Primary chancre in the rectum: an underdiagnosed cause of rectal ulcer.

We report the case of a 35-year-old homosexual man with previous history of HIV, with primary chacre in the rectum. We believe this paper is significant because the diagnosis of rectal ulcer is more common in recent years, however rectal syphilis is a poorly recognized entity, especially with primary chancre formation.

Mondor's disease of the penis associated with primary syphilis.

A case of penile Mondor's disease associated with syphilitic chancre is reported. The aetiology and management of Mondor's disease is also discussed.

[A focal infiltration in the upper lobe of the right lung as a manifestation of the initial stage of secondary syphilis].

Among sexually transmitted diseases, the incidence of primary and secondary syphilis has substantially increased in Russian Federation within the recent years. Modern clinicians, acquainted only with conventional dermatovenerologic symptoms of the disease, are less aware of rare manifestations of syphilis as a generalized infection. A rare case of syphilis with infiltrative pulmonary lesion is discussed in the article; the attention of practitioners is drawn to "unusual" manifestations of syphilis.

Update on syphilis and pregnancy.

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

Protracted Treponema pallidum-induced cutaneous chancres in rabbits infected with human T-cell leukemia virus type I.

In a preliminary study, two of four rabbits infected with human T-cell leukemia virus type I (HTLV-I) demonstrated prolonged primary chancres following superinfection with Treponema pallidum, the causative agent of syphilis. Two rabbits inoculated with 1 x 10(7) HTLV-I-infected human MT-2 cells and two with infected rabbit cells from a line established in this laboratory (RLT-P), developed latent HTLV-I infection as detected by seroconversion 10 weeks after infection and by detection of HTLV-I sequences in the DNA of peripheral blood lymphocytes after amplification by polymerase chair reaction (PCR) 15 weeks after infection. The rabbits remained clinically normal and had normal blood counts. Six months after infection, the four HTLV-infected rabbits and two noninfected controls were challenged by the intradermal inoculation of 1 x 10(6) Treponema pallidum into eight sites on the shaved back. The lesions of two of the HTLV-I-infected rabbits had a time course similar to non-HTLV-I-infected controls and were completely healed by 4 weeks. The lesions of one of the other two rabbits with progressive disease began to heal about 7 weeks after T. pallidum challenge. The cutaneous lesions in the other rabbit remained dark-field positive and became a confluent eschar at 8 weeks; healing only after treatment with penicillin. Four months after the primary challenge none of the six rabbits previously challenged with T. pallidum had developed lesions after rechallenge and thus expressed chancre immunity. These results demonstrate that rabbits with latent HTLV-I infections may have defective cell-mediated immunity.

Primary syphilitic chancre on the upper arm in an HIV-1-infected patient.

A 32-year-old HIV-infected man presented with an ulcerating skin lesion with indurated borders on the upper right arm. Both dark-field microscopy and syphilis serology confirmed the diagnosis of primary syphilis. Extragenital syphilitic chancres are uncommon but nevertheless have to be kept in mind as they often delay diagnosis.

Chancro luético multiple / Multiple syphilitic chancre

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["Lues maligna" in a female patient with diabetes]. / "Lues maligna" bei insulinpflichtigem Diabetes mellitus.

A 40-year-old female patient with diabetes mellitus presented with multiple erythematous ulcerated nodules and plaques predominantly on the trunk. A few months ago her partner had a small ulcer on the penis. She was HIV negative but showed markedly elevated syphilis serology titers (TPPA titer > 1:20.480, VDRL titer 1:128). The serum glucose levels exceeded 275 mg/dl. After exclusion of neurological involvement, we made the diagnosis of "lues maligna" arising in the setting of diabetes mellitus. The patient was treated with 2.4 million units benzathine penicillin intramuscularly weekly for three weeks. Simultaneously, diabetes therapy was improved with insulin injections. The syphilitic lesions cleared rapidly. In the follow-up VDRL titer was negative. "Lues maligna" is an unusual ulcerative variant of secondary syphilis which has been observed more frequently in HIV-infected patients in the last years. The occurrence of this aggressive variant in the clinical setting of diabetes mellitus is extremely rare.

Evaluation of syphilis in patients with HIV infection in Nigeria.

OBJECTIVE: To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. METHOD: Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken. RESULTS: Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months +/- 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD)--particularly genital ulcers--while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. CONCLUSION: Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.