Jurnal
Health Sains: p–ISSN: 2723-4339 e-ISSN:
2548-1398
Vol. 3, No. 9, September
2022
CONDILOMATA
LATA AS CLINICAL MANIFESTATION OF SECONDARY SYPHILLIS IN PREGNANCY: STUDY CASE
REPORT
A A Ayu Adisti Nina Yuniandari, Diana Wijayanti
Muhammadiyah Hospital,
Bandung, West Java, Indonesia
Email:
agungayunina@gmail.com, adisti.nina@gmail.com
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artikel
info |
abstract |
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Date received: 02 August 2022 Revision date: 10 September 2022 Received date: 25 September 2022 |
Syphilis is one of the most common sexually transmitted infection caused by Treponema pallidum. Syphilis is called the “great imitator” as it can present very similar to a large variety of other diseases, which can sometimes complicate its diagnosis, especially in the later stages.One of the symptoms of secondary syphilis is condyloma lata. This report aims to discuss the case report information related condyloma lata as clinical manifestation of secondary syphilis in pregnancy. We describe case G1P0A0, a 29-year-old woman who is 28 weeks pregnant. The patient's main complaint upon arrival was that he had been developing larger and more frequent warts on his genitalia for the past month. Multiple 2 cm grey circular plaques with a localized status were found on the labia majora. A VDRL serological examination was performed as a follow-up examination on June 16; the results were reactive. At 28 weeks of gestation, the patient was diagnosed with secondary syphilis in the form of condyloma lata based on the history, physical examination, and supportive examination. Erythromycin 500 mg 4x1, paracetamol 500 mg for pain, and a 0.9% NaCl compress were administered to the patient as treatment. Reevaluated after the first month. The VDRL test yielded a titer of 1: 16 and the complaints of lumps in the genitalia had vanished. This report is using the literature review technique from PUBMED with PICO format. We use the specific question about condyloma lata treatment in secondary syphilis disease. Based on inclusion and exclusion criteria there are two research articles that appropriate with this case. Condyloma lata is one manifestation of secondary syphilis caused by Treponema pallidum. The diagnosis of condyloma lata in this case was established based on anamnesis, physical examination, and serologic findings. Treatment with Erythromycin gave satisfactory result. Serologic examination as follow up needs to be performed at 6 and 12-months after the initial treatment to monitor the success of therapy. |
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Keywords: secondary
syphilis; pregnancy; condyloma lata |
Introduction
Treponema pallidum is the
bacteria that causes the sexually transmitted illness syphilis (Majid,
2010). Syphilis is widespread throughout the world and is a serious
issue in
developing nations. According to age,
those between the ages of 20 and 30 are most commonly affected with syphilis.
Untreated early syphilis will result in transmission to the fetus in 40% of
pregnant women. The prevalence of syphilis is currently rising, making it a
health issue. According to information from the Global AIDS Response Progress
Reporting (GARPR), there may be five million cases of syphilis among people
aged 15 to 49 reaching up to 55,000 cases annually (Newman, 2015).
In 2017, there were 30,644 primary and secondary syphilis cases. Since 2013,
this number has climbed by 76%. The epidemic of primary and secondary syphilis
as well as the rising rate of screening for STDs are to blame for this rise in
syphilis prevalence. In women, the frequency of syphilis increased by 30.4%
between 2017 and 2018.
Congenital syphilis can
be contracted from the mother at birth, but most instances are brought on by
intrauterine infection. Congenital syphilis risk is inversely correlated with
the mother's syphilis stage at conception. Congenital syphilitic lesions often
develop 4 months into pregnancy, by which time the fetus is immune competent.
Treponema pallidum can be found in the placenta, umbilical cord, and amniotic
fluid due to the fact that intrauterine infection is transplacental. Because of
the important conditions of pregnant patient with syphilis disease, through
this report we try to discuss the case report information related condyloma
lata as clinical manifestation of secondary syphilis in pregnancy.
Multiple phases of
syphilis exist. Primary syphilis, secondary syphilis, latent syphilis, and
tertiary syphilis are the four phases of syphilis, respectively. There are many
different clinical manifestations of secondary syphilis, such as rash,
lymphadenopathy, and mucocutaneous lesions like condyloma lata and mucous
patches. A secondary syphilis known as condyloma lata manifests as
grayish-white papules in warm, humid environments9. Condyloma lata is diagnosed
based on the history and physical examination. The lump in the wet area is the
main complaint. During a physical examination, hypertrophic, granulomatous
red-brown tissue was discovered to be lesions with efflorescence. Surface that
is smooth, elevated, or cauliflower-shaped, as well as lesions that have
treponemes. The following describes a case of condyloma lata in a woman who was
28 weeks pregnant G1P0A.
