English Polski
Vol 21 (2023): Continuous Publishing
Case report
Published online: 2023-06-09

open access

Page views 488
Article views/downloads 426
Get Citation

Connect on Social Media

Connect on Social Media

Late latent syphilis as a challenging issue in the twenty-first century

Katarzyna Plagens-Rotman12, Piotr Merks3, Grażyna Jarząbek-Bielecka14, Ada Kaczmarek4, Witold Kędzia4, Magdalena Czarnecka-Operacz5
Journal of Sexual and Mental Health 2023;21:8-11.

Abstract

Introduction: Syphilis is one of the oldest sexually transmitted diseases caused by the bacterium Treponema pallidum. It is characterized by multiple clinical presentations and a long duration. Acquired syphilis is divided into early (≤ 1 year after infection) and late (> 1 year after infection) stages. Venereal diseases, more often defined as sexually transmitted diseases (STDs), result from behaviours influenced by socio-economic, psychological, and cultural factors. Although the spectrum of sexually transmitted diseases, apart from classic syphilis and gonorrhoea, encompasses a wide range of aerobic and anaerobic bacteria, viruses, protozoans, fungi, and even insects, the frequency of late syphilis has been on the rise in recent years. It is a significant clinical problem in our country. Irrespective of the COVID SARS-19 pandemic, this is an important issue of contemporary epidemiology. Objectives: The objective of this study was to present two cases of women diagnosed with acquired late syphilis of unknown duration, treated at the Department and Clinic of Dermatology at the Poznań University of Medical Sciences. Material and methods: CASE 1 — A 72-year-old female patient was admitted to the Clinic of Dermatology with late latent syphilis of unknown duration. The results of laboratory tests showed: a positive syphilis reaction: FTA-ABS 1:100, TPHA — 1:160. One dose of 2.4 million units of intramuscular benzathine penicillin was administered. It was recommended to administer the second dose of 2.4 million units of benzathine penicillin within 7 days of the first dose. CASE 2 — A 29-year-old female patient was admitted to the Department and Clinic of Dermatology at the Poznań University of Medical Sciences with late latent syphilis of unknown duration. A primary lesion on the right labium major, regional lymphadenopathy, and a rash on the right side of the chest were observed. The results of laboratory tests showed: qualitative TPHA test — positive, quantitative TPHA test — positive (titre 1:180), RPR — positive (RPR – titre 1:1). Conclusions: In recent years, the incidence of late syphilis has been on the rise globally. This disease has again become a significant clinical issue requiring particular attention in dermatological and venereological practice. When syphilis is diagnosed, adequate treatment is necessary in accordance with the updated EADV guidelines.

