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Kingston M, Apea V, Evans C, Fifer H, Foster K, Patrick P, Grant A, Manns V, Ramsden S, Sinka K, Sukthankar A, Sullivan A, Tyler S. BASHH UK guidelines for the management of syphilis 2024. Int J STD AIDS 2024:9564624241280406. [PMID: 39270129 DOI: 10.1177/09564624241280406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The 2024 UK guidelines for the management of syphilis are in line with current evidence and practice within the UK. Key updates are detailed at the start of the article. These guidelines are accompanied by the first UK guidelines for the management of syphilis in pregnant people and children, 2024.
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Affiliation(s)
- Margaret Kingston
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vanessa Apea
- Consultant Physician Genitourinary Medicine, Barts Health NHS Trust, London, UK
| | - Ceri Evans
- Senior Sexual Health Advisor, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Helen Fifer
- Consultant Microbiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Kirsty Foster
- Consultant in Health Protection, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Patrick Patrick
- Mortimer Market Centre, Central and North West London NHS Trust, London, UK
| | - Alison Grant
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Manns
- Advanced Nurse Specialist, Churchill Hospital, Oxford, UK
| | - Sophie Ramsden
- Consultant Physician Genitourinary Medicine, Bolton NHS Foundation Trust, Bolton, UK
| | - Katy Sinka
- Consultant Scientist and Epidemiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Ashish Sukthankar
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Sullivan
- BASHH Clinical Effectiveness Group (CEG) Editor, Consultant Physician Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Ohira K, Hashimoto N, Kanai D, Inoue Y. Novel and characteristic radiological features of neurosyphilis: a case series. BMC Neurol 2024; 24:248. [PMID: 39033301 PMCID: PMC11264952 DOI: 10.1186/s12883-024-03762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Treponema pallidum can invade the central nervous system (CNS) early in its infection, causing neurosyphilis. Neurosyphilis typically presents with meningovasculitis in the acute or subacute phase, while tabes dorsalis and dementia paralytica are classical conditions in the later stages. However, syphilis is often misdiagnosed as other conditions such as tumors or autoimmune diseases including vasculitis and encephalitis, which is why the condition is known as "The Great Mimicker." The increasing incidence of syphilis in recent years emphasizes the importance of early diagnosis and treatment; however, its multiple clinical manifestations impose diagnostic challenges for clinicians because it resembles other diseases. In this case series, we present the impressive manifestations of neurosyphilis through three unique radiological presentations. CASE PRESENTATION Case 1 details optic nerve involvement in an HIV-positive male, where MRI and fundoscopic findings confirmed syphilitic optic neuritis. Case 2 describes a patient in her pregnancy initially suspected of acoustic neuroma on MRI, later diagnosed with syphilitic gumma affecting the inner ear canal. Case 3 is a young male with clinical features mimicking temporal arteritis, ultimately identified as skull osteomyelitis secondarily causing inflammation of the musculus temporalis and meningitis. CONCLUSIONS These cases underscore the necessity of considering syphilis in differential diagnoses, given the diversity of its clinical presentations. Radiology plays an important role in avoiding unnecessary interventions. The increasing prevalence of recurrent syphilis imposes diagnostic challenges, emphasizing the importance of the early diagnosis and treatment of neurosyphilis by clinicians.
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Affiliation(s)
- Kenji Ohira
- Department of Radiology, Japanese Red Cross Society Shizuoka Hospital, 8-2 Otemachi, Aoi Ku, Shizuoka City, Shizuoka Prefecture, 420- 0853, Japan.
| | - Nanako Hashimoto
- Department of Radiology, Chutoen General Medical Center, 1-1 Shobudaike, Kakegawa City, Shizuoka Prefecture, 436-8555, Japan
| | - Daisuke Kanai
- Department of Radiology, Japanese Red Cross Society Shizuoka Hospital, 8-2 Otemachi, Aoi Ku, Shizuoka City, Shizuoka Prefecture, 420- 0853, Japan
| | - Yukio Inoue
- Department of Radiology, Japanese Red Cross Society Shizuoka Hospital, 8-2 Otemachi, Aoi Ku, Shizuoka City, Shizuoka Prefecture, 420- 0853, Japan
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Gu H, Xu Y, Xu J, Zhuang J. A rare case report of bilateral vestibulopathy due to otosyphilis. Medicine (Baltimore) 2024; 103:e38149. [PMID: 38758873 PMCID: PMC11098173 DOI: 10.1097/md.0000000000038149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
RATIONALE Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are rare. PATIENT CONCERNS A 39-year-old male was referred to our medical center due to vertigo, persistent dizziness and gait disturbance for 2 months. DIAGNOSES Bilateral vestibulopathy due to otosyphilis was considered in this case, as confirmed through analyses of vestibular function, laboratory tests, and penicillin treatment. INTERVENTIONS The patient was was treated with a high dose of penicillin G (24 × 106 IU/d) for 14 days. OUTCOMES The patient's symptoms had improved greatly following treatment, with dizziness and gait disturbance having completely resolved at 3 months following hospital discharge. LESSONS Bilateral vestibulopathy should be considered when evaluating patients with acute or subacute persistent dizziness. Clinicians should also be aware of the potential for otosyphilis among patients who report BVP.
