Syphilisinfektion im HNO-Bereich

Inga Marte Charlott Seuthe; Sabine Eichhorn; Jonghui Kim; Konstantin van Ackeren; Jonas Jae-Hyun Park; Stefan Dazert; Kai-Christian Klespe

doi:10.1055/a-1808-7321

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2022; 101(06): 484-493
DOI: 10.1055/a-1808-7321

Übersicht

Syphilisinfektion im HNO-Bereich

Syphilis infection in the ENT area

Inga Marte Charlott Seuthe

¹Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany

,

Sabine Eichhorn

¹Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany

,

Jonghui Kim

¹Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany

,

Konstantin van Ackeren

²Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany

,

Jonas Jae-Hyun Park

¹Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Lehrstuhl für Hals-Nasen-Ohrenheilkunde der Universität Witten/Herdecke, St-Josefs-Hospital Hagen, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany

,

Stefan Dazert

²Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, Bochum, Germany

,

Kai-Christian Klespe

³Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln, Köln, Germany

› Author Affiliations

Abstract

Zusammenfassung

Die Anzahl der gemeldeten Syphilis-Fälle steigt seit Jahren an. Die sexuell übertragbare Erkrankung wird durch die Spirochäte Treponema pallidum Subspezies pallidum verursacht und verläuft hierbei in verschiedenen Stadien. In allen Stadien können hierbei Symptome im HNO-Bereich auftreten. Hierdurch ist bei passenden Symptomen eine Syphilis-Infektion als Differenzialdiagnose vom HNO-Arzt stets zu bedenken. So ist bei zunehmendem oralem Geschlechtsverkehr der Primäraffekt/harter Schanker zunehmend häufig im Mundraum zu beobachten. Zudem können Symptome nicht nur im Mundraum, sondern auch im Bereich des Ohrs, der Nase, des Larynx sowie auch zervikal und fazial auftreten. Die Diagnose wird hierbei über den direkten Erregernachweis oder über einen serologischen Nachweis gesichert. Die Spirochäte ist nicht kultivierbar. Der therapeutische Goldstandard ist die Gabe von Benzathin-Penicillin G oder Procain-Penicillin G. Als Alternative stehen Doxycyclin, Makrolide oder Ceftriaxon zur Verfügung. Bei einer Innenohr- oder Hirnnervenbeteiligung ist die zusätzliche Gabe eines Glukokortikoids zu empfehlen. Vor Durchführung der antibiotischen Therapie ist der Patient über die Möglichkeit einer Jarisch-Herxheimer-Reaktion aufzuklären. Bei einer Syphilis-Infektion ist stets eine kollegiale Zusammenarbeit mit den Venerologen zu empfehlen, sodass eine effektive und umfassende Diagnostik und Therapie erfolgen kann.

Abstract

The number of reported cases of syphilis has been increasing for years. The sexually transmitted disease is caused by the spirochete Treponema pallidum subspecies pallidum and progresses in different stages. Symptoms in the ENT area can occur in all stages. This means that a syphilis infection should always be considered by the ENT doctor as a differential diagnosis if the symptoms are suitable. Thus, with increasing oral sexual intercourse, the primary effect/hard chancre is more often observed in the oral cavity. In addition, symptoms can occur not only in the oral cavity, but also in the ear, nose, larynx, cervical and facial regions. The diagnosis is confirmed by direct pathogen detection or by serological detection. The spirochete cannot be cultivated. The therapeutic gold standard is the administration of benzathine penicillin G or procaine penicillin G. Doxycycline, macrolides or ceftriaxone are available as alternatives. In case of inner ear or cranial nerve involvement, the additional administration of a glucocorticoid is recommended. Before antibiotic therapy is administered, the patient must be informed about the possibility of a Jarisch-Herxheimer reaction. In cases of a syphilis infection, a collegial cooperation with the venereologists is always recommended so that an effective and comprehensive diagnosis and therapy can be carried out.

