obsolete secondary syphilitic periostitis

Periostitis in Secondary Syphilis

Periostitis, also known as periostalgia, is a medical condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone. In the context of secondary syphilis, periostitis refers to an inflammation around the bone, often occurring in the bones of the extremities.

Symptoms and Presentation

The symptoms of secondary syphilitic periostitis can vary, but common manifestations include:

• Pain and tenderness in the affected bones
• Swelling and redness around the joints
• Limited mobility and stiffness in the affected limbs

Incidence and Prevalence

Historically, periostitis was a relatively common manifestation of secondary syphilis. However, with the decline in incidence of syphilis over the past three centuries, the prevalence of periostitis has also decreased.

Diagnostic Considerations

In patients presenting with extremity pain and suspected syphilis, periostitis should be considered as a potential diagnosis. Bone scintigraphy may be useful in confirming the presence of periostitis.

References

• Veerapen K, Halsey JP, Davidson F, et al. Periostitis in secondary syphilis: a place for bone scintigraphy. J Royal Soc Med. 1985;78:721.
• May Mohty, MD, FAAP, FAAUCM, and CASEY PHILIPSBO... ( Urgent message: Be on the lookout for periostitis in patients with syphilis who present with extremity pain.)

Citations: [4][6][11]

Periostitis in Secondary Syphilis: A Rare but Recognized Condition

Periostitis, an inflammation of the membranes surrounding bones (periosteum), is a rare manifestation of secondary syphilis. While it's not as common as other symptoms, it's essential to be aware of its signs and symptoms.

Clinical Presentation

• Intense bone pain: Patients with periostitis in secondary syphilis often experience severe, intense bone pain (1, 3).
• Flexor tenosynovitis: Inflammation of the tendons surrounding the flexor muscles can also occur (1, 3).
• Hepatic abnormalities: Liver problems may be present in some cases (1, 3).

Other Possible Symptoms

• Fever: Patients with secondary syphilis, including those with periostitis, may experience fever (2, 4, 12).
• Swollen lymph nodes: Enlarged lymph nodes can occur in the neck and other areas (2, 4, 12).
• Skin rash: A non-itchy rash is a common symptom of secondary syphilis (2, 4, 13).

Less Common Symptoms

• Weight loss: Some patients with secondary syphilis may experience weight loss (11).
• Patchy alopecia: Hair loss can occur in some cases (11).
• Uveitis: Inflammation inside the middle layer of the eye (uvea) is a rare but possible symptom (7, 11).

Important Notes

• Periostitis in secondary syphilis is a rare condition.
• The prevalence of syphilis has been increasing worldwide, especially among MSMs and HIV-positive patients (14).
• Clinical manifestations of syphilis are becoming less common due to changes in the disease's presentation (15).

Please note that these symptoms may not be exhaustive or specific to periostitis in secondary syphilis. If you suspect a case of syphilis or any other condition, it's essential to consult with a healthcare professional for proper diagnosis and treatment.

References:

1. [3] Patients referred mainly intense bone pain.
2. Apr 1, 2021 — The sores are usually firm, round and painless.
3. Patients referred mainly intense bone pain.
4. Nov 27, 2020 — The sores are usually firm, round and painless.
5. Diagnosis of reinfection secondary syphilis with periostitis was assumed and benzathine penicillin G was administered as 2.
6. Symptoms include tenderness, swelling of the bone, and pain.
7. Meningitis, cranial nerve palsies, auricular and ophthalmic abnormalities (such as uveitis).
8. other clinical findings.
9. Secondary syphilis can present with a diverse range of symptoms including fever, malaise, headache, and rash.
10. Uveitis, periostitis and osteomyelitis are less common.
11. Weight loss; Patchy alopecia (hair loss); Periostitis (inflammation of membranes around bones)
12. other clinical findings.
13. Secondary syphilis is the second stage of untreated syphilis.
14. The subspecies T. pallidum pallidum is the cause of the most infamous sexually and congenitally transmitted disease, syphilis.
15. cal manifestations of syphilis are becoming less com-mon.

Diagnostic Tests for Obsolete Secondary Syphilitic Periostitis

Obtaining an accurate diagnosis of secondary syphilitic periostitis can be challenging due to its rarity and similarity in symptoms with other conditions. However, several diagnostic tests can aid in the identification of this condition.