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Affiliation(s)
- Huanhuan Gu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Yixin Xu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Jin Xu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
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Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis. Clin Infect Dis 2024; 78:e57-e68. [PMID: 37593890 DOI: 10.1093/cid/ciad437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/19/2023] Open
Abstract
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe the cardinal clinical features of early and late (tertiary) neurosyphilis and characterize the clinical significance of asymptomatic neurosyphilis in the antibiotic era. We review the indications for cerebrospinal fluid (CSF) examination and the performance characteristics of different CSF assays including treponemal and lipoidal antibodies, white cell count, and protein concentration. Future biomarkers and the role of imaging are briefly considered. We review preferred and alternative treatments for neurosyphilis and evidence for their use, including evidence for the use of enhanced intramuscular benzathine penicillin G to supplement intravenous penicillin.
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Affiliation(s)
- Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wu MY, Chen L, Liu LC, Liu MJ, Li YF, Zheng HY, Leng L, Zou YJ, Chen WJ, Li J. Using circulating microbial cell-free DNA to identify persistent Treponema pallidum infection in serofast syphilis patients. iScience 2024; 27:109399. [PMID: 38523794 PMCID: PMC10959656 DOI: 10.1016/j.isci.2024.109399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
The question of whether serofast status of syphilis patients indicates an ongoing low-grade Treponema pallidum (T. pallidum) infection remains unanswered. To address this, we developed a machine learning model to identify T. pallidum in cell-free DNA (cfDNA) using next-generation sequencing (NGS). Our findings showed that a TP_rate cut-off of 0.033 demonstrated superior diagnostic performance for syphilis, with a specificity of 92.3% and a sensitivity of 71.4% (AUROC = 0.92). This diagnosis model predicted that 20 out of 92 serofast patients had a persistent low-level infection. Based on these predictions, re-treatment was administered to these patients and its efficacy was evaluated. The results showed a statistically significant decrease in RPR titers in the prediction-positive group compared to the prediction-negative group after re-treatment (p < 0.05). These findings provide evidence for the existence of T. pallidum under serofast status and support the use of intensive treatment for serofast patients at higher risk in clinical practice.
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Affiliation(s)
- Meng Yin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lu Chen
- Beijing Macro & Micro-test Bio-Tech Co., Ltd, Beijing 100083, China
| | - Li Cheng Liu
- Beijing Macro & Micro-test Bio-Tech Co., Ltd, Beijing 100083, China
| | - Ming Juan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Feng Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - He Yi Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ling Leng
- State Key Laboratory of Complex Severe and Rare Diseases, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi Jun Zou
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Jun Chen
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Gilliams EA, Lorenz Z, Hamill MM. Syphilis Serologies: A Practical Approach for the Primary Care Clinician. Med Clin North Am 2024; 108:325-337. [PMID: 38331483 DOI: 10.1016/j.mcna.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Syphilis serology interpretation can be challenging even for experienced providers. This article reviews the staging of syphilis and the principles of syphilis serology testing, the algorithms used in diagnosis, and guidance for their use in monitoring the response to treatment. The authors illustrate these principles through a series of clinical scenarios and describe the rationale behind the management approaches.
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Affiliation(s)
- Elizabeth A Gilliams
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Zachary Lorenz
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224, USA
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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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An P, Gao Y, Lou L, Zhao Y. Cochlear implantation for syphilis-associated sensorineural hearing loss. Asian J Surg 2024; 47:1172-1174. [PMID: 38001001 DOI: 10.1016/j.asjsur.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- Ping An
- Department of Otorhinolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Gao
- Department of Otorhinolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Lou
- Department of Otorhinolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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9
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Chen X, Zheng X, Chen Y, Xu S. Otosyphilis as a rare cause of secondary benign paroxysmal positional vertigo: a case report. J Int Med Res 2023; 51:3000605231153317. [PMID: 37365906 DOI: 10.1177/03000605231153317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Otosyphilis is a rare cause of audiovestibular dysfunction that can easily be misdiagnosed. Here, we report a rare case in which a patient presented with secondary benign paroxysmal positional vertigo (BPPV) 2 weeks after symptoms of otosyphilis appeared. The Dix-Hallpike test showed a classical response in the head-hanging left position. The patient was treated with intravenous penicillin G and the canalith repositioning maneuver, which completely resolved the vertigo. The patient's audiovestibular symptoms resolved gradually. The elevated cerebrospinal fluid (CSF) white blood cell (WBC) count returned to normal and the results of the Treponema pallidum particle agglutination (TPPA) test were negative at the 3-month follow-up. This report suggests that otosyphilis should be considered in the differential diagnosis of audiovestibular dysfunction in patients at risk. Additionally, clinicians should remain vigilant about the possibility of secondary BPPV in patients with otosyphilis who report positional vertigo.
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Affiliation(s)
- Xiang Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Xiaofen Zheng
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Yingzhi Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Shanhu Xu
- Department of Neurology, Zhejiang Hospital, Hangzhou City, China
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10
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Sadoghi B, Stary G, Wolf P. Syphilis. J Dtsch Dermatol Ges 2023; 21:504-517. [PMID: 37183747 DOI: 10.1111/ddg.14999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 05/16/2023]
Abstract
Syphilis is a curable systemic infectious disease with a clear increase in incidence in recent years. The disease presents with a broad clinical spectrum and challenges clinicians due to the long incubation period and the sometimes complex interpretation of serological test results. Penicillin G remains the treatment of choice in all stages of syphilis.
