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Sexually Transmitted Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Aarthy K. Uthayakumar, Christopher B. Bunker
Tertiary syphilis can occur after an asymptomatic latent period ranging between 5–50 years. It includes such cardiovascular manifestations as aortic aneurysm formation, central nervous system involvement, including paresis and tabes dorsalis, and gummatous disease of the skin, subcutaneous tissues, or bones. Cutaneous signs involve asymptomatic nodular lesions, which typically involve the extensor surface of the arms, back, and face, which may be grouped, often in a circinate arrangement. In contrast, a gumma is often a single lesion, composed of granulomatous plaques or nodules irregularly shaped. There is often central ulceration that is usually painless, plus peripheral healing
Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
In late (tertiary) syphilis, gummas in the liver may cause fever, hepatic tenderness and a form of cirrhosis, with a characteristic shape of the organ (hepar lobatum). Serologic tests (rapid plasma reagin, V.D.R.L., FTA-ABS, microhemagglutination assay) may confirm the diagnosis. Failure to consider syphilis in the evaluation of obscure fever, especially in cases associated with a rash, may be critical.84
Sexually Transmitted Infection and Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Kareim Khalafalla, Haitham Elbardisi, Mohamed Arafa
T. pallidum is responsible for causing syphilis with approximately 12 million new cases per year worldwide [51]. The effect of T. pallidum on male fertility is not well documented; however, there are a number of theories linking it to infertility. Epididymal obstruction can be caused by syphilitic epididymitis. Gummas of tertiary syphilis can destroy testicular tissue in cases of syphilitic orchitis. Also, endarteritis obliterans found in tertiary and congenital syphilis may lead to small and fibrotic testes. Lastly, neurosyphilis and tabes dorsalis can influence male infertility by causing erectile or ejaculatory dysfunction [5,52].
Imaging of infectious and inflammatory cystic lesions of the brain, a narrative review
Published in Expert Review of Neurotherapeutics, 2023
Anna Cervantes-Arslanian, Hector H Garcia, Otto Rapalino
Cerebral syphilitic gumma are rare forms of advanced meningovascular syphilis attributed to chronic granulomatous inflammation to the spirochete, Treponema pallidum, infection. Clinical features are nonspecific, usually presenting with headache, vomiting, and occasionally focal neurologic deficits, often leading to initial concern for malignancy or abscess. Gumma may be solitary or multiple and may occur in the parenchyma or extra-axial [13]. On CT, lesions are hypodense but may have hyperdense foci with hemorrhage or late-stage calcification. MR imaging is superior and generally shows T1 hypointensity and T2 hyperintensity with adjacent edema and varying patterns of enhancement [14]. An adjacent region of dural enhancement, suggesting a dural tail, may occur often raising suspicion instead for meningioma [15]. Occasionally, syphilitic gumma show heterogeneous signal due to hemorrhage, necrosis, or calcification.
Ocular Syphilis: An Update
Published in Ocular Immunology and Inflammation, 2019
Parthopratim Dutta Majumder, Elizabeth J. Chen, Janika Shah, Dawn Ching Wen Ho, Jyotirmay Biswas, Leo See Yin, Vishali Gupta, Carlos Pavesio, Rupesh Agrawal
The natural history of syphilis is complex and variable, spanning three progressive clinical stages with chronological overlap.13 Primary syphilis is characterized by a painless chancre occurring at the site of inoculation that resolves spontaneously within 2 to 8 weeks. The incubation period ranges from 3 days to 3 months, with a median of 3 weeks. Secondary syphilis occurs 2 to 12 weeks after inoculation, presenting with systemic symptoms (fever, malaise, lymphadenopathy and mucocutaneous lesions) coinciding with maximal treponemal bacteremia. Tertiary syphilis occurs when gummas affect any organ. It is subdivided into benign tertiary syphilis, cardiovascular syphilis, and neurosyphilis. Ocular syphilis typically does not manifest in the primary stage, except as chancres of eyelid and conjunctiva. The secondary stage may have ocular involvement such as keratitis, iris nodules, iridocyclitis, episcleritis, and scleritis. Latent syphilis is defined as positive serological tests with no clinical evidence of infection. However, in the first year after the initial infection, infectious mucocutaneous lesions may recur. This is known as early latent syphilis. Late latent phase occurs after 1 year of infection, during which infectious relapses are rare. Late in the secondary stage, chorioretinitis and vitritis may develop. However, it is still more frequent in the late, latent, and tertiary stages.14,15
Diversity in clinical manifestations and imaging features of neurosyphilis: obstacles to the diagnosis and treatment (report of three cases)
Published in International Journal of Neuroscience, 2018
Hui Liu, Zong-Bo Zhao, Nian-Xing You
Case 1: A 56-year-old man had sudden numbness and weakness in his left lower limb and muscle fasciculation three days before admission. Neurologic examination showed a slight weakness of left knee extension and hyperalgia of left lower limb. Magnetic resonance imaging (MRI) revealed cortical and subcortical nodular lesion in the right parietal lobe. Gd-diethylenetriamine pentaacetic acid-enhanced image showed that nodular lesion was enhanced and local meningeal was enhanced (Figure 1(a,b)). Diagnosis was right parietal lobe space-occupying lesion in the beginning, and meningioma was considered the first. Then, this patient underwent surgical exairesis. Pathological examination revealed more vascular endothelial cell and vascular proliferation. Many inflammatory cells, including plasmocyte, lymphocyte and eosinophile granulocyte infiltrated. Plasmocyte was primary. There was no bright zone of necrosis (Figure 2). Blood rapid plasma regain test (RPR) was negative. And blood T. pallidum particle agglutination test (TPPA) was positive. Screening for immunodeficiency virus antibodies was negative. Consequently, revising diagnosis was cerebral syphilitic gumma. Then, the patient was treated with 1 g/day ceftriaxone intravenously for three weeks because he was allergic to Penicillin G. As a result, numbness of his left lower limb disappeared. Three months after the ceftriaxone treatment, the patient's blood RPR was negative and .T. pallidum IgM antibody (Tp-IgM) was positive. T. pallidum DNA quantitation test (Tp-DNA) was 18,000 copies/ml. Cerebrospinal fluid (CSF) examination showed red blood cell (RBC) count was 9/mm3, and white blood cell (WBC) count was 2/mm3. Protein content was 510 mg/L. CSF–RPR was positive at 1:4 titers. CSF–TPPA and CSF–Tp-IgM were also positive. CSF–Tp-DNA was 3200 copy/ml. 99mTc-ethyl cysteinate dimer (ECD) was used in single photon emission computed tomography (SPECT) to assess regional cerebral blood flow: right parietal lobe had nonperfusion of cerebral blood flow (Figure 3). Nine months after treatment, his left knee extension was normal. His blood RPR was negative and Tp-IgM was weakly positive. Tp-DNA was 2580 copies/ml. In his CSF, the RBC count, WBC count, RPR, Tp-IgM, TPPA and Tp-DNA were 0/mm3, 0/mm3, 1:1, negative, positive and 160 copies/ml, respectively.