We read the study from Roberts et al
1
about syphilis as a cause of thoracic aortic aneurysm that prompted us to make some
considerations. We agree that syphilitic aortitis, far from disappeared, remains a
major cause of thoracic aortic aneurism. Besides, coronary artery ostial stenosis,
a less common manifestation of syphilitic aortitis, is still described in the study.
2
Recently, we conducted a survey of the report of the last 5 years on the clinical
presentation of neurosyphilis founding 286 affected patients (unpublished data). Regrettably,
however, such cases are incompletely reported. In particular, most studies do not
inform how early the patients did show cutaneous or mucosal symptoms of early infection,
whether they had undergone a standard therapy nor the time elapsed before developing
late complications. However, according to the study by Zhou et al and Drago et al
3
,
4
and evidence that up to 5% of immunocompetent patients treated with benzathine penicillin
G (BPG) experience treatment failure
5
has wavered our confidence in BPG as the gold standard therapy for early and late
latent syphilis. Trying to prevent long-term complications, we adopted in the last
5 years an enhanced therapy for early syphilis that uses doxycycline and ceftriaxone
in addition to BPG. In fact, these treponemicidal antibiotics can penetrate all tissues
more effectively than BPG
6
and might be considered as a completion of the standard BPG therapy.To read this article in full you will need to make a payment
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References
- Syphilis as a cause of thoracic aortic aneurysm.Am J Cardiol. 2015; 116: 1298-1303
- Cardiovascular syphilis with coronary stenosis and aneurysm.Indian Heart J. 2014; 66: 735-736
- Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy.Sex Transm Infect. 2012; 88: 342-345
- Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy: a reply.Sex Transm Infect. 2012; 88: 509
- Doxycycline compared with benzathine penicillin for the treatment of early syphilis.Clin Infect Dis. 2006; 42: e45-49
- Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections.Clin Microbiol Rev. 2010; 23: 858-883
- Sexually transmitted diseases treatment guidelines, 2010.MMWR Recomm Rep. 2010; 59: 1-110
- Serologic response to treatment of infectious syphilis.Ann Intern Med. 1991; 114: 1005-1009
- A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group.N Engl J Med. 1997; 337: 307-314
- Syphilitic retinitis and panuveitis simulating acute retinal necrosis: case report.Arq Bras Oftalmol. 2010; 73: 288-290
- Syphilitic aortitis in secondary syphilis.JAMA Dermatol. 2014; 150: 790-791
Article Info
Publication History
Published online: November 06, 2015
Received:
October 26,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Syphilis as a Cause of Thoracic Aortic AneurysmAmerican Journal of CardiologyVol. 116Issue 8
- PreviewIn 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively.
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