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Haddad AW, Prince MA, Kloub M, Tewoldemedhin B, Adelakun AA, Haddad D, Al-Radideh O. Sculpting the Silent Intricacies: A Rare Triad of Syphilitic Aneurysms Unveiled. Cureus 2024; 16:e60944. [PMID: 38910719 PMCID: PMC11193547 DOI: 10.7759/cureus.60944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
This case report revolves around a 73-year-old male patient who initially sought medical attention due to left lower extremity weakness. Suspicions of a potential vascular etiology arose during the initial clinical examination, prompting further investigation. Unexpectedly, computed tomography (CT) imaging of the abdomen and pelvis revealed the presence of three giant aneurysms. Concurrently, positive syphilis titers were identified. The patient's presentation, marked by focal neurological deficits, unveiled the incidental discovery of a triad of aneurysms involving the distal abdominal aorta, right common iliac, and left common iliac. The neurological symptoms observed in the patient were attributed to the compression within the left common iliac artery, leading to compromised blood flow to the lower extremity. Alternatively, the neurological deficits could be linked to neurosyphilis or a combination of both factors. This case underscores the critical role of considering syphilis in patients presenting with neurological symptoms. The unique discovery of extensive aortic abnormalities through imaging studies, specifically CT angiography, emphasized the importance of such diagnostic tools in unraveling complex and potentially life-threatening vascular pathologies. Recognizing the diverse manifestations of syphilis in patients with vast neurological symptoms is crucial for timely diagnosis and multidisciplinary management. This case emphasizes the need to keep a high index of suspicion for syphilis in individuals who have widespread aortic anomalies together with neurological symptoms, to sum up. The triad of aneurysms discovered incidentally in this 73-year-old patient underscores the intricate interplay between vascular and neurological manifestations. The timely diagnosis and multidisciplinary management of both the neurological and vascular aspects of this unique presentation are essential for ensuring optimal patient outcomes.
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Affiliation(s)
- Ahmad W Haddad
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | | | - Mohammad Kloub
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Bereket Tewoldemedhin
- Internal Medicine, Suburban Community Hospital, Lower Bucks Hospital, Bristol, USA
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | - Adeniyi A Adelakun
- Internal Medicine, Saint Mary's General Hospital, Saint Clare's Health, Passaic, USA
| | - Deema Haddad
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Omar Al-Radideh
- Internal Medicine, University of Florida College of Medicine, Gainseville, USA
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Barry MP, Thibault CS, Berzkalns A, Spellman DR, Rowlinson E, Barbee LA, Golden MR, Kerani RP. Previous Sexually Transmitted Infections and Partner Services Interviews as Predictors of Subsequent Interview Completion Among Cisgender MSM: Partner Services Fatigue? Sex Transm Dis 2023; 50:506-511. [PMID: 37213183 PMCID: PMC10523844 DOI: 10.1097/olq.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Anecdotal reports suggest that partner services (PS) are less successful among people with repeat sexually transmitted infection (STI) diagnoses and/or previous PS interactions. We examine whether having repeated STI diagnoses and/or PS interactions is associated with PS outcomes among men who have sex with men (MSM). METHODS With STI surveillance and PS data for MSM diagnosed with gonorrhea, chlamydia, and/or syphilis from 2007 to 2018, in King County, WA, we used Poisson regression models to examine the relationships between PS outcomes (e.g., completing a PS interview and providing identifying information for a contact) with (1) number of previous STI case episodes and (2) number of previous PS interviews completed. RESULTS Of the 18,501 MSM STI case patients initiated for interview in the analytic period (2011-2018), 13,232 (72%) completed a PS interview, and 8,030 (43%) had at least 1 prior PS interview. The proportion of initiated cases successfully interviewed declined from 71% among those with no previous PS interview to 66% among those with ≥3 prior interviews. Similarly, the proportion of interviews with ≥1 partner identified declined with greater numbers of previous PS interviews (from 46% [0 interviews] to 35% [≥3 interviews]). In multivariate models, having ≥1 prior PS interview was negatively associated with completing a subsequent interview and providing partner locating information. CONCLUSIONS Having a history of STI PS interviews is associated with less PS engagement among MSM. New approaches to PS should be explored to address the growing epidemic of STIs among MSM.
