendente epidemiologicamente na saúde pública brasileira, devendo todos os profissionais da área de saúde estarem atentos a essa patologia, incluindo as manifestações extragenitais. Objetivo: relatar um caso clínico de sífilis primária que foi diagnosticado a partir de uveíte e de lesões primárias disseminadas. Métodos: foram feitos estudos de mapeamento e fundo de olho do paciente, bem como análise clínica e exames laboratoriais (VDRL, FTA-Abs IgM e IgG, sorologia para HIV, HBsAg, anti-HBc total, anti-HBsAg, anti-HCV). Resultados: a análise clínica, associada à investigação epidemiológica, com o resultado reagente do VDRL, acompanhado de FTA-Abs IgM, em um paciente soronegativo para HIV, com boa resposta ao tratamento com penicilina benzatina, confirma a hipótese diagnóstica de sífilis primária. Conclusão: é de fundamental importância que o profissional de saúde consulte novas referências bibliográficas para o conhecimento sobre as manifestações extragenitais de sífilis para que executem um diagnóstico correto e o tratamento adequado da doença, a fim de evitar possíveis seqüelas.

Introduction: syphilis is an infectious and contagious illness caused by sexual transmission, which is ascending in the Brazilian public health scenario.Therefore all professionals of the health area must be aware of the manifestations of this illness including extragenital manifestations. Objective: analyzing a clinical case of primary syphilis that was diagnosised from ocular manifestations and disseminated primary injuries. Methods: ophthalmologic and clinical analysis of the injuries of the patient, as well as examinations in laboratories (VDRL, FTA-Abs IgM/IgG, HIV sorology, HBsAg, anti-HBc total, antiHBsAg, anti-HCV) have been conducted. Results: the association of the clinical findings and epidemiologic investigation, with the positive result of VDRL, with FTA-Abs IgM in a no-HIV patient, confirmed the diagnostic hypothesis of primary syphilis. Conclusion: it is of utmost importance for health professionals, to gather new references of the knowledge of other manifestations of syphilis, in order to be able to establish a correct diagnosis and treatment, and avoid complications.

Sobrevivente de cancro: uma outra realidade / Cancer survivors: another reality

Nas últimas décadas tem-se verificado uma melhoria significativa do prognóstico das pessoasportadoras de cancro, emergindo com peso crescente a problemática dos sobreviventes de cancro. Apesar deo conceito ter entrado na literatura referente à oncologia, não há consenso sobre a sua definição. A substânciado conceito, ora assenta numa perspectiva mais biomédica, partindo de dados objectivos como os anos desobrevida, ora em outras perspectivas relacionadas com as idiossincrasias individuais e a trajectória da doença.Numa óptica qualitativa, mais do que a longevidade, há que incluir a avaliação da pessoa sobre as implicações da doença e dos tratamentos na vida pessoal, familiar e social. Compreender como as pessoas sobreviventes geremo impacto do cancro e a experiência das transformações na vida torna-se relevante para todos os profissionaisde saúde, de modo a potenciar uma sobrevivência de qualidade...

In recent decades, a significant prognostic improvement in people with cancer has been verified, thus emerging as an important issue the problem set of cancer survivors. Although this concept is integrated in modern oncology literature, we found no consensus about its definition. Some authors emphasized a biomedical approach, using objective data, like the number of surviving years. Others included other perspectives related to individual characteristics and disease trajectory. From a qualitative point of view, more than longevity, wemust include an evaluation of the personÆs disease based on its implications to personal, familiar, and social life. Understanding how cancer survivors deal with the impact of the disease and their transformations is relevant for all health professionals, in order to promote a better quality of survival...

A Case of Primary Inoculation Tuberculosis / 대한피부과학회지

Primary inoculation tuberculosis results from the inoculation of mycobacteria into the skin of a host not previously infected with tuberculosis. Tuberculous chancre and the affected regional lymph nodes constitute the tuberculous primary complex of the skin. A 21-year-old female visited our clinic with an erythematous, ulcerative, indurated plaque on her right upper eyelid. The skin lesion developed 2 months after bilateral upper blepharoplasty. The results of a skin biopsy with acid-fast bacilli staining and polymerase chain reaction were compatible with tuberculosis of the skin. After 9 months of antituberculosis chemotherapy, the skin lesion was improved.