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Sample records for syphilis

  1. Syphilis

    MedlinePlus

    ... can I get more information? Sexually Transmitted Diseases http: / / www. cdc. gov/ std/ Syphilis http: / / www. cdc. gov/ std/ syphilis/ Syphilis and MSM Fact Sheet http: / / www. cdc. gov/ std/ syphilis/ STDFact- MSM- Syphilis. ...

  2. Syphilis

    MedlinePlus

    ... Health Gynecology Medical Conditions Nutrition & Fitness Emotional Health Syphilis Posted under Health Guides . Updated 6 September 2016. + ... early to avoid serious problems. How common is syphilis? According to the Centers for Disease Control and ...

  3. Syphilis

    MedlinePlus

    Syphilis is a sexually transmitted disease caused by bacteria. It infects the genital area, lips, mouth, or ... of both men and women. You usually get syphilis from sexual contact with someone who has it. ...

  4. Syphilis

    MedlinePlus

    ... women who have sex with women get syphilis? Yes. It is possible to get syphilis, or any other STI, if you are a woman who ... sex and avoid sexual activity during an outbreak. Yes. It is possible to get syphilis, or any other STI, if you are a woman who ...

  5. Syphilis

    MedlinePlus

    ... easier to get or give someone HIV during sex. If you are pregnant, syphilis can cause birth defects, or you could lose your baby. In rare cases, syphilis causes serious health problems and even death. Syphilis is easy to cure with antibiotics if ...

  6. Syphilis.

    PubMed

    Zeltser, Ross; Kurban, Amal K

    2004-01-01

    In the last half of the 20(th) century, medicine has made tremendous inroads against syphilis chiefly owing to the introduction of penicillin and vigorous public health initiatives. Yet, the world continues to be burdened by this disease. Since 2000, overall rates of syphilis have risen in the US and throughout the world. Furthermore, through its association with an increased risk of HIV infection, syphilis has acquired a new potential for morbidity and mortality. The aim of this review is to survey the latest knowledge about syphilis, including pathogenesis and host response, clinical manifestations, diagnostic methods and, especially, treatment and follow-up. PMID:15596316

  7. Syphilis - primary

    MedlinePlus

    Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis ... Syphilis is a sexually transmitted, infectious disease caused by the spirochete bacterium Treponema pallidum . This bacterium causes ...

  8. Syphilis - primary

    MedlinePlus

    ... patients will have late complications of syphilis. Late syphilis may be permanently disabling, and it may lead to death. ... Cardiovascular complications (aortitis and aneurysms) Destructive ... to the developing baby. This is called congenital syphilis.

  9. [Congenital syphilis].

    PubMed

    Tabák, Réka; Tabák, Adám; Várkonyi, Viktória

    2010-01-10

    Syphilis has been a re-emerging disease in the past few decades. As a consequence, the prevalence of congenital syphilis is expected to be on the rise. Maternal syphilis may be related to several pathologies, such as miscarriage, stillbirth, or congenital syphilis in the child. Infants that acquire syphilis in utero are frequently asymptomatic, and the organ damage caused by the infection may be apparent only years later. Syphilis is a curable disease, and most of its complications in the infant can be prevented by screening and treating the mother. Every newborn potentially infected should be treated with penicillin immediately starting on the day of birth. PMID:20061233

  10. Congenital syphilis

    MedlinePlus

    ... fact that this disease can be cured with antibiotics if caught early, rising rates of syphilis among pregnant women in the United States have increased the number of infants born with congenital syphilis.

  11. [Ocular syphilis].

    PubMed

    Chiquet, C; Khayi, H; Puech, C; Tonini, M; Pavese, P; Aptel, F; Romanet, J-P

    2014-04-01

    Syphilis is a sexually transmitted disease caused by Treponema pallidum. Previously known as the "great imitator", this disease can have numerous and complex manifestations. The ophthalmologist should suspect the diagnosis in patients with uveitis or optic neuropathy and high-risk sexual behavior and/or another sexually transmitted disease (such as HIV) or those presenting with posterior placoid chorioretinitis or necrotising retinitis. Ocular involvement in acquired syphilis is rare, tending to occur during the secondary and tertiary stages of the disease. Syphilis may affect all the structures of the eye, but uveitis (accounting for 1-5% of the uveitis in a tertiary referral center) is the most common ocular finding. Granulomatous or non-granulomatous iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%) are often described. In the secondary stage, the meninges and the central nervous system can be affected, sometimes with no symptoms, which justifies performing lumbar puncture in patients with uveitis and/or optic neuropathy. The diagnosis of ocular syphilis requires screening with a non-treponemal serology and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of ocular syphilis. Systemic corticosteroids are an appropriate adjunct treatment for posterior uveitis, scleritis and optic neuritis if ocular inflammation is severe. Prolonged follow-up is necessary because of the possibility of relapse of the disease. With proper diagnosis and prompt antibiotic treatment, the majority of cases of ocular syphilis can be cured. PMID:24655791