Article available in PDF format

View PDF Download PDF file

References

  1. Burgdorf WH, Plewig G, Wolff HH, Landthaler M. Choroby przenoszone drogą płciową. Kiła. In: Burgdorf WH. ed. Braun–Falco Dermatologia. Vol. 1. Czelej, Lublin 2010.
  2. Zajkowska J, Drozdowski W, Grygorczuk S. Kiła ośrodkowego układu nerwowego – trudności diagnostyczne. Neurologia po Dyplomie. 2014; 9(1): 26–39.
  3. Janier M, Unemo M, Dupin N, et al. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021; 35(3): 574–588.
  4. Fenton KA, Breban R, Vardavas R, et al. Infectious syphilis in high-income settings in the 21st century. Lancet Infect Dis. 2008; 8(4): 244–253.
  5. WHO. Global health sector strategy on sexually transmitted infections 2016–2021. https://www.who.int/publications/i/item/WHO-RHR-16.09 (20.09.2022).
  6. National Institute of Public Health. Annual reports “Infectious diseases and poisonings in Poland”. http://wwwold.pzh.gov.pl/oldpage/epimeld/index_a.html (20.09.2022).
  7. Serwin AB, Unemo M. Syphilis in females in Bialystok, Poland, 2000-2015. Przegl Epidemiol. 2016; 70(2): 273–280.
  8. Tanfer K, Cubbins LA, Billy JO. Gender, race, class and self-reported sexually transmitted disease incidence. Fam Plann Perspect. 1995; 27(5): 196–202.
  9. De Santis M, De Luca C, Mappa I, et al. Syphilis Infection during pregnancy: fetal risks and clinical management. Infect Dis Obstet Gynecol. 2012; 2012: 430585.
  10. Tuddenham S, Ghanem KG. What is the evidence for the sexual transmission of syphilis from asymptomatic persons? Sex Transm Dis. 2019; 46(6): e60–e61.
  11. Tuddenham SA, Page KR, Chaulk P, et al. Patients fifty years and older attending two sexually transmitted disease clinics in Baltimore, Maryland. Int J STD AIDS. 2017; 28(4): 330–344.
  12. Relhan V, Bansal A, Hegde P, et al. Sexually transmitted infections in the elderly: a 6-year retrospective study in a tertiary care hospital in new delhi. Indian J Sex Transm Dis AIDS. 2021; 42: 144S–149S.
  13. Wyglądacz D, Głowaczewska A, Jaworecka K, et al. Analiza przypadków kiły wśród chorych hospitalizowanych w Klinice Dermatologii, Wenerologii i Alergologii we Wrocławiu w latach 2009-2016. Forum Dermatol. 2017; 3(4): 143–146.
  14. Niedźwiedzka-Stadnik M, Zakrzewska K. Syphilis in Poland in 2020. Przegl Epidemiol. 2022; 76(3): 391–401.
  15. Majewski S, Rudnicka I. Choroby przenoszone drogą płciową w Polsce w 2009 roku. Przegl Epidemiol. 2011; 65(2): 307–311.
  16. Sulkowska E. Kiła — nowa diagnostyka starej choroby. Dane prezentowane podczas seminarium „Postępy w badaniach przeglądowych dawców krwi”(Warszawa, 5–6 października 2015 r. J Transfus Med. 2015; 8: 157–159.
  17. Serwin AB, Kaczyńska J, Flisiak I. The impact of the COVID-19 pandemic on sexually transmitted infections services — experience from Bialystok, Poland. Przegl Epidemiol. 2021; 75(2): 151–158.
  18. Simões D, Stengaard AR, Combs L, et al. EuroTEST COVID-19 impact as-sessment consortium of partners. Impact of the COVID-19 pandemic on testing ser-vices for HIV, viral hepatitis and sexually transmitted infections in the WHO Euro-pean Region, March to August 2020. Euro Surveill. 2020; 25(47): 2001943.
  19. Plagens-Rotman K, Przybylska R, Gerke K, et al. Syphilis and a pregnant woman: a real danger for the woman and the child. Post Derm Alerg. 2019; 36(1): 119–124.
  20. Hawkes S, Matin N, Broutet N, et al. Effectiveness of intervensions to improve screening for syphilis in pregnancy: a systemic review and meta-analysis. Lancet Infect Dis. 2011; 11(9): 684–691.
  21. Marra CM, Maxwell CL, Smith SL, et al. Cerebrospinal fluid abnormalities in patients with syphilis: associattion with clinical and laboratory features. J Infect Dis. 2004; 189(3): 369–376.
  22. Ghanem KG. REVIEW: Neurosyphilis: A historical perspective and review. CNS Neurosci Ther. 2010; 16(5): e157–e168.
  23. Dabis R, Radcliffe K. What is the role of a full physical examination in the management of asymptomatic patients with late syphilis? Int J STD AIDS. 2012; 23(12): 901–902.
  24. Pastuszczak M, Jakiela B, Wielowieyska-Szybinska D, et al. Elevated cerebrospinal fluid interleukin-17A and interferon-gamma levels in early asymptomatic neurosyphilis. Sex Transm Dis. 2013; 40(10): 808–812.
  25. Plagens-Rotman K, Przybylska R, Gerke K, et al. Genital herpes as still significant dermatological, gynaecological and venereological problem. Postepy Dermatol Alergol. 2021; 38(2): 210–213.
  26. Kojima N, Klausner JD. An update on the global epidemiology of syphilis. Curr Epidemiol Rep. 2018; 5(1): 24–38.