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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. AEDV Expert Consensus for the Management of Syphilis. Actas Dermosifiliogr 2024:S0001-7310(24)00339-9. [PMID: 38663730 DOI: 10.1016/j.ad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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Edwards SK, Bunker CB, van der Snoek EM, van der Meijden WI. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol 2023; 37:1104-1117. [PMID: 36942977 DOI: 10.1111/jdv.18954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy. OBJECTIVE The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions. METHODS The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence. RESULTS The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN). CONCLUSION Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.
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Campoli M, Cozzi C, Caravello S, Minuti A, Lombardo M, Salvemini I, Zerbinati N. Syphilitic balanitis of Follmann in a patient with a history of previous infection. Int J STD AIDS 2023:9564624231160578. [PMID: 36929714 DOI: 10.1177/09564624231160578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
We report a case of syphilitic balanitis of Follmann arising in a man with a history of prior infection with syphilis. Few cases have been described in the literature. In our case, a man with history of multiple unprotected sexual contacts presented with erosive balanitis and painless inguinal bilateral lymphadenopathy. All tests for sexually transmitted infections (STIs) performed were negative with the exception of serology for syphilis. We made the diagnosis of syphilitic balanitis of Follmann that was confirmed by prompt resolution after treatment.
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Affiliation(s)
- Marco Campoli
- Dermatology Unit, 18709Ospedale di Circolo, ASST Sette Laghi, Varese, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Cozzi
- Department of Medicine and Surgery, 19045University of Insubria, Varese, Italy.,Department of Dermatology and Venereology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Simone Caravello
- Dermatology Unit, 18709Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Anna Minuti
- Dermatology Unit, 18709Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Maurizio Lombardo
- Dermatology Unit, 18709Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Isabella Salvemini
- Dermatology Unit, 18709Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Nicola Zerbinati
- Department of Medicine and Surgery, 19045University of Insubria, Varese, Italy
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Ren XQ, Nie QL, Liu AQ. Primary syphilis without chancre – A case report of rare syphilitic balanitis of Follmann. Front Med (Lausanne) 2022; 9:958456. [PMID: 36213674 PMCID: PMC9533062 DOI: 10.3389/fmed.2022.958456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Syphilitic balanitis of Follmann (SBF) is a rare condition of primary syphilis which is characterized by any kind of balanitis with or without chancre on the penis combined with the presence of swollen inguinal lymph nodes confirmed by the finding of Treponema pallidum in the lesions or by the positive serological syphilitic testing. Timely identification of the SBF is very important in properly treating the disease stopping the spread of syphilis. Case presentation A 42year-old heterosexual male patient came to our clinic and complained of a painless, hard erythema nodule with a whitish scale in his coronal sulcus of the penis for about a week. The dermatologic examination revealed an infiltrative, hard erythematous lesion surrounding the coronal sulcus of the patient’s penis, with mild erosion and a small amount of exudation. There was a whitish pseudomembrane-like covering on the surface of the erythematous lesion in the coronal sulcus, which is mimicked as candidal balanitis. The result of the fungus microscopic examination was negative, while the laboratory findings showed positive results in serologic syphilitic testing. The patient was diagnosed with primary syphilis and intramuscularly treated with a dose of benzylpenicillin of 2.4 million units. The patient’s skin lesions disappeared completely 60 days after penicillin treatment. Conclusion To our knowledge, this is the first SBF case reported in China. Syphilitic balanitis of Follmann may have variable clinical appearances. We emphasize that when balanitis with risky sexual activities or with sexually transmitted diseases, the diagnosis of SBF should be kept in mind.
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Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Hospital Padre Hurtado, Santiago, Chile
| | | | - Juana Benedetto
- Department of Dermatology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Christopher B Bunker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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Sardinha JC, de Lima LL, Heibel M, Schettini A, Talhari S, Talhari C. Atypical manifestations of recent syphilis: study of 19 cases. An Bras Dermatol 2020; 95:589-593. [PMID: 32727677 PMCID: PMC7563017 DOI: 10.1016/j.abd.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Syphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare. Objectives To describe atypical penile manifestations in patients with early syphilis. Methods The present study reports patients who developed cord-like lesions on the penis. Results The study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed. Study limitations Small number of patients included. Conclusions In view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.
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Affiliation(s)
- José Carlos Sardinha
- Department of Sexually Transmitted Infections, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil
| | - Livia Lima de Lima
- Department of Sexually Transmitted Infections, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil
| | - Marcel Heibel
- Department of Urology, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Antonio Schettini
- Department of Dermatopathology, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil
| | - Sinesio Talhari
- Department of Sexually Transmitted Infections, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil
| | - Carolina Talhari
- Department of Sexually Transmitted Infections, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil; Department of Dermatology, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
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Zaouak A, Chamli A, Hammami H, Fenniche S. A tale of an acute erosive balanitis. Presse Med 2019; 48:877-879. [DOI: 10.1016/j.lpm.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/29/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022] Open
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Abstract
Syphilis is an infectious disease caused by the spirochaete Treponema pallidum subsp. pallidum which is transmitted by sexual contact or vertical transmission during pregnancy. The incidence of syphilis has increased in the last years, mainly among men who have sex with men. Without treatment, the disease develops into different clinical stages, being able to present cardiovascular or irreversible neurological complications after a number of years. The disease is classified as early syphilis - primary, secondary and early latent syphilis (less than 12 months) - which is contagious, and as late syphilis - late latent and tertiary syphilis- which is rarely contagious. Diagnosis and management are often a challenge because of its diversity of manifestations and the difficulty of interpretation of serological tests. The treatment of syphilis is based on penicillin or doxycycline in allergic patients. Treatment failure because of resistance has been described with azithromycin. The follow up with a serological test is recommended in all patients with syphilis in order to ascertain cure after the treatment and to diagnose possible reinfections.
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Platsidaki E, Tsimbos I, Vassis P, Tzanetakou V, Rigopoulos D, Kontochristopoulos G. Syphilitic balanitis of Follmann: two case reports. Int J Dermatol 2018; 58:e55-e57. [PMID: 30471083 DOI: 10.1111/ijd.14319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Ioannis Tsimbos
- State Department of Dermatology, Andreas Sygros Hospital, Athens, Greece
| | - Polytimos Vassis
- State Department of Dermatology, Andreas Sygros Hospital, Athens, Greece
| | | | - Dimitrios Rigopoulos
- 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
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