Schaudin and Hoffman had discovered Syphilis in 1905 when they observed the causative spirochete on initial lesions. But in 1521, physichian Hieronymus Frascatorio told the history of a shepherd named Sifilo who was punished with this illness by the gods.

In the late 1980s, the incidence of syphilis in the United States rose rapidly in most urban areas.

Populations at maximal risk were those with high incidences of illicit drug use and prostitution. The shift predominantly homosexual male transmission in the 1970s and early 1980s to heterosexual transmission among socioeconomically disvantaged populations has been associated wit rapidly rising rates of congenital syphilis, the most seriously form of the disease. In the United States, 51.000 cases of primary syphilis was reported in 1990 ( 87 percent higher than in 1985) (1). In our country, in 1992 we have had 119 cases of syphilis; In 1996, there were 1367; in 1997: 206 cases; in 2000: 1821cases (2); and in 2003 > 400. Today range of syphilis infected individuals represent 0,4x 10.000 inhabitantsand.

The presence of sexually transmitted diseases increases the risk of both transmitting and acquiring HIV infection. Primary and secondary syphilitic lesions in patients with HIV infection may develop in an analogous fashion to those in HIV-seronegative individuals .but it can presents a variety of another characteristics as well. Atypical manifestations including fulminant presentations(3,4) rapid progression, irregular serologic findings and failure of conventional doses of penicillin to eradicate the infection have been described. Immuno suppression induced by HIV infection might cause currently available screening tests for syphilis to be inadequate to detect active infection.( 5), and that VDRL and FTA-ABS can be repeated twice but they can be non reactive, even with mucocutaneous manifestations.(6,7,8).

Doctors commonly find HIV positive patients that many times developed syphilitic lesions . There are also those individuals , with unknown HIV serology, with primary or secondary syphilis fashions.

In wiew of the evidence that the results of syphilis tests are obtained before as HIV serology and very oft patients do not rescue it any more, Public Health Services are in front of a very serious problem. The Centers for Disease Control and Prevention (9) )has produced recommendations for the evaluation, treatment and follow-up of persons with HIV infection and syphilis. Some recommendations include the following. All sexually active persons with syphilis should be tested for the presence of HIV because HIV test results are clinically important in the management of patients with syphilis. For primary or secondary syphilis, HIV infected persons should be treated as other cases but close follow-up is mandatory.

Actually syphilis is considered as a Sexual Transmitted Disease (STD) of high incidence and prevalence in association with HIV infection .Its recognition and treatment is one of the hallmarks of the Public Health in most of countries associated with detection and control of the Acquired Human Immunodeficiency Syndrome

A female sixteen years old student with a general good aspect, came to our Unite and referred she had been violated two months before of this consultation. She didn’t denaunce that experience because personal reasons. She consulted about some lesions in her mouth from 2 weeks approximatelly of evolution. Its caused difficulties in phonation and deglutition. When the anamnesis was performed the patient showed insecurity and hidings in her answers.

Examination of oral mucosa revealed typical opaline plaques of secondary. They were slightly raised and grayish and more white lesions surrounded by a red halo, some of them multiple, some ones solitary and very evidents. On figure 1, we can observe white plaques in both angles of the mouth, on the lower lip’s mucosa and at the middle line. On figure 2, man can observe similar plaques ocurring on left border of the tongue, and at the point and posterior location as well.(figure 3)

A white lesions, not smooth, coarrugated or markledy folded at the lateral margin of the tongue that is extended to ventral face and recognized as hairy leucoplasia. (LV)

Patient had allowed to been tested for HIV infection, which was made the next day. Its result usually is given, in person, after 30 days. VDRL was high reactive (128 dls). There were also made fluorescent treponemal antibody test (FTA-ABS) and treponemal hematoaglutination test ( TPHA) demostration of spirochetes in exudate from oral lesion (dark field examination) was performed wit positive result. As syphilis serology was finished conventional treatment with benzathine penicilline inyections was established immediatelly. Searching of this young girl is actually make to communicate HIV’s result and to control the effectiveness of syphilis therapy and eventual treatment and follow up of her immunodeficiency.

CORRESPONDENCE

Bartolomé Mitre 1371-4M Buenos Aires-Argentina
Tel/Fax: 0054-11-4-3720444
patologia@folp.unlp.edu.ar

REFERENCES