scholarly journals Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Robert Jame ◽  
Yousif Al-Saeigh ◽  
Leo L. Wang ◽  
Kevin Wang
Keyword(s):  
Undetectable Viral Load ◽  
Secondary Syphilis ◽  
Warning Signs ◽  
Penicillin G ◽  
Hiv Positive ◽  
Ocular Infection ◽  
Blurred Vision ◽  
Syphilis Infection ◽  
Transmitted Infection ◽  
History Of

Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.

Prevalence and predictors of HIV-syphilis co-infection among HIV-infected pregnant women in China, 2011-2018

2020 ◽  
Author(s):  
Qian Wang ◽  
Xiao-Yan Wang ◽  
Xiaomeng Ma ◽  
Lori M Newman ◽  
Li-Xia Dou ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pregnant Women ◽  
Junior High School ◽  
Case Reports ◽  
Care Service ◽  
Trend Test ◽  
Hiv Positive ◽  
Syphilis Infection ◽  
Transmitted Infection ◽  
Sexually Transmitted

Abstract Background The co-infection of Human Immunodeficiency Virus (HIV) and syphilis is risky for pregnant women and their expected children. In 2015, the Integrated Prevention of Mother-to-Child Transmission (iPMTCT) programwas established to offer all pregnant women with free screening, counseling, and testing of HIV and syphilis during regular obstetric inspections. To summarize the phase progress of this program, we reported the trends of maternal HIV-syphilis co-infection in China. We tried to socioeconomic factors associated with HIV-syphilis co-infection to inform the stratified control strategy for future work. Methods We obtained the prevalence data of HIV and syphilis over 2011–2018 by reviewing the Sexually Transmitted Infection (STI) monthly update reporting to the central surveillance system. With health status, background characteristics, and health outcomes reported, we collected the case reports from 2,578 HIV-positive pregnant women who accepted the screening at the local clinic. The trends of HIV and syphilis prevalence were examined using the Cochran-Armitage trend test. Logistic regression was applied to detect the features associated with syphilis infection among HIV-positive women and the potential risk factor to neonatal death. Results The prevalence of HIV decreased from 0.076–0.039% among registered pregnant women but increased slightly to 0.054% in 2018. The trend of syphilis prevalence in HIV-infected pregnant women fluctuated slightly around an average of 1.80% (p = .378). Multivariate logistic regression indicated finishing education of junior high school or below (aOR: 1.79, 95%CI: 1.31–2.43; p < .001), on regular Antiretroviral Therapy (ART) (aOR: 1.89, 95%CI: 1.47–2.45; p < .001) and exposed HIV from injective drug use (aOR: 5.49, 95%CI: 3.51–8.61; p < .001) are associated with high syphilis infection risk. Syphilis co-infection with HIV (aOR: 2.81, 95%CI: 1.32–5.96; p < .007) significantly increases the risk of newborns death. Conclusion Syphilis infection is still very prevalent in HIV-positive pregnant women five years after the implementation of iPMTCT program. Promoting the health education for maternal infection of STIs and increasing the availability of early intervention to link more marginalized women with care service should be the focuses of work in the next stage.

Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study

2017 ◽  
Vol 94 (8) ◽  
pp. 571-573 ◽  
Author(s):  
Janet M Towns ◽  
Sarah Huffam ◽  
Eric P F Chow ◽  
Ian Denham ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Health Centre ◽  
Secondary Syphilis ◽  
Sexual Partners ◽  
Concordance Rate ◽  
Hiv Positive ◽  
Clinical Factors ◽  
Syphilis Infection ◽  
Factors Associated ◽  
Early Syphilis ◽  
Male Sexual Partners

BackgroundSyphilis infections continue to increase among men who have sex with men (MSM) in many countries, with rates often higher among HIV-positive MSM. There is limited understanding of the risk and determinants of syphilis transmission between men. We aimed to examine the concordance of early syphilis infection between male sexual partners and clinical factors associated with transmission.MethodsMen attending Melbourne Sexual Health Centre with their male partners, where at least one was diagnosed with early syphilis, were identified from linkage of partner records between March 2011 and April 2016. Early latent syphilis was defined as a new asymptomatic syphilis presentation of less than 2 years’ duration. Associations between concordance and potential risk factors were examined using Fisher’s exact test.ResultsAmong 43 couples (86 men) identified, there were 13 couples (26 men) where both were diagnosed with early syphilis, representing a concordance rate of 30.2% (95% CI 17.2% to 46.1%). Among the 13 concordant couples, 5 men had primary syphilis (4 penile, 1 anal), 11 secondary syphilis (8 generalised rash, 3 penile, 2 anal, 1 oral lesion) and 10 early latent infections. Concordance was higher among couples where at least one partner had secondary syphilis compared with couples where neither partner had secondary syphilis (53% (9/17) vs 15% (4/26), P=0.016). Furthermore, concordance was higher among couples where one was HIV positive compared with couples where both were HIV negative (62% (5/8) vs 23% (8/35), P=0.042).ConclusionsThere was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.

