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Open access

Milan Bjekić

Abstract

Artificial penile nodules are inert objects inserted beneath the skin of the penis. Objects placed underneath the skin of the penile shaft may include plastic beads made from toothbrushes, silicon, metal pellets, glass, ivory, precious metals, marbles or pearls. The penile bead implantation is performed largely due to the belief that it will enhance sexual performance and pleasure of female or male sexual partners during intercourse. In this article, three cases with artificial penile nodules made of toothbrushes and dice are presented. All three men have implanted foreign bodies underneath the dorsal aspect of the penile skin during their prison stay and implantations were not followed by any side effects. However, insertion of foreign bodies may be followed by early and late complications and transmission of blood-borne viruses. Penile implants are important for dermatological consideration, because they make condom use more difficult and may represent a risk factor for sexually transmitted infections.

Open access

Milan Bjekić

Abstract

Two feet-one hand syndrome is a superficial fungal infections of the skin which involves both feet and one hand. Trichophyton rubrum and occasionally Trichophyton mentagrophytes are the usual causative organisms.

We present a 32-year-old healthy man with sharply demarcated papular erythematous and squamous lesions on dorsal aspect of the feet and diffuse dry scaling lesions of the right palm. In this syndrome, the development of tinea pedis generally precedes the development of tinea manus, which usually occurs on the hand that excoriated the pruritic feet or picked the toenails with onychomycosis. Our patient often used his dominant right hand to scratch the feet.

On mycological examination, fungal spores and mycelia were present and Trichophyton mentagrophytes was isolated. The patient was treated with itraconazole 200 mg daily for two weeks and topical terbinafine cream for four weeks. After the treatment all lesions resolved and fungal culture was negative.

Early diagnoses and treatment of tinea pedis and education about prophylaxis, constant care and regular medical assistance would minimize this problem in predisposed individuals.

Open access

Milan Bjekić

SUMMARY

Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis.

Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

Open access

Milan Bjekić

Abstract

Lues maligna is a rare ulcerative form of secondary syphilis. This clinical entity is predominantly found in patients living with HIV or AIDS. We report a case of a 32-year-old homosexual man with diffuse non-pruritic, papular skin lesions, ulcerated nodules and plaques disseminated on the face, trunk and extremities. The rash was followed by fever, malaise and joint pains. Serological tests for syphilis were positive. The patient was treated with intramuscular penicillin and the lesions resolved completely. Lues maligna was an initial presentation of underlying HIV infection. The HIV seropositivity was confirmed by Western blot analysis. Due to the increased number of syphilis cases and frequent HIV co-infection in Serbia, dermatologists must be able to recognize this condition based on clinical characteristics and risk factors and to diagnose and treat it promptly.

Open access

Milan Bjekić

Abstract

The aim of this study was to analyze the characteristics and clinical manifestations of secondary syphilis among patients registered at the City Institute for Skin and Venereal Diseases in Belgrade, during the period from 2010 to 2014. The study was designed as a case-note review. In the five-year period, a total of 62 patients with secondary syphilis were registered. The average patient age was 32 years. There were 45 (72.6%) HIV-negative, and 17 (27.4%) HIV-positive patients. The incidence of HIV–positive patients was significantly different from random distribution (p = 0.016). All HIV-positive patients were unmarried men. A significant percentage of HIV-positive patients were unemployed (p < 0.001), reported unknown source of infection (p = 0.002) and were all homosexuall (p = 0.026). More than 25% of all patients with syphilis had a history of chancres, and it was still present at the time of examination in 11.3% of all patients. The majority of cases (87.1%) had a rash, and lymphadenopathy was found in 20% of patients. However, syphilitic alopecia was detected only in HIV-positive cases (p = 0.004). There were no statistically significant differences between HIV-positive and HIV-negative patients in regard to other clinical manifestations, such as mucous patches and condylomata lata. Being a great imitator, secondary syphilis may manifest in a myriad of diverse morphological entities and clinical manifestations. We review a range of cutaneous manifestations of secondary syphilis and skin diseases it may mimic. Clinicians must be vigilant and consider syphilis in differential diagnosis, and maintain a high index of suspicion, especially when assessing vulnerable populations, such as men who have sex with men and HIV-infected individuals.

Open access

Milan Bjekić and Sandra Šipetić

Abstract

The purpose of this study was to analyze the characteristics of an outbreak of early syphilis registered at the City Institute for Skin and Venereal Diseases in Belgrade, during the period from 2010 to 2012. The study was designed as a case-note review. In a three-year-long period, a total of 86 patients with early syphilis were registered: 33 cases of primary, 31 of secondary and 22 cases of early latent syphilis. Sixty-five (76.5%) of all patients were men who have sex with men, 15 were heterosexual men and 6 were women. The majority of patients were infected in Belgrade, and in 51/86 cases oral sex was the only risk factor. There were 13 HIV-positive patients, all men who have sex with men. Thus, 20% of men who had sex with men in this study were co-infected with HIV. In conclusion, this outbreak of early syphilis in Belgrade, in which more than two thirds of all patients were men who have sex with men, of whom 20% were HIV-infected, shows the need for: 1) enhanced prevention efforts targeting this group more important than ever, with education and condom use for oral sex as an important part of patient counseling; 2) coordinated and expeditious surveillance, partner services, screening among population at-risk, as well as early diagnosis and treatment.