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Affiliation(s)
- Michael P. Barry
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | | | - Anna Berzkalns
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | - Dawn R. Spellman
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
| | - Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Lindley A. Barbee
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle and King County, Seattle, WA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
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3
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Khan M, Sharma A, Hathorn T, Sandhu M, Rosen R, Riddle N, Mifsud M. The Mucosal Manifestations of Syphilis in the Head and Neck. EAR, NOSE & THROAT JOURNAL 2023:1455613231165159. [PMID: 37129418 DOI: 10.1177/01455613231165159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Objectives: Syphilis is a resurging disease which can present itself in many ways, including lesions within the head and neck mucosa. Some of these lesions may clinically mimic oral malignancies. This literature review aims to better characterize the mucosal presentations of syphilis. Methods: PubMed, EMBASE, and clinicaltrials.gov were searched for full-text, English articles published from 1950 to 2022 that reported patients with head and neck mucosal manifestations of syphilis. Articles were screened according to PRISMA guidelines. Results: One hundred forty-three manuscripts documenting 236 individual patients were included in the review. Patients with secondary syphilis accounted for 62% of patients presenting with head and neck mucosal lesions. The most common lesions found in primary and secondary syphilis were ulcerations, primarily found on the tongue, lips, and palate. While serologic studies are the gold standard for diagnosing syphilis, biopsy of these lesions have characteristic syphilitic changes. Conclusions: Syphilis' nickname of "The great imitator" remains to be true, and the head and neck mucosal manifestations of this disease can resemble commonly seen malignancies. Awareness of this disease and its lesions is prudent given the rising incidence of syphilis within the United States.
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Affiliation(s)
- Mahnoor Khan
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Abhay Sharma
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Travis Hathorn
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Ross Rosen
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Nicole Riddle
- Department of Pathology and Cell Biology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Matthew Mifsud
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
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Tavares CSS, Gomes dos Santos Oliveira SJ, de Gois-Santos VT, Vaez AC, de Menezes MO, Santos Jr HP, Santos VS, Martins-Filho PR. Quality of life, depressive symptoms, anxiety, and sexual function in mothers of neonates with congenital syphilis in the Northeast Brazil: A cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100127. [PMID: 36777650 PMCID: PMC9903911 DOI: 10.1016/j.lana.2021.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Congenital syphilis is an important public health problem in low- and middle-income countries. Poor neonatal health outcomes associated with the disease may lead to maternal psychological distress and feelings of helplessness. This study aimed to evaluate the quality of life, anxiety levels, depressive symptoms, and sexual function in mothers of neonates with congenital syphilis in the Northeast of Brazil. Methods This cohort study compared patient-centered outcomes between mothers of neonates with congenital syphilis and mothers of healthy neonates during the first three months of the postpartum period. The study was conducted in Sergipe state, Northeast Brazil, a region with one of the highest rates of congenital syphilis (14·1 cases per 1000 live births). Quality of life, depressive symptoms, anxiety levels, and sexual function were evaluated by using the World Health Organization Quality of Live - shortened version (WHOQoL-BREF) instrument, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Female Sexual Function Index, respectively. Unadjusted differences between groups were anayzed by using the Mann-Whitney test. Glass's delta with 95% confidence interval (CI) was used to measure the effect size. Findings Sixty-three women were included in each group. During the in-hospital stay, mothers of neonates with congenital syphilis had lower scores for overall quality of life (p < 0·001; large effect size: -0·559 [95% CI -0·683 to -0·405]) and higher levels of anxiety (p < 0·001; large effect size: 0·558 [95% CI 0·403 to 0·681]) and depressive symptoms (p < 0·001; large effect size: 0·561 [95% CI 0·407 to 0·684]) than mothers of healthy neonates. Three months after childbirth, we found persistent depressive symptoms (p = 0·021; small effect size: 0·239 [95% CI 0·041 to 0·419]) and low overall sexual function (p = 0·041; small effect size: -0·211 [95% CI -0·394 to -0·012]) among mothers of neonates with congenital syphilis compared to the control group. Interpretation Mothers of neonates with congenital syphilis present poorer quality of life, mental health, and sexual function compared to mothers of healthy neonates. Funding Brazilian Federal Agency for Coordination of Improvement of Higher Education Personnel (CAPES).
