Case and Research Letters
Whitish Dots Provide the Key to Diagnosing Condyloma Lata: A Report of 5 Cases
Puntos blanquecinos como clave diagnóstica de condilomas planos: reporte de 5 casos
J. Magdaleno-Tapial, P. Hernández-Bel
, C. Valenzuela-Oñate, V. Alegre-de Miquel
Corresponding author
Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
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Well-defined raised, thickened lesions are evident in the red-colored areas of skin, with no surrounding inflammatory reaction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Conejero, C. Conejero, V. Alcalde, J. García-Latasa de Araníbar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Conejero" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Conejero" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Alcalde" ] 3 => array:2 [ "nombre" => "J." 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Magdaleno-Tapial, P. Hernández-Bel, C. Valenzuela-Oñate, V. Alegre-de Miquel" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Magdaleno-Tapial" ] 1 => array:4 [ "nombre" => "P." "apellidos" => "Hernández-Bel" "email" => array:1 [ 0 => "pablohernandezbel@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Valenzuela-Oñate" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Alegre-de Miquel" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Puntos blanquecinos como clave diagnóstica de condilomas planos: reporte de 5 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 1505 "Tamanyo" => 339246 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Condylomata lata of the 4 patients who showed white spots in the central area of the lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Syphilis, traditionally known as the <span class="elsevierStyleItalic">great imitator</span> remains among us and requires maintaining a high level of diagnostic suspicion. As well as its usual forms of clinical presentation, extremely rare skin manifestations may appear that sometimes make diagnosing this entity difficult.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Condyloma latum (CL) is a classic, though rare, cutaneous manifestation of secondary syphilis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The increased incidence of syphilis may lead to an increase in the number of cases with atypical presentation,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> such as those we describe below.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this study, we collected all the cases of CL diagnosed in the STI unit of the dermatology department of Hospital General de Valencia, Valencia, Spain, between January 2015 and January 2019. In this period, a total of 95 cases were diagnosed, 49.5% of which (47 cases) were secondary syphilis. Of these, 11 cases (23.4%) showed CL in the anogenital region. We found CL with white spots on the surface in only 5 patients diagnosed with syphilis in this time. The characteristics of these patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the physical examination, the 5 patients presented a notable lesion in the perianal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This lesion was raised, with pink fleshy edges surrounding a friable erythematous center with characteristic white spots on the surface. Dermoscopy revealed a lesion with milky-red areas in the center and well-defined pearly globules in the center (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). In Case 1, this lesion was the patient’s only clinical sign. In Cases 3 and 4, this lesion was accompanied by perianal condylomata acuminata (CA).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsies were performed in 2 of the cases to confirm the diagnosis of CL. The characteristics of both samples are very similar, with a psoriasiform hyperplasia of the epidermis with marked exocytosis and formation of spongiform pustules, accompanied by a dense lymphoplasmacytic dermal infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B-D). Immune staining with anti-<span class="elsevierStyleItalic">Treponema pallidum</span> antibodies was positive in both patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the 2 patients with suspected coinfection with the human papillomavirus (HPV), samples were taken for histopathology and genotyping of the virus. One of the patients developed epidermoid carcinoma of the anal canal. Another patient developed perianal CA after a year of follow-up.</p><p id="par0030" class="elsevierStylePara elsevierViewall">CL is a rare pseudotumoral manifestation of secondary syphilis, with an incidence of between 5% and 22%, depending on the series.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In our series, the incidence of CL was 23% of patients diagnosed with secondary syphilis, in relation to studies published in the literature. In other series, prevalence may reach 50%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These lesions are typically defined as plaques or nodules in the anogenital region, with a smooth, flat, or papillary moist surface.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Location outside the genital region has rarely been reported.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> These lesions may be verrucous or pediculated, thus mimicking other diagnoses, such as CA, Bowen disease, anal epidermoid carcinoma, hemorrhoids, or lymphogranuloma venereum.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathogenesis of these lesions is unknown, although their location in moist areas subject to constant friction may be responsible for the transformation of syphilitic papules to CL.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Our series of 5 patients is characterized by flat, raised lesions with an erythematous friable center with clinically visible disperse white spots. These spots are more evident under dermoscopy and appear pearly, rounded, and with clearly defined edges. We have found no other cases of CL that present such clinically characteristic findings. Dermoscopy of CL, however, has been described and reveals multiple small, whiteish, rounded structures in the center of the lesions.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histopathology of 2 of these lesions showed a psoriasiform hyperplasia of the epidermis with marked exocytosis and formation of spongiform pustules, accompanied by a dense lymphoplasmacytic dermal infiltrate. This is similar to cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> However, we have found no reports showing spongiform pustules in CL lesions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Furthermore, coinfection with HPV was found in 3 of the 5 patients, 2 of them with clinical lesions of CA that even masked the CP lesion. This coinfection may be a pathogenic factor in the development of these lesions.