Histologic Features of Secondary Syphilis: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
ABSTRACT: Secondary syphilis, caused by Treponema pallidum and known as the "the great imitator," presents with varied manifestations that may mimic other skin conditions. Histopathology is critical when clinical or serologic findings are atypical, and this study analyzed its key features to improve recognition and reduce diagnostic errors. A systematic search was conducted in PubMed, Embase, and Cochrane. Statistical analyses were performed using R, version 4.3.2. A random-effects model was used to determine the proportion with 95% confidence interval (CI). Heterogeneity was assessed using Cochrane Q test and I2 statistics. Eight studies encompassing 384 patients and 460 lesions were included. The mean age was 38.1 years, and approximately 24% of the patients were female. The most common histological features were endothelial swelling, reported by five studies, with a prevalence of 85% (95% CI 0.75-0.96; I2 = 82.6%), and moderate to dense plasma cell infiltration, as reported by six studies, with a prevalence of 83% (95% CI 0.74-0.92; I2 = 90.7%). Acanthosis was observed in six studies, with a prevalence of 66% (95% CI 0.47-0.86; I2 = 96.0%), followed by perivascular inflammatory infiltrate, reported in five studies, with a prevalence of 64% (95% CI 0.37-0.90; I2 = 96.9%). Histopathology reveals consistent features, particularly endothelial swelling and plasma cell-rich infiltrates, in secondary syphilis, reinforcing its diagnostic value when clinical or serologic findings are inconclusive.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.021 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.028 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".