scholarly journals Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

2021 ◽  
Vol 7 (6) ◽  
pp. 872
Author(s):  
Rajesh Munusamy ◽  
Nithin Nagaraja
Keyword(s):  
Sexual Abuse ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Intellectually Disabled ◽  
Transmitted Infection ◽  
Sexual Transmitted Infection ◽  
Benzathine Penicillin G

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and <em>Treponema pallidum </em>hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.</p><p class="abstract"> </p>

scholarly journals Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

2012 ◽  
Vol 29 (4) ◽  
pp. 193-197 ◽  
Author(s):  
Milan Bjekić
Keyword(s):  
Hair Loss ◽  
Scalp Hair ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Hiv Positive ◽  
Oral Lesions ◽  
Benzathine Penicillin ◽  
Serological Tests ◽  
Benzathine Penicillin G ◽  
Macular Rash

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

scholarly journals Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
R. M. Ngwanya ◽  
B. Kakande ◽  
N. P. Khumalo
Keyword(s):  
Past History ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Rapid Progression ◽  
Tertiary Syphilis ◽  
History Of ◽  
Generalized Lymphadenopathy ◽  
Immunodeficiency Syndrome ◽  
Cluster Of Differentiation

Background. Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation. A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion. Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.

scholarly journals Seroepidemiology of Trichomonas vaginalis in rural women in Zimbabwe and patterns of association with HIV infection

2005 ◽  
Vol 133 (2) ◽  
pp. 315-323 ◽  
Author(s):  
PETER R. MASON ◽  
PIER LUIGI FIORI ◽  
PIERO CAPPUCCINELLI ◽  
PAOLA RAPPELLI ◽  
SIMON GREGSON
Keyword(s):  
Rural Women ◽  
Rural Areas ◽  
Trichomonas Vaginalis ◽  
Demographic Data ◽  
Hiv Positive ◽  
Sex Partners ◽  
Transmitted Infection ◽  
Multiple Sex Partners ◽  
Increased Risk ◽  
History Of

Serological assays using dried blood spots from 5221 women in rural areas of eastern Zimbabwe were used to assess the epidemiology of Trichomonas vaginalis infection, and its association with HIV. Antibodies to T. vaginalis and to HIV were detected by enzyme immunoassays. Behavioural and demographic data were collected by confidential questionnaires. In total, 516 (9·9%) women were seropositive for T. vaginalis and seroprevalence increased with age among younger women. Divorced, widowed and single women were more likely to be seropositive. After controlling for age, seropositivity was significantly associated with being sexually active, having multiple sex partners, having a partner who had multiple sex partners, and having a new sex partner in the past year. Seropositivity was associated with a recent history of genital discharge. Overall, 208 (40·3%) T. vaginalis-positive samples were also positive for HIV, compared with 1106 (23·5%) T. vaginalis-negative samples (age and sex adjusted OR 2·11, 95% CI 1·74–2·55, P<0·001). There was increased risk for being HIV-positive amongst T. vaginalis-seropositive women regardless of residence, employment or education. In a logistic regression controlling for common risk factors, the association remained significant. T. vaginalis-seropositive young women with a history of genital discharge were much more likely to be HIV-positive than women who were T. vaginalis-seronegative and had no history of discharge (OR 6·08, 95% CI 2·95–12·53). Although a causal relationship cannot be assumed, detection and treatment of trichomoniasis may be important in strategies to reduce HIV transmission through sexually transmitted infection control.

An unexpected undetectable viral load in a vulnerable woman

2012 ◽  
Vol 23 (7) ◽  
pp. 531-532
Author(s):  
G Fraser ◽  
F Fargie
Keyword(s):  
Viral Load ◽  
Undetectable Viral Load ◽  
Significant Rise ◽  
African Woman ◽  
Hiv Positive ◽  
Treatment Level ◽  
Elite Controllers ◽  
Hiv Viral Load ◽  
Recommended Treatment ◽  
History Of

We present a case of a vulnerable HIV-positive African woman who on initial visits to the clinic had an undetectable HIV viral load without giving a history of being on antiretroviral therapy (ART) who then had an abrupt and significant rise in viral load and fall in CD4 count to below the recommended treatment level of 350 cells/μL. She gave a history of having been given a ‘white tablet’ from the man who had trafficked her. As genuine ‘elite controllers’ are rare and do not usually follow this pattern, we suspect that this woman was unknowingly on ART.

