Title : Rise of Syphilis: a series of 16 cases with skin manifestations of Syphilis
Abstract:
Background: Syphilis is a treatable bacterial infection caused by Treponema pallidum. There has been a change in incidence of syphilis in various nations over the years. Due to its many protean clinical manifestations, it has been named the “great imitator and mimicker.” Syphilis remains a contemporary plague that continues to afflict millions of people worldwide. The infection progresses through 4 stages primary, secondary, latent, and tertiary and can affect virtually every organ system in the body, even many years or even decades after the original infection.
Case Synopsis: We report a series of 16 syphilis cases with varied clinical symptoms.
The first case, A 27year old unmarried male presented with multiple asymptomatic lesions over palms and soles since 2 months, History of fever 3 days ago and History of unprotected sex, Bisexual.
On examination: Multiple polysized hyperpigmented scaly Plaques noted over bilateral palms and soles, Biett sign positive.
Diagnosis: VDRL:1:16 and TPHA Positive, IgE. Patient was treated with weekly doses of injection Benzathine penicillin G 2.4 million units IM for 3 weeks
Second case 24year female G2P1L1, was positive for VDRL 1:124 on screening and confirmed by TPHA test. she was married 5years ago, History of exposure was denied, History of unprotected sex (pervaginal) with husband 10 days ago on examination multiple hypopigmented macula’s noted around the neck (leucoderma colli) and few hypopigmented macula’s over bilateral hands. Screening for congenital syphilis is done.
Treatment: Weekly doses of injection Benzathine penicillin G 2.4 million units IM for 3 weeks.
Eight cases presented with asymptomatic lesions over palms, soles, back, abdomen since 4 months. History of unprotected sex, History of loss of weight present, history of usage of antiretroviral therapy for HIV on examination multiple hyperpigmented macula’s and plaques noted over bilateral palms, soles, back, abdomen.
Diagnosis: VDRL and TPHA Positive
Treatment: Treated with weekly doses of injection Benzathine penicillin G 2.4 million units IM for 3 weeks, Antiretroviral therapy was continued.
Other cases presented with similar complaints on examination we observed. Buschke ollendorff sign positive, maculopapular lesions, biettes collarette, corymbose, acneform papules, tissue paper scars, lymphadenopathy, moth eaten alopecia, hyperpigmented lesions over oral mucosa, lesions over genital mucosa.
Diagnosis: VDRL and TPHA Positive
Treatment: Treated with weekly doses of injection Benzathine penicillin G 2.4 million units IM for 3 weeks. In few cases Tablet DOXYCYCLINE 100mg BD for 2weeks is given.
Discussion: Syphilis diagnosis may be usually missed or delayed due to multiple reasons. These cases present with heterogenous manifestations not only to venereologists but to other medical and surgical specialties where due to a low index of suspicion they are not serologically tested and diagnosed. Delays may also occur at the patient's end for fear of the judgemental attitude of health care providers, self-medication by patients, and social stigma. Also due to the non-problematic nature and non-persistent nature of various clinical features, patient has a false impression that they are disease free and hence continue transmitting the infection. Due to the involvement of non-reproductive organs, patients believe that their disease is not sexually transmitted. Visit to a non-registered medical professional and syndromic management adds to decreased notification of syphilis, all these lead ultimately to underreporting of disease. So even the small numbers of syphilis patients in our study should be considered a tip of the iceberg. Lack of adequate and timely treatment may ultimately lead to tertiary syphilis, recurrence of the highly infective phases, and also continuous transmission of infection. The re-emergence of early syphilis cases in different parts of India highlights that we still have to be vigilant and have an eagle's eye and a high index of suspicion to achieve the goal set by WHO. The effective control of syphilis remains a formidable challenge and can be achieved by early diagnosis, treatment, and contact tracing.