Open access

Milan D. Bjekić

Abstract

Hand, foot and mouth disease is a systemic infection caused by enteroviruses. It is highly contagious, spreads by direct contact, and is commonly seen in young children. The disease is characterized by ulcerative oral lesions and a vesicular rash on palms, soles and characteristically between the fingers and toes, associated with mild systemic symptoms and signs such as fever and lymphadenopathy.

We present a 35-year-old man referred to a dermatologist with mouth lesions and skin rash. The patient had a fever, followed by a sore throat and malaise, which occurred two days before the rash. Physical examination revealed numerous superficial erosions and small vesicular lesions on the lower lip mucous membrane and on the hard palate, and also, multiple, discrete small vesicular lesions on fingers and toes. The patient was treated symptomatically and all the lesions resolved completely in a week. Adults with hand, foot and mouth disease usually experience milder symptoms than children. In conclusion: the disease should not be overlooked in middle-aged adults with a vesicular rash.

Open access

Milan Bjekić and Sandra Šipetić

Abstract

Human immunodeficiency virus (HIV) infection may be associated with a wide spectrum of dermatological disorders. This study reports the prevalence of dermatologic diseases and sexually transmitted infections among 38 HIV-infected adults who consecutively sought treatment at the City Institute for Skin and Venereal Diseases in Belgrade. Patients were referred by their primary HIV providers between January 2011 and June 2012. More than 80% of patients were men who have sex with men. The most prevalent diseases were anogenital warts (36.8%) and syphilis (34.2%), followed by folliculitis and dermatophyte infections (7.9% each). Thirty-four patients (89.5%) were on highly active antiretroviral therapy (HAART) before the first visit to the dermatologist. Although, the pattern of skin disorders was consistent with literature data, high prevalence of sexually transmitted infections among our patients was rather peculiar. These facts point to the need for education of sexually active persons with HIV about the consequences of sexually transmitted infections, risks of transmission of drug resistant HIV strains, as well as safe sex practice and consistent condom use.

Open access

Milan Bjekić and Hristina Vlajinac

Abstract

“Contact tracing” or “partner notification” refers to clinicians’ efforts to identify sex partners of infected persons to ensure their medical evaluation and treatment. For many years partner notification has been a cornerstone in the management of patients diagnosed with sexually transmitted infections (STIs) and it is the essential component in the control of these infections. Clinicians’ efforts to ensure the treatment of a patient’s sex partners can reduce the risk for re-infection and potentially diminish transmission of STIs. Partner notification includes three different approaches for notifying the sexual partners of the person infected with a STI: provider referral, patient referral, and contract referral. The aim of our study was to evaluate the efficacy of partner notification among syphilis and gonorrhea cases registered at the City Institute for Skin and Venereal Diseases in Belgrade in 2016, and its contribution to prevention and control of these diseases. A retrospective chart review of patients with gonorrhea and early syphilis registered in 2016 was undertaken. We analyzed data about the possible source of infection as well as sexual orientation, provided on the official form for notification of syphilis and gonorrhea. The study included 112 male patients, 67 with gonorrhea and 45 with syphilis. Out of three modalities of partner notification offered to patients, only patient notification of sexual partner/s was accepted. Although all patients accepted this type of partner notification, index patients with gonorrhea notified only 17 partners (25.4%) and index patients with syphilis also notified 17 partners (37.8%). The effectiveness of partner notification for gonorrhea and syphilis cases was only 30.4%, and its contribution to prevention and control of these diseases was lower than we expected. National guidelines offering standardized protocols for partner notification service provision can improve this process, as a novel approach with non-traditional method of partner notification such as patient-delivered partner therapy.

Open access

Milan Bjekić and Kiro Ivanovski

Abstract

Oral lesions are described in all stages of syphilis, except in the latent stage. During the secondary stage of infection, oral lesions, saliva and blood of infected person are very contagious. The aim of this case report was to point to the secondary syphilis in differential diagnosis of oral diseases.

A 30-year-old homosexual man presented with a three-week history of a painless verrucous lesion on his lower lip. Physical examination revealed a hypertrophic painless papillomatous lesion on the lower lip. The lesion was partly split with peripheral fissures. There were no generalized lymphadenopathies and no evidence of systemic disease. Further examination showed no other mucous membrane or cutaneous lesions elsewhere on the body. The external genitalia were normal. The patient was HIV-negative and otherwise healthy. A review of his medical history was significant for previous well documented treatment of anal chancre, which was successfully commenced at our Institute in 2010. It also revealed a history of a single unprotected receptive oral sex with an unknown partner 3 months before the onset of lesion. The diagnosis of condyloma latum on the lower lip was considered on clinical grounds. Laboratory findings, including complete blood count and blood chemistry were within normal limits. The VDRL (venereal disease research laboratory) test was positive with a titre of 1 : 128. Treponema pallidum hemagglutination assay (TPHA) was positive. HIV serology was non-reactive.

The final diagnosis of solitary condyloma latum on the lower lip, as the only sign of secondary syphilis, was confirmed by positive results of routine serologic tests for syphilis. The patient was diagnosed with secondary syphilis and treated with a single intramuscular injection of benzathine penicillin, 2.4 million units. The lesion regressed completely within 2 weeks. Three months later the VDRL titer had fallen to 1 : 8 and HIV serology remained negative.

Polymorphic oral manifestations in syphilis indicate that this disease should not be overlooked in the differential diagnosis of not only benign, but even malignant oral lesions.

In conclusion, as far as the world literature available to us is concerned, this would be the first report of isolated solitary condyloma latum on the oral lip that, in the absence of any other clinical signs or symptoms of the disease, led to the diagnosis of secondary syphilis.