Pablo Hernández Bel

Background: Syphilis, caused by Treponema pallidum , is a re‐emerging sexually transmitted infection. The oropharynx may be a site of T. pallidum DNA detection, but real‐world data on the diagnostic performance and epidemiological relevance of pharyngeal polymerase chain reaction (PCR) are scarce. Methods: We retrospectively analyzed 149 pharyngeal PCR testing episodes from 131 unique patients collected between 2018 and 2025. Seventy‐six testing episodes were classified as syphilis cases, defined by compatible clinical features, serology, and/or PCR positivity at another site, along with 73 controls. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results were contextualized through a literature review. Results: Pharyngeal PCR was positive in 38 of 76 syphilis cases (50%), with a specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 65.8%. Positivity rates were 44.4% in primary syphilis, 55.8% in secondary syphilis, 55.6% in early latent syphilis, and 0% in late latent syphilis. Notably, T. pallidum DNA was detected in the pharynx of patients without oral lesions and in some primary syphilis cases with negative rapid plasma reagin (RPR), suggesting possible early oropharyngeal mucosal shedding. In contrast, certain palmoplantar lesions yielded negative PCR results despite concomitant pharyngeal positivity. Conclusions: Pharyngeal PCR is a highly specific complementary diagnostic tool, particularly useful in early syphilis and in cases with discordant serology. Detection of T. pallidum DNA in the oropharynx, even without oral lesions, provides evidence of mucosal DNA shedding and suggests potential implications for transmission dynamics. However, PCR does not demonstrate viable organisms, and whether such DNA detection reflects organisms capable of transmission requires further study. image

The global resurgence of treponematoses, particularly syphilis, poses a growing public health challenge. Despite recent advances in sequencing technologies, obtaining complete Treponema pallidum genome sequences for epidemiological studies remains time-consuming and challenging due to the difficulty related to procuring clinical samples with sufficient treponemal burden to fulfil the sequencing requirements. There is an urgent need for rapid, cost-effective and accessible typing methods suitable for laboratories with Sanger sequencing resources. Based on the analysis of 121 T. pallidum genomes from geographically diverse regions, we selected seven highly variable genes to form the basis of this new typing system. These seven genes show high discrimination capacity, identifying many allelic profiles among T. pallidum isolates. Importantly, the scheme employs a single-step PCR protocol for the amplification and sequencing of all seven targets enabling straightforward implementation in standard laboratory settings. The MLST was validated using a diverse set of T. pallidum clinical samples from across the globe. A significant proportion of the tested samples showed macrolide resistance, emphasizing the need for epidemiological surveillance. Utilizing this new tool, we have analyzed the genetic variation within and between populations of T. pallidum , considering the geographical origin of the samples. Population structure analysis revealed distinct genetic clusters, underlining complex transmission dynamics of T. pallidum , shaped by local epidemiological factors. The MLST scheme is publicly accessible through the PubMLST database, encouraging widespread adoption in standard laboratories due to this database being user-friendly, intuitive, and fast to implement. The novel MLST scheme offers a promising tool to advance the study of the molecular epidemiology of T. pallidum , facilitate tracking transmission, and establish a global surveillance network with the overall goal of strengthening public health interventions for syphilis control.

Background. Current psoriasis treatment goals emphasize achieving complete or near‐complete skin clearance while preserving the quality of life, necessitating treatment modification for a suboptimal or inadequate response. Despite risankizumab’s demonstrated efficacy, evidence remains limited for patients switching from ustekinumab, particularly those with suboptimal or inadequate response. Objective. This study assesses risankizumab’s real‐world effectiveness in patients with suboptimal response (PASI 2‐3), inadequate response (PASI 3–5), or failure (PASI >5) to ustekinumab, based on a multicenter retrospective cohort in Spain. Method. A multicenter retrospective study across 24 Spanish hospitals included 102 patients previously treated with ustekinumab and switched to risankizumab. Results. Out of 102 patients, 78 experienced ustekinumab treatment failure (PASI >5), while 24 had an inadequate response (PASI 3–5), including 6 with a suboptimal response (PASI 2‐3). Remarkably, after one year of treatment with risankizumab, all patients demonstrated improvement, achieving near‐complete or complete skin clearance (PASI 0‐1). Conclusion. Risankizumab displayed effectiveness in patients with suboptimal/inadequate response or treatment failure to ustekinumab, aligning with the current treatment goals of complete or near‐complete skin clearance. These real‐world results corroborate clinical trial data, emphasizing risankizumab’s potential as a powerful therapeutic alternative for this patient population. Further prospective studies are essential to validate these findings.

We report, to the best of our knowledge, the first case of Bowen disease treated with tirbanibulin. In addition to the successful treatment of the malignant lesions, the improvement in skin texture and photodamage is remarkable. With a good safety profile, tolerability and the dosing convenience of this new drug, we believe that its use in pathologies beyond Olsen grade 1 actinic keratoses is promising, but further studies are required.

Monkeypox is a rare zoonotic disease with a progressive increase in cases among men who have sex with men (MSM) worldwide in recent months. New complications of this infection have been described. The aim of the study was to describe this new pattern of presentation of monkeypox at the level of the finger. We present the cases of three patients with monkeypox whitlow, a new clinical presentation of monkeypox. The patients were three MSM with ages ranging from 32 to 49 years. All three had involvement of the third finger of the dominant hand as well as skin lesions at other sites. Two of the three patients had severe inflammation in the digit and proximal arm and were treated with systemic corticosteroids with significant improvement. In two of the three cases we observed onychodystrophy as a complication. All patients reported sexual intercourse with previous digital-anal penetration with the affected finger, which may be the mode of transmission. Distinguishing features that need to be considered are discussed.