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Gutierrez-Lanz E, Smith LB, Perry AM. Syphilis in Hematopathology Practice: A Diagnostic Challenge. Arch Pathol Lab Med 2024; 148:633-641. [PMID: 37535664 DOI: 10.5858/arpa.2023-0078-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT.— Syphilis, a reemerging disease caused by the spirochete Treponema pallidum, is becoming more frequent in surgical pathology and hematopathology practices. Hematopathologists typically receive lymph node biopsies from patients with syphilis who have localized or diffuse lymphadenopathy. Occasionally, syphilis infection in the aerodigestive tract can show a prominent lymphoplasmacytic infiltrate and mimic lymphoma. Besides the varying and occasional atypical morphology, the fact that clinical suspicion tends to be low or absent when histologic evaluation is requested adds to the importance of making this diagnosis. OBJECTIVE.— To summarize histologic features of syphilitic lymphadenitis and syphilis lesions in the aerodigestive tract, and to review differential diagnosis and potential diagnostic pitfalls. DATA SOURCES.— Literature review via PubMed search. CONCLUSIONS.— Characteristic histologic findings in syphilitic lymphadenitis include thickened capsule with plasma cell-rich inflammatory infiltrate, reactive follicular and paracortical hyperplasia with prominent lymphoplasmacytic infiltrate, and vasculitis. Lymph nodes, however, can show a number of other nonspecific histologic features, which frequently makes the diagnosis quite challenging. In the aerodigestive tract, syphilis is characterized by plasma cell-rich infiltrates. Immunohistochemistry for T pallidum is the preferred method for detecting spirochetes; however, this immunohistochemical stain shows cross-reactivity with other treponemal and commensal spirochetes. Differential diagnosis of syphilis in lymph nodes and the aerodigestive tract is broad and includes reactive, infectious, and neoplastic entities. Pathologists should be aware of the histologic features of syphilis and keep this challenging entity in the differential diagnosis.
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2
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Chakraborty A. Biases in dermatology: A primer. Indian J Dermatol Venereol Leprol 2024; 0:1-5. [PMID: 38314974 DOI: 10.25259/ijdvl_126_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/10/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Atreyo Chakraborty
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Veerbhadra Marg, Rishikesh, India
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3
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Sadoghi B, Stary G, Wolf P. Syphilis. J Dtsch Dermatol Ges 2023; 21:504-517. [PMID: 37183747 DOI: 10.1111/ddg.14999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 05/16/2023]
Abstract
Syphilis is a curable systemic infectious disease with a clear increase in incidence in recent years. The disease presents with a broad clinical spectrum and challenges clinicians due to the long incubation period and the sometimes complex interpretation of serological test results. Penicillin G remains the treatment of choice in all stages of syphilis.
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Affiliation(s)
- Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Georg Stary
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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4
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Sadoghi B, Stary G, Wolf P. Syphilis. J Dtsch Dermatol Ges 2023; 21:504-519. [PMID: 37183735 DOI: 10.1111/ddg.14999_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 05/16/2023]
Affiliation(s)
- Birgit Sadoghi
- Universitätsklink für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Georg Stary
- Universiätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Peter Wolf
- Universitätsklink für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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5
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Karanfilian KM, Almohssen AA, Kapila R, Schwartz RA. Malignant syphilis: a new and revised definition. Int J Dermatol 2023; 62:369-375. [PMID: 36250867 DOI: 10.1111/ijd.16444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 08/07/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV-positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long-term effects.
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Affiliation(s)
| | | | - Rajendra Kapila
- Infectious Disease, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, NJ, USA
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6
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Seuthe IMC, Eichhorn S, Kim J, van Ackeren K, Park JJH, Dazert S, Klespe KC. [Syphilis infection in the ENT area]. Laryngorhinootologie 2022. [PMID: 35395693 DOI: 10.1055/a-1808-7321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The number of reported cases of syphilis has been increasing for years. The sexually transmitted disease is caused by the spirochete Treponema pallidum subspecies pallidum and progresses in different stages. Symptoms in the ENT area can occur in all stages. This means that a syphilis infection should always be considered by the ENT doctor as a differential diagnosis if the symptoms are suitable. Thus, with increasing oral sexual intercourse, the primary effect/hard chancre is more often observed in the oral cavity. In addition, symptoms can occur not only in the oral cavity, but also in the ear, nose, larynx, cervical and facial regions. The diagnosis is confirmed by direct pathogen detection or by serological detection. The spirochete cannot be cultivated. The therapeutic gold standard is the administration of benzathine penicillin G or procaine penicillin G. Doxycycline, macrolides or ceftriaxone are available as alternatives. In case of inner ear or cranial nerve involvement, the additional administration of a glucocorticoid is recommended. Before antibiotic therapy is administered, the patient must be informed about the possibility of a Jarisch-Herxheimer reaction. In cases of a syphilis infection, a collegial cooperation with the venereologists is always recommended so that an effective and comprehensive diagnosis and therapy can be carried out.