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Affiliation(s)
- Carolina Santos Souza Tavares
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Sheila Jaqueline Gomes dos Santos Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Vanessa Tavares de Gois-Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
| | - Andreia Centenaro Vaez
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
- Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
| | | | - Hudson P Santos Jr
- Biobehavioral Laboratory, University of North Carolina, Chapel Hill, USA
| | - Victor Santana Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Hospital Universitário, Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju CEP: 49060-100, Brazil
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5
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Tripathy DM, Gupta S, Vasudevan B. Resurgence of syphilis, the great imitator. Med J Armed Forces India 2022; 78:131-135. [PMID: 35463552 PMCID: PMC9023770 DOI: 10.1016/j.mjafi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Syphilis, one of the earliest diseases to be discovered in humans, still remains an enigma when it comes to its myriad manifestations and changing epidemiological profiles. There has been a surge in cases in the last few decades due to various factors. The human immunodeficiency virus (HIV) epidemics, global travel, increased incidence of male to male sexually transmitted diseases, online relationships culminating in casual sex are few of the important factors. Increased awareness could also be a factor for increased diagnosis. The multitude of clinical features especially when it comes to secondary syphilis and the rare tertiary manifestations, which can mimic various systemic disorders still pose a diagnostic challenge to the best of venereologists and physicians. This review aims to discuss the causes of resurgence in syphilis and few recent developments in pathogenesis, which could have led to this resurgence.
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Sahi SK, Zahlan JM, Tantalo LC, Marra CM. A Comparison of Treponema pallidum Subspecies pallidum Molecular Typing Systems: Multilocus Sequence Typing vs. Enhanced Centers for Disease Control and Prevention Typing. Sex Transm Dis 2021; 48:670-674. [PMID: 34110749 PMCID: PMC8373628 DOI: 10.1097/olq.0000000000001378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND At least 3 syphilis typing systems are proposed. Recent work suggests that multilocus sequence typing (MLST) may be superior to enhanced Centers for Disease Control and Prevention typing (ECDCT) by yielding a higher discriminatory power. The goal of this study was to compare the 2 systems and identify associations between neurosyphilis and strain types. METHODS Multilocus sequence typing for tp0136, tp0548, and tp0705 was determined for DNA from 78 Treponema pallidum subspecies pallidum isolates propagated in rabbits, 10 oral and 10 genital or non-genital lesion swabs, and 10 blood samples from patients with syphilis. These samples were chosen because they were completely typeable by ECDCT. Using both systems, association between strain types and neurosyphilis, defined as a reactive cerebrospinal fluid Venereal Disease Research Laboratory test, was determined. Partial and complete ECDCT types were also determined for samples from different anatomical sites in 35 patients, and from blood and blood isolates (rabbit propagated) from 13 patients. RESULTS The MLST type could be fully determined for 100 (92.6%) of 108 samples. Although MLST subdivided 3 common ECDCT types, it failed to distinguish among others. Neurosyphilis was more common in individuals infected with type 1.1.2 and tp0705 type 2 using MLST, and tp0548 type f using ECDCT. Enhanced Centers for Disease Control and Prevention typing was stable among anatomical sites and between patient-derived and rabbit propagated organisms. CONCLUSIONS Compared with ECDCT, MLST was not uniformly more discriminating. Both typing systems demonstrate that specific types may be more neurotropic than others.
