Historical and contemporary correlates of syphilis and cancer

Sexually and non-sexually transmitted infections and the risk of prostate cancer: Results from the EPICAP study

INTRODUCTION

Prostate cancer (PCa) is by far the most common type of cancer among men in western countries. However, relatively little is known about its etiology despite the high morbidity and mortality. It has been suggested that chronic inflammation may be involved in prostate carcinogenesis. We investigated the role of sexually and non-sexually transmitted infections in prostate cancer risk with a specific interest in the aggressive types.

METHODS

We used data from epidemiological study of prostate cancer (EPICAP), a population-based case-control study. A total of 819 incident cases and 879 controls were interviewed face-to-face using a standardized questionnaire gathering information on known or suspected risk factors of prostate cancer and personal history of specific sexually and non-sexually transmitted infections: gonorrhea, syphilis, trichomonas, herpes, mononucleosis, Epstein-Barr virus, varicella-zoster, and dengue. Odds ratios (OR) and their 95% confidence interval were estimated using multivariate unconditional logistic regression.

RESULTS

There was no significant association between gonorrhea (OR: 0.90, 95% CI: 0.61-1.33), trichomonas (OR: 0.74, 95% CI: 0.27-2.07), genital herpes (OR: 0.69, 95% CI: 0.38-1.27), and the risk of prostate cancer. No association emerged for overall sexually transmitted bacterial and viral infections (OR 1.05, 95% CI: 0.86-1.29) and overall non-sexually transmitted viral infections (OR 1.11, 95% CI: 0.90-1.35) and the risk of prostate cancer.

CONCLUSION

Our results showed that sexually or non-sexually transmitted infections, either bacterial or viral, were not associated to prostate cancer. Therefore, further investigation is needed to help advance our understanding of the role of chronic inflammation in the etiology of prostate cancer, with a particular focus on its most aggressive types.

A Case of Syphilis Suspected Preoperatively as a Case of Tongue Cancer

Syphilis is a sexually transmitted disease caused by Treponema pallidum (TP). We report a case of syphilis that was initially suspected as tongue cancer. An 86-year-old man consulted a neighborhood clinic with an approximately one-month history of pain in the right tongue. The result of scraping cytology of the tongue performed at the clinic was classified as class V, squamous cell carcinoma, and the patient was referred to our hospital. Physical examination revealed a mass on the right side of the tongue and a firm cervical mass. Biopsy revealed no evidence of malignancy; however, the imaging findings led to the suspicion of tongue cancer and lymph node metastasis. The results of blood examination revealed that the patient had syphilis, but since the patient showed few other symptoms, we decided to treat the infection after the planned surgery. We performed right partial glossectomy and neck dissection; however, the postoperative histopathology revealed no evidence of malignancy but nonspecific inflammatory changes with TP spirochetes. The incidence of syphilis has increased dramatically around the world, including Japan, during the last 20 years, and it no longer remains a rare disease. Therefore, syphilis should be included in the differential diagnosis of oral or cervical masses.

Comparison of five-year survival rates among patients with oral squamous cell carcinoma with and without association with syphilis: a retrospective case-control study

BACKGROUND

Syphilis is an infectious disease that is at least discussed to be premalignant. This potential, combined with its general pathological impact, raises the question if syphilis increases mortality in oral cancer patients. The aim of the study was to assess if the five-year survival rates among patients suffering from oral squamous cell carcinoma (OSCC) with (cohort I) and without association with syphilis (cohort II) differ.

METHODS

Retrospective clinical data of patients diagnosed with OSCC (International Classification of Diseases [ICD]-10 codes C01-06) within the past 20 years from the access date September 25, 2021 were retrieved from the TriNetX network (TriNetX, Cambridge, Massachusetts, USA) to gain initial cohort 0. Subjects also diagnosed with syphilis (ICD-10 codes A51-53) were assigned to cohort I. Cohort II was comprised of the remaining individuals of cohort 0 by creating a group with the same number of patients as cohort I, and by matching for age and gender. Subsequently, Kaplan-Meier analysis and Cox proportional hazards regression were performed, and risk, odds and hazard ratios were calculated.

