%0 Journal Article
%T Clinical Spectrum of Oral Secondary Syphilis in HIV-Infected Patients
%A Velia Ram¨ªrez-Amador
%A Gabriela Anaya-Saavedra
%A Brenda Crabtree-Ram¨ªrez
%A Lilly Esquivel-Pedraza
%A Marcela Saeb-Lima
%A Juan Sierra-Madero
%J Journal of Sexually Transmitted Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/892427
%X Background. Oral lesions may constitute the first clinical manifestation in secondary syphilis, but detailed descriptions in HIV-infected individuals are scarce. Objective. To describe the clinical characteristics of oral secondary syphilis in HIV-infected patients and its relevance in the early diagnosis of syphilis. Methods. Twenty HIV/AIDS adult subjects with oral secondary syphilis lesions presenting at two HIV/AIDS referral centers in Mexico City (2003¨C2011) are described. An oral examination was performed by specialists in oral pathology and medicine; when possible, a punch biopsy was done, and Warthin-Starry stain and immunohistochemistry were completed. Intraoral herpes virus infection and erythematous candidosis were ruled out by cytological analysis. Diagnosis of oral syphilis was confirmed with positive nontreponemal test (VDRL), and, if possible, fluorescent treponemal antibody test. Results. Twenty male patients (median age 31.5, 21¨C59 years) with oral secondary syphilis lesions were included. Oral lesions were the first clinical sign of syphilis in 16 (80%) cases. Mucous patch was the most common oral manifestation (17, 85.5%), followed by shallow ulcers (2, 10%) and macular lesions (1, 5%). Conclusions. Due to the recent rise in HIV-syphilis coinfection, dental and medical practitioners should consider secondary syphilis in the differential diagnosis of oral lesions, particularly in HIV-infected patients. 1. Background In the USA, since 2001 a resurgence in syphilis incidence, especially among males who have sex with men (MSM), has been observed [1]. By 2004, more than a half of new cases reported of primary and secondary syphilis were estimated to occur in MSM, with a high rate of HIV coinfection [2, 3]. During 2007-2008, the total number of cases of syphilis reported to the CDC increased 13.1% [4]. The increasing incidence of syphilis reported in many studies in the last decade, especially among MSM, is clearly a marker for higher risk behavior in this population and raises concerns for a parallel increase in HIV transmission [5¨C8]. It has been suggested that HIV infection modifies the clinical presentation of syphilis with greater organ involvement, atypical and florid skin rashes, and more rapid progression to neurosyphilis [9¨C12]; consequently, the diagnosis of syphilis in HIV-infected individuals represents a challenge for care providers. A careful sexual exposure history, recognition of clinical signs and symptoms, and interpretation of diagnostic testing are crucial in this context [13]. Detailed descriptions of oral
%U http://www.hindawi.com/journals/jstd/2013/892427/