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Affiliation(s)
- Sharon K. Sahi
- Department of Neurology, University of Washington, Seattle, WA
| | - Jana M. Zahlan
- Department of Neurology, University of Washington, Seattle, WA
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7
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Bond SM, Blain MLM. Diagnosis and Treatment of Secondary Syphilis in Women. J Midwifery Womens Health 2021; 66:372-379. [PMID: 34101969 DOI: 10.1111/jmwh.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023]
Abstract
Secondary syphilis develops approximately 3 to 12 weeks following undetected and untreated primary syphilis. Despite historically low rates of syphilis infection in 2000, the United States is now experiencing an alarming resurgence in primary, secondary, and congenital syphilis. This case report describes an unexpected presentation in a young woman presenting for an initial well-woman examination. Social and behavioral drivers of syphilis infection, diagnosis, and treatment are presented. Implications for women's health are examined. The need for new and more effective preventive health strategies is reviewed.
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Affiliation(s)
- Sharon M Bond
- Department of Obstetrics and Gynecology, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Michela L M Blain
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Seattle, Washington
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8
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Fasciana T, Capra G, Di Carlo P, Calà C, Vella M, Pistone G, Colomba C, Giammanco A. Socio-Demographic Characteristics and Sexual Behavioral Factors of Patients with Sexually Transmitted Infections Attending a Hospital in Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094722. [PMID: 33925258 PMCID: PMC8125464 DOI: 10.3390/ijerph18094722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
Sexually transmitted infections (STIs) are a serious global health problem. In Italy, data describing the vulnerability to STIs of specific sexual minorities and the influence of sociodemographic and behavioral determinants are limited, as most infections are not subject to mandatory notification. This retrospective study describes the sociodemographic profile and main sexual behaviors of patients attending a hospital in Palermo (Sicily, Italy) from January 2018 to March 2019 as predictors of STI risk. Patients were divided in subgroups: men-who-have-sex-with-men (MSM), men-who-have-sex-with-women (MSW), bisexual men and females. Data were obtained through an anonymous questionnaire. Patients were tested for chlamydia, syphilis, Mycoplasma genitalium infection, genital herpes and HPV infection. A total of 294 subjects with STIs (male/female ratio about 2:1) were screened. Of the total sample, 79.6% of patients were Italian. MSM accounted for 34.3%, MSW for 29.6%, bisexual men for 5.8% and females for 30.3%. A total of 44.5% of patients had a high education level, 42.5% reported irregular use of condoms, 20.7% reported having had 5-10 partners in the six months prior to the visit and 32.9% were HIV-positive. HPV infection and syphilis were the most prevalent STIs. Conclusions: The most common profile of patients attending our clinic was that of an adult, Italian man with a high level of education, poor use of condoms and a high number of partners. MSM had the highest sex-behavior-related risk for STIs. In addition, our results suggest that all STD teams need to implement counselling topics and recommendations to share with patients, as well as tips on how to approach sexual health education/counselling, thereby promoting patient-centered approaches and educational programs.
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Affiliation(s)
- Teresa Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
- Correspondence: ; Tel.: +39-3882422122
| | - Giuseppina Capra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
| | - Paola Di Carlo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
| | - Cinzia Calà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
| | - Marco Vella
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, 90127 Palermo, Italy;
| | - Giuseppe Pistone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
| | - Anna Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.C.); (P.D.C.); (C.C.); (G.P.); (C.C.); (A.G.)
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9
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Chaudhary F, Faghihimehr A, Subedi Y, Hodanazari SM, Yousaf MN. Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics. Cureus 2021; 13:e13647. [PMID: 33824800 PMCID: PMC8012739 DOI: 10.7759/cureus.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest. Further workup demonstrated a positive syphilis test. Untreated earlier stages of syphilis attribute to the development of the ascending aortic aneurysm. The patient was medically treated with IV penicillin and underwent surgical repair of the aortic aneurysm. Histopathology confirmed the diagnosis of syphilitic aortitis. Tertiary syphilis often presents several years after initial infection and usually after a latent phase, making it difficult to diagnose. Syphilitic aortic aneurysms may result in a high mortality rate in untreated patients. Therefore, a high index of suspicion is required for the early recognition of a syphilitic aortic aneurysm. Early treatment with antibiotic therapy and surgical repair of syphilitic aortic aneurysms can prevent life-threatening complications.
