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

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

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*

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

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*

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

Lues maligna (malignant syphilis), also called noduloulcerative syphilis, is a kind of cutaneous secondary syphilis, which presents virulent clinical features and is frequently associated with an immunosuppressed state. Though there are many possible debilitative diseases, it has recently been more frequently presented in the human immunodeficiency virus (HIV)-infected patients. Other causes are diabetes and chronic alcoholism. Prompt diagnosis and early treatment can result in a desirable recovery and prevent spread of the disease. We report two cases of lues maligna associated with the underlying diseases of HIV-infection and diabetes. The skin lesions in these cases showed favorable results after treatment with benzathine penicillin.
Alcoholism ; Diagnosis ; HIV ; Humans ; Penicillin G Benzathine ; Skin ; Syphilis

OBJECTIVETo investigate the clinical features and diagnosis of infants under 3 months of age with congenital syphilis.

METHODData of 121 infants below 3 months of age with congenital syphilis were collected from January 1997 to May 2007 at the authors' hospital. Their clinical features, laboratory findings and treatment were reviewed.

RESULTClinical manifestations of congenital syphilis in the infants were diverse. The disease involved multiple systems such as the skin, respiratory, digestive, blood, and nervous system, skeleton and so on. Among the 121 infants, the manifestations included increased leukocyte count (89.3%), skin damage (59.5%), hepatomegaly (56.2%), splenomegaly (41.3%), anemia (38.8%), fever (28.9%), pathologic jaundice (24.0%), growth retardation after birth (12.4%) and bone damage (54.3%), etc. The rate of misdiagnosis was 17.4 percent, and the kinds of disease misdiagnosed were up to 10.

CONCLUSIONClinical manifestations of congenital syphilis in infants under 3 months of age were complicated and nonspecific, therefore doctors misdiagnosed it very easily. Clinicians should attach great importance to it. At the same time, the restoration of antemarital examination, vigorously carrying out screening for syphilis and strengthening the management of immigrants are necessary to prevent congenital syphilis.