Study Case The patient is
a 29 years old woman who is 28 weeks along with her first pregnancy. On June
16, 2022, the patient was admitted to the hospital with the primary complaint
that she had genital warts that had appeared a month earlier and were
escalating in size. The wart's surface seems smooth and wet to the touch. The
outer genitalia is where the warts are located. The patient had never before
gone through this. The patient, who has only ever been married once, denies
ever having had intercourse with anyone other than her husband. The final sex
took place in April 2022. The patient's husband, who was genetically carried
out, did not use condoms during sexual activity. The patient's husband
allegedly had sex with prostitutes without wearing a condom in 2021 and
admitted to having previously experienced genital injuries in November of that
same year but choosing not to seek medical attention. The patient was not currently on long-term
steroids, had no history of weight loss in the previous six months, or any
genital disorders. It is known that the patient has a history of penicillin
allergy. Her vital signs and overall status were within normal ranges, and she
appeared to be in good health. Multiple gray plaques averaging 2 cm in
diameter, with a circular shape, and being localized on the labia majora.
Figure 1
On the labia majora, there are several whitish plaques that are 2 cm in
diameter and spherical in shape
On June 16, a VDRL
serological examination was performed as a follow-up examination; the outcomes
were reactive (Emerson CR, 2009) . At 28 weeks of gestation, the patient was
diagnosed with secondary syphilis in the form of condyloma lata based on the
history, physical examination, and supportive examination. Erythromycin 500 mg
four time’s day, paracetamol 500 mg for pain, and 0.9% NACL compresses were
used as treatment for the patients. Re-examined after a month. When complaints
of genital lumps vanished, a follow-up examination was conducted, and the
results revealed a titer of 1:8 for the VDRL test. Patients are encouraged to
have the exam repeated in three, six, and twelve months.
Method
Using the
PICO format with the questions about how to treat condyloma lata.
With inclusion criteria:
1. Appropriate with
keywords
2. Published at the last
of 10 years
3. Full paper accessed
Exclusion criteria:
1.
1. Article review type
Figure 2
Search terms and publication selection
process (PRISMA Flowchart)
Table 1
Charting Data
Result
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Journal Writer |
Population/Patient /Problem |
Intervention/ Index/ Indicator |
Comparator |
Results |
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1 |
Pourang et al., 2021 |
Nine
patients with secondary syphilis diagnosed and presented with condyloma lata.
Patient age range was 22-50 years. All of 9 patients presented with
hypertrophic anogenital lesions. |
Seven from nine patients
were treated with intramuscular dose of Penicillin G Benzathine (2.4 million
units). Meanwhile, the remaining patients were treated with intravenous
Penicillin G. |
- |
Follow
up and monitoring of rapid plasma regain titers. This report showed unknown
result because of no one patient visit the doctor after the treatment period. |
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2 |
Bjekic and Vlajinac, 2019 |
25 years old woman with
manifestation of secondary syphilis and presented condyloma lata on her
vulva. |
The patient received a
single dose of 2.4 million units of intramuscular Benxathine Penicillin G as
a treatment procedure. |
- |
The lesions completely improved three weeks after
treatment procedure. Additionally, six months later, the Veneral Disease
Research Laboratory titer significantly decrease (1:4). |
Discussion
Syphilis can be found during
pregnancy, which is one way to stop congenital syphilis from occurring. The
primary step in preventing congenital syphilis is identifying and treating
pregnant women who are infected with the disease, as penicillin treatment for
syphilis during pregnancy can prevent congenital infection by up to 98%.
Serological tests (VDRL and TPHA) should be conducted throughout prenatal care,
including at the initial visit, again at 28 weeks of pregnancy, and at birth
for high-risk individuals (Goh BT, 2005)
Early
and late stages of the syphilis clinical course are distinguished. Early
syphilis, which includes primary syphilis, secondary syphilis, and early latent
syphilis, develops within a year of the main infection. The trinity of
neurosyphilis, cardiovascular syphilis, and late benign syphilis, also known as
gummatous syphilis, is included in late latent syphilis, which develops more
than a year after the initial lesion first appears. 3–12 weeks after the first
primary syphilis lesions appear, secondary syphilis sets in. Secondary syphilis
is frequently referred to as the great imitator because to the abnormalities
that subsequently develop and have a picture that can resemble a range of other
diseases (Rocha Felix, 2015). A clinical sign of secondary syphilis is
condyloma lata, which appears as grayish white lesions in hot, humid climates
occurs as a result of skin damage in the body's moist places. Flat plaques that
are pale, confluent in shape, and have erosion on their surface are the clinical
Signs of condyloma lata (Timmons, 2018)
The labia majora is one area where condyloma lata frequently develops. Armpits,
the space between the fingers, and the region under the breast folds are
examples of perianal and fold regions (Fitzpatrick TB, 2008) T. pallidum bacteria are present in
enormous concentrations and are extremely contagious in these lesions. In
secondary syphilis, lesions can arise before or right after the widespread
lesions (Minarto, 2014).