RESULTS

Of a total of 73,736 patients in cohort 0, 199 individuals were each assigned to cohort I and II. During the five-year period after tumor diagnosis, 39 and 30 patients in cohort I and II died. The five-year survival probabilities did not significantly differ between the cohorts (I vs. II = 74.19% vs. 75.01%; p = 0.52; Log-Rank test), nor the risk of dying (I vs. II = 19.6% vs. 15.08%; risk difference = 4.52%; p = 0.23). The calculated risk, odds and hazard ratios were 1.3 (95% confidence interval [CI] = 0.84; 2.00), 1.37 (95% CI = 0.81; 2.31) and 1.17 (95% CI = 0.73; 1.88), respectively.

CONCLUSIONS

The obtained results indicate that the survival rate of individuals with OSCC might not be negatively influenced if syphilis is present/associated. However, the results need to be interpreted cautiously due to limitations related to the retrospective approach, especially as data on the tumor staging were not accessible.

TRIAL REGISTRATION

Due to the retrospective nature of the study, no registration was necessary.

Clinical Reasoning: Longitudinally Extensive Spinal Cord Lesions in a Middle-aged Man

An immunocompetent 47-year-old man presented with a five-month history of progressive lower limb weakness, back pain, sphincter dysfunction, and intermittent fever, suggesting myelopathy in a chronic deteriorating course. A comprehensive analysis comprising of blood tests, neuroimaging, CSF profiling, molecular analysis, and histopathology was performed. Notably, enhanced spinal cord MRI revealed longitudinally extensive intradural-extramedullary lesions involving the cervical, thoracic, and lumbosacral spinal cord, with homogeneous enhancement and spinal cord compression. Serum TPHA and RPR tests were positive. CSF profiling showed pleocytosis, significant protein elevations, hypoglycorrhachia, and positive TPHA test. 18F-FDG-PET/CT indicated slightly increased intraspinal FDG uptake. Spinal cord biopsy further showed small round blue cells in poorly differentiated tissues. Immunostaining was positive for NKX2.2, CD56, CD99, Synaptophysin, and Ki67 (50%). Molecular analysis detected a novel MALAT-CYSLTR1 fusion protein and variants in oncogenic genes including PTCH1, TERT, CREBBP, SPEN, and STK11 The diagnosis of intraspinal extraosseous Ewing's sarcoma (ES) was confirmed. Briefly, our case details the diagnosis of a patient with intradural-extramedullary ES and highlights the value of spinal cord biopsy in progressive myelopathy of unknown causes.

Oral manifestations of systemic disease

While the majority of disorders of the mouth are centred upon the direct action of plaque, the oral tissues can be subject to change or damage as a consequence of disease that predominantly affects other body systems. Such oral manifestations of systemic disease can be highly variable in both frequency and presentation. As lifespan increases and medical care becomes ever more complex and effective it is likely that the numbers of individuals with oral manifestations of systemic disease will continue to rise. The present article provides a succinct review of oral manifestations of systemic disease. In view of this article being part of a wider BDJ themed issue on the subject of oral medicine, this review focuses upon oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease.

The impact of GSTM1/GSTT1 polymorphism for the risk of oral cancer

OBJECTIVES

Since development of oral squamous cell cancer (OSCC) is triggered by various noxa, different variants of the antioxidant glutathione S-transferases (GSTs) can counteract toxic compounds (e.g., tobacco smoke). Because different polymorphisms of GST are known to have an increased sensitivity to carcinogenic agents, the aim of this study was to analyze whether GSTM1 or GSTT1 polymorphisms increase the risk for the development of OSCC.

MATERIALS AND METHODS

GSTM1 and GSTT1 polymorphism was examined in healthy volunteers (n = 93) and in patients with OSCC (n = 100) by PCR after brush biopsy of oral mucosa. Odds ratio (OR) was calculated to evaluate the risk of oral cancer development.