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Affiliation(s)
- Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Georg Stary
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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Sadoghi B, Stary G, Wolf P. Syphilis. J Dtsch Dermatol Ges 2023; 21:504-519. [PMID: 37183735 DOI: 10.1111/ddg.14999_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 05/16/2023]
Affiliation(s)
- Birgit Sadoghi
- Universitätsklink für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Georg Stary
- Universiätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Peter Wolf
- Universitätsklink für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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Witt LS, Wendy Fujita A, Ho J, Shin YM, Kobaidze K, Workowski K. Otosyphilis. Open Forum Infect Dis 2022; 10:ofac685. [PMID: 36776779 PMCID: PMC9907508 DOI: 10.1093/ofid/ofac685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Otosyphilis can be challenging to diagnose, but, if left unrecognized, it may cause irreversible damage. An immunologic interplay between syphilis and human immunodeficiency virus (HIV) makes coinfection likely and may predispose people with HIV to neurosyphilis. In this study, we present a case of a man in his 50s with hearing loss and vertigo diagnosed with otosyphilis as well as a new diagnosis of HIV. This case and corresponding discussion serve to inform the noninfectious disease-trained clinician of the symptoms, diagnostics, and treatment options for otosyphilis as well as to discuss the relationship between HIV and syphilis and demonstrate the importance of disease recognition.
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Affiliation(s)
- Lucy S Witt
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - A Wendy Fujita
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - Jeanne Ho
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoo Mee Shin
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Sarsak EW, Omer WE, Al Bishawi AA, Maslamani MA, Abdulmajed AAB. Otosyphilis: A rare case of reversible hearing loss in a young man with secondary syphilis. IDCases 2022; 31:e01666. [PMID: 36593890 PMCID: PMC9803778 DOI: 10.1016/j.idcr.2022.e01666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Over the last decade, it has been noticed a significant increase in the number of cases of syphilis with a concurrent increased number of patients presenting with syphilis-related complications. Otosyphilis is a well-known complication of syphilis that most of the time, can lead to irreversible hearing loss, especially with delayed diagnosis and treatment. A high index of suspicion is needed for an accurate diagnosis of otosyphilis. Complete audiologic recovery is rare but still possible with the appropriate treatment. Case report Herein, we describe a case of reversible hearing loss secondary to otosyphilis in a young healthy man who was initially diagnosed and treated as a case of secondary syphilis, and presented later to the clinic with unilateral tinnitus and hearing loss. Audiology findings were consistent with asymmetric sensorineural hearing loss. Fortunately, complete recovery of hearing was achieved after treatment with a 14-day course of intravenous penicillin. Conclusion Otosyphilis is one of the rare presentations of syphilis; thus, the diagnosis is often missed or delayed. Prompt diagnosis and treatment can help prevent the occurrence of permanent hearing loss.
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Affiliation(s)
- Enas W. Sarsak
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar,Correspondence to: Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
| | - Walid E. Omer
- Department of ENT, Hamad Medical Corporation, Doha, Qatar
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Seuthe IMC, Eichhorn S, Kim J, van Ackeren K, Park JJH, Dazert S, Klespe KC. [Syphilis infection in the ENT area]. Laryngorhinootologie 2022. [PMID: 35395693 DOI: 10.1055/a-1808-7321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The number of reported cases of syphilis has been increasing for years. The sexually transmitted disease is caused by the spirochete Treponema pallidum subspecies pallidum and progresses in different stages. Symptoms in the ENT area can occur in all stages. This means that a syphilis infection should always be considered by the ENT doctor as a differential diagnosis if the symptoms are suitable. Thus, with increasing oral sexual intercourse, the primary effect/hard chancre is more often observed in the oral cavity. In addition, symptoms can occur not only in the oral cavity, but also in the ear, nose, larynx, cervical and facial regions. The diagnosis is confirmed by direct pathogen detection or by serological detection. The spirochete cannot be cultivated. The therapeutic gold standard is the administration of benzathine penicillin G or procaine penicillin G. Doxycycline, macrolides or ceftriaxone are available as alternatives. In case of inner ear or cranial nerve involvement, the additional administration of a glucocorticoid is recommended. Before antibiotic therapy is administered, the patient must be informed about the possibility of a Jarisch-Herxheimer reaction. In cases of a syphilis infection, a collegial cooperation with the venereologists is always recommended so that an effective and comprehensive diagnosis and therapy can be carried out.
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Affiliation(s)
- Inga Marte Charlott Seuthe
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Sabine Eichhorn
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Jonghui Kim
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Konstantin van Ackeren
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany
| | - Jonas Jae-Hyun Park
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Stefan Dazert
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany
| | - Kai-Christian Klespe
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln, Köln, Germany
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He S, Messner AH, Mirani G. Otosyphilis: A Rare Cause of Reversible Hearing Loss in a Teenage Male. Cureus 2022; 14:e23468. [PMID: 35494944 PMCID: PMC9038597 DOI: 10.7759/cureus.23468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
A high index of suspicion and a thorough neurotologic examination at the onset of presentation are imperative to generate the diagnosis of otosyphilis. Complete audiologic recovery is rare but possible in approximately 20%-25% of patients after appropriate treatment. We present a case of reversible hearing loss secondary to otosyphilis in a teenage male patient with a new diagnosis of human immunodeficiency virus (HIV). Audiology findings were consistent with mixed hearing loss. Lumbar puncture results were consistent with neurosyphilis. Prompt treatment with a 14-day course of intravenous penicillin led to the complete recovery of hearing. In this case report, the pathophysiology, symptomology, and management of otosyphilis are discussed.
