A 32-year-old man is being presented with a 1-week history of erythematous annular flat plaque with scales on his scalp. He displays only a solitary skin lesion on his scalp without any presence or other histories for other skin lesions or constitutional symptoms. It is difficult to consider the possibilities of syphilis based on such clinical findings. A diagnosis of syphilid is being made on the basis of clinical, serological and histological findings. Herein, we report an interesting case of secondary syphilis which is presented as a solitary annular plaque on the scalp.
Adult ; Diagnosis ; Humans ; Scalp* ; Skin ; Syphilis* ; Syphilis, Cutaneous ; Weights and Measures

Humans ; Infant, Newborn ; Syphilis Serodiagnosis ; Syphilis, Congenital ; diagnosis

BACKGROUND: Serologic testing is considered a standard method for syphilis diagnosis. We compared Auto RPR Plus and Auto TPIM Plus with previously developed assays. METHODS: The precision around the cut-off, linearity, and recovery rate of Auto RPR Plus and Auto TPIM Plus was evaluated using their positive/negative control materials. The results of these two tests were compared with those of Mediace RPR and Abbott Syphilis TP using 431 remnant serum samples collected from people who underwent medical examinations. RESULTS: The within-run precisions (coefficient of variation, CV values) of negative/positive control materials of Auto RPR Plus, Mediace RPR, Auto TPIM Plus and Abbott Syphilis TP were 15.7/2.3%, 20.4/2.3%, -/2.7%, and 8.5/2.3%, respectively; between-run precisions were 67.7/3.3%, 39.1/3.4%, -/4.0%, and 7.0/1.5%, respectively. Auto RPR Plus showed better precision around the cutoff level (1.0 U) compared to Mediace RPR (7.2–7.3% vs. 12.2–14.3%). The CVs of Auto TPIM Plus around the cutoff (10.0 U) were 13.5% at 10.5 U and 6.6% at 12.5 U. Agreement rates between Auto RPR Plus and Mediace RPR and between Auto TPIM Plus and Abbott Syphilis TP were 97.2% and 98.4%, respectively. However, twelve samples showed discrepant results for Auto RPR Plus (−)/Mediace RPR (+) and false-positive Mediace RPR results could not be excluded around the cutoff of 1.0 U. CONCLUSIONS: Auto RPR Plus showing good precision near the cutoff can be used for syphilis screening in health checkups. However, Auto TPIM Plus needs improvement in precision and adjusting the cutoff to be used for syphilis screening.
Diagnosis* ; Mass Screening ; Methods ; Serologic Tests ; Syphilis*

Humans ; Male ; Middle Aged ; POEMS Syndrome ; diagnosis ; Syphilis ; diagnosis

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.
Chancre/diagnosis* ; Female ; Humans ; Male ; Nipples ; Skin ; Syphilis/diagnosis*

Psoriasiform lesion is a rare manifestation in secondary syphilis. A 34-year-old woman patient presented with a month history of condylomata lata on the perineum and erythematous scaling psoriasiform plaque on the back. The preliminary differential diagnosis included psoriasis and lichen simplex chronicus but a psoriasiform syphilid was confirmed through skin biopsies and serologic tests. We report a case of psoriasiform syphilid.
Adult ; Biopsy ; Diagnosis, Differential ; Female ; Humans ; Neurodermatitis ; Perineum ; Psoriasis ; Serologic Tests ; Skin ; Syphilis ; Syphilis, Cutaneous*

