Late Benign Syphilis of the Skin

Goette, Detlef K.; Prescott, Cheryl

doi:10.1097/00007611-197805000-00009

Cited by 9 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The noduloulcerative form appears as indurated and elevated papules or nodules that are red-brown in color. They expand to form serpiginous or arciform plaques, often healing centrally and occasionally eroding or ulcerating with thick crusts [ 43 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Syphilis in Dermatology: Recognition and Management

2023

View full text Add to dashboard Cite

The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.

show abstract

Section: Clinical Manifestationsmentioning

confidence: 99%

Syphilis in Dermatology: Recognition and Management

2023

View full text Add to dashboard Cite

show abstract

“…One third of patients with untreated or inadequately treated syphilis will develop late manifestations of the disease . Cutaneous lesions of late syphilis can begin as early as 3 years and as late as 35 year after infection . Although usually asymptomatic, cutaneous lesions in late syphilis are pruritic in up to 42% of patients…”

mentioning

confidence: 99%

“…With time, hyperpigmented and non‐contracting scars result. The second, the gumma, can be seen in the skin, bone and liver and is more destructive . Lesions exhibit punched‐out ulcerations with drainage of necrotic material.…”

mentioning

confidence: 99%

“…They are painless and rubbery (hence their name) and usually situated in the subcutis and/or deep dermis. Lesions may be single or few in number and can grow to many centimeters in diameter . They can progress to a stage where they are indistinguishable from the noduloulcerative variant .…”

mentioning

confidence: 99%

“…They can progress to a stage where they are indistinguishable from the noduloulcerative variant . Even following treatment, focal spirochetes are thought to be capable of producing gummatous lesions …”

mentioning

confidence: 99%

See 2 more Smart Citations

Syphilitic gumma arising in association with foreign material

Boyd

2016

J Cutan Pathol

View full text Add to dashboard Cite

Until recently the number of patients with syphilis has been diminishing. Although that trend has reversed cases of tertiary syphilis are rare and often difficult to diagnose as a substantial number of patients will have a negative rapid plasma reagin. Histologically, cutaneous lesions in late stage syphilis exist in two forms, noduloulcerative and gummatous. Silver stains for spirochetes are almost invariably negative and, surprisingly, immunohistochemical stains are problematic as most lesions contain few, if any organisms. Presented here is a case of gummatous tertiary syphilis arising in association with foreign material deposited after a motor vehicle accident.

show abstract