fibrin and Syphilis

Malignant syphilis (MS) is a rare, atypical manifestation of secondary syphilis. Ulcerative lesions should be suspected as MS when found with supporting microscopic morphology, a high syphilis serology titer test, a Jarisch-Herxheimer reaction (JHR), and rapid disease resolution. To date, there is no specific recommendation for treatment for MS. A 24-year-old HIV-positive MSM patient with a CD4 count of 470 cells/µl presented with a chief complaint of necrotic, ulcerative lesions and oyster shell-like surface plaques on his face, trunk, groin, and extremities. The patient also developed various typical presentations of secondary syphilis. Dark-field microscopy revealed spirochetes. Histopathological examination showed spongiotic dermatitis with many neutrophil cells in the dermis, together with endarteritis and fibrin micro-thrombus in the blood vessels. The patient had a high venereal disease research laboratory (VDRL) titer of 1:512. There was rapid disease resolution following a single injection of 2,400,000-unit benzathine penicillin G (BPG); together with anti-retroviral therapy, this was supportive treatment for MS. JHR was not observed in this study and many other reports. This case showed that ulcerative lesions with an oyster shell-like surface presenting in HIV-positive patients along with supporting microscopic morphology, high VDRL titer, and a dramatic improvement after antibiotic treatment is highly suggestive of MS. JHR may no longer be a characteristic of MS. A single dose of 2,400,000-unit BPG is sufficient for MS treatment.

Topics: Adult; Anti-Bacterial Agents; Fibrin; HIV Infections; Homosexuality, Male; Humans; Male; Penicillin G Benzathine; Syphilis; Young Adult

In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, including 937 000 in Brazil. Early diagnosis and treatment of syphilis are essential to reduce morbidity and prevent transmission. The availability of rapid tests (RTs) for this diagnosis means that testing can be performed more quickly, as a point-of-care test, even in non-laboratory environments and requires only simple technical training to antibodies detection. The objective of this study was to evaluate the performance and operational aspects of seven commercially available RTs for syphilis in Brazil.. Seven rapid treponemal tests were evaluated for sensitivity, specificity, accuracy and Kappa value, according to a panel composed of 493 members. The operational performance of the assay was also determined for these tests.. The seven RTs showed sensitivity ranging from 94.5% to 100% when compared with the reference tests and specificity of between 91.5% and 100%. All the RTs evaluated presented good operational performance, and only one failed to present the minimum specificity as defined by Brazil's Ministry of Health.. All the tests presented good operational performance, and the professionals who performed them considered them to be easy to use and interpret. This evaluation is important for making informed choices of tests to be used in the Brazilian Unified Health System.

Topics: Adult; Brazil; Diagnostic Tests, Routine; Female; Fibrin; Humans; Male; Mass Screening; Reproducibility of Results; Sensitivity and Specificity; Syphilis; Treponema pallidum