Schlüsselwörter

Syphilis - Lues - sexuell übertragbare Erkrankung - Infektionserkrankung - Treponema pallidum

Keywords

syphilis - lues - STI - STD - sexually transmitted disease - sexually transmitted infection - treponema pallidum

Full Text

References

Literatur
1 Lautenschlager S. Diagnosis of syphilis: Clinical and laboratory problems. JDDG – Journal of the German Society of Dermatology 2006; 4: 1058-1075
2 LaFond RE, Lukehart SA. Biological Basis for Syphilis. Clinical Microbiology Reviews 2006; 19: 29-49
3 Robert Koch Institut. Epidemiologisches Bulletin. In: . Epidemiologisches Bulletin; 2018: 493-508
4 Hook EW, Peeling RW. Syphilis Control – A Continuing Challenge. New England Journal of Medicine 2004; 351: 122-124
5 Kojima N, Klausner JD. An Update on the Global Epidemiology of Syphilis. Curr Epidemiol Rep 2018; 5: 24-38
6 Petty-Saphon N, Brady M, Cullen G. et al. A proposal for changes to the European Union syphilis surveillance case definition using evidence from evaluations in Ireland. Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2019; 24: 1-6
7 Cohen SE, Ng RAC, Katz KA. et al. Repeat syphilis among men who have sex with men in California 2002–2006: Implications for syphilis elimination efforts. American Journal of Public Health 2012; 102: 2002-2006
8 Lautenschlager S. Sexually transmitted infections in Switzerland: Return of the classics. Dermatology 2005; 210: 134-142
9 Di Carlo RP, Martin DH. The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis 1997; 25: 292-298
10 Schöfer H. Syphilis: Klinik der Treponema-pallidum-infektion. Hautarzt 2004; 55: 112-119
11 Lacey HB, Higgins SP, Graham D. An outbreak of early syphilis: Cases from North Manchester general hospital. Sexually Transmitted Infections 2001; 77: 311-313
12 Ghanem KG. Neurosyphilis: A historical perspective and review. CNS Neuroscience and Therapeutics 2010; 16: 157-168
13 Clement ME, Okeke NL, Hicks CB. Treatment of Syphilis a systematic Review. JAMA 2014; 312: 1905-1917
14 Butterfield R. Syphilis. Pediatrics in Review 2014; 35: 212-213
15 Leuci S, Martina S, Adamo D. et al. Oral Syphilis: A retrospective analysis of 12 cases and a review of the literature. Oral Diseases 2013; 19: 738-746
16 Fukuda H, Takahashi M, Kato K. et al. Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. Journal of Dermatology 2015; 42: 515-517
17 De Andrade RS, De Freitas EM, Rocha BA. et al. Oral findings in secondary syphilis. Medicina Oral Patologia Oral y Cirugia Bucal 2018; 23: e138-e143
18 Leão JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clinics 2006; 61: 161-166
19 Ficarra G, Carlos R. Syphilis: The renaissance of an old disease with oral implications. Head and Neck Pathology 2009; 3: 195-206
20 Singh AE, Romanowski B. Syphilis: Review with emphasis on clinical, epidemiologic, and some biologic features. Clinical Microbiology Reviews 1999; 12: 187-209
21 Neville BW, Damm DD, Allen CM. et al. Oral and Maxillofacial Pathology. Fourth Edi. St. Louis: Elsevier; 2015
22 Trieger N, Ship II, Taylor GW. et al. Cirrhosis and other predisposing factors in carcinoma of the tongue. Cancer 1958; 11: 357-362
23 Meyer I, Abbey LM. The relationship of syphilis to primary carcinoma of the tongue. Northwest dentistry 1970; 30: 678-681
24 Dickenson AJ, Currie WJR, Avery BS. Screening for syphilis in patients with carcinoma of the tongue. British Journal of Oral and Maxillofacial Surgery 1995; 33: 319-320
25 Lahav G, Lahav Y, Ciobotaro P. et al. Laryngeal Syphilis. Archives of Otolaryngology Head and Neck Surgery 2011; 137: 294-297
26 Syphilis of the Throat and Nose-II. The Hospital 1908; 44: 179