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Otosyphilis with Clinical and Serologic Responses with Weekly Intramuscular Penicillin: A Case Report and Literature Review. Case Rep Infect Dis 2022; 2022:3152383. [PMID: 35251721 PMCID: PMC8896948 DOI: 10.1155/2022/3152383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
With the increasing prevalence of syphilis in different parts of the world, it is important to be cognizant of serious forms of syphilis. Otosyphilis is a rare form of syphilis with an extremely high rate of complications. Early diagnosis is essential to prevent a complete loss of hearing and decrease mortality. We present a unique case of otosyphilis who presented with left hearing loss, tinnitus, and vertigo, with audiometric findings confirming the hearing loss. An MRI brain showed asymmetric enhancement of the left cochlea and vestibular apparatus. She initially received oral steroids and trans-tympanic steroid injections with transient improvement of symptoms. She was diagnosed with syphilis through contact tracing after her ex-boyfriend tested positive. She received three weekly doses of intramuscular penicillin. Interestingly, her symptoms, rapid plasma regain (RPR) titer, and audiometry findings markedly improved. Once a diagnosis of otosyphilis was established, she received 14 days of intravenous penicillin.
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Abstract
PURPOSE OF REVIEW This article focuses on the epidemiology, clinical presentation, diagnosis, and management of neurosyphilis, with an emphasis on clinically relevant issues faced by the practicing neurologist. RECENT FINDINGS The incidence of primary and secondary syphilis, the sexually transmissible stages of infection, has been on the rise for the past 2 decades. A concerning recent trend is the surge in cases of syphilis in women and of congenital syphilis. Neurosyphilis remains a relatively common complication that can occur at any stage of syphilis. Along with meningitis, meningovascular syphilis, which has been historically described as a late presentation of neurosyphilis, now frequently occurs as a manifestation of early infection. Late forms of neurosyphilis, including tabes dorsalis and general paresis, are less prevalent in the era of widespread penicillin use. As more laboratories adopt the reverse-sequence algorithm for syphilis testing, patients with serodiscordant results (ie, a reactive serum treponemal test with a nonreactive nontreponemal test) may present an increasingly encountered diagnostic challenge for neurologists. Although the CSF Venereal Disease Research Laboratory (VDRL) remains a mainstay of diagnostic testing for neurosyphilis, using a higher titer cutoff (greater than 1:320) for the Treponema pallidum particle agglutination assay (TPPA) from the CSF may improve the utility of the TPPA as a supporting criterion for the diagnosis of neurosyphilis. Penicillin G is the treatment of choice for neurosyphilis, although ceftriaxone may be a reasonable alternative therapy. SUMMARY A high index of suspicion and awareness of the variable clinical presentations of neurosyphilis are essential to the approach to this treatable infection. Neurologists should be mindful of the limitations of serologic testing in the diagnosis of neurosyphilis and exercise clinical judgment to determine the likelihood of the diagnosis.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 816] [Impact Index Per Article: 272.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Traidl S, Angela Y, Stender A, Kulberg A, Tronnier M, Prenzler NK, Wattjes MP, Kapp A, Stangel M, Schacht V, Werfel T. A rare case of neuro- and otosyphilis in secondary syphilis. J Eur Acad Dermatol Venereol 2021; 35:e823-e826. [PMID: 34242450 DOI: 10.1111/jdv.17512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S Traidl
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Y Angela
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Stender
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Germany
| | - A Kulberg
- Department of Dermatology, Venereology, and Allergolgy, HELIOS Hospital, Hildesheim, Germany
| | - M Tronnier
- Department of Dermatology, Venereology, and Allergolgy, HELIOS Hospital, Hildesheim, Germany
| | - N K Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - M P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - A Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - M Stangel
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.,Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Germany.,Center for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
| | - V Schacht
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
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20
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Hearing Loss Due to Otosyphilis: Imaging Case of the Month. Otol Neurotol 2021; 42:e1634-e1635. [PMID: 34172666 DOI: 10.1097/mao.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, Terrier B, Régent A, Ghosn J, Charlier C, Martin-Blondel G, Dupin N. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1441-1447. [PMID: 34051142 DOI: 10.1016/s1473-3099(20)30857-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intravenous benzylpenicillin is the gold-standard treatment for neurosyphilis, but it requires prolonged hospitalisation. Ceftriaxone is a possible alternative treatment, the effectiveness of which remains unclear. We aimed to assess the effectiveness of ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis. METHODS We did a retrospective multicentre study including patients with neurosyphilis who were treated at one of eight tertiary care centres in France, from Jan 1, 1997, to Dec 31, 2017. We defined neurosyphilis as positive treponemal and non-treponemal tests and at least one of otic syphilis, ocular syphilis, either neurological symptom with a positive result on cerebrospinal fluid (CSF)-VDRL or CSF-PCR tests, or more than five leukocytes in a CSF cell count. Patients with neurosyphilis were identified from the medical information department database of each centre and assigned to one of two groups on the basis of the initial treatment received (ie, benzylpenicillin group or ceftriaxone group). The primary outcome was the overall clinical response (ie, proportion of patients with a complete or partial response) 1 month after treatment initiation. The secondary endpoints were proportions of patients with a complete response at 1 month and serological response at 6 months, and length of hospital stay. FINDINGS Of 365 patients with a coded diagnosis of neurosyphilis in one of the eight care centres during 1997-2017, 208 were included in this study (42 in the ceftriaxone group and 166 in the benzylpenicillin group). The mean age of patients was 44·4 years (SD 13·4), and 193 (93%) were men. We observed 41 instances of overall clinical response (98%) in the ceftriaxone group versus 125 (76%) in the benzylpenicillin group (crude odds ratio [OR] 13·02 [95% CI 1·73-97·66], p=0·017). After propensity score weighting, overall clinical response rates remained different between the groups (OR 1·22 [95% CI 1·12-1·33], p<0·0001). 22 (52%) patients in the ceftriaxone group and 55 (33%) in the benzylpenicillin group had a complete response (crude OR 2·26 [95% CI 1·12-4·41], p=0·031), with no significant difference after propensity score weighting (OR 1·08 [95% CI 0·94-1·24], p=0·269). Serological response at 6 months did not differ between the groups (21 [88%] of 24 in the ceftriaxone group vs 76 [82%] of 93 in the benzylpenicillin group; crude OR 1·56 [95% CI 0·42-5·86], p=0·50), whereas hospital stay was shorter for patients in the ceftriaxone group than for those in the benzylpenicillin group (mean 13·8 days [95% CI 12·8-14·8] vs 8·9 days [5·7-12·0], p<0·0001). No major adverse effects were reported in either group. INTERPRETATION Our results suggest that ceftriaxone is similarly effective to benzylpenicillin for the treatment of neurosyphilis, potentially decreasing the length of hospital stay. Randomised, controlled trials should be done to confirm these results. FUNDING None.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; EpiDermE, University Paris Est Créteil, Créteil, France
| | - Aurélie Jourdes
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Isabelle Alcaraz
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Victoria Manda
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Jean Michel Molina
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Maxime Mehlen
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Tattevin
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sami Mensi
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jade Ghosn
- Service de Maladies Infectieuses, Hôpital Bichat, AP-HP, Paris, France
| | - Caroline Charlier
- Université de Paris, Paris, France; Service de Maladies Infectieuses, Hôpital Necker, AP-HP, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases, Université Toulouse III, Toulouse, France
| | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Centre National de Référence de la Syphilis, Institut Cochin, Unité Inserm U1016, Université de Paris, Paris, France.