Figure 3
Results of physical examination
after one month It was found that the lump in the genitals had disappeared.
The
patient's main complaint in this instance was that she had many gray-colored
tumors on her genitals. On the labia majora, the lesion's surface appears
bright and wet (Bjekic M, 2019) In condyloma lata, these
clinical signs and symptoms are pathognomonic (Deshpande DJ, 2009)
Since the patient was unaware of the earlier vaginal sores, it's possible that
the patient had an ulcer in the early stages of the disease but was unaware of
it because syphilis ulcers don't hurt. In this instance, the patient's husband,
who had previously engaged in sexual activity with a prostitute, was the source
of the patient's syphilis infection. Three primary factors—history,
physical examination, and corroborating research—can be used to diagnose syphilis (Ghanem KG, 2011) Dark-field microscopy, the gold standard for
the diagnosis of syphilis, is used to identify pathogens. Serological
testing is currently the predominant method of syphilis diagnosis. Syphilis can
be detected using this test at any stage (World Health
Organization, 2015).
Serological
tests can be broadly divided into two categories: treponemal and nontreponemal
tests. Rapid Plasma Reagent RPR) and VDRL nontreponemal examinations were
employed for screening and follow-up care. The sensitivity and specificity of
VDRL are 86% and 85%, respectively, while those of RPR are 78% and 85% (Wiwanitkit
V, 2009). The patient will have reactive results 4-5 weeks following
the infection. A high titer is a sign that the infection is active (E Lyytikai
nen, 2008) FTA-ABS, TPPA, and TPHA are the components of the treponemal
examination. These three tests, which have higher sensitivity and specificity, namely
>95% and >99%, aid to confirm the diagnosis (AAAAN Yuniandari, 2015).
In this instance,
secondary syphilis was discovered in the patient during 28 weeks' gestation
(third trimester) (K Adachi, 2018). Syphilis screening was conducted on the
patient at 28 weeks' gestation, but it wasn't done at the initial appointment,
delaying the diagnosis. For the first three months, follow-up clinical exams
and non-treponemal serological tests were conducted monthly; they were then repeated
at 6, 12, and 24 months (Rocha Felix, 2015) If the nontreponemal
examination titer has decreased by four times by the sixth or twelfth month,
the treatment is considered to have been successful (Workowski 2015).
Unresponsive or 4-fold-increasing titers indicate either treatment failure or
reinfection. The most effective treatment for syphilis in pregnant women is
penicillin. There haven't been any substantial T. pallidum penicillin-resistant
strains discovered as of now (Rac MW, 2017). Penicillin therapy
is used to treat maternal illness, stop the spread of it to the fetus, and cure
syphilis that has already affected the fetus in pregnant women. One of the
alternatives for treating primary and secondary syphilis, including condyloma
lata in pregnant women, especially those who are penicillin allergic, is
erythromycin (Ling J, 2015) Because the patient had a history of penicillin allergies,
erythromycin 500 mg four times a day for a month was prescribed to them (Kemenkes
2013). Clinical symptoms improved and the VDRL and TPHA titers
dropped after a month of follow-up, showing that the patient had responded to
the treatment. lesions are known as condyloma lata. Syphilis is diagnosed based
on a patient's medical history, physical examination, and investigations. Based
on (Nova Scotla, 2020). Communicable Diseases Manual, the
preferred treatment for pregnant women with primary, secondary, and early
latent syphilis is Benzathine Penicillin G 2.4 million units weekly for 1 – 2
doses (Baughn, 2005). Several experts recommended other regimen with 3 weekly
doses of Benzathine Penicillin G in HIV infected individuals (Pourang,
2021).
Conclusion
Condyloma lata is one manifestation of
secondary syphilis caused by Treponema pallidum. The diagnosis of condyloma
lata in this case was established based on anamnesis, physical examination, and
serologic findings. Pregnant women diagnosed with syphilis should be treated
immediately.Syphilis is easily treated using the antibiotic penicillin.
Primary, secondary and latent syphilis can all be treated with penicillin, but
it is most effective in the primary and secondary phases.Treatment with
Erythromycin gave satisfactory result. Serologic examination as follow up needs
to be performed at 6 and 12-months after the initial treatment to monitor the
success of therapy.
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Copyright
holder: A A Ayu Adisti Nina
Yuniandari, Diana Wijayanti (2022) |
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publication right: Jurnal Health Sains |
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