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Affiliation(s)
- Inga Marte Charlott Seuthe
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Sabine Eichhorn
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Jonghui Kim
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Konstantin van Ackeren
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany
| | - Jonas Jae-Hyun Park
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Stefan Dazert
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany
| | - Kai-Christian Klespe
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln, Köln, Germany
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7
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Evren K, Berkem R, Yücel M. Evaluation of The Diagnostic Algorithms for Serodiagnosis of Syphilis. Jpn J Infect Dis 2021; 75:70-75. [PMID: 34193666 DOI: 10.7883/yoken.jjid.2021.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We analyzed the performance parameters of the traditional and the reverse algorithms to find out which one is more convenient for serodiagnosis of syphilis. In total, 4789 serum samples were obtained in a cross-sectional study. Venereal Disease Research Laboratory (VDRL), Treponema pallidum Haemagglutination Assay (TPHA) and Chemiluminescent Microparticle Immunoassay (CMIA) tests were performed for every serum sample. In case of discordance between results, the TPHA was applied as a second treponemal test. Overall, 207 patients were serodiagnosed with syphilis. Among 4789 subjects tested, 125 (2.6%) and 206 (4.3%) were positive using the traditional algorithm and the reverse algorithm, respectively. The missed diagnosis rate of the traditional algorithm was 42.5%. The reverse algorithm had higher sensitivity than the traditional algorithm. Sensitivity levels of the traditional and the reverse algorithms were 57.49% and 99.85% respectively. The false positivity of the reverse algorithms was 0.02%.
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Affiliation(s)
- Kübra Evren
- Department of Microbiology, University of Health Sciences, Ankara Training and Research Hospital, TURKEY
| | - Rukiye Berkem
- Department of Microbiology, University of Health Sciences, Ankara Training and Research Hospital, TURKEY
| | - Mihriban Yücel
- Department of Microbiology, University of Health Sciences, Ankara Training and Research Hospital, TURKEY
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8
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Smith MH, Vargo RJ, Bilodeau EA, Anderson KM, Trzcinska A, Canterbury CR, Fantasia JE, Rawal YB. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head Neck Pathol 2021; 15:787-795. [PMID: 33459991 PMCID: PMC8384985 DOI: 10.1007/s12105-020-01283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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Affiliation(s)
- Molly Housley Smith
- Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA.
| | - Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA
| | - Elizabeth Ann Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA
| | - K Mark Anderson
- Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA
| | - Anna Trzcinska
- Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Carleigh R Canterbury
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - John E Fantasia
- Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA
| | - Yeshwant B Rawal
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
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9
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Santacroce L, Bottalico L, Topi S, Castellaneta F, Charitos IA. The "Scourge of the Renaissance". A Short Review About Treponema pallidum infection. Endocr Metab Immune Disord Drug Targets 2021; 20:335-343. [PMID: 31625831 DOI: 10.2174/1871530319666191009144217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is not a time in the history when epidemics did not loom large: infectious diseases have always had civilisation and evolution-altering consequences. Throughout history, there have been a number of pandemics: cholera, bubonic plague, influenza, smallpox are some of the most brutal killers in human history. Historical accounts of pandemics clearly demonstrate that war, unhygienic conditions, social and health inequality create conditions for the transmission of infectious diseases, and existing health disparities can contribute to unequal morbidity and mortality. The Renaissance was a period of European cultural, artistic, political and economic "rebirth" following the Middle Ages, but it was also the time when new infectious disease appeared, such as Syphilis. The epidemic spread of Syphilis began between the late 15th century and early 16th century due to the increased migration of peoples across Europe. The rapid spread of venereal syphilis throughout Europe suggests the introduction of a disease into a population that had not previously been exposed. Syphilis is a type of treponematosis, which includes syphilis, bejel, yaws, and pinta, but, while syphilis is venereal disease, the others are nonvenereal. Syphilis was, at the beginning, a disease of great severity due to its novelty, as the population had no time to gain any immunity against this venereal disease. METHODS The purpose of this study is to investigate the origin of syphilis and the evolution of the treatments from the empiric means to the discovery of penicillin, but also to understand how this venereal disease has largely influenced human lifestyle and evolution. CONCLUSION The first of the three hypotheses about its origins is the Columbian hypothesis, which states that Columbus's crew acquired syphilis from Native Americans and carried it back to Europe in 1493 A. D. On the contrary, the second hypothesis (pre-Columbian) asserts that syphilis was present in Europe long before Columbus's voyage and was transferred to the New World by Columbus's men. The Unitarian theory argues that syphilis, bejel, yaws, and pinta are not separate diseases but they represent syndromes caused by slightly different strains of one organism. Nowadays, Syphilis' origin is still uncertain and remains controversial. However, the large impact on the social behavior and international public health is an important reason to investigate about its origins and how to prevent the transmission.
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Affiliation(s)
- Luigi Santacroce
- Ionian Department, University of Bari "A. Moro", Bari, Italy.,Clinical Department of Microbiology & Virology, University Hospital of Bari, Bari, Italy.,Department of Clinical Subjects, School of Technical Medical Sciences, "A. Xhuvani" University of Elbasan, Elbasan, Albania
| | - Lucrezia Bottalico
- Ionian Department, Polypheno srl Academic Spin Off, "Aldo Moro" University of Bari, Bari, Italy
| | - Skender Topi
- Ionian Department, University of Bari "A. Moro", Bari, Italy.,Department of Clinical Subjects, School of Technical Medical Sciences, "A. Xhuvani" University of Elbasan, Elbasan, Albania
| | - Francesca Castellaneta
- Department of Internal Medicine and Oncology, School of Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Ioannis A Charitos
- Department of Emergency/Urgent, National Poison Center, Riuniti University Hospital (OO.RR.) of Foggia, Foggia, Italy
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10
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Lautenschlager SA, Lautenschlager S. [CME Dermatology 19/Answer: Patchy Hair Loss]. PRAXIS 2019; 108:705-706. [PMID: 31387496 DOI: 10.1024/1661-8157/a003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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11
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Thakrar P, Aclimandos W, Goldmeier D, Setterfield JF. Oral ulcers as a presentation of secondary syphilis. Clin Exp Dermatol 2018; 43:868-875. [PMID: 30039628 DOI: 10.1111/ced.13640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/01/2022]
Abstract
The incidence of syphilis is increasing, and it typically presents in patients with known risk factors, often to genitourinary physicians. Patients presenting to a dermatologist or ophthalmologist will more likely have secondary syphilis, with the potential for having the associated complications. Early recognition is therefore vital to limit both the disease and risk of further contact spread. In this review, we include two case histories demonstrating the value of recognizing oral signs. Additionally, we review the currently accepted diagnostic and therapeutic recommendations.
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Affiliation(s)
- P Thakrar
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - W Aclimandos
- Department of Ophthalmology, King's College Hospital, London, UK
| | - D Goldmeier
- Department of Genitourinary medicine, Imperial College NHS Healthcare Trust, London, UK
| | - J F Setterfield
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Mucosal and Salivary Division, Dental Institute, King's College, London, UK
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12
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de Andrade RS, de Freitas EM, Rocha BA, Gusmão ES, Filho MRM, Júnior HM. Oral findings in secondary syphilis. Med Oral Patol Oral Cir Bucal 2018; 23:e138-e143. [PMID: 29476680 PMCID: PMC5911365 DOI: 10.4317/medoral.22196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Syphilis is a sexually transmitted disease caused by Treponema pallidum. However, there are of hematogenic and vertical transmission. All health care professionals must be aware of the manifestations of this condition, such as oral lesions. Objectives This study to analyze and compare four clinical cases of syphilis that were diagnosed based on lesions in the oral cavity with published literature. Material and Methods Four patients with a confirmed sorologic and clinical diagnosis of syphilis were examined, confirmated from manifestation of oral lesions together with analysis of serological laboratory tests and histopathological analyses. Results Lesions were found in classic sites such as lips, tongue and skin. However, there were also lesions on the hard palate, and labial commissure, which correspond to less than 5% of the syphilis oral manifestations. Conclusions The practice of unprotected oral sex may result in infection and development of syphilis. The acknowledgment of the oral manifestations of syphilis in all its period of training for health professionals is of basic importance, the association of clinical features, histopathological findings and serological tests are required to complete the diagnosis and correct treatment. Key words:Oral syphilis, treponema infections, secondary syphilis.