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Tuddenham S, Katz SS, Ghanem KG. Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests. Clin Infect Dis 2021; 71:S21-S42. [PMID: 32578862 PMCID: PMC7312285 DOI: 10.1093/cid/ciaa306] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960–2017, and for data related to the venereal disease research laboratory test from 1940–1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha S Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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23
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Abstract
The number of cases of syphilis has increased in the United States and in many high-income nations. Otosyphilis is a less recognized complication of syphilis that can lead to irreversible sensorineural hearing loss. Different pathophysiological mechanisms have been proposed to explain hearing loss in otosyphilis. We review the literature on otosyphilis in adults and propose the need for future work in this field to identify better ways to diagnose, treat, and manage this disease. Patients with syphilis should be screened routinely for hearing loss, and all patients with new, sudden, or fluctuating sensorineural hearing loss should be evaluated for syphilis.
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24
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Abstract
PURPOSE OF REVIEW Neurosyphilis (NS) and Lyme neuroborreliosis (LNB) are spirochetal diseases with distinct clinical manifestations. The diagnosis of NS remains challenging due to imperfect diagnostic criteria and testing modalities. With LNB, misconceptions about diagnosis and treatment lead to considerable morbidity and drug related adverse effects. RECENT FINDINGS Although studies continue investigating alternate approaches and new diagnostic tests for NS, few data exist to change current approaches to diagnosis, management or follow up. In the diagnosis of LNB, the chemokine CXCL13 shows promising diagnostic accuracy. A systematic review discourages the use of cell-based assays when investigating Lyme disease. Clinical studies show no benefit from extended antibiotic treatment for patients with unspecific symptoms labelled as having Lyme disease. SUMMARY The diagnosis of NS may be delayed due to a lack of specificity of findings, low suspicion for syphilis, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis is required provide timely diagnosis and management of NS. Fortunately, penicillin remains the treatment of choice. Overdiagnosis and overtreatment in patients labelled as having Lyme disease can be avoided by an evidence-based approach towards diagnosis and treatment.
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25
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Syphilis 2021 - die Infektionszahlen steigen stetig. ÄSTHETISCHE DERMATOLOGIE & KOSMETOLOGIE 2021. [PMCID: PMC7878652 DOI: 10.1007/s12634-021-1430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Syphilis 2020 - die Infektionszahlen steigen stetig. GYNÄKOLOGIE + GEBURTSHILFE 2020. [PMCID: PMC7714672 DOI: 10.1007/s15013-020-3175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Abstract
Syphilis is a bacterial infection caused by Treponema pallidum. It spreads usually via sexual contact. Syphilis generally presents as a multisystem disease, with symptoms resembling and often confused with those of other diseases, thus often called “the great mimicker”. Neurosyphilis is a rare but late course of the disease process when the meninges and central nervous system (CNS) are involved. Otosyphilis is an even rarer, yet important complication of neurosyphilis and a rare cause of sensorineural deafness often misdiagnosed. We present the case of a 46-year-old Caucasian male admitted for acute onset bilateral hearing loss caused by otosyphilis. We include a discussion about cerebrospinal fluid (CSF) protein analysis in individuals diagnosed with neurosyphilis.
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28
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Marra CM, Maxwell CL, Ramchandani M, Tantalo LC, Sahi SK, Dunaway SB, Litvack JR. Hearing loss in individuals at risk for neurosyphilis. Int J STD AIDS 2020; 31:1178-1185. [PMID: 32928054 DOI: 10.1177/0956462420947584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Otosyphilis is a serious complication of syphilis.329 participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent portable audiometry (250 Hz to 8000 Hz at 5-75 dB); it was repeated in 33 after otosyphilis treatment. Treponema pallidum spp pallidum (T. pallidum) DNA in blood was quantitated by polymerase chain reaction. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were determined by logistic, ordinal or Cox regression.166 (50.5%) had normal hearing; 15 (4.6%) had low frequency (LF) loss alone, 93 (28.3%) had high frequency (HF) loss alone, and 55 (16.7%) had both. Adjusted odds of any hearing loss were higher with detectable blood T. pallidum DNA (3.00 [1.58-5.69], p = 0.001), CSF pleocytosis (2.02 [1.12-3.66], p = 0.02), and older age (2.22 per 10-year increase, [1.70-2.91], p < 0.001). HRs of normalization of LF and HF loss were lower for older individuals (0.20 [0.07-0.63, p = 0.005] and 0.22 [0.05-0.94, p = 0.04]), and HRs for normalization of HF loss were lower for those with more severe loss (0.09 [0.02-0.43], p = 0.002), and in those with CSF pleocytosis (0.32 [0.11-0.96], p = 0.04).Older age and CSF pleocytosis increase the likelihood of otosyphilis and impair hearing recovery after otosyphilis treatment.