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Affiliation(s)
- Fizah Chaudhary
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Yogesh Subedi
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Muhammad N Yousaf
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
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10
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Wanni NHO, Dossary RA, Obeid OE, Qahtani NHA, Siddiqui ZI, El-Badry AA, Alkharsah KR. Seropositivity of syphilis among individuals screened in a tertiary hospital in the Eastern Province of Saudi Arabia. Ann Saudi Med 2021; 41:8-13. [PMID: 33550909 PMCID: PMC7868618 DOI: 10.5144/0256-4947.2021.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sexually transmitted infections are a serious public health problem. Syphilis, a multistage, curable chronic disease caused by the spirochete Treponema pallidum, remains a major health problem worldwide. The disease re-emerged in the era of HIV in many countries despite the accessibility of curative therapy and continuing public health efforts to eliminate it. OBJECTIVE Analyse the seropositivity for syphilis. DESIGN Retrospective cross-sectional. SETTING Tertiary hospital. PATIENTS AND METHODS We retrospectively studied individuals who underwent screening tests for syphilis between January 2014 and December 2018. The samples that were positive by both screening and confirmatory tests were considered as confirmed positive for syphilis. MAIN OUTCOME MEASURES Syphilis positivity identified by chemiluminescence immunoassay, the rapid plasma reagin test, and specific antibodies against Treponema pallidum. SAMPLE SIZE 11 832. RESULTS Of the 11 832, 54 (0.45%) were confirmed as seropositive for syphilis. Thirty-three (61.1%) were non-Saudi; 21 (38.9%) were Saudis. Thirty (55.6%) cases were males. Twenty-two (40.74%) were married and 29 (53.70%) were unmarried. Of the 54 diagnosed as syphilis positive, 28 (51.9%) were expatriate workers screened for pre-employment. The percentage of syphilis among Saudis was 0.36%. In an overall chi-square analysis, a P<.0001 indicated a difference among nationalities in the frequency of syphilis. A post-hoc analysis showed that Somalians (P=.004) and Sudanese (P=.005) differed significantly from other nationalities. CONCLUSION The study showed that syphilis was low among the screened population. More than half of the syphilis positive cases in this study were household employees. Screening for syphilis assists in planning complementary services for target populations and improves syphilis control. LIMITATIONS Retrospective design. Hospital-based findings may not be representative of the seroprevalence of syphilis in the general population. CONFLICT OF INTEREST None.
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Affiliation(s)
- Nahid H. O. Wanni
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Al Dossary
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Obeid E. Obeid
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourah Hasan Al Qahtani
- From the Department of Obstetrics and Gynecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Damam, Saudi Arabia
| | - Zaheenul Islam Siddiqui
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayman A. El-Badry
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khaled R. Alkharsah
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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11
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Affiliation(s)
- Joseph A Puccio
- USF Morsani College of Medicine, 4202 East Fowler Avenue, SHS 100, Tampa, FL 33620, USA.
| | - Aileen Cannon
- USF Morsani College of Medicine, 4202 East Fowler Avenue, SHS 100, Tampa, FL 33620, USA
| | - Kalyani Derasari
- USF Morsani College of Medicine, 4202 East Fowler Avenue, SHS 100, Tampa, FL 33620, USA
| | - Rodney Friend
- USF Morsani College of Medicine, 4202 East Fowler Avenue, SHS 100, Tampa, FL 33620, USA
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Fries F, Winckelmann HJ. [Venereal diseases in a "general practice" in the 17th and early 18th centuries]. Urologe A 2019; 57:717-722. [PMID: 29387905 DOI: 10.1007/s00120-018-0574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The diary of the town physician Johannes Franc (1649-1725), handwritten in Latin, gives-among other diseases-an overview of sexually transmitted infections affecting citizens in Ulm such as syphilis and gonorrhea. Franc reported on his own experiences in the diary and also included many theoretical details on the causes of the diseases and the corresponding therapies, including ethical considerations. Even in ancient times, there are indications of venereal diseases. However, at the latest with the outbreak of syphilis around the year 1495, the treatment and control of the spread of venereal diseases became an important task of medicine. Before gonococci were detected by Neisser in 1879, sexually transmitted diseases were generally seen as a single disease. However, at the beginning of the 18th century, there were several doctors who treated syphilis and gonorrhea as separate entities. Franc was one of them. Examining the milestones in the history of syphilis and gonorrhea, the present article reviews the existing theories that tried to explain the origins of these diseases. Franc's treatment patterns are illustrated. Franc's case reports indicate a fundamental change in the perception of STIs at the end of the 17th/beginning of the 18th century.
