Syphilis on the Rise: Diagnosis, Treatment, and Prevention
Syphilis on the Rise: Diagnosis, Treatment, and Prevention
At our clinic, we diagnosis syphilis infection regularly and have observed many atypical presentations that are not generally described in textbooks. For instance, invasion of the liver may cause a moderate elevation in liver enzymes. In a high-risk patient without infectious hepatitis, this lab abnormality may signal recent infection and warrants syphilis screening as part of the workup.
Many of our patients have presented with severe pharyngitis, which may be diagnosed as a viral or streptococcal infection. Although syphilis can be the cause, providers should also consider gonorrhea and chlamydia throat swabs in addition to their normal workup, as pharyngeal infection with these organisms also occurs at a higher frequency in certain populations. Recently, a young woman with a history of prostitution presented for cervical cancer screening. While undergoing a full physical exam, it was noted that she had a palpable red, painless lesion on her tongue, which she had not noticed before. She was given a full STI screening, which was positive for treponemal antibodies, and was subsequently treated for primary syphilis.
One patient with HIV was referred to our clinic with a single, enlarged anterior cervical lymph node worrisome for lymphoma. Fine needle aspiration of the lymph node revealed only cellular debris, indicating a reactive process. He was incidentally screened for syphilis as part of workup for new HIV infection, which returned with a positive RPR test and a titer of 1:1,024. After appropriate treatment, his lymphadenopathy quickly resolved.
Another patient complained of a "weird stinging feeling" on the top of his head for 2 weeks as his chief complaint. He was diagnosed with secondary syphilis and his unusual symptom resolved immediately after treatment. Patients frequently have vague or confusing complaints for many conditions; however, in a clinic treating known high-risk patients, routine screening for sexually transmitted infections may yield high positive rates and cost-effective results.
Atypical Presentations
At our clinic, we diagnosis syphilis infection regularly and have observed many atypical presentations that are not generally described in textbooks. For instance, invasion of the liver may cause a moderate elevation in liver enzymes. In a high-risk patient without infectious hepatitis, this lab abnormality may signal recent infection and warrants syphilis screening as part of the workup.
Many of our patients have presented with severe pharyngitis, which may be diagnosed as a viral or streptococcal infection. Although syphilis can be the cause, providers should also consider gonorrhea and chlamydia throat swabs in addition to their normal workup, as pharyngeal infection with these organisms also occurs at a higher frequency in certain populations. Recently, a young woman with a history of prostitution presented for cervical cancer screening. While undergoing a full physical exam, it was noted that she had a palpable red, painless lesion on her tongue, which she had not noticed before. She was given a full STI screening, which was positive for treponemal antibodies, and was subsequently treated for primary syphilis.
One patient with HIV was referred to our clinic with a single, enlarged anterior cervical lymph node worrisome for lymphoma. Fine needle aspiration of the lymph node revealed only cellular debris, indicating a reactive process. He was incidentally screened for syphilis as part of workup for new HIV infection, which returned with a positive RPR test and a titer of 1:1,024. After appropriate treatment, his lymphadenopathy quickly resolved.
Another patient complained of a "weird stinging feeling" on the top of his head for 2 weeks as his chief complaint. He was diagnosed with secondary syphilis and his unusual symptom resolved immediately after treatment. Patients frequently have vague or confusing complaints for many conditions; however, in a clinic treating known high-risk patients, routine screening for sexually transmitted infections may yield high positive rates and cost-effective results.
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