Correspondence

Syphilis and Coincidence

N Engl J Med 1995; 332:1175-1176April 27, 1995

Article

To the Editor:

It is instructive to see the vivid illustrations in the Images in Clinical Medicine series, especially Wong and Mihm's images of primary syphilis (Dec. 1 issue).1

The photograph showing the hunterian chancre is superb. Also, Wong and Mihm have demonstrated classic histologic techniques with the hematoxylin-and-eosin staining and the spirochetes visualized with silver staining.

The evaluation of this disease would be enhanced, and an immediate diagnosis of a treatable disorder provided, if direct dark-field microscopy was performed on a serum specimen obtained directly from the edge of the chancre by touching a coverslip to the lesion and pressing the edge. The presence of treponema organisms, which look like twirling, spinning corkscrews, establishes the diagnosis of primary syphilis. This procedure is readily performed with a microscope and a dark-field adapter.

Dark-field microscopy must not be pushed aside when it can offer the most immediate and definite diagnosis, as in this remarkable case, thereby permitting prompt treatment for a potentially destructive systemic disease.

Robert Lee Carter, M.D.
1515 Chain Bridge Rd., McLean, VA 22101

1 References

1
Wong T-Y, Mihm MC Jr. Primary syphilis. N Engl J Med 1994;331:1492-1492
Full Text | Web of Science | Medline

To the Editor:

With two articles on syphilis1,2 and an editorial on the same topic,3 the December 1 issue might be said to be truly venereal. Appropriately, the Images in Clinical Medicine section also concerns syphilis. The master stroke, however, was to place these illustrations on page 1492. Was this inadvertent, or was it a sly reference to the belief — possibly erroneous — that it was the sailors on Columbus's expedition who brought syphilis back from the New World, whereupon the disease ravaged Europe? If the page allocation was inadvertent, it was certainly felicitous.

Alexander S.D. Spiers, M.D., Ph.D.
University of South Florida, Tampa, FL 33682

3 References

1
Gordon SM, Eaton ME, George R, et al. The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. N Engl J Med 1994;331:1469-1473
Full Text | Web of Science | Medline

2
Horowitz HW, Valsamis MP, Wicher V, et al. Cerebral syphilitic gumma confirmed by the polymerase chain reaction in a man with human immunodeficiency virus infection. N Engl J Med 1994;331:1488-1491
Full Text | Web of Science | Medline

3
Musher DM, Baughn RE. Neurosyphilis in HIV-infected persons. N Engl J Med 1994;331:1516-1517
Full Text | Web of Science | Medline

To the Editor:

There is strong evidence that syphilis was introduced into the Old World after Columbus's expedition to the New World in 1492. I am therefore delighted to note the sense of history reflected in the coincidental publication of the images of syphilis on page 1492.

Peter K. Lewin, M.D.
Hospital for Sick Children, Toronto, ON M5G 1X8, Canada