RESULTS

GSTM1 and GSTT1 deletion was found in 57% (53/93) and 18% (17/93), respectively, in healthy patients, while the OSCC group showed 57% (57/100) for GSTM1 deletion and 22% (22/100) with a deletion of GSTT1. Odds ratio for GSTM1 polymorphism was 1.00 and for GSTT1 1.26. Comparing smokers and nonsmokers with GSTM1 deletion polymorphism, OR was 4.35, while smokers without GSTM1 deletion showed an OR of 1.45. Adapting these data to the smoking habits of the general population in Germany, the OR was 9.25 for smokers with a GSTM1 deletion and OR 6.68 for smokers without a GSTM1 deletion. In smokers with GSTT1 deletion polymorphism, OR was 1.6 (adapted to the smoking habits of the general population: OR 6.16) and 3.16 (OR 8.56) in smokers without deletion in GSTT1 gene.

CONCLUSIONS

Analysis of GST-M1 polymorphism in smokers could help to identify patients with a higher risk for the development of oral cancer.

CLINICAL RELEVANCE

Early detection of OSCC due to a close meshed monitoring program for patients with GST-M1 polymorphism could help to improve the patient outcome. For polymorphism investigations, the oral brush biopsy is a sufficient method to gain DNA material.

Sexually transmitted infections and prostate cancer risk: a systematic review and meta-analysis

Prostate cancer (PC) is the second most incident cancer and the sixth cause of death by cancer in men worldwide. Despite extensive research efforts, no modifiable risk factors have been consistently identified for PC risk. A number of studies have focused on possible relationships between sexually transmitted infections (STIs) and PC. We performed a meta-analysis to explore the association between infection caused by Neisseria gonorrheae, Treponema pallidum, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Herpes Simplex Virus types 1 and 2, Human Herpes Virus 8 and Cytomegalovirus, and PC. We conducted a comprehensive, systematic bibliographic search of medical literature to identify relevant studies. We calculated summary relative risk (SRR) and 95% confidence intervals (CI) for the association between each STI and PC through random effect models. Subgroup, meta-regression and sensitivity analyses were carried out to detect between-study heterogeneity and bias. We included 47 studies published between 1971 and 2011. Men who reported having ever had any STI in lifetime had an increased PC (SRR 1.49, 95% CI 1.19-1.92). We found a significantly increased PC risk in men having had gonorrhoea (SRR 1.20, 95% CI 1.05-1.37). No other single STI was significantly associated with PC. Due to high incidence of both STIs and PC worldwide, prevention of STIs may help preventing a considerable number of PC cases.

Sexually transmitted infections and risk of prostate cancer: review of historical and emerging hypotheses

Since the early 1950s when sexually transmitted infections (STIs) were first proposed as a possible risk factor for prostate cancer, numerous epidemiologic studies have been conducted. Initially, these studies were primarily small case-control studies with retrospective, self-reported assessments of a narrow range of STIs, typically either any STIs, or gonorrhea and syphilis. However, as new STIs have been discovered/recognized, new and better tests to detect histories of STIs have been developed, and new resources for prostate cancer research have been created, epidemiologic studies have expanded to include a wide range of STIs, and have moved towards more rigorous, prospective study designs and serological assessment of STI histories. The results of these studies are reviewed and discussed, as well as possible new avenues of research, such as Trichomonas vaginalis infection and infections not typically considered to be sexually transmitted.

Resurgence of syphilis: a diagnosis based on unusual oral mucosa lesions

BACKGROUND

Known as "the great imitator," secondary syphilis may clinically manifest itself in myriad of ways, involving different organs (including the oral cavity), and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians.

