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, Hesham Awadh, MD Internal Medicine, Marshall University – Joan C Edwards School of Medicine , Huntington, West Virginia Search for other works by this author on: Oxford Academic Haresh Visweshwar, MD Internal Medicine, Marshall University – Joan C Edwards School of Medicine , Huntington, West Virginia Search for other works by this author on: Oxford Academic Jacob Kilgore, MD Medicine-Pediatrics, Marshall University – Joan C Edwards School of Medicine , Huntington, West Virginia Search for other works by this author on: Oxford Academic Kara Willenburg, MD Infectious Diseases, Marshall University – Joan C Edwards School of Medicine , Huntington, West Virginia Search for other works by this author on: Oxford Academic
Session: 46. Clinical: Sexually Transmitted Infections Thursday, October 5, 2017: 12:30 PM
Author Notes
Open Forum Infectious Diseases, Volume 4, Issue suppl_1, Fall 2017, Page S106, https://doi.org/10.1093/ofid/ofx163.101
Published:
04 October 2017
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Hesham Awadh, Haresh Visweshwar, Jacob Kilgore, Kara Willenburg, Watch Out! Syphilis Is Back – Case Series of Four Cases of Ocular syphilis, Open Forum Infectious Diseases, Volume 4, Issue suppl_1, Fall 2017, Page S106, https://doi.org/10.1093/ofid/ofx163.101
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Abstract
Background
Syphilis is an ulcerative sexually transmitted genital infection caused by Treponema pallidum, which is a member of the order Spirochaetales, family Spirochaetaceae, and genus Treponema. The incidence rate of Syphilis has been steadily rising since 2000; from 2.1 cases per 100,000 population to up to 7.5 cases per 100,000 population in 2014–2015 (the highest rate since 1994). In the state of West Virginia, we have witnessed an increase in the number of cases from 0.5 cases per 100,000 population in 2011, to 5.9 cases per 100,000 population in 2015. Systemic symptoms can include cardiovascular and neurological manifestations. We report to your attention four cases of syphilis mainly with neurological and ocular manifestations.
Methods
We report a series of four cases of neurosyphilis we encountered between 2013 and 2016. Main presentation of all four cases was ocular; primarily redness and photophobia. Diagnosis was confirmed by standard ophthalmological examination with positive initial rapid plasma regain titers (RPR) and fluorescent treponemal antibody absorption testing (FTA-ABS). The cerebrospinal fluid venereal disease research laboratory test (CSF-VDRL) was positive in two of the four cases (in which lumbar puncture was performed). Two of the four cases suffered from an overt immunodeficiency (HIV and laryngeal cancer on chemotherapy) and subjects of all four cases confessed to high-risk sexual behaviors. All four cases were managed with continuous infusions of Penicillin G potassium 24 million International Units for 14days with variable response.
Results
Response to treatment was variable in that initial complete resolution was achieved in one patient (Case #3), another (Case #1) was retreated in 6months due to rising RPR titers on follow-up with subsequent improvement. Two patients were lost to follow-up (Cases #2 and #4).
Conclusion
Sir William Osler reportedly said: “He who knows syphilis knows medicine”. The steady rise in the incidence of Syphilis warrants that health care providers consider such a diagnosis in the evaluation of suggestive neurological and ocular manifestations in predisposed patients. We also stress on the importance of follow-up to detect failure of initial treatment.
Disclosures
All authors: No reported disclosures.
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Author notes
Session: 46. Clinical: Sexually Transmitted Infections Thursday, October 5, 2017: 12:30 PM
© The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Topic:
- hiv
- process of absorption
- chemotherapy regimen
- ulcer
- syphilis
- cardiovascular system
- disclosure
- eye manifestations
- fluorescent treponemal antibody-absorption test
- follow-up
- health personnel
- immunologic deficiency syndromes
- laboratory techniques and procedures
- neurologic manifestations
- neurosyphilis
- photophobia
- plasma
- sex behavior
- sexually transmitted diseases
- spirochaetaceae
- spirochaetales
- treponema
- west virginia
- infections
- antibodies
- cerebrospinal fluid
- diagnosis
- diagnostic spinal puncture
- stress
- malignant neoplasm of larynx
- ophthalmic examination and evaluation
- treponema pallidum
- genital system
- vdrl test, csf
- intravenous infusion, continuous
- lost to follow-up
- penicillin g potassium
- ocular syphilis
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