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Syphilis: A Contemporary Clinicopathologic Assessment.

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Syphilis, a sexually transmitted infection, is seeing rising case numbers. Biopsies reveal varied symptoms, highlighting the need for pathologist awareness in diagnosing this treponema pallidum infection.

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Area of Science:

  • Infectious Diseases
  • Dermatopathology
  • Bacteriology

Background:

  • Syphilis, caused by Treponema pallidum, is a growing public health concern in the US.
  • Increasing syphilis cases are noted, particularly in immunocompromised individuals and men who have sex with men.
  • This study reviews biopsy findings from patients with varied syphilis presentations.

Purpose of the Study:

  • To analyze the histological features of mucocutaneous lesions in syphilis patients.
  • To assess the utility of immunostaining in diagnosing syphilis, especially in cases with atypical presentations.
  • To emphasize the importance of pathologist awareness for timely syphilis diagnosis and treatment.

Main Methods:

  • Retrospective examination of 13 patient biopsies over a 12-year period.
  • Histologic analysis of mucocutaneous lesions, including ulceration and inflammation patterns.
  • Application of immunostaining techniques to detect Treponema pallidum.

Main Results:

  • Histological findings included ulceration, psoriasiform hyperplasia, and band-like inflammation with plasma cells.
  • Immunostaining is a valuable adjunct, though organism presence may vary.
  • Treponema pallidum morphology in immunostains reflects its ultrastructural corkscrew shape.

Conclusions:

  • Syphilis diagnosis often relies on clinical presentation, but atypical cases necessitate biopsy.
  • Histopathology and immunostaining aid in diagnosing challenging syphilis cases.
  • Pathologist awareness of syphilis manifestations is crucial for effective patient management.