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Affiliation(s)
- F Fries
- Institut für Geschichte, Theorie und Ethik der Medizin, Universität Ulm, Parkstraße 11, 89073, Ulm, Deutschland
| | - H J Winckelmann
- Institut für Geschichte, Theorie und Ethik der Medizin, Universität Ulm, Parkstraße 11, 89073, Ulm, Deutschland.
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Schuch LF, da Silva KD, de Arruda JAA, Etges A, Gomes APN, Mesquita RA, Vasconcelos ACU, Tarquinio SBC. Forty cases of acquired oral syphilis and a review of the literature. Int J Oral Maxillofac Surg 2018; 48:635-643. [PMID: 30459066 DOI: 10.1016/j.ijom.2018.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/20/2018] [Accepted: 10/31/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.
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Affiliation(s)
- L F Schuch
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - K D da Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - J A A de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - A Etges
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - A P N Gomes
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - R A Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A C U Vasconcelos
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - S B C Tarquinio
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Stone RB, Chung Y, Ansa BE. Syphilis Trends in the Central Savannah River Area (CSRA) of Georgia and South Carolina, USA. J Clin Med 2018; 7:jcm7080190. [PMID: 30065154 PMCID: PMC6112017 DOI: 10.3390/jcm7080190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022] Open
Abstract
There has been an alarming resurgence of early syphilis since 2000, especially in the southeast region, which has one of the highest rates of primary and secondary syphilis in the United States of America (USA). Although the Central Savannah River Area (CSRA) is the second most populous area in Georgia with a large presence of health care facilities, its counties have one of the lowest overall rankings in health outcomes. This study examined the syphilis rates and trends in the CSRA. Data from the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention’s AtlasPlus was used. Cases of primary and secondary syphilis diagnosed during 2010–2015 were analyzed to describe reported syphilis among CSRA residents. In the CSRA, between 2010 and 2015, the incidence rate of primary and secondary syphilis increased from 5.9 to 9.4 cases per 100,000 population. The lowest rate of syphilis was observed in 2011 (2.7 cases per 100,000) and the highest rate in 2015. In 2015, the highest syphilis rates were observed among males (15.9 per 100,000), non-Hispanic blacks (16.9 per 100,000), and persons between the ages 20–24 years (34.5 per 100,000). The relevance of preventive measures has been widely communicated, yet it is clear that risk-taking sexual behavior is on the rise. Greater effort is warranted to reduce risky behaviors that promote the transmission of syphilis, including areas outside of major metropolitan areas.
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Affiliation(s)
- Rebecca B Stone
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Yunmi Chung
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
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Szwarcwald CL, de Almeida WDS, Damacena GN, de Souza-Júnior PRB, Ferreira-Júnior ODC, Guimarães MDC. Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016. Medicine (Baltimore) 2018; 97:S46-S53. [PMID: 29893747 PMCID: PMC5991537 DOI: 10.1097/md.0000000000009227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
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Narayan N, Bennett P, Chan C, Rhodes B. Secondary Syphilis Mimicking Giant Cell Arteritis. ACTA ACUST UNITED AC 2018; 26:18-20. [DOI: 10.1097/rhu.0000000000000764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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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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