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Open Access Publications from the University of California

Scholarly Works (1601 results)

  • Article
  • Peer Reviewed
Dermatology Online Journal, Volume 24, Issue 4 (2018)
Physicians should be aware of unusual presentations of syphilis. For dermatologists, the visual recognition of lesional morphology and distribution is a fundamental part of clinical evaluation, which dictates the workup and diagnosis. Secondary syphilis has a variety of presentations, the most common being a diffuse symmetrical papulosquamous eruption. It continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic many dermatological disorders. Herein we report a case of secondary syphilis with an uncommon presentation characterized by disseminated annular and arcuate lesions.
    Cover page: Annular and arcuate syphilis: an uncommon presentation of disseminated secondary syphilisCreative Commons 'BY-NC-ND' version 4.0 license
    • Article
    • Peer Reviewed
    Clinical Practice and Cases in Emergency Medicine, Volume 4, Issue 4 (2020)

    Case Presentation: A 40-year-old male presented the the emergency department (ED) due to a diffuse body rash after a sexual encounter. Examination revealed a maculopapular rash that included the palms and soles of the feet bilaterally. A rapid plasma reagin was positive, and the patient was treated with 2.4 million units of benzathine benzylpenicillin intramuscularly.

    Diagnosis: Secondary syphilis can mimic many disease processes but classically presents as a painless macular rash on the palms of the hands and soles of the feet. Diagnosis is based upon clinical examination coupled with serological testing. Emergency department management should include 2.4 million units of benzathine benzylpenicillin intramuscularly and mitigation strategies.

      Cover page: Secondary SyphilisCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      Dermatology Online Journal, Volume 30, Issue 4 (2024)
      Syphilis is a sexually transmitted infection with manifestations that can mimic other diseases, leading to misdiagnosis. Annular syphilis is a rare atypical secondary syphilitic lesion that seldomly involves the face. Human immunodeficiency virus (HIV) coinfection can increasingly lead to atypical manifestations of syphilis and complicate the diagnosis. Herein, we describe a 29-year-old man with a diagnosis of annular secondary syphilis and HIV coinfection. He had clinical manifestations of annular erythematous papules and plaques with white scales at the edges, distributed and scattered on the face, neck, and upper back. The skin lesions went undetected on several visits and were misdiagnosed owing to similarities with other dermatoses. Serological examination showed positive Treponema pallidum particle agglutination assay and venereal disease research laboratory test titer 1/512, confirming syphilis infection. Results from the histopathological examination supported the diagnosis of secondary syphilis. Positive anti-HIV rapid test results indicated concurrent HIV infection. He was treated for syphilis and given antiretroviral therapy, and showed a good response as demonstrated by improvement of the lesions and serological titers. This case highlights the importance of recognizing the possibility of annular secondary syphilis and HIV coinfection which can have atypical manifestations.
        Cover page: Annular secondary syphilis with HIV coinfection that resembles other dermatosesCreative Commons 'BY-NC-ND' version 4.0 license
        • Article
        • Peer Reviewed
        Dermatology Online Journal, Volume 31, Issue 1 (2025)
        Malignant syphilis, also known as lues maligna, is an atypical and aggressive form of secondary syphilis characterized by nodules and ulcers associated with a spectrum of nonspecific systemic manifestations. The underlying states of immunosuppression represent the primary risk factor. We present a 30-year-old immunocompetent man exhibiting dermatological lesions at various stages clinically and histologically consistent with the established criteria for malignant syphilis. He received antibiotic therapy with complete clearing. Furthermore, we emphasize the importance of proper interpretation of serological tests, both for diagnosis and systematic monitoring.
          Cover page: Early malignant syphilis in an immunocompetent young manCreative Commons 'BY-NC-ND' version 4.0 license
          • Article
          • Peer Reviewed
          Dermatology Online Journal, Volume 29, Issue 5 (2023)
          Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.
            Cover page: Secondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old manCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            Dermatology Online Journal, Volume 21, Issue 3 (2015)

