Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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  Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 39  |  Issue : 1  |  Page : 63-64
 

Emergence of forgotten entities


Department of Dermatology, Venereology and Leprosy, Sree Mookambika Institute of Medical Sciences, Kanyakumarai, Tamil Nadu, India

Date of Web Publication21-Jun-2018

Correspondence Address:
Prof. Murugan Sankaranantham
Department of Dermatology, Venereology and Leprosy, Sree Mookambika Institute of Medical Sciences, Kulaskaram, Kanyakumarai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.IJSTD_107_16

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How to cite this article:
Sankaranantham M. Emergence of forgotten entities. Indian J Sex Transm Dis 2018;39:63-4

How to cite this URL:
Sankaranantham M. Emergence of forgotten entities. Indian J Sex Transm Dis [serial online] 2018 [cited 2018 Dec 15];39:63-4. Available from: http://www.ijstd.org/text.asp?2018/39/1/63/228643


Sir,

Cases of syphilis are encountered in all centers.[1] Late syphilitic manifestations of cardiovascular system and central nervous system (CNS) can occur with these cases.[2],[3] Late complications of lymphogranuloma venereum (LGV) and Granuloma inguinale cases would be likely to persist in spite of all treatments. Few cases of precocious tertiary syphilitic CNS cases were reported in the presence of AIDS.[4],[5]

In the last 1 year duration, I had 3 cases of late syphilitic manifestations and one case of LGV with genital elephantiasis (esthiomene) in the absence of HIV infection. Coronary ostial stenosis went unnoticed even during 1980s. However, present day advances in the modalities of investigations made it easy to clinch such diagnosis. This type of diagnosis will avoid unnecessary surgeries for ischemia which are done widely nowadays. Without medical treatment, these surgeries would be likely to end up in failure.

  • A 72-year-old man came to cardiology department with the complaints of breathlessness. On investigation, he was found to have reactive serology for syphilis and referred to our department. He is married and gave a history of promiscuity and genital ulcer before marriage. His venereal disease research laboratory and Treponema pallidum hemagglutination assay (TPHA) were reactive in 32 dilutions and 160 dilutions respectively and nonreactive for HIV. Blood investigations were within normal limits. Angiogram revealed triple vessel disease along with ostial stenosis. This patient was treated with anti-syphilitic treatment. Patient is doing well with medical management for the past 6 months without any problem
  • A 62–year-old male came with defective vision. Cataract surgery was planned. Preoperative investigations revealed reactive for syphilis and nonreactive for HIV. X-ray chest revealed a mediastinal mass [Figure 1]. On examination, patient gave a history of premarital sex and sore genitals. He has two wives, and history of abortion was present with the first wife whereas no issue for the second wife. His rapid plasma reagin (RPR) and TPHA were reactive in 32 dilutions and 2560 dilutions respectively and nonreactive for HIV. A saccular aneurysm arising from the arch of aorta with partial thrombosis occupied the aneurysmal sac revealed by C. T Thorax. This patient lost for follow-up
  • A 44-year-old married man came with the complaints of the progressive dimness of vision and photophobia on his left eye. As he was reactive for syphilis, referred for the management of syphilis. He gave a history of both pre- and extra-marital sex without the previous venereal disease. He was a diabetic for more than 5 years. His RPR and TPHA were reactive in 16 dilutions and 160 dilutions, respectively. Other blood parameters were within normal limits. He was treated with anti-syphilitic treatment as for late latent syphilis under cover of steroids
  • A 65-year-old man with bilateral swelling of scrotum and inguinal region for more than a year. The patient was sexually active and had inguinal swelling for which he had an incision and drainage 20 years back. On examination, he had an elephantiatic swelling of scrotum [Figure 2]. Epididymis and testes were free. Penis was edematous looked like a saxophone [Figure 2]. Left inguinal area nodes were matted and little hard. The skin over the inguinal glands was edematous ('Pu De Orange') [Figure 3]. Blood parameters were within normal limits including the serum proteins and A-G ratio. He was nonreactive for HIV. His swelling of scrotum and penis were not responding to antibiotics such as Doxycyclin, Co-Trimaxazole, Azithromycin, and steroids. The patient was not willing for surgical correction. Patient's clinical picture fits with genital syndrome of LGV.
Figure 1: Chest X-ray: Aneurysm of arch of aorta

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Figure 2: Scrotal elephantiasis

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Figure 3: Lymphedema of skin

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Complications of old untreated diseases can be presented at any time. A high index of suspicion is necessary to recognize the same. Advanced technology can pick up forgotten entities.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Garg T, Chander R, Jain A, Barara M. Sexually transmitted diseases among men who have sex with men: A retrospective analysis from Suraksha clinic in a tertiary care hospital. Indian J Sex Transm Dis 2012;33:16-9.  Back to cited text no. 1
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2.
Gjestland T. The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material. Acta Derm Venereol Suppl (Stockh) 1955;35 Suppl 34:3-368.  Back to cited text no. 2
    
3.
Stokes J, Berman H, Ingraham NR. Modern Syphilology, 3rd ed, Philadelphia and London: W.B Saunders. 1945.  Back to cited text no. 3
    
4.
Barragan EP, Hernandez EU, Orozco BP, Gonzalez MS. Meningovascular Neurosyphilis with basialar artery thrombosis in HIV patient. J infect Public Health 2017;814:3.  Back to cited text no. 4
    
5.
Almekhlafi MA, Williams G, Costello F. Clinical reasoning: Optic disc swelling in a patient with AIDS. Neurology 2011;77:e28-32.  Back to cited text no. 5
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