scholarly journals Lymphomatoid Papulosis in a Case of Atypical Secondary Syphilis

2019 ◽  
Vol 14 (4) ◽  
pp. e32-e33
Author(s):  
Xin (Peter) Mu ◽  
Ian Mazzetti
Keyword(s):  
Clinical History ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Low Grade ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Lymphomatoid Papulosis ◽  
History Of ◽  
Skin Biopsies ◽  
Syphilis Serology

AbstractLymphomatoid papulosis is an indolent cutaneous lymphoproliferative disorder that presents as recurrent self-resolving papulonodular skin lesions. Currently, there are no known causes for lymphomatoid papulosis and definitive diagnosis is only made histologically. A 64-year-old man presented with a 6-week history of bilateral leg pains, low-grade fevers, and a widespread eruption of painless erythematic papules. Despite testing positive for syphilis serology, he lacked the typical clinical history for classic syphilis and therefore, skin biopsies were performed to confirm the diagnosis. Unexpectedly, the skin biopsies revealed lymphomatoid papulosis which resolved with antibiotic treatments for syphilis. Considering the synchronous resolution of the patient’s syphilis infection and his cutaneous lesions, this is the first report of findings to suggest syphilis as a possible cause for lymphomatoid papulosis. Clinicians should appreciate the possibility of alternative diagnosis for cutaneous presentations in settings of confirmed syphilis infections. RESUMELa papulose lympho-matoïde est un trouble lymphoprolifératif cutané indolent qui se présente sous la forme de lésions cutanées papulonodulaires auto-résolutives récurrentes. Actuellement, il n’y a pas de causes connues de la papulose lymphomatoïde et le diagnostic définitif n’est posé que sur le plan histologique. Un homme de 64 ans a présenté une histoire de 6 semaines de douleurs bilatérales aux jambes, de fièvres de bas grade et d’éruptions généralisées de papules érythémateuses indolores. Malgré un test sérologique positif pour la syphilis, il n’avait pas les antécédents cliniques typiques de la syphilis classique et des biopsies cutanées ont donc été effectuées pour confirmer le diagnostic. De façon inattendue, les biopsies cutanées ont révélé une papulose lymphomatoïde qui s’est résorbée grâce à des traitements antibiotiques contre la syphilis. Compte tenu de la résolution synchrone de l’infection syphilitique du patient et de ses lésions cutanées, il s’agit du premier rapport de résultats suggérant que la syphilis est une cause possible de papulose lymphomatoïde. Les cliniciens devraient apprécier la possibilité d’un diagnostic alternatif pour les présentations cutanées dans les contextes d’infections syphilitiques confirmées.

Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology - an infrequent but important laboratory phenomenon

Sexual Health ◽  
2012 ◽  
Vol 9 (5) ◽  
pp. 488 ◽  
Author(s):  
Jeffrey J. Post ◽  
Candice Khor ◽  
Virginia Furner ◽  
Don E. Smith ◽  
L. Ross Whybin ◽  
...  
Keyword(s):  
Previous History ◽  
Treponema Pallidum ◽  
Delayed Diagnosis ◽  
Secondary Syphilis ◽  
Serum Samples ◽  
Syphilis Infection ◽  
Reactive Sample ◽  
Assay Result ◽  
History Of ◽  
Prozone Phenomenon

Background Treponema pallidum specific serology generally remains reactive for life. Therefore, the diagnosis of syphilis reinfection relies on clinical assessment and nontreponemal (reagin) serologic testing. The prozone phenomenon can lead to a falsely nonreactive rapid plasma reagin (RPR) assay result. Methods: We report a case of secondary syphilis in a HIV infected patient with a previous history of syphilis infection, where a falsely nonreactive RPR assay was associated with a delayed diagnosis of reinfection and infectious syphilis. The prozone phenomenon was detected in several of the patient’s serum samples collected around this time. We subsequently undertook a prospective evaluation for the prozone phenomenon in 3222 consecutive sera, which were assayed using the RPR assay for clinical purposes over a 10-month period. Results: The overall rate of the prozone phenomenon was 2 out of 3222 samples (0.06%; 95% confidence interval (CI): 0.02–0.22%) and the rate per reactive sample was 2 out of 397 (0.5%; 95% CI: 0.14–1.81%). Conclusion: Clinicians should request RPR testing at dilutions of sera when syphilis is suspected clinically and the RPR assay is nonreactive.

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