INTRODUCTION The Jarisch-Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2-g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance...

Syphilis presenting with balanitis and penile edema is rare, and in most cases has been considered to be a manifestation of primary syphilis. We report the case of an HIV-infected man who presented with penile edema and balanitis concomitant with an eruption on his buttocks, lower abdomen and thighs. Histologic examination and serology were diagnostic of syphilis, and the patient was successful...

AIMS The primary aim of this study was to determine adherence to benzathine penicillin (BPG) for individuals diagnosed with rheumatic heart disease (RHD) by echocardiographic screening between 2007-2012. METHODS BPG records were obtained for 57 patients, median age 12 at time of diagnosis. A 'days at risk' analysis was undertaken. Annual adherence was calculated for each individual. A compari...

A 27-year-old black woman presented with complaints of skin lesions on the vulva, back, nipple and ear. Darkfield examination of the cxudate from the moist vulvar papules (A) revealed motile spirochetes. A VDRL was reactive at a titer of 1:1,024. A papular lesion with raised borders (annular syphilid) (B) was discovered during examination of the back. Split papules were also discovered on the n...

A recent U.S. survey demonstrated wide variation in the management of syphilis. 25/31 (73.5%) Consultants and Specialist Registrars in Infectious Diseases and Genitourinary Medicine, in Ireland were surveyed. 23 (92%) treat more than 50 HIV patients a year, 18 (72%) had been consulted on a patient with syphilis in the last year. With secondary syphilis, 13 (52%) give 3 doses of benzathine penic...

BACKGROUND Rheumatic heart disease (RHD), the long-term consequence of rheumatic fever, accounts for most cardiovascular morbidity and mortality among young adults in developing countries. However, data on contemporary outcomes from resource constrained areas are limited. METHODS A prospective cohort study of participants aged 5-60 years with established RHD was conducted in Kampala, Uganda, ...

The incidence of cellulitis is 24.6 in 1000 person-years, according to a US population-based study of insurance claims for the years 1997 to 2002—the most recent data available. The lower extremities are most commonly affected, accounting for 70% to 80% of cases. Risk factors associated with recurrence include venous insufficiency, lymphedema, overweight, skin breakdown, and leg edema, which ar...

Since mid-1997 British Columbia has experienced an outbreak of syphilis, initially in heterosexuals and more recently among men who have sex with men (MSM). Starting in 1999, primarily in patients presenting to the sexually transmitted diseases clinic at the BC Centre for Disease Control (BCCDC), moist lesions of primary and secondary syphilis were swabbed for polymerase chain reaction (PCR) te...

BACKGROUND Erythromycin is recommended for secondary prophylaxis in children with rheumatic heart disease, who are allergic to penicillin. CASE CHARACTERISTICS A 9-year-old girl, with rheumatic heart disease, on secondary prophylaxis with erythromycin 250 mg BD, presented with acute rheumatic fever. OUTCOME Responded to steroids and started on a higher dose (250 mg TDS) of erythromycin for ...