1/33. Subclinical syphilitic hepatitis, which was markedly worsened by a Jarisch-Herxheimer reaction.Early syphilitic hepatitis is uncommon and tends to be overlooked. However, the diagnosis of this disease is important, because appropriate treatment results in rapid resolution of the hepatitis. We report a case of subclinical early syphilitic hepatitis exaggerated by a Jarisch-Herxheimer reaction. This reaction helped to realize the diagnosis in this case.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/33. Secondary syphilitic hepatitis in a fourteen-year-old male youth.An unusual case of a secondary syphilitic hepatitis in a 14-year-old male youth is presented. Although he had extremely high aspartate and alanine aminotransferase values, improvement was rapid after antibiotic therapy. Histologic examination of the liver performed during convalescence revealed patchy necrosis and inflammatory cell infiltration.- - - - - - - - - - ranking = 0.71428571428571keywords = hepatitis (Clic here for more details about this article) |
3/33. Initial low CD4 lymphocyte counts in recent human immunodeficiency virus infection and lack of association with identified coinfections.Initial CD4 lymphocyte counts were studied in 244 patients with human immunodeficiency virus (hiv) seroconversion. The CD4 cell counts at initial presentation after seroconversion were normally distributed (mean, 579/mm3; SD, 252). The mean percentage of CD4 cells was 26.1% (SD, 5.6). CD4 cell counts were < 500/mm3 in 41% and < 200/mm3 in 4%. The mean calculated duration of hiv infection was 7.7 months, which was not significantly different between the highest and lowest CD4 count quartiles (8.1 vs. 7.9). Age, sex, race, and serologic evidence of toxoplasmosis, cytomegalovirus, hepatitis b, syphilis, and varicella-zoster virus were not associated with initial low CD4 cell counts; however, never-married men were significantly overrepresented in the lowest quartile. These findings suggest that extensive CD4 lymphocyte depletion is common in early hiv infection and that frequent screening is necessary to identify newly infected patients who would benefit from antiretroviral therapy.- - - - - - - - - - ranking = 0.14285714285714keywords = hepatitis (Clic here for more details about this article) |
4/33. internet use and early syphilis infection among men who have sex with men--san francisco, california, 1999-2003.During the summer of 1999, an outbreak of early syphilis among men who have sex with men (MSM) who met their sex partners on the internet presaged a rapidly expanding syphilis epidemic in san francisco. By 2002, san francisco had the highest rates of primary and secondary syphilis of any metropolitan area in the united states. During 1998-2002, the number of early syphilis cases increased, from 41 cases in 1998 to 495 cases in 2002. Concomitant with the increase in early syphilis was an increase in the proportion of cases among MSM, from 22% in 1998 to 88% in 2002. To assess the association between early syphilis infection and use of the internet by MSM to meet sex partners, the san francisco Department of public health (SFDPH) analyzed surveillance data and case reports. This report summarizes the results of that analysis, which suggest that public health officials might find the internet to be an important tool for 1) promoting disease awareness, prevention, and control and 2) accessing sex partners of syphilis patients to conduct appropriate partner notification, evaluation, and management. The findings underscore the need for public health officials to understand the role of the internet in facilitating the spread of sexually transmitted diseases (STDs), including the human immunodeficiency virus (hiv). With the assistance of community partners, other jurisdictions can examine the online social/sexual networks that are used commonly in their gay and bisexual communities and develop an effective means of communicating prevention and control messages online.- - - - - - - - - - ranking = 0.0020766594163592keywords = epidemic (Clic here for more details about this article) |
5/33. sexually transmitted diseases in the hiv care setting: what's really going on down there?Syphilis epidemics are occurring in a number of cities in the united states and worldwide. In new york city, the number of cases primary or secondary syphilis has increased from 130 in 1999 to 434 in 2002. The majority of new cases occur in men, with most of these occurring in men who have sex with men. The presentations of primary and secondary syphilis are varied and can be overlooked or confused with other diseases. Health care providers should be aware of atypical presentations of sexually transmitted diseases (STDs), screen for nonapparent STDs, and know how to treat such diseases once they are identified. Client-centered counseling may be successful in reducing risky behaviors and the transmission of STDs. This article summarizes a presentation given by Jeanne Marrazzo, MD, MPH, at the October 2003 International AIDS Society-USA course in New York.- - - - - - - - - - ranking = 0.0020766594163592keywords = epidemic (Clic here for more details about this article) |
