Tadas Raudonis, Tatjana Orlovskytė, Algirdas Šumila, Aldona Kajutytė, Genovaitė Lapinskaitė, Matilda Bylaitė-Bučinskienė
Syphilis is a disease of systemic nature which is characterised by varied clinical manifestations, therefore physicians of most specialities may encounter it. Also, Lithuania has one of the highest incidence rates of syphilis in the European Union. In this paper we present data collected over a period of 15 years in two Lithuanian dermatovenereology centres – Vilnius University Dermatovenereology centre (DVC) and Department of Skin and Venereal Diseases at Republic Klaipeda Hospital (RKL). Objectives: To determine the annual rate of syphilis’ cases during the 15 year period, the frequency of different stages, gender differences, clinical morphology, diagnostic measures and treatment efficacy of syphilis. Material and methods: We conducted a retrospective analysis consisting of 1245 patient medical records: 793 patients from DVC and 452 from RKL. Data was processed with SPSS, ANOVA test was used for means, the significance of other data was assessed with either Fisher’s or Chi-square tests. Results: 691 case was registered in DVC and RKL during 2000–2003, and 554 cases – during 2004–2014. 49% (610) of patients were female, their age average – 29.5 ± 11.3 years, male age – 34.3 ± 12.3 years. (p<0.001). Among patients living in the city, males were more frequently employed (55% (222) than females (48% (172)(p=0.050). Primary syphilis was diagnosed for 14% (173) of patients, secondary – 34% (427), early latent – 45% (561). 53% (660) of patients presented with skin lesions on examination. Papules were observed in 55% (364) of patients, erosions – 39% (254), chancre – 33% (220). Primary and early latent syphilis were associated with lower RPR titres, whereas secondary syphilis – with exceptionally high titres (69% (296). 6% (70) had a negative RPR test. Four or more RPR tests were carried out on 19% (76) of DVC and 48% (90) of RKL patients (p<0.001). Dark-field microscopy was used for 19% (151) of DVC and 41% (186) of RKL patients (p<0.001). HIV test was performed for 61% (485) of DVC and 10% (47) of RKL patients (p<0.001). 37% (462) of patients were treated with benzathine benzylpenicillin, on average 3 injections of 2.4 mU per week. Doxycycline was prescribed for 7% (90) of patients, on average 200mg daily for 23 days (cumulative dose of 4.7 ± 1.2 g.). Time to serological response varied insignificantly (5.09 [3.94; 6.25] vs. 4.85 [2.86; 6.85] months). 7.3% (91) of patients experienced treatment failure (7% (55) in DVC vs. 8% (36) in RKL (p=0.951). Conclusions: Even though the number of registered syphilis’ cases in DVC and RKL has decreased almost 10-fold over the course of 15 years, the incidence rate remains among the highest in the European Union. Early latent and secondary were the two most diagnosed stages of syphilis. The male to female ratio was close to 1, though males were approximately 5 years older. Only half of the patients presented with lesions. Less than half of the patients were tested for HIV. Both doxycycline and benzathine benzylpeniciline were equally effective. Only one-third of patients had the recommended number of follow-up RPR tests done.
Keyword(s): syphilis; chancre; RPR; TPHA; HIV; benzathine benzylpenicillin; doxycycline
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