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Affiliation(s)
- R-S de Andrade
- Av. Limeira, 901 - Areião, Piracicaba, SP 13414-018 Piracicaba, São Paulo, Brazil,
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13
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Kim TJ, Yoon HG, Koh JW. A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.2.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Jin Kim
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
| | - Han Gyul Yoon
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
| | - Jae Woong Koh
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
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14
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Kim Y, Yu SY, Kwak HW. Non-human Immunodeficiency Virus-related Ocular Syphilis in a Korean Population: Clinical Manifestations and Treatment Outcomes. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:360-368. [PMID: 27729756 PMCID: PMC5057012 DOI: 10.3341/kjo.2016.30.5.360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. Methods A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. Results The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. Conclusions Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.
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Affiliation(s)
- Yonguk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Woo Kwak
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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15
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Mainetti C, Scolari F, Lautenschlager S. The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature. J Eur Acad Dermatol Venereol 2016; 30:1810-1813. [PMID: 27421838 DOI: 10.1111/jdv.13802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann (SBF). So far, SBF has rarely been described in literature. OBJECTIVES We are reporting five additional cases of SBF considering the broad differential diagnosis of balanitis. METHODS A review of the available literature of SBF was performed and five additional cases analyzed. RESULTS In our case series, the clinical appearance of SBF shows a heterogeneous spectrum varying from painful oedematous balanoposthitis with beginning paraphimosis to superficial erosive balanitis and even to painless induration of the glans. CONCLUSIONS SBF might be seen more frequently than has been described due to misinterpretation. Therefore primary syphilis should be included in the differential diagnosis of balanitis and balanoposthitis.
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Affiliation(s)
- C Mainetti
- Department of Dermatology, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - F Scolari
- Private Practice, Geneva, Switzerland
| | - S Lautenschlager
- Outpatient Clinic of Dermato-Venereology, Triemli Hospital, Zürich, Switzerland.
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16
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Kroehl V, Kogut M, Enk AH, Haenssle HA. [Enanthema and painful ulceration of the tongue in a young woman]. Hautarzt 2015; 67:85-8. [PMID: 26495449 DOI: 10.1007/s00105-015-3715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Kroehl
- Universitätsklinikum Heidelberg, Hautklinik, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - M Kogut
- Universitätsklinikum Heidelberg, Hautklinik, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - A H Enk
- Universitätsklinikum Heidelberg, Hautklinik, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - H A Haenssle
- Universitätsklinikum Heidelberg, Hautklinik, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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17
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Malisiewicz B, Schöfer H. [Diagnosis and therapy of genitoanal ulcers of infectious etiology]. Hautarzt 2015; 66:19-29. [PMID: 25523404 DOI: 10.1007/s00105-014-3551-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted. Besides frequent causative infections rare but relevant diseases in the differential diagnosis are discussed in detail. MATERIAL AND METHODS A Pubmed literature search was carried out, guidelines from different task groups and clinical experiences are presented. RESULTS Infections with herpes simplex virus (first) and syphilis (second) are still the most common causes of infectious genital ulcers. An endemic occurrence, previously rare in Europe, has been observed in recent years. Particular risk groups, such as men who have sex with men (MSM), sex workers or sex tourists are affected. Even less common locations, such as the mouth or the rectum, lymphogranuloma venereum (LGV) and atypical clinical symptoms (e.g. pelvic pain in pelvic lymphadenopathy with LGV) must be considered in the differential diagnosis. CONCLUSION In recent years sexually transmitted infections (STI) have shown a significant increase in western industrialized nations. In all cases with unclear findings in the genital and anal areas (and also in the oral cavity) STI diseases must be reconsidered in the differential diagnosis.
