We have diagnosed 4 cases of early syphilis resens at Kyushu University Hospital (Fukuoka, Japan) in a relatively short period (from November 2005 to June 2006), although syphilis is rarely seen in a university clinic these days. The first 2 of the 4 cases were males with refractory genital ulcers and were diagnosed as having typical primary syphilis. The other 2 cases were females with secondary syphilis who developed erythematous papules. One of the females had a high fever, inguinal lymph node swelling and liver dysfunction and previously had been misdiagnosed as having a viral infection in many other clinics, including a dermatology clinic. The skin eruptions and systemic symptoms rapidly improved after the administration of amoxicillin (750-1000 mg/day) for 4 to 7 weeks. During treatment, the syphilis markers, STS and TPHA, were also improved along with the symptoms of secondary syphilis. However, STS, but not necessarily TPHA, reflected the clinical course of primary syphilis in accordance with previous reports. After the historical finding of amoxicillin in 1942, the disease became curable and the diagnosis of syphilis might not be thought of as significant, as in previous times. However, there have been many reports of concomitant syphilitic cases with HIV infection, and Japan is one of the few developed countries where AIDS patients and HIV carriers have been increasing in number. It is thought that the existence of genital ulcerations may allow easy HIV entry through sexual activities. Furthermore, moderate outbreaks of syphilis have occurred in a roughly 20-year cycle in Japan since the end of World War II (1945) for some unknown reasons. According to statistics, such outbreak-peaks seem to come several years after in smaller cities such as Fukuoka. Thus, we would like to point out that diagnostic capabilities for the diagnosis of syphilis are again significant today.
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