BACKGROUND: We evaluated the performance and false positive rate of Mediace RPR test (Sekisui, Japan), a newly introduced nontreponemal test using a chemistry autoanalyzer. METHODS: The sensitivity of Mediace RPR test was analyzed using sera from 50 patients with syphilis in different stages (8 primary, 7 secondary, and 35 latent), 14 sera positive with fluorescent treponemal antibody absorption (FTA-ABS) IgM, and 74 sera positive with conventional rapid plasma regain (RPR) card test (Asan, Korea) and also positive with Treponema pallidum hemagglutination (TPHA) test or FTA-ABS IgG test. The specificity was analyzed on 108 healthy blood donors. We also performed RPR card test on 302 sera that had been tested positive with Mediace RPR test and also performed TPHA or FTA-ABS IgG test to analyze the false positive rate of Mediace RPR test. A cutoff value of 0.5 R.U. (RPR unit) was used for Mediace RPR test. RESULTS: Mediace RPR test on syphilitic sera of different stages (primary, secondary, and latent stages) and FTA-ABS IgM positive sera showed a sensitivity of 100%, 100%, 82.9% and 100%, respectively. Among the 74 sera positive with conventional RPR card test and TPHA or FTA-ABS IgG test, 55 were positive with Mediace test. The specificity of Mediace RPR test on blood donors was 97.2%. Among the 302 sera positive with Mediace RPR test, 137 sera (45.4%) were negative by RPR card and TPHA/FTA-ABS IgG tests. CONCLUSIONS: Although the sensitivities of Mediace RPR were good for primary and secondary syphilis, due to its high negative rate of Mediace RPR over the conventional RPR positive samples, further studies are necessary whether it can replace conventional nontreponemal test for screening purpose. Moreover, in view of the high false positive rate, positive results by Mediace RPR test should be confirmed with treponemal tests.
Autoanalysis/methods ; False Positive Reactions ; Humans ; ROC Curve ; Sensitivity and Specificity ; Syphilis/*diagnosis ; Syphilis Serodiagnosis/*methods

Syphilis was known to be generalized disease and it had been decreased until 1960's. But, it has been increased again recently. The author analysed the 22 cases of congenital syphilis which were treated at department of orthopaedic surgery at Ewha Womans University Hospital from Jan. 1979 to July 1983 and the following results were obtained. 1. There were no significant changes of the number of patient by years. 2. Common symptom and sign were hepatosplenomegaly(84%), fever(62%) and skin changes(50%), and pseudoparalysis was observed in one case. 3. Radiologic bone changes were observed in 11 cases (50%) and the following results were obtained: a. Below the two week old, there was relatively low incidence of bone change with 22%. b. There was high incidence of bone change in prematurity with 75%. c. Common features of bone changes were periosteal reaction, osteochondritis and metaphysitis (91%). Pathologic fracture was observed. in one case. 4. Although we have observed the bone changes only in 50% of cases, all the other reports has reported more than 80% and we thought that radiologic bone change would aid the diagnosis of congenital syphilis.
Clinical Study ; Diagnosis ; Female ; Fractures, Spontaneous ; Humans ; Incidence ; Osteochondritis ; Skin ; Syphilis ; Syphilis, Congenital

It is recognized not only by the health experts but also by the public that venereal diseases are remarkably increasing in these days. Therefore, every available measure for declining of the diseases are planned and implemented through case-finding, diagnosis, treatment, education and research. The author intended to compare and analyse infection rates of venereal diseases between reporting from the Ministry of Health and author's private V.D. clinic during 1961-1971. The following results are obtained through the study: 1. According to the report of the Ministry of Health, 45.0% of total examinees were sick with gonorrhea and 6.5% with syphilis, in one hand, on the other hand 78.7% with gonorrhea and 16.3% with syphilis at the author's clinic. 2. By both the report of the ministry and author, highest infection rates were found in 196601968, and this fact was considered by the higher infection rate of G.I. in same years. 3. Contrarily, the lowest infection rates were found out in 1970-1971 through both reports.
Diagnosis ; Education ; Gonorrhea ; Hand ; Korea* ; Sexually Transmitted Diseases* ; Syphilis

Congenital syphilis is one of the most well-known congenital infections, yet it remains a worldwide public health problem. Congenital syphilis can involve any organ system and present with various symptoms. However, early diagnosis of congenital syphilis is difficult because more than half of the affected infants are asymptomatic, and the signs in symptomatic infants may be subtle and nonspecific. Here, we report a case of congenital syphilis with only a skin rash, which led to a delay in diagnosis. This case indicates that congenital syphilis should be considered throughout early childhood.
Early Diagnosis ; Exanthema ; Humans ; Infant ; Public Health ; Skin ; Syphilis, Congenital