Nicholas J. Fiumara

Treatment of secondary syphilis: an evaluation of 204 patients.

Our recommended treatment schedule for secondary syphilis is intramuscular benzathine penicillin G, 2.4 million units weekly for two consecutive weeks. If the patient is allergic to penicillin, we recommend that 2 gm of oral tetracycline be given each day for 12 days. Two hundred and four patients with secondary syphilis were treated with these schedules; 165 were given benzathine penicillin G and 39 received tetracycline. All of the patients were cured clinically and all achieved seronegativity within 24 months. There was a direct correlation between the duration of the rash and the secondary lesions that the patients exhibited. Patients who presented early in the course of illness tended to have macular and maculopapular lesions, whereas those who appeared later were more likely to have papular or pustular lesions. The serologie response to treatment was correlated with the duration of the rash and the appearance of the secondary lesions. Patients whose rash was of short duration and those with macular and maculopapular lesions became seronegative sooner than those patients whose rash was of longer duration and who had papular or pustular lesions.

Treatment of seropositive primary syphilis: an evaluation of 196 patients.

One hundred seventy-five patients with primary infection with Treponema pallidum were treated with benzathine penicillin G, 2.4 million units given intramuscularly weekly for two weeks for a total of 4.8 million units. Twenty-one patients with primary syphilis who were allergic to penicillin were treated with oral tetracycline, 500 mg four times daily for 12 days for a total of 24 gm. All 196 patients had resolution of their lesions, and all were seronegative within one year. White patients presented for treatment earlier than black patients. The duration of symptoms prior to presentation for treatment was positively correlated with the height of the serologie titer in the rapid plasma reagin card test. Patients who had high titers before treatment became seronegative less rapidly than patients who had low pre-treatment titers.

Perianal Bowen's disease associated with anorectal warts: a case report.

The occurrence of anogenital warts has increased both in clinic and in private practice. Both sexes and all races are affected, with the highest prevalence in patients aged 15 to 40 years. The etiologic agent, the human papillomavirus (HPV), has been classified by DNA hybridization techniques into at least 42 types, of which types 16 and 18 are considered to carry a high risk for cancer. A patient who had been seen intermittently over a period of 26 years with perianal and anal warts that responded to treatment finally developed two granulomatous nodules morphologically different from the previous lesions. A biopsy confirmed that the nodules were typical of Bowens disease, a precancerous lesion, and they were surgically excised. Thus, anogenital warts that fail to respond to conventional therapy or change in appearance warrant a biopsy and, where the technique is available, DNA typing to identify the viral pathogen.

Reinfection primary and secondary syphilis: the post treatment serologic response.

It has long been observed that patients with reinfection primary and secondary syphilis have a slower serologic response to treatment than those with an initial infection. The case records of three patients with reinfection primary and seven patients with reinfection secondary syphilis were examined and confirmed the clinical observation.

Facts about gonorrhea and dentistry

This article reviews gonorrhea and discusses various misconceptions that have appeared in the dental literature and in verbal presentations about gonorrhea and dentistry. Facts are presented and some conclusions are offered for the dental profession.

The diagnosis and treatment of chancroid

Chancroid, a disappearing disease in the United States, was reintroduced into the country in 1980 by immigrants from the Caribbean, Mexico, and Southeast Asia. Point epidemics resulted, each of them associated with prostitution. During the 4-month period between March 1 to June 30, 1985, forty-five patients were diagnosed and treated in Massachusetts, thirty-seven from Boston alone. By means of these case records, the morphologic characteristics, laboratory diagnosis, and treatment regimens are described.

Untreated relapsing secondary syphilis with meningitis

Another important zone is the superior extremity, whereas the inferior extremity is only affected in one case. 5 To our knowledge, no case of segmental neurofibromatosis has been reported with development of malignant schwannoma, pheochromocytoma, or neurofibrosarcoma, as occurs in classic neurofibromatosis. Moreover, none of the patients was neurologically affected. Only 15 cases of all segmental neurofibromaloses published may be called true segmental neurofibromatosis, following the strict definition of Riccardi. As occurs in classic neurofibromatosis, segmental neurofibromatosis may present great variability in its clinical expressions. For this reason, Roth et al? proposed classifying segmental neurofibromatosis into four different groups, in which the first group would only include the true cases of segmental neurofibromatosis. In the other groups, family history, bilateral disposition, deep soft tissue, or bone involvement can be found. 6 Our case presents some interesting details. It is the first case of segmental neurofibromatosis described in black African people. In addition, our patient had mental retardation; this association has been previously observed in one case. 4 Finally, we find the pain he had when any of his skin lesions were pressed a significant detail, and the fact that this pain irradiates to an ipsilateral paravertebral region of D12, L1-2 is interesting. This clinical sign, which would refer to an underlying neural affection in these zones and would explain its metameric arrangement, has not been previously described in the literature. Nevertheless, we find it necessary to have this noted and encourage its exploration in further eases.