CASE REPORT

We highlight an interesting case of a 45-year-old man on whose diagnosis of secondary syphilis was based on the presence of unusual oral lesions, consisting of a well delimited, raised, nonhomogeneous, and corrugated white plaque on the right buccal mucosa which mimicked, clinically and histologically, a "leukoplakia-like" plaque and several whitish oral mucous patches localized on the lower labial mucosa and the right lateral margin of the tongue. After the oral lesions, the patient developed a symmetric maculopapular cutaneous rash on the palms, soles, and the trunk of the body. Furthermore, during the anamnesis the patient stated an asymptomatic ulcerative lesion on the glans penis, which had appeared 7 months before the onset of the oral lesions and spontaneously disappeared after 2 weeks. The history of these genital and cutaneous lesions suggested performing serologic tests for syphilis, revealing strongly positive titers and leading us to making a diagnosis of secondary syphilis.

CONCLUSION

This case is remarkable because it displays an unusual oral sign, associated with secondary syphilis; in fact, only occasionally does syphilis manifest itself with a "leukoplakia-like" plaque. Dentists should consider secondary syphilis in the differential diagnosis of white and/or ulcerative oral lesions, above all in at-risk patients, given the continuing rise of syphilis in western Europe.

[Late secondary syphilis with ulceration of the tongue during HIV coinfection: case report]

With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.

Oral manifestations of syphilis

The past decade has shown a significant rise in the prevalence of infective syphilis in the developed world, and striking increases in its frequency have occurred in Eastern Europe, particularly the UK, and in the US. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Significant oral lesions such as gumma-associated bony destruction and a possible predisposition to oral squamous cell carcinoma are associated with tertiary disease. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. The aim of this report is to review syphilis-related oral lesions, as well as to summarize the relations between human immunodeficiency virus (HIV) and syphilis.

Medical history, sexual, and maturational factors and prostate cancer risk

PURPOSE

Sexual, physical, and medical factors were investigated in a case-control study of prostate cancer.

METHODS

This population-based study, conducted from 1995 to 1999 in northeastern Ontario, used cancer registry-identified cases (n=760), aged 45 to 84 years, diagnosed between 1995 and 1998. Age-frequency matched controls (n=1632) were obtained from telephone listings. Two separate logistic regression analyses considered: 1) sexual and physical; and 2) medical factors.

RESULTS

For the sexual-physical model, marital status, family income, maximum height, number of marriages, having children, age at first marriage, birth, and needing to shave, and acne were not significantly related to risk. In the medical model, a family history of prostate cancer (OR, 2.99; 95% CI, 2.21-4.04) and history of venereal disease (OR, 2.12; 95% CI, 1.27-3.53) were associated with significantly increased risk. A history of allergies (OR, 0.78; 95% CI, 0.60-1.00), benign prostatic hyperplasia (OR, 0.63; 95% CI, 0.49-0.81), and an annual physical exam (OR, 0.43; 95% CI, 0.21-0.85) were associated with reduced risk. Other factors considered in the medical conditions model, body mass index, smoking non-filter cigarettes, and family income were not associated with prostate cancer.

CONCLUSIONS

This study is consistent with other studies that suggest that infectious agents may be involved in prostate cancer development.

[Oral precancerous conditions--an overview]

Precancerous conditions are defined as a generalized state associated with a significantly increased risk of cancer. For the oral and perioral region, sideropenic dysphagia, oral lichen planus (OLP), oral submucous fibrosis (OSF), syphilis, discoid lupus erythematosus, xeroderma pigmentosum as well as epidermolysis bullosa play a role as precancerous conditions. The number of published cases of oral or perioral malignant transformation for some of these diseases is small. In addition, carcinomas of the tongue and the oral cavity associated with syphilis are of historical interest, although publications in the 1990s still reported positive serology of syphilis and carcinomas of the tongue. OLP is still controversially discussed as to its premalignant nature. Transformation rates have been reported between 0% and 5.6%. Recent prospective studies have revealed that possibly oral lichenoid reactions (OLR) are more likely to form the basis of malignant transformation as compared to the classic OLP. The differentiation between OLP and OLR is difficult both from clinical and histopathological aspects. The second most important precancerous condition is oral submucous fibrosis, which is caused by betel quid chewing. OSF is most prevalent in South and Southeast Asia. The transformation rate is as high as 7.6% making OSF one of the most important precancerous conditions of the oral region.