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Affiliation(s)
- B Malisiewicz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Goethe-Universität Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland
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18
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Tröltzsch M, Pache C, Tröltzsch M, Ehrenfeld M, Otto S. [Multiple aphthous lesions of the oral mucosa]. HNO 2015; 63:60-2. [PMID: 25604539 DOI: 10.1007/s00106-014-2947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Tröltzsch
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Ludwig-Maximilians-Universität München, Lindwurmstr. 2a, 80337, München, Deutschland,
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19
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Oral syphilis: report of three cases and characterization of the inflammatory cells. Ann Diagn Pathol 2015; 19:76-80. [PMID: 25736987 DOI: 10.1016/j.anndiagpath.2015.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/09/2015] [Indexed: 12/22/2022]
Abstract
Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. This study reports 3 cases of syphilis and highlights the importance of identifying oral lesions for its final diagnosis. Case 1: a 48-year-old male patient presented with a bleeding ulcer in the lower lip. Overall clinical examination revealed patchy alopecia and skin target lesions. Case 2: a 61-year-old male patient presented with white spots on the lateral tongue and nodules on the dorsum of the tongue. Overall clinical examination showed erythematous target lesions on the abdomen, forearm, palms of the hand, and soles of the feet. Case 3: a 17-year-old male patient presented with an ulcerated lesion on the tongue and lymph node involvement. The following serologic tests were requested: Venereal Disease Research Laboratory, fluorescent treponemal antibody-absorption, anti-HIV-1 and anti-HIV-2, and anti-hepatitis C virus. An incisional biopsy revealed epithelial hyperplasia associated with intense and diffuse mononuclear inflammatory cell infiltration consisting mainly of plasma cells, in a perivascular and perineural distribution. The final diagnosis in the 3 patients was syphilis. Treatment consisted of 1 weekly dose of penicillin (2.4 million units, intramuscular) for 2 or 3 weeks. Immunohistochemical reactions for XIIIa, CD3, CD20, CD68, CD163, S100, CD1a, CD11c, CD83, CD138, and CD208 were performed. Clinicians should be familiarized with oral syphilis lesions in order to be able to diagnose this emerging infectious disease of variable clinical presentation.
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20
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21
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Gross G, Flaig B, Rode S. [Syphilis. Part 2: Laboratory diagnostics, therapy and prevention]. Hautarzt 2013; 64:851-61; quiz 862-3. [PMID: 24177666 DOI: 10.1007/s00105-013-2617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sexually transmitted infections and sexually transmitted diseases such as syphilis are a great problem for public health systems worldwide. Syphilis can be curatively treated with penicillin after early diagnosis, competent therapy and consistent monitoring. The fundamentals of syphilis diagnostics are direct and serological methods for pathogen detection. Prevention of syphilis includes exposition prophylaxis and in particular the routine use of condoms and the consistent education of affected persons and their sexual contacts.
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Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland,
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22
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Hertel M, Matter D, Schmidt-Westhausen AM, Bornstein MM. Oral syphilis: a series of 5 cases. J Oral Maxillofac Surg 2013; 72:338-45. [PMID: 24045192 DOI: 10.1016/j.joms.2013.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
Syphilis is an infectious, usually sexually transmitted, disease caused by Treponema pallidum, subspecies pallidum. Because of the increasing prevalence in Europe during the past few years, dentists could be confronted with patients with oral manifestations of syphilis. Because oral lesions are highly contagious, it is vital to make the correct diagnosis quickly to initiate the proper therapy and to interrupt the chain of infection. We present the cases of 5 patients with syphilis-related oral lesions. These cases are representative because of their clinical presentation, age, and gender distribution and the diagnostic approach. The aim of the present report is to emphasize the importance of the dentist knowing and identifying syphilis in different stages to diagnose the disease and institute treatment at an early stage.