6/33. Acute hepatitis c in hiv-infected men who have sex with men.BACKGROUND: hepatitis c virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether hiv or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in hiv-infected men underline the major public health implications of this issue. case reports: Between June 2002 and July 2003, five hiv-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV. CONCLUSIONS: Sexual transmission may be fuelling a significant increase in HCV seroconversions among hiv-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among hiv-infected gay men, specific recommendations concerning safe sex are urgently needed.- - - - - - - - - - ranking = 0.71428571428571keywords = hepatitis (Clic here for more details about this article) |
7/33. Primary syphilis of oral mucosa: case report of an unusual manifestation.Dental clinicians and other health care providers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. Many infectious diseases, including human immunodeficiency virus, hepatitis, tuberculosis, and syphilis are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. Oral disease as a consequence of primary syphilis is rare. This article details a patient presenting with a labial nodule as her only clinical manifestation of undiagnosed primary syphilis.- - - - - - - - - - ranking = 0.14285714285714keywords = hepatitis (Clic here for more details about this article) |
8/33. Syphilitic hepatitis in hiv-infected patients: a report of 7 cases and review of the literature.BACKGROUND: A recent resurgence of primary and secondary syphilis has been observed in certain population groups, particularly among persons infected with human immunodeficiency virus (hiv). Liver involvement is an infrequently recognized complication of early syphilis, with no previous reports among hiv-infected patients. methods: We describe 7 cases of syphilitic hepatitis in hiv-positive individuals and review the literature. RESULTS: At our institutions, all patients presented with a rash consistent with secondary syphilis. Each case was characterized by a conspicuous increase in serum alkaline phosphatase level (mean level /- standard deviation, 905 /- 523.6 IU/L) and milder elevations in serum transaminase levels. The mean CD4 absolute T cell count was 317 cells/mm3, and the median rapid plasma reagin (RPR) titer was 1 : 128. There was a significant correlation between higher CD4 cell counts and the RPR titers (R=0.93; P=.002). Symptomatic resolution and biochemical improvement, particularly a significant decrease in serum alkaline phosphatase levels (P=.02), occurred following antibiotic therapy. CONCLUSIONS: Hepatic dysfunction is not uncommon in hiv-infected persons and is attributable to multiple causes. In the appropriate clinical setting, syphilitic hepatitis is an easily diagnosed and reversible etiology of liver dysfunction. The recognition of this entity will prevent unnecessary evaluation of abnormal liver enzyme levels in hiv-positive patients.- - - - - - - - - - ranking = 0.85714285714286keywords = hepatitis (Clic here for more details about this article) |
9/33. Is syphilis resurgent in new zealand in the 21st century? A case series of infectious syphilis presenting to the Auckland Sexual Health Service.Bacterial sexually transmitted infections such as chlamydia and gonorrhoea have been on the rise in recent years in new zealand. Infectious syphilis has however remained rare over the last few decades, except in New Zealanders who have had sex overseas or in recent immigrants. However, in the previous 2 and a half years (1/2002-9/2004), the number of people presenting to Auckland Sexual Health Service with infectious syphilis has more than doubled. The main people at risk for acquiring infectious syphilis appear to be either men who have sex with men, or heterosexuals who have recently had sex overseas. More information is urgently required about the epidemiology of syphilis in new zealand. One expedient way to determine whether we have an emerging epidemic would be to make syphilis a notifiable condition.- - - - - - - - - - ranking = 0.0020766594163592keywords = epidemic (Clic here for more details about this article) |
10/33. Ocular syphilis: the new epidemic.AIM: To present the clinical presentation, diagnosis, and management of syphilitic uveitis in the context of an epidemic of syphilis in the UK. METHOD: Retrospective clinical case series. RESULTS: Six new cases of syphilitic uveitis presented to the Manchester Uveitis Clinic in 2004, after a 15-fold increase in the incidence of syphilis in the UK, including 615 cases in Greater Manchester in the 5 years to 2004. Four cases had secondary syphilis, two had latent disease, two had no rash, and two were hiv positive. Ocular involvement included anterior or panuveitis, retinitis, retinal vasculitis, and papillitis. All resolved on treatment including intramuscular procaine penicillin g with oral probenecid. CONCLUSIONS: Syphilis is much more common recently and syphilitic uveitis should be considered in all patients with rash and/or headache, where there is retinitis and/or retinal vasculitis, or in any uveitis of uncertain origin. Treatment is that of neurosyphilis.- - - - - - - - - - ranking = 0.010383297081796keywords = epidemic (Clic here for more details about this article) |
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