            Syphilis is commonly known as “the great imitator” owing to its varied clinical manifestations. Secondary syphilis has a variety of presentations, with the most common manifesting as a diffuse papulosquamous eruption on the palms and soles. Lues maligna praecox is a rare form of secondary syphilis, with severe constitutional symptoms, seen primarily in HIV-positive individuals. We report an atypical case of suspected lues maligna in a 45-year-old male. The patient was HIV-positive with a CD4 count of 441. He presented to our clinic with large painful gummatous ulcers in the groin and lower back. He also reported daily fevers, night sweats, and weight loss consistent with secondary syphilis. Prior to this episode the patient had a history of acute active syphilis (RPR 1:128) in 2012 treated at that time with a single dose of 2.4 million units intramuscular benzathine penicillin; he had no reported exposures since that time. The patient was treated with three weekly doses of benzathine penicillin, 2.4 million units, given intramuscularly. This case demonstrates the importance of recognizing the varied clinical presentation of secondary syphilis and keeping lues maligna in consideration for ulceronodular skin lesions in patients who are HIV-positive.

            • 7 supplemental images
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            Cover page: Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesionsCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2023)
            Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing all over world with 700,000 to 1.5 million cases reported annually between 2016 and 2023. Despite the widespread availability of Penicillin, 2677 cases were reported in 2021 in the US. Clinical manifestations at birth can vary widely ranging from asymptomatic infection to stillbirth or neonatal death. Low birth weight, rash, hepatosplenomegaly, osteolytic bone lesions, pseudoparalysis, central nervous system infection, and long-term disabilities have been reported in newborns with congenital syphilis. Prevention of congenital syphilis is multifaceted and involves routine antenatal screening, timely treatment of perinatal syphilis with penicillin, partner tracing and treatment, and health education programs emphasizing safe sex practices and strategies to curb illicit drug use. Neonatal management includes risk stratification based on maternal syphilis history, evaluation (nontreponemal testing, complete blood counts, cerebrospinal fluid, and long-bone analysis), treatment with penicillin, and followup treponemal testing. Public health measures that enhance early detection during pregnancy and treatment with penicillin, especially in high-risk mothers, are urgently needed to prevent future cases of congenital syphilis.
              Cover page: Congenital Syphilis-An Illustrative Review.Creative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2023)
              Several studies from the current 2022 monkeypox (MPX) outbreak have documented co-infections with sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis. We present a patient with MPX and secondary syphilis who failed to clear the MPX virus 30 days after illness onset despite a 14-day course of tecovirimat therapy.
                Cover page: Delayed clearance of monkeypox virus in a patient with co infection with secondary syphilisCreative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2018)

                Background

                Researchers have suggested that social media and online search data might be used to monitor and predict syphilis and other sexually transmitted diseases. Because people at risk for syphilis might seek sexual health and risk-related information on the internet, we investigated associations between internet state-level search query data (e.g., Google Trends) and reported weekly syphilis cases.

                Methods

                We obtained weekly counts of reported primary and secondary syphilis for 50 states from 2012 to 2014 from the US Centers for Disease Control and Prevention. We collected weekly internet search query data regarding 25 risk-related keywords from 2012 to 2014 for 50 states using Google Trends. We joined 155 weeks of Google Trends data with 1-week lag to weekly syphilis data for a total of 7750 data points. Using the least absolute shrinkage and selection operator, we trained three linear mixed models on the first 10 weeks of each year. We validated models for 2012 and 2014 for the following 52 weeks and the 2014 model for the following 42 weeks.

                Results

                The models, consisting of different sets of keyword predictors for each year, accurately predicted 144 weeks of primary and secondary syphilis counts for each state, with an overall average R of 0.9 and overall average root mean squared error of 4.9.

                Conclusions

                We used Google Trends search data from the prior week to predict cases of syphilis in the following weeks for each state. Further research could explore how search data could be integrated into public health monitoring systems.
                  Cover page: Using Search Engine Data as a Tool to Predict Syphilis
                  • Article
                  • Peer Reviewed
                  Dermatology Online Journal, Volume 24, Issue 12 (2018)
                  We present a woman with an unusual case of secondary syphilis after an unnoticed primary infection. She initially presented with multiple grayish plaques and nodules on the vulva associated with an erythematous macular symmetrical rash affecting the trunk and extremities. Despite the increasing incidence of sexually transmitted diseases such as syphilis, presentation with unusual manifestations can lead to a delayed diagnosis.
                    Cover page: Whitish vulvar tumors associated with macular symmetrical rashCreative Commons 'BY-NC-ND' version 4.0 license
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