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Affiliation(s)
- Moritz Hertel
- Resident, Charité Centre 3, Department of Oral Medicine, Dental Radiology, and Oral Surgery, Charité Medical University Berlin, Berlin, Germany.
| | - Daniel Matter
- Resident, Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland
| | - Andrea M Schmidt-Westhausen
- Professor, Charité Centre 3, Department of Oral Medicine, Dental Radiology and Oral Surgery, Charité Medical University Berlin, Berlin, Germany
| | - Michael M Bornstein
- Senior Lecturer, Department of Oral Surgery and Stomatology, University of Bern, School of Dental Medicine, Bern, Switzerland
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23
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da Silva Carneiro SC, Pirmez R, de Hollanda TR, Cuzzi T, Ramos-E-Silva M. Syphilis mimicking other dermatological diseases: reactive arthritis and mucha-habermann disease. Case Rep Dermatol 2013; 5:15-20. [PMID: 23467097 PMCID: PMC3573780 DOI: 10.1159/000346745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The authors present two cases of syphilis: one mimicking reactive arthritis and the other Mucha-Habermann disease. Both reports illustrate syphilis as ‘the great imitator’, a description given by Sir William Osler, and call attention to the strong need for awareness among physicians of all specialties, especially the younger ones, who are not used to seeing this increasingly prevalent disease, as it once was in the past.
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24
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Fast growing penis ulcer: an unusual coincidence. Urology 2012; 80:e9-10. [PMID: 22748894 DOI: 10.1016/j.urology.2012.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/23/2022]
Abstract
A 57-year-old man was seen with a 2-week history of progressive enlargement of an asymptomatic genital ulcer associated with bilateral inguinal lymphadenomegaly. Multiple unprotected heterosexual contacts were reported. The family doctor misdiagnosed primary syphilis with the following laboratory results: negative findings on the Venereal Disease Research Laboratory test, positive findings on the Treponema pallidum particle agglutination assay (titer 1:1280), and IgM negative on the Treponema pallidum particle agglutination assay. The patient was treated with penicillin G for the diagnosis of indeterminate latent syphilis and initially denied authorization for a skin biopsy. After 2 weeks, fast enlargement of the lesion was documented. He underwent skin biopsy, and the histopathologic examination revealed squamous cell carcinoma, and polymerase chain reaction for human papillomavirus 16 was positive.
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25
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Kelner N, Rabelo GD, da Cruz Perez DE, Assunção JNR, Witzel AL, Migliari DA, Alves FA. Analysis of nonspecific oral mucosal and dermal lesions suggestive of syphilis: a report of 6 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 117:1-7. [PMID: 22959147 DOI: 10.1016/j.oooo.2012.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 03/20/2012] [Accepted: 04/05/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Natalie Kelner
- Stomatology Department, A. C. Camargo Hospital, São Paulo, Brazil
| | - Gustavo Davi Rabelo
- Stomatology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Fabio Abreu Alves
- Stomatology Department, A. C. Camargo Hospital, São Paulo, Brazil; Stomatology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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26
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Onesimo R, Buonsenso D, Gioè C, Valetini P. Congenital syphilis: remember to not forget. BMJ Case Rep 2012; 2012:bcr.01.2012.5597. [PMID: 22669017 DOI: 10.1136/bcr.01.2012.5597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Roberta Onesimo
- Pediatrics Department, Catholic University of Sacred Heart, Rome, Italy.
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Sammet S, Niedermeier A, Bogner J, Mackert M, Gauglitz G, Ruzicka T. Die ungewöhnlichen Gesichter der Syphilis. Hautarzt 2011; 63:415-22. [DOI: 10.1007/s00105-011-2249-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Tóth V, Hornyák C, Kovács T, Tóth B, Várallyay G, Ostorházi E, Köles J, Bereczki D, Marschalkó M, Kárpáti S. Meningovascular neurosyphilis as the cause of ischemic cerebrovascular disease in a young man. Orv Hetil 2011; 152:763-7. [DOI: 10.1556/oh.2011.29115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Authors report a case of a 35-year-old male with right-sided mild paresis, incontinence, dysexecutive syndrome, short-term memory loss and behavioral changes. Bilateral cerebral infarcts in the region of the caudate nuclei and the adjacent white matter were proved by brain MRI and multiple stenoses of the branches of Willis-circle were confirmed by MR angiography. Elevated protein level and pleocytosis were found in the cerebrospinal fluid with intrathecal IgG synthesis. Serum rapid plasma reagin, Treponema pallidum Particle Agglutination test, Treponema pallidum ELISA, liquor Venereal Disease Research Laboratory tests were positive. Meningovascular neurosyphilis was diagnosed. 24M U/day intravenous penicillin-G treatment was given for 14 days. The patient has vascular dementia due to the bilateral strategic infarcts disconnecting the prefrontal circuits; his symptoms are similar to general paresis. Laboratory and radiologic improvement was observed. Still, the patient have severe residual cognitive decline. Orv. Hetil., 2011, 152, 763–767.