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Affiliation(s)
- Christina M Marra
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Clare L Maxwell
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Meena Ramchandani
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Lauren C Tantalo
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sharon K Sahi
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shelia B Dunaway
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA
| | - Jamie R Litvack
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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29
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Affiliation(s)
- Khalil G Ghanem
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Sanjay Ram
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Peter A Rice
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
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Penicillin G Sodium as a Treatment of Otosyphilis with Hearing Loss. Antibiotics (Basel) 2019; 8:antibiotics8020047. [PMID: 31035371 PMCID: PMC6628065 DOI: 10.3390/antibiotics8020047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022] Open
Abstract
Otosyphilis is one contributing cause of hearing loss in adult patients. There are limited studies on the treatment regimens of otosyphilis. Penicillin G sodium (PGS) plus additional medications, such as benzathine penicillin and probenecid, is an effective regimen. This study investigated the efficacy of PGS alone for the treatment of otosyphilis. We conducted a retrospective study and included all consecutive patients diagnosed with otosyphilis who received only PGS treatment. The study period was from 2009 to 2013. The PGS treatment regimen was PGS 4 mu intravenously every four hours (24 mu/day) for 14 days. Clinical and audiogram outcomes were evaluated one year after treatment. There were 34 otosyphilis patients that were treated with PGS. After one year of treatment, 18 patients (52.9%) had a clinical improvement and 11 patients (32.4%) had an audiogram improvement. In conclusion, PGS at 24 mu/day for two weeks provided an audiogram improvement one year after treatment in one-third of the patients.
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Abstract
After reaching a nadir at the turn of the century, syphilis rates in the United States have increased since 2000. Treponema pallidum may disseminate to the central nervous system within hours to days after inoculation. In this review, we focus on knowledge gaps and areas of controversy in neurosyphilis epidemiology, diagnosis, and management. Modern estimates of the prevalence of neurosyphilis are hindered by the lack of consistent reporting data and are based on relatively small retrospective cohort studies. The various diagnostic modalities for neurosyphilis have significant limitations. Although several novel biomarkers for neurosyphilis have been evaluated, none to date have found a place in clinical practice. The role of a cerebrospinal fluid examination in patients without neurological symptoms continues to be an area of controversy, whereas the data for the use of antibiotic regimens other than intravenous aqueous or intramuscular procaine penicillin for the treatment of neurosyphilis are limited. As syphilis incidence continues to increase unabated in many countries around the world, it is critical to address these gaps of knowledge.
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32
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Theeuwen H, Whipple M, Litvack JR. Otosyphilis: Resurgence of an Old Disease. Laryngoscope 2018; 129:1680-1684. [PMID: 30592050 DOI: 10.1002/lary.27635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/29/2018] [Accepted: 10/03/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients presenting with a new diagnosis of otosyphilis over the past 10 years in a large, urban, safety-net hospital affiliated with a large county sexually transmitted disease clinic. METHODS Retrospective case series. A chart review was performed of all patients who presented to an adult otolaryngology clinic with a new diagnosis of syphilis and hearing loss from January 2008 to December 2017. RESULTS Twelve patients met the criteria for "suspected" or "likely" otosyphilis based on Centers for Disease Control and Prevention definitions. The average age was 48 years (range 19-59). All were male. Nine (75%) were men who have sex with men. Eight (67%) were positive for human immunodeficiency virus. One (8%) presented with primary, nine (75%) with secondary, and two (17%) with early latent syphilis. Seven (58%) presented with bilateral audiogram-confirmed hearing loss, two (17%) with unilateral hearing loss, and three (25%) with suspected hearing loss based on fluctuating symptoms. Nine (75%) presented with tinnitus and two (17%) with vertigo. The median duration of otologic symptoms prior to presentation was 2 weeks (range: 0-16 weeks). All presented within the last 2 years surveyed. CONCLUSION We have seen an increase in the number of otosyphilis cases in our clinic. We suspect otosyphilis may be underdiagnosed and emphasize the importance of screening for syphilis in patients with new audiologic symptoms of vertigo, tinnitus, or hearing loss. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1680-1684, 2019.
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Affiliation(s)
- Hailey Theeuwen
- University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Mark Whipple
- University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Jamie R Litvack
- Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, U.S.A
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Komamura H, Nakamura T, Kobayashi J, Harada R, Endo K, Ogura M, Higuchi J. Early neurosyphilis presenting with multiple cranial nerve palsies: A case report of management by combined penicillin-corticosteroid treatment. J Infect Chemother 2018; 25:362-364. [PMID: 30538059 DOI: 10.1016/j.jiac.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/16/2018] [Accepted: 11/11/2018] [Indexed: 12/27/2022]
Abstract
Early neurosyphilis commonly appears in basilar meninges, and its meningeal inflammation can spread to neighboring cranial nerves, resulting in some cranial nerve palsies. Herein, we report a case of a 51-year-old man who presented with right peripheral facial nerve palsy. His symptoms completely disappeared with prednisolone monotherapy without antibiotics use and were not exacerbated during clinical treatment. However, 2 months after remission of seventh cranial neuropathy, fifth and eighth cranial neuropathies appeared on the right side. Serologic tests for syphilis were revealed to be abnormal. Finally, the patient was diagnosed with early neurosyphilis with multiple cranial palsies. His neurological symptoms were markedly improved by combined penicillin-corticosteroid treatment. Systemic corticosteroids could be effective as adjunctive therapy to ameliorate neurological sequelae in early neurosyphilis.