27 Ramstad T, Traaholt L. Destruction of the soft palate and nose by tertiary „benign“ syphilis. A case report. Journal of Oral Rehabilitation 1980; 7: 111-115
28 Masege S, Karstaedt A. A rare case of a chronic syphilitic gumma in a man infected with human immunodeficiency virus. The Journal of Laryngology & Otology 2014; 128: 557-560
29 Morrison AW. On syphilis and the ear – an otologist’s view. Genitourinary Medicine 1992; 68: 420-422
30 Sardana K, Goel K. Nasal septal ulceration. Clinics in Dermatology 2014; 32: 817-826
31 Syphilis of the Throat and Nose-I. The Hospital 1908; 44: 125
32 Pan X, Zhu X, Qingdi QL. Syphilis manifesting as a nasopharyngeal carcinoma with cervical lymphadenopathy: A case report. Experimental and Therapeutic Medicine 2012; 3: 1023-1025
33 Merritt HH, Moore M. Acute syphilitic meningitis. Medicine 1935; 14: 119-183
34 Piura Y, Mina Y, Aizenstein O. et al. Neurosyphilis presenting as cranial nerve palsy, an entity which is easy to miss. BMJ Case Reports 2019; 12: 2018-2020
35 Young AS, Carroll AS, Welgampola MS. et al. Acute unilateral peripheral vestibulopathy in neurosyphilis. Journal of the Neurological Sciences 2017; 378: 55-58
36 Hong JH, Lee HY, Lim MK. et al. Meningovascular and Spinal form of Neurosyphilis Presenting as Multiple Cranial Nerve Palsy, Cerebral Infarction and Meningomyelitis in a Human Immunodeficiency Virus Negative-Patient: MR Imaging Features. Journal of the Korean Society of Magnetic Resonance in Medicine 2014; 18: 263-268
37 Ting CH, Wang CW, Lee JT. et al. Bilateral facial nerve palsy as the sole initial symptom of syphilis: A case report. Canadian Journal of Emergency Medicine 2015; 17: 576-581
38 Maeda T, Yoshizawa S, Hirayama T. et al. Neurosyphilis mimicking Ramsay Hunt syndrome. Journal of Nippon Medical School 2015; 82: 254-256
39 Alqahtani S. Acute cranial neuropathies heralding neurosyphilis in a human immunodeficiency virus-infected patient. American Journal of Case Reports 2014; 15: 411-415
40 Smith MM, Anderson JC. Neurosyphilis as a cause of facial and vestibulocochlear nerve dysfunction: MR imaging features. American Journal of Neuroradiology 2000; 21: 1673-1675
41 Kılıç Çoban E, Aldan MA, Gez S. et al. A Case of Neurosyphilis Presenting with Multiple Cranial Neuropathy. Turkish Journal Of Neurology 2016; 22: 127-129
42 Eliott D, Papaliodis GN, Durand ML. Case 20–2016: A 50-year-old man with cloudy vision, hearing loss, and unsteadiness. New England Journal of Medicine 2016; 374: 2586-2593
43 Sonne JE, Zeifer B, Linstrom C. Manifestations of otosyphilis as visualized with computed tomography. Otology and Neurotology 2002; 23: 806-807
44 Darmstadt GL, Harris JP. Luetic Hearing Loss: Clinical Presentation, Diagnosis, and Treatment. American journal of otolaryngology 1989; 10: 410-421
45 García-Berrocal JR, Górriz C, Ramírez-Camacho R. et al. Otosyphilis mimics immune disorders of the inner ear. Acta Oto-Laryngologica 2006; 126: 679-684
46 Hart G. Syphilis tests in diagnostic and therapeutic decision making. Annals of internal medicine 1986; 104: 368-376
47 Gayet-Ageron A, Combescure C, Lautenschlager S. et al. Comparison of diagnostic accuracy of PCR targeting the 47-kilodalton protein membrane gene of Treponema pallidum and PCR targeting the DNA Polymerase I gene: systematic review and meta-analysis. Journal of clinical microbiology 2015; 53: 3522-3529
48 Buder S, Schöfer H, Meyer T. et al. Bakterielle sexuell übertragbare Infektionen. Journal of the German Society of Dermatology 2019; 17: 287-317
49 Nandwani R, Evans D. Are you sure it’s syphilis? A review of false positive serology. International Journal of STD & AIDS 1995; 6: 241-248
