Clinical manifestations of treponema pallidum dna positive syphilitic lesions among patients from sti clinics in peru

BackgroundThe control of Syphilis, a sexually transmitted infection (STI) cause by Treponema Pallidum (TP), requires early diagnosis and treatment, especially during primary syphilis when serologic tests may fail to confirm infection. In our PICASSO cohort, we detected TP DNA from anogenital lesions from people with active syphilis, described clinical findings and took lesion images.MethodologyThe Picasso cohort study recruited adults with active syphilis, diagnosed either by laboratory (new seroconversions or fourfold increase in RPR) or clinical criteria (new anogenital ulcer compatible with primary syphilis). Patients underwent a short survey, clinical examination and laboratory tests including serum RPR, TP-rapid test (TP-RT), HIV rapid test, and TP-PCR from lesion swabs. Clinical examination was performed and documented by a trained clinician and pictures were taken after obtaining consent.ResultsAmong 161 participants, 61 (38%) had suspected primary lesions which were swabbed and analyzed using PCR. Results were available from 58 participants. TP-DNA was detected in 27/58 (47%) lesions. Among those 27 participants, 11(41%) were HIV positive, RPR titer ≤1:4 was found in 12 (44%), 2 were RPR non-reactive and TP-RT negative. The most common presentations were a single painless ulcer, found in 11/27 cases (41%) and multiple painless ulcers found in 10/27 cases (37%). Two participants with multiple lesions (one with painful lesions) also had cutaneous rash on the trunk and back; and one of them had rash on palms and soles. Five participants consented for the use of photographs of their lesions for research/publication purposes.ConclusionWe were able to confirm primary syphilis cases by detecting TP-DNA from anogenital lesions. Describing those cases and showing lesion photographs can contribute to the current tools for clinical training to improve syphilis diagnosis and early treatment during symptomatic stages.