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Clinical and laboratory aspects of condylomata lata lesions of syphilis
  1. Janet M Towns1,2,
  2. Ian Denham1,
  3. Eric P F Chow1,2,
  4. Stephen Graves3,
  5. Christopher K Fairley1,2,
  6. Deborah Williamson4,5,
  7. Francesca Azzato5,
  8. Marcus Y Chen1,2
  1. 1Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
  2. 2Central Clinical School, Monash University, Clayton, Victoria, Australia
  3. 3Barwon Health, Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
  4. 4Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  5. 5Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  1. Correspondence to Dr Janet M Towns, Melbourne Sexual Health Centre, Carlton, Victoria, Australia; jtowns{at}mshc.org.au

Abstract

Objectives Condylomata lata are a less common but distinctive syphilitic lesion. Variable theories as to their nature and origin exist. The aim of this study was to determine the clinical and laboratory characteristics of condylomata lata by determining (1): the most closely aligned stage of syphilis, based on the rapid plasma reagin (RPR) titre; (2) symptom duration and (3) Treponema pallidum PCR cycle threshold (CT) values, as an indicator of organism load.

Methods This was a retrospective study of patients with T. pallidum PCR-positive condylomata lata lesions, attending a clinic in Melbourne, Australia, between 2011 and 2021. Syphilis serology was undertaken and RPR titres compared between condylomata lata, primary and secondary syphilis cases.

Results 51 cases with T. pallidum PCR-positive condylomata lata were included. 41 cases were in men, 40 of whom were men who have sex with men (MSM), and 10 in women. Twelve of 51 (24%) cases were in HIV-positive MSM. Thirty-three of 51 (65%) had other mucocutaneous signs of secondary syphilis; 18 (35%) had no other signs of secondary syphilis. The median RPR titre among the 51 condylomata lata cases was 1:128, compared with the median RPR titre of primary syphilis (1:4) and of secondary syphilis (1:128). The median duration of lesions was 24 (IQR 10–60) days, with no significant difference between those with and without other signs of secondary syphilis (p=0.75). Median CT values for condylomata lata (CT=31) and primary syphilis (CT=31) were significantly lower than for other secondary syphilis lesion types (CT=33), indicating higher T. pallidum loads for condylomata lata and primary lesions compared with other secondary syphilis lesion types.

Discussion These findings support condylomata lata as lesions that occur during the secondary stage of syphilis and which are likely to be highly infectious.

  • Polymerase Chain Reaction
  • SYPHILIS
  • DIAGNOSIS

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Bea Vuylsteke

  • Twitter @EricPFChow, @drdebwilliamson

  • Contributors JMT planned the study and performed the data analysis. JMT and MYC drafted the final version of the manuscript. EPFC and CKF provided advice on statistical analysis. All authors critically reviewed and approved the final manuscript. JMT is responsible for the overall content and acts as guarantor for the work.

  • Funding This work was supported by the Australian National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP2003399). EPFC is supported by an NHMRC Emerging Leadership Investigator Grant (GNT1172873). DW is supported by an NHMRC Investigator Grant (APP1174555). JMT is supported by a Monash University post-doctoral fellowship bridging grant.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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