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Affiliation(s)
- Veronika Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest
| | - Csilla Hornyák
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest
| | - Tibor Kovács
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest
| | - Béla Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest
| | - György Várallyay
- Semmelweis Egyetem, Általános Orvostudományi Kar MR-Kutató Központ Budapest
| | - Eszter Ostorházi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest
| | | | - Dániel Bereczki
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest
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Drummond F, Guy R, Kaldor JM, Donovan B. The intersection between HIV and syphilis in men who have sex with men: some fresh perspectives. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Syphilis is increasing in men who have sex with men and disproportionately affects HIV-infected men. Here we review the epidemiology, diagnostic techniques, treatment guidelines, follow-up procedures and control of syphilis. The difference in these factors in HIV-infected men and uninfected men and evidence for this is reviewed. We explain that HIV-infected men are at higher risk of syphilis acquisition as a result of different behavioral factors. Thus, some control strategies may be different for HIV-infected men owing to these factors and also because HIV-infected men are more closely linked with medical care. There is no strong evidence to suggest there should be any differences in diagnostic techniques, treatment guidelines or follow-up procedures between HIV-infected and uninfected men.
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Affiliation(s)
| | - Rebecca Guy
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
| | - John M Kaldor
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
| | - Basil Donovan
- National Centre in HIV Epidemiology & Clinical Research, University of New South Wales, Sydney NSW 2052, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
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Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M. Manifest psychosis in neurosyphilis. Gen Hosp Psychiatry 2009; 31:379-81. [PMID: 19555800 DOI: 10.1016/j.genhosppsych.2008.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 08/24/2008] [Accepted: 09/04/2008] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recent surveys have assessed a remarkable increase in the prevalence of infectious syphilis. If left untreated, 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. CASE REPORT The authors present a case of an acute psychosis during and after pregnancy in a 37-year-old woman, which was identified as a manifestation of neurosyphilis after admission to a psychiatric ward. The positive screening test for syphilis provided the first hint of syphilis and gave direction for further diagnosis and specific treatment. Subsequently, the patient was treated with psychotropic medication concurrent with an adequate antibiotic treatment for neurosyphilis and was simultaneously psychologically monitored. An improvement of psychotic symptoms during antibiotic therapy was observed. CONCLUSION This case emphasises that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases. Owing to current epidemiological data and difficulties in diagnosing syphilis, routine screening tests in the psychiatric field are necessary.
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Affiliation(s)
- Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna 1090, Austria.
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31
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Sífilis congénita en un niño de 7 semanas: ¿se hubiera evitado con otro protocolo? An Pediatr (Barc) 2009; 70:190-1. [DOI: 10.1016/j.anpedi.2008.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 08/03/2008] [Accepted: 08/04/2008] [Indexed: 11/20/2022] Open
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32
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Evaluation of a Particle Gel Immunoassay as a Screening Test for Syphilis. Infection 2009; 37:26-8. [DOI: 10.1007/s15010-008-7082-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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33
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Choi KC, Song JY. Recent Trends in Clinical Observation of Syphilis and Consideration for Laboratory Tests. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.11.1100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyu Chul Choi
- Department of Dermatology, Chosun University College of Medicine, Korea.
| | - Ji Young Song
- Department of Dermatology, Chosun University College of Medicine, Korea.
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34
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Ortega KL, Rezende NPM, Magalhães MHCG. Diagnosing secondary syphilis in a patient with HIV. Br J Oral Maxillofac Surg 2008; 47:169-70. [PMID: 18801603 DOI: 10.1016/j.bjoms.2008.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2008] [Indexed: 11/29/2022]
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35
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Durani HK, Römer A, Kutzner H, Hartschuh W. [What is your diagnosis? Pruritic brown papules. Early secondary stage syphilis]. Hautarzt 2008; 59:513-5. [PMID: 18299809 DOI: 10.1007/s00105-008-1488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H K Durani
- Universitätshautklinik Heidelberg, Vobstrabe 2, 69115, Heidelberg, Deutschland.
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