  12. Syphilis: an update.

    PubMed

    Little, James W

    2005-07-01

    Syphilis can be spread during the practice of dentistry by direct contact with mucosal lesions of primary and secondary syphilis or blood and saliva from infected patients. The dentist also can play an important role in the control of syphilis by identification of the signs and symptoms of syphilis, patient education, and referral. The incidence of syphilis and the impact of control measures are presented with the emphasis on the past 5 years. The signs and symptoms of primary, secondary, latent, and late (tertiary) syphilis are reviewed. Current medical treatment is presented. The oral manifestations of syphilis are discussed as well as the dental management of the infected patient. PMID:15953910

  13. Syphilis Profiles, 2012

    MedlinePlus

    ... STD on Facebook Data & Statistics Sexually Transmitted Diseases Syphilis Profiles, 2012 Recommend on Facebook Tweet Share Compartir ... Profiles The following profiles provide an overview of syphilis morbidity in each of the 50 states, the ...

  14. Syphilis management and treatment.

    PubMed

    van Voorst Vader, P C

    1998-10-01

    Syphilis poses a serious health problem in many developing countries and in some areas of North America and Europe, especially Eastern Europe. This article initially addresses the state of the art regarding the interaction between syphilis and HIV infection and its consequences for management and treatment. Further attention is given to laboratory diagnosis of syphilis and false-positive and false-negative serologic reactions. The diagnosis and management of neurosyphilis, ocular, cardiovascular, and congenital syphilis are addressed, as well as management of syphilis patients allergic to penicillin and the Jarisch-Herxheimer reaction. Finally, the role of partner(s) and contact tracing is discussed. PMID:9891669

  15. Syphilis in adults

    PubMed Central

    Goh, B

    2005-01-01

    Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection. PMID:16326843

  16. Diagnostic tests for syphilis

    PubMed Central

    Johnson, Steven C.

    2014-01-01

    Summary Syphilis is a sexually transmitted infection caused by Treponema pallidum. A total of 13,106 cases of primary and secondary syphilis were reported in the United States in 2011 and the rate of infection has increased in subgroups, particularly men who have sex with men. The disease is mainly diagnosed through clinical findings and serologic testing. However, no single serologic test of syphilis is sufficient. Hence, the serologic diagnosis of syphilis requires the detection of 2 types of antibodies (nontreponemal antibodies and treponemal antibodies). The paradigm in syphilis testing has recently shifted in many centers to screen with a treponemal antibody test, reflexing to a nontreponemal test if the treponemal antibody test is positive. This reverse of the traditional algorithm may not be widely recognized among clinicians.

  17. Syphilis (For Parents)

    MedlinePlus

    ... large blood vessels, heart, bones, and central nervous system (called neurosyphilis). Symptoms of this late stage of syphilis can include memory loss, problems with mental function, walking, balance, bladder ...

  18. [Cutaneomucous tertiary syphilis].

    PubMed

    Sekkat, A; Sedrati, O; Derdabi, D

    1994-01-01

    On the basis of two new cases of cutaneous mucosal tertiary syphilis and a personal series of 30 cases observed at the University Hospital of Rabat and Casablanca from 1963 to 1980, we reviewed the clinical presentations of this disease. Late stage syphilis has not disappeared and appears to be increasing over the last decade. Lesions of the nervous system are increasingly reported in atypical often unrecognized forms. Cutaneous mucosal tertiary syphilis is very rare and little known and can take on the form of skin lesions suggesting tuberculosis, deep mycosis, sarcoidosis, leprosy or leishmaniasis. Based on our experience, we recall the variety of clinical presentations including superficial nodules and deep gommas leading to atrophic and rarely hypertrophic scars. The diagnosis relies essentially on the serology results which are always positive at a significant level. The pathology examination adds no essential information. Rapid response to treatment is one of the important criteria of the diagnosis of syphilis. PMID:7979026

  19. [Cardiovascular syphilis: diagnosis, treatment].

