Primary syphilis

Case report:

A 32 year old patient comes into practice and complains of a moderately painful small ulcer on his penis and swelling of the lymph nodes in both Inguinalbereichen. A history of the patient reports that he returned two weeks ago from a vacation trip from South East Asia and during this trip, there had been also to unprotected intercourse.

Diagnosis:

In the investigation falls to the head of the penis is a small, yellowish-reddish, clean, non-purulent ulcer on with little mild swelling around. The inguinal lymph nodes are enlarged moderately, not confluent and the overlying skin is normal. Rectal examination shows no pathological findings, the body temperature is not increased cardiovascular findings are normal.

Pathogenesis:

Primary syphilis runs with an incubation period of three to six weeks and is caused by Treponema pallidum. The first clinical manifestation is usually the genital ulcer (chancre), but care must be taken to atypical manifestations. Without treatment, the ulcer and the regional lymph node enlargement disappear spontaneously after a few weeks, and typically the image of secondary syphilis develops after two to four months. The diagnosis of primary syphilis is first performed over a search response by Treponema pallidum hemagglutination assay (TPHA test). If the results of the serum diagnosis is to expand, to arrive at a confirmation. With the indirect immunofluorescence technique (FTA-ABS test) can be Treponema-specific IgG and IgM prove. Treponema-specific IgM antibodies are no longer detectable three to 24 months after treatment, while specific IgG antibodies usually remain lifelong.

Therapy:

When syphilis I and II a depot penicillin is administered, usually a procaine penicillin (BIPEN-SAAR) at a daily dose of 2.4 million units intramuscularly for 14 days. When penicillin allergy ceftriaxone (Rocephin) given once daily two grams more than two weeks intravenously; alternatively doxycycline (VIBRAMYCIN others) 200 mg daily or intravenous minocycline (Klinomycin others) 100 mg orally twice daily for three weeks. Three, six and twelve months after the completion of antibiotic treatment control of serological findings is necessary.