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Affiliation(s)
- Hiroshi Komamura
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Takaaki Nakamura
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan.
| | - Junpei Kobayashi
- Department of Neurology, National Hospital Organization Yonezawa Hospital, 26100-1, Misawa, Yonezawa, Yamagata, Japan
| | - Ryuhei Harada
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Masaki Ogura
- Division of Otolaryngology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, Japan
| | - Jun Higuchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
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Young AS, Carroll AS, Welgampola MS, McCluskey PJ, van Hal SJ, Thompson EO, Burn J, Fulham MJ, Halmagyi GM. Acute unilateral peripheral vestibulopathy in neurosyphilis. J Neurol Sci 2017; 378:55-58. [DOI: 10.1016/j.jns.2017.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Abstract
Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.
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Affiliation(s)
- Kuan Lai
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | | | | | - Shanshan Wei
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kang Zeng
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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[Skin and mucosal erosions revealing secondary syphilis with otologic and eye disorders]. Ann Dermatol Venereol 2016; 143:691-696. [PMID: 27646571 DOI: 10.1016/j.annder.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/09/2016] [Accepted: 07/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The clinical polymorphism of syphilis leads to diagnostic issues. We report a case of secondary syphilis revealed by skin and mucosal erosions, and responsible for sensorineural hearing loss and asymptomatic papillitis. PATIENTS AND METHODS A 55-year-old man presented oral and peri-anal erosions as the initial symptoms of secondary syphilis. He reported hypoacusis and a pure-tone audiogram revealed bilateral sensorineural hearing loss. Ophthalmological investigation revealed isolated right papillitis and superior temporal scotoma with blind-spot enlargement. TPHA-VDRL serology was strongly positive for plasma (TPHA 1/10,240 and VDRL 1/64) but doubtful for cerebrospinal fluid. For his hearing and eye disorders, considered as related to neurosyphilis, the patient received a 14-day course of intravenous penicillin G, associated with systemic corticosteroids with gradual reduction over a period of fifteen weeks. The patient's skin and mucosal erosions resolved, as did his papillitis. His hearing loss remained stable. Serological monitoring at three months showed a sixteen-fold decrease in VDRL titre. DISCUSSION The re-emergence of syphilis has led to increasing incidence of related ophthalmological and otological disorders. This report highlights the first-line role of the dermatologist in systematic diagnosis and in screening for associated involvement.
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Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, McBrien B, Tipple C, Turner A, Sullivan AK, Radcliffe K, Cousins D, FitzGerald M, Fisher M, Grover D, Higgins S, Kingston M, Rayment M, Sullivan A. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2015; 27:421-46. [PMID: 26721608 DOI: 10.1177/0956462415624059] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
Abstract
These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.
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Affiliation(s)
- M Kingston
- Manchester Centre for Sexual Health, Manchester, UK
| | - P French
- Mortimer Market Centre, London, UK
| | - S Higgins
- North Manchester General Hospital, Manchester, UK
| | - O McQuillan
- Manchester Centre for Sexual Health, Manchester, UK
| | - A Sukthankar
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Stott
- Manchester Centre for Sexual Health, Manchester, UK
| | - B McBrien
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Tipple
- Jefferiss Wing Centre for Sexual Health, Imperial College Health Care NHS Trust, London, UK
| | - A Turner
- The Public Health England/Clinical Virology Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Keith Radcliffe
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Darren Cousins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Mark FitzGerald
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Martin Fisher
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Deepa Grover
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Stephen Higgins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Margaret Kingston
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Michael Rayment
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Ann Sullivan
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
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Histopathologic ear findings of syphilis: a temporal bone study. Eur Arch Otorhinolaryngol 2015; 273:2443-9. [PMID: 26573155 DOI: 10.1007/s00405-015-3834-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
To the best of our knowledge, histopathologic studies of syphilitic ears have generally focused on hydropic changes; so far, no such studies have investigated peripheral vestibular otopathology using differential interference contrast microscopy, in patients with syphilis. For this study, we examined 13 human temporal bone samples from 8 patients with a history of syphilis. Using conventional light microscopy, we performed qualitative histopathologic assessment. In addition, using differential interference contrast microscopy, we performed type I and type II vestibular hair cell counts on each vestibular sense organ with minimal autolysis; in which the neuroepithelium was oriented perpendicular to the plane of section. We then compared vestibular hair cell densities (cells per 0.01 mm² surface area) in the syphilis group vs. the control group. In the syphilis group, we observed precipitate in the endolymphatic or perilymphatic spaces in 1 (7.7 %) of the samples and endolymphatic hydrops in eight (61.5 %) of the samples. Hydrops involved the cochlea (four samples) and/or saccule (four samples). In addition, the syphilis group experienced a significant loss of type II vestibular hair cells in the maculae of the utricle and saccule, and in the cristae of the lateral and posterior semicircular canals, as compared with the control group (P < 0.05).