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The statement of Sir William Osler notwithstanding, we believe that syphilis is not the only disease one needs to understand in order to become an expert dermatologist.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, the fact that it can simulate any disease forces us to be cautious and to keep this diagnosis in mind, even when it begins with clinically rare manifestations. CL may occasionally be the only manifestation of the disease, and it is therefore important to retain a high degree of suspicion. In conclusion, we present the whiteish spots of syphilitic CL as a novel important clinical finding for being able to make an accurate diagnosis and prescribe appropriate treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-06" "fechaAceptado" => "2019-02-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Magdaleno-Tapial J, Hernández-Bel P, Valenzuela-Oñate C, Alegre-de Miquel V. Puntos blanquecinos como clave diagnóstica de condilomas planos: reporte de 5 casos. Actas Dermosifiliogr. 2020;111:892–895.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 1505 "Tamanyo" => 339246 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Condylomata lata of the 4 patients who showed white spots in the central area of the lesion.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1235 "Ancho" => 1505 "Tamanyo" => 609020 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Dermoscopy of the condyloma latum lesion of Case 5, showing 2 rounded white spots with well-defined edges, on a milky-red central area. B, Histology of a condyloma latum lesion showing a psoriasiform hyperplasia of the epidermis with marked exocytosis and formation of neutrophilic spongiform pustules, accompanied by a dense lymphoplasmacytic dermal infiltrate.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: CA indicates condyloma acuminatum; MSM, man who has sex with men; STIs, sexually transmitted infections; PCR, polymerase chain reaction; RPR, rapid plasma reagin test; TP, <span class="elsevierStyleItalic">Treponema pallidum;</span> HIV, human immunodeficiency virus; HPV, human papillomavirus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age, Y/Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous Diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexual Orientation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous STIs \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Associated Clinical Presentation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RPR on Diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TP PCR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HPV Genotypes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical Course \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1(<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G benzathine 2.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>IU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RPR 1/1. Clinical cure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evanescent maculopapular rash, depapillated tongue, swollen lymph nodes in the groin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 6 in anal swab (after 1<span class="elsevierStyleHsp" style=""></span>year of follow-up, patient developed perianal condylomata acuminata) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G benzathine 2.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>IU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RPR negative. Clinical cure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV, condylomata acuminata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perianal CA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 6 (in condyloma acuminatum lesion) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G benzathine 2.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>IU/3 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RPR negative. Clinical cure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA, papillomatous tumor in anal canal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 16, 62, 72, 81 (epidermoid carcinoma of anal canal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G benzathine 2.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>IU/3 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RPR negative. Clinical cure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perianal genital herpes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV, condylomata acuminata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maculopapular rash \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive (also in pharyngeal exudate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G benzathine 2.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>IU/3 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RPR negative. Clinical cure \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2469266.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiologic Characteristics of the Study Patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nodular secondary syphilis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Hernández-Bel" 1 => "J. López" 2 => "J.L. Sánchez" 3 => "V. Alegre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 2 | 13 |
| 2024 October | 229 | 55 | 284 |
| 2024 September | 301 | 56 | 357 |
| 2024 August | 367 | 72 | 439 |
| 2024 July | 311 | 41 | 352 |
| 2024 June | 280 | 75 | 355 |
| 2024 May | 216 | 39 | 255 |
| 2024 April | 205 | 27 | 232 |
| 2024 March | 228 | 37 | 265 |
| 2024 February | 195 | 23 | 218 |
| 2024 January | 226 | 47 | 273 |
| 2023 December | 207 | 22 | 229 |
| 2023 November | 245 | 37 | 282 |
| 2023 October | 226 | 42 | 268 |
| 2023 September | 222 | 37 | 259 |
| 2023 August | 262 | 19 | 281 |
| 2023 July | 275 | 47 | 322 |
| 2023 June | 196 | 37 | 233 |
| 2023 May | 238 | 49 | 287 |
| 2023 April | 220 | 28 | 248 |
| 2023 March | 221 | 47 | 268 |
| 2023 February | 199 | 41 | 240 |
| 2023 January | 228 | 38 | 266 |
| 2022 December | 238 | 62 | 300 |
| 2022 November | 146 | 43 | 189 |
| 2022 October | 71 | 57 | 128 |
| 2022 September | 46 | 64 | 110 |
| 2022 August | 31 | 54 | 85 |
| 2022 July | 40 | 54 | 94 |
| 2022 June | 50 | 44 | 94 |
| 2022 May | 217 | 56 | 273 |
| 2022 April | 287 | 53 | 340 |
| 2022 March | 353 | 62 | 415 |
| 2022 February | 358 | 35 | 393 |
| 2022 January | 364 | 59 | 423 |
| 2021 December | 335 | 59 | 394 |
| 2021 November | 394 | 62 | 456 |
| 2021 October | 449 | 89 | 538 |
| 2021 September | 362 | 64 | 426 |
| 2021 August | 434 | 51 | 485 |
| 2021 July | 360 | 38 | 398 |
| 2021 June | 387 | 59 | 446 |
| 2021 May | 318 | 70 | 388 |
| 2021 April | 518 | 155 | 673 |
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| 2020 December | 80 | 30 | 110 |
| 2020 November | 14 | 28 | 42 |
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