Epidemiologic association between prostatitis and prostate cancer

OBJECTIVES

To quantify the relationship between prostatitis and prostate cancer by pooling previous epidemiologic studies of this association.

METHODS

A comprehensive search for articles published through 2000 was performed, blinded reviews of each study were conducted, data were abstracted, and all such studies were pooled.

RESULTS

In this meta-analysis, an increased risk was seen among men with a history of prostatitis (odds ratio = 1.6), particularly with population-based case-control studies (odds ratio = 1.8). Increased relative risk estimates were also seen among men with a history of syphilis and a history of gonorrhea.

CONCLUSIONS

These associations with prostate cancer suggest that infections may represent one mechanism through which prostate cancer develops. However, causality is unclear, because recall bias and detection bias cannot be ruled out. Future cohort studies of prostate cancer should examine sexually transmitted infections, as well as other infections, as potential risk factors.

Meta-analysis of measures of sexual activity and prostate cancer

We conducted a meta-analysis of the association between prostate cancer and aspects of sexual activity. The data suggest an elevated relative risk (RR) of prostate cancer among men with a history of sexually transmitted infections. This was observed with both random- and fixed-effects models (RR = 1.4; 95% CI = 1.2-1.7; N = 17 studies; heterogeneity P = 0.14), especially for syphilis (RR = 2.3; 95% CI = 1.3-3.9; N = 6; heterogeneity P = 0.47). Risk of prostate cancer is also associated with increasing frequency of sexual activity (RR = 1.2 for an increase of three times per week; 95% CI = 1.1-1.3; N = 12). However, these studies are heterogeneous (P < 0.001). Increasing number of sexual partners is also associated with prostate cancer (RR = 1.2 for an increase of 20 partners; 95% CI = 1.1-1.3; N = 16; heterogeneity P = 0.11). The data do not support associations with multiple marriages, age at first intercourse, or age at first marriage. These results indicate an association between prostate cancer and sexually transmitted infections, suggesting that infections may represent one mechanism through which prostate cancer develops. The mechanism through which frequency of sexual activity may be related to prostate cancer is unclear.

Kaposi's sarcoma and human herpesvirus-8

KS is a major cause of morbidity and mortality among AIDS patients and a treatment problem in the sporadic cases that are not associated with HIV. All four forms of the disease are linked to a newly described herpesvirus, HHV-8 or KSHV, via strong epidemiologic associations and biologic plausibility as a causal agent. HHV-8 is also epidemiologically associated with body cavity-based lymphomas, which are almost unique to AIDS, and Castleman's disease. Existing radiation and chemotherapeutic treatments of KS are only partially effective and cause significant adverse effects. New preventive approaches and therapies aimed at inhibiting HHV-8 may be effective. New treatments that interfere with the molecular mechanisms that drive KS may, in the future, provide the best opportunities to control the disease.

Syphilis and the risk of penis cancer

BACKGROUND AND OBJECTIVES

Until recently, syphilis was considered a major cause of penis cancer. The possible role of syphilis was discarded without much debate with the detection of certain of human papillomaviruses centrally involved in the etiology of penis cancer.

GOALS

To reevaluate the association between syphilis and penis cancer by using truly population-based cancer and syphilis data and to generate a more sound basis for judging the possible role of syphilis in the etiology of penis cancer.

STUDY DESIGN

Patients with epidermoid cancer of the penis, totalling 1,523, were diagnosed and reported to the Danish Cancer Registry from 1943 to 1990. Through linkage with the Danish Syphilis Registry, the impact of prior syphilis infection was evaluated in a case-control design using patients with colon cancer or stomach cancer as controls.

RESULTS

Depending on the criteria used to assess prior syphilis status, 3% to 5% of patients with penis cancer had had syphilis before the cancer diagnosis. The corresponding proportions were 2% to 4% among patients with colon cancer and 2% to 5% among patients with stomach cancer. Logistic regression showed that patients with penis cancer did not have a syphilis history significantly more often than control cancer patients.

CONCLUSION

Syphilis should be removed from the list of possible causes of penis cancer.