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Tipple C. Impact of HIV-1 infection on the clinical presentation of syphilis in men who have sex with men. Sex Health 2015; 12:110-8. [PMID: 25513993 DOI: 10.1071/sh14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM), especially those with HIV-1 infection, are disproportionately affected by syphilis in higher income countries. The course, and some of the clinical features of the disease, especially the development of neurosyphilis, can be affected by HIV-1 co-infection. This review documents potential differences in the clinical features of syphilis in HIV-1 infected and uninfected MSM and highlights the importance of a thorough examination and high index of suspicion when seeing and treating MSM at risk of sexually transmissible infections.
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Affiliation(s)
- Craig Tipple
- Department of Medicine, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK.
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Abstract
No portion of the central nervous system is immune to the ravages of syphilis. Infection by Treponema pallidum can affect the meninges, brain, brainstem, spinal cord, nerve roots, and cerebral and spinal blood vessels. As a consequence, the disease may present in diverse and, at times, diagnostically challenging fashions. Neurologic manifestations of syphilis may develop within months of the initial infection or, alternatively, take decades to appear. Although approximately one-third of individuals infected by T. pallidum display cerebrospinal fluid abnormalities suggestive of invasion of the central nervous system by the organism, only a fraction of these develop clinically significant neurologic manifestations. The features of neurosyphilis may be modified by the concomitant presence of immunosuppressive agents or conditions such as HIV/AIDS. The epidemiology of neurosyphilis has largely paralleled that of syphilis in general. A dramatic decline occurred by the early 1950s as a consequence of public health measures and the widespread use of antibiotics. The incidence had increased by the onset of the AIDS pandemic and has since corresponded with the adoption of safe sex practices. The CSF Venereal Disease Research Laboratory (VDRL) test remains the "gold standard" for diagnosis, but is not invariably positive. Penicillin remains the most effective and recommended therapy.
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Affiliation(s)
- Joseph R Berger
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Dawson Dean
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
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Affiliation(s)
- Malcolm Proudfoot
- Department of Neurology, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK.
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Kuhn M, Heman-Ackah SE, Shaikh JA, Roehm PC. Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 2011; 15:91-105. [PMID: 21606048 PMCID: PMC4040829 DOI: 10.1177/1084713811408349] [Citation(s) in RCA: 312] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sudden sensorineural hearing loss (SSNHL) is commonly encountered in audiologic and otolaryngologic practice. SSNHL is most commonly defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period. Although the differential for SSNHL is vast, for the majority of patients an etiologic factor is not identified. Treatment for SSNHL of known etiology is directed toward that agent, with poor hearing outcomes characteristic for discoverable etiologies that cause inner ear hair cell loss. Steroid therapy is the current mainstay of treatment of idiopathic SSNHL in the United States. The prognosis for hearing recovery for idiopathic SSNHL is dependent on a number of factors including the severity of hearing loss, age, presence of vertigo, and shape of the audiogram.
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Affiliation(s)
- Maggie Kuhn
- New York University School of Medicine, New York
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Abstract
Neurosyphilis literally means syphilitic infection of the central nervous system, but it is often referred to incorrectly as "tertiary syphilis." Neurosyphilis can occur at any time in the course of syphilis, even in the earliest, primary, stage. Early forms of neurosyphilis primarily affect the meninges, cerebrospinal fluid, and cerebral or spinal cord vasculature. Late forms of neurosyphilis primarily affect the brain and spinal cord parenchyma. Uveitis and hearing loss related to syphilis are most common in early syphilis and may be accompanied by early neurosyphilis. The treatment for syphilis-related eye disease and hearing loss is the same as the treatment for neurosyphilis. Neurosyphilis is more commonly seen in patients infected with HIV, and much of the recent literature pertains to this risk group. This article provides a critical review of recent literature on the diagnosis, clinical findings, risk factors, and management of neurosyphilis.
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Affiliation(s)
- Christina M Marra
- University of Washington School of Medicine, Harborview Medical Center, Box 359775, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Courjon J, Cua E, Hubiche T, de Salvador F, Dellamonica P, Fuzibet J, Del Giudice P. Trouble de l’audition au cours de la syphilis précoce : à propos de cinq cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chan SY, Medhi M, Ekbote A, Moses S, Sibtain N, Andrews T, O'Connor AF, Kulasegaram R. Syphilis causing hearing loss. Int J STD AIDS 2008; 19:721-2. [PMID: 18824631 DOI: 10.1258/ijsa.2008.008124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An HIV-positive man with hepatitis B co-infection, naïve to highly active antiretroviral therapy, with a CD4 of 594 copies/mL and HIV-1 viral load of 140,070 copies, presented with right-sided facial weakness and hearing loss. He had been treated for secondary syphilis three months earlier when his rapid plasma reagin (RPR) result was 1:16, this had fallen to neat. At presentation, his RPR had risen to 1:16 again. A magnetic resonance imaging scan showed enhancement of the internal auditory canal and right cochlea. His cerebrospinal fluid examination was normal. He was treated with acyclovir and prednisolone before the syphilis serology was known. He was then treated for syphilis with doxycycline. He made an excellent recovery.
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Affiliation(s)
- S Y Chan
- Department of Genitourinary Medicine, St Thomas's Hospital, London, UK.
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Clasificación de los vértigos periféricos. Documento de Consenso de la Comisión de Otoneurología de la Sociedad Española de Otorrinolaringología (2003-2006). ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73266-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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50
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Morera C, Pérez H, Pérez N, Soto A. Peripheral Vertigo Classification. Consensus Document. Otoneurology Committee of the Spanish Otorhinolaryngology Society (2003–2006). ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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