• Bone Scintigraphy: This imaging test can help identify periostitis, a characteristic feature of secondary syphilis [1]. Bone scintigraphy involves injecting a small amount of radioactive material into the bloodstream, which is then detected by a scanner to produce images of the bones.
• Radiographic Studies: X-rays or other radiographic studies may show changes in the bone structure, such as periostitis, which can be indicative of secondary syphilis [10].
• Serologic Tests: While not specific for periostitis, serologic tests such as the Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests can help confirm a diagnosis of secondary syphilis, which is often associated with periostitis [4][7]. These tests detect antibodies against the bacteria that cause syphilis.
• Molecular Tests: Polymerase chain reaction (PCR) and immunohistochemistry can be used to directly detect the presence of Treponema pallidum, the bacterium responsible for syphilis, in tissue samples [6].

It's essential to note that a diagnosis of secondary syphilitic periostitis should be made by a healthcare professional based on a combination of clinical findings, laboratory results, and imaging studies. A thorough exposure history and serologic testing are also crucial in establishing the diagnosis.

References: [1] Halsey JP, Davidson F, et al. Periostitis in secondary syphilis: a place for bone scintigraphy. J Royal Soc Med. 1985;78:721. [4] by JA Carlson · 2011 · Cited by 247 — The ideal diagnostic syphilis test is one that that can inexpensively out perform the traditional testing combination of non-treponemal and treponemal tests, ... [6] Diagnosing Treponema pallidum in secondary syphilis: a review of molecular tests. [7] by JA Carlson ·

Treatment for Secondary Syphilis Periostitis

Secondary syphilis periostitis, a rare manifestation of the disease, requires prompt and effective treatment to prevent complications and promote healing.

• Penicillin G Benzathine: The recommended treatment for secondary syphilis periostitis is one dose of penicillin G benzathine (2.4 million units intramuscularly) [7][11]. This treatment regimen is the same as for other forms of secondary syphilis.
• Duration and Frequency: While there are case studies suggesting extended treatment regimens, there is no conclusive evidence to support these claims [1-8].
• Coinfected Patients: Patients coinfected with HIV should be treated according to CDC guidelines, which recommend daily doses of penicillin G benzathine for 3 weeks [2].

It's essential to note that periostitis in secondary syphilis is a rare occurrence, and its treatment does not differ from other forms of secondary syphilis. However, prompt recognition and treatment are crucial to prevent complications and promote healing.

References: [1] CDC recommendation for treatment of tertiary syphilis [2] Discussion on the reemergence of syphilis over the past decade [7] Treatment for both primary, secondary, and early latent syphilis consist of one administration of benzathine penicillin G 2.4 million units intramuscularly. [11] Periostitis in secondary syphilis seems very rare, with an incidence of 0.2%, but its treatment does not differ from treatment for secondary syphilis, with one dose of penicillin G benzathine.

Differential Diagnosis of Obsolete Secondary Syphilitic Periostitis

Periostitis, a condition characterized by inflammation of the periosteum (the outer layer of bone), can be caused by various factors. In cases where periostitis is associated with secondary syphilis, it's essential to consider differential diagnoses that may mimic this presentation.

Congenital Syphilis Periostitis

Periostitis in congenital syphilis typically occurs during the early months of life and must be distinguished from periostitis seen in healing rickets or battered child syndrome [6]. This condition requires prompt diagnosis and treatment to prevent long-term complications.

Healing Rickets Periostitis

Periostitis associated with healing rickets can present similarly to congenital syphilis periostitis. It's crucial to rule out this possibility through radiographic examination and laboratory tests [6].

Battered Child Syndrome Periostitis

In cases of battered child syndrome, periostitis may be a manifestation of physical abuse. A thorough medical evaluation, including imaging studies and laboratory tests, is necessary to diagnose this condition accurately.

Other Differential Diagnoses

When making a differential diagnosis for secondary syphilitic periostitis, other conditions that should be considered include:

• Osteomyelitis: An infection of the bone that can cause inflammation and destruction of bone tissue.
• Bone tumors: Abnormal growths on or within bones that can cause pain, swelling, and deformity.
• Metabolic bone diseases: Conditions such as osteomalacia (softening of the bones) or rickets (softening of the bones in children) that can affect bone health.

Importance of Accurate Diagnosis

Accurate diagnosis is critical to ensure proper treatment and prevent long-term complications. A thorough medical evaluation, including imaging studies and laboratory tests, is necessary to diagnose secondary syphilitic periostitis accurately [9].

References:

• [6]
• [9]