50 Deutsche-STI-Gesellschaft. Leitlinie Diagnostik und Therapie der Syphilis. AWMF online 2020; 1–83 Im Internet. https://www.awmf.org/uploads/tx_szleitlinien/059–002l_S2k_Diagnostik_Therapie_Syphilis_2020_06_1_01.pdf
51 Workowski KA, Bolan GA. Sexually Transmitted Diseases Tretment Guidelines, 2015. MMWR Recomm Rep 2015; 64: 1-137
52 World Health Organization. WHO Guidelines for the Treatment of Treponema pallidum (syphilis). Geneva,; 2016
53 Deutsche Gesellschaft für Neurologie. Neurosyphilis – S1 Leitlinie. AWMF online 2020; 1–38 Im Internet. https://dgn.org/wp-content/uploads/2013/01/030101_LL_Neurosyphilis_2020.pdf
54 Stamm L V. Global Challenge of Antibiotic-Resistant Treponema pallidum. Antimicrobial Agents and Chemotherapy 2010; 54: 583-589
55 Giacani L, Ciccarese G, Puga-Salazar C. et al. Enhanced molecular typing of treponema pallidum subspecies pallidum strains from 4 Italian hospitals shows geographical differences in strain type heterogeneity, widespread resistance to macrolides, and lack of mutations associated with doxycycline resist. Sexually Transmitted Diseases 2018; 45: 237-242
56 Butler T. The Jarisch-Herxheimer Reaction after antibiotic treatment of spirochetal infections: A review of recent cases and our understanding of pathogenesis. The American Journal of tropical medicine and hygiene 2017; 96: 46-52
57 Teklu B, Habte-Michael A, Warrell DA. et al. Meptazinol diminishes the Jarisch-Herxheimer reaction of relapsing fever. The Lancet 1983; 321: 835-839
58 Dobbin JM, Perkins JH. Otosyphilis and hearing loss: Response to Penicillin and steroid therapy. The Laryngoscope 1983; 93: 1540-1543
59 Yimtae K, Srirompotong S, Lertsukprasert K. Otosyphilis: A review of 85 cases. Otolaryngology – Head and Neck Surgery 2007; 136: 67-71
60 Steckelberg JM, McDonald TJ. Otologic involvement in late syphilis. The Laryngoscope 1984; 94: 753-757
61 Wong RT, Lepore ML, Burch GR. et al. Luetic Hearing Loss. The Laryngoscope 1977; 87: 1765-1769
62 Hendershot EL. Luetic Deafness. The Laryngoscope 1973; 83: 865-870
63 Pulec J. Meniere’s disease: results of a two and one-half-year study of etiology, natural history and results of treatment. The Laryngoscope 1972; 82: 1703-1715
64 Hahn RD, Rodin P, Haskins HL. Treatment of neural deafness with prednisone. Journal of Chronic Diseases 1962; 15: 395-409
65 Gleich LL, Linstrom CJ, Kimmelman CP. Otosyphilis: A Diagnostic and Therapeutic Dilemma. The Laryngoscope 1992; 102: 1255-1259
66 Smith ME, Canalis RF. Otologic Manifestations of AIDS: The Otosyphilis Connection. The Laryngoscope 1989; 99: 365-372
67 Chotmongkol V, Khamsai S, Vatanasapt P. et al. Penicillin G sodium as a treatment of otosyphilis with hearing loss. Antibiotics 2019; 8: 4-8
68 Bigelow DC, Kay DJ, Rafter KO. et al. Facial nerve stimulation from cochlear implants. American Journal of Otology 1998; 19: 163-169
69 Karmody C, Schuhknecht H. Deafness in congenital syphilis. Archives of Otolaryngology 1966; 83: 18-27
70 Komamura H, Nakamura T, Kobayashi J. et al. Early neurosyphilis presenting with multiple cranial nerve palsies: A case report of management by combined penicillin-corticosteroid treatment. Journal of Infection and Chemotherapy 2019; 25: 362-364
71 Bolan RK, Beymer MR, Weiss RE. et al. Doxycycline Prophlaxis to Reduce Incident Syphilis among HIV-Infected Men who have Sex with Men who Continue to Engage in High Risk Sex: A Randomized, Controlled Pilot Study. Sexually Transmitted Diseases 2015; 42: 98-103
72 Molina J-M, Charreau I, Chidiac C. et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis 2018; 18: 308-317