    PubMed

    Carrada-Bravo, Teodoro

    2006-01-01

    Cardiovascular tertiary syphilis may lead to aortitis, aortic aneurism, coronary stenosis, aortic insufficiency and, rarely, to myocarditis. The physician must be familiar with the clinical presentations of this process, including the asymptomatic variety and must be able to have an organized plan for the diagnosis and evaluation to establish or exclude the presence of cardiovascular pathology and the differential diagnosis with other entities. Once the etiologic and topographic diagnosis is established, the patient should be treated with penicillin, doxicycline and other antibiotics, and the consequences of the disorder, both actual and potential, should be considered before deciding weather to recommend surgical intervention. Although late syphilis can be prevented by appropriate therapy of early syphilis, this is a cardiovascular disease that most likely will continue to be diagnosed lately. Understanding of the pathology and pathophysiology of the disease, is most important for its prompt recognition and subsequent management. This paper reviews the natural history, diagnosis and therapy of cardiovascular syphilis. PMID:17469346

  20. Pregnancy Complications: Syphilis

    MedlinePlus

    ... Syphilis usually is treated with an antibiotic called penicillin. Antibiotics are medicines that kill infections caused by ... less than a year, a single shot of penicillin usually can cure the infection. But if you’ ...

  1. Treatment of primary syphilis.

    PubMed

    Elliott, W C

    1976-12-01

    Reports in the English language of the treatment of primary syphilis are reviewed. Except for benzathine penicillin, the efficacy of the currently recommended dosage schedules are documented only by Schroeter et al. Although these investigators reported generally acceptable failure rates, further study is necessary to determine: (1) if differences in efficacy exist among regimes; (2) if the current schedules are equally effective in both primary and secondary syphilis; and (3) if increased dosages reduce failure rates. PMID:1010777

  2. Brief History of Syphilis

    PubMed Central

    Tampa, M; Sarbu, I; Matei, C; Benea, V; Georgescu, SR

    2014-01-01

    Abstract Before the discovery of Treponema pallidum as the etiologic agent, the origins of syphilis have been the subject of several debates. Diverse therapeutic agents were employed in an attempt to cure the disease. Examining the milestones in the history of syphilis, the present article reviews the existing theories that tried to explain the origins of the disease, the approach in art, the cultural and the evolution of the treatments from the empiric means to the discovery of penicillin. PMID:24653750

  3. [Syphilis and blood transfusion].

    PubMed

    Serrano, J

    1991-06-01

    Along 17 years (1973-1989), syphilis screening has been performed on 146,355 blood units in the author's blood bank. A total number of 143 positive results (confirmed by MHA-TP) was registered, which means an incidence of 0.097%. Of the total number of blood units, 31,529 came from professional donors, 51 of them (0.16%) being positive, while of the 114,826 blood units from voluntary donors 92 were positive (0.08%). With respect to voluntary donations, the highest incidence of positive reactions was found between 1980 and 1982, but this period registered also the highest number of blood units studied. Along this 17 year period 8 patients have received blood products with positive syphilis test. They were transfused on urgent request with fresh blood or platelet concentrates, the transfusion being performed before knowing the results of the screening for syphilis. No special measures were taken in 2 such cases, who died shortly after the transfusion on account of their disease. Two other were treated with penicillin at the time of transfusion. The remaining four patients received preventive penicillin. Even taking into account that positive screening tests are uncommon amongst blood donors, and that only under special circumstances the patients receiving contaminated blood may develop the illness, it seems advisable for every blood bank to perform the screening for syphilis on every blood donation. PMID:1948541

  4. Syphilis and borreliosis during pregnancy.

    PubMed

    Hercogova, J; Vanousova, D

    2008-01-01

    Syphilis and lyme borreliosis have similar etiologic, clinical, and epidemiologic characteristics. Both are multisystem infectious disorders spread worldwide. Their clinical course can be divided into three stages and as to spirochetal origin, antibiotic therapy is similar too. Taxonomical relationship of Treponema and Borrelia could explain also congenital manifestations well-known in syphilis, and suggested in borreliosis. Therapy of pregnant women with syphilis and lyme borreliosis should follow the same strategy. PMID:18564251

  5. Oral Manifestations of Secondary Syphilis.

    PubMed

    de Paulo, Luiz Fernando Barbosa; Servato, João Paulo Silva; Oliveira, Maiolino Thomaz Fonseca; Durighetto, Antonio Francisco; Zanetta-Barbosa, Darceny

    2015-06-01

    Known as "the great imitator," secondary syphilis may clinically manifest itself in myriad ways, involving different organs including the oral mucosa, and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians. We highlight the clinical aspects of oral manifestation in 7 patients with secondary syphilis. Clinicians should consider secondary syphilis in the differential diagnosis of ulcerative and/or white oral lesions. PMID:25892249

  6. Syphilis in the United States.

    PubMed

    Shockman, Solomon; Buescher, Lucinda S; Stone, Stephen P

    2014-01-01

    Syphilis gained notoriety in the 1500s, when it became widespread throughout Europe. While the origins of syphilis are not certain, recent data have shown that it may have originated in the Americas from a close relative that causes Yaws (Treponema pallidum pertenue).(1) For the past 500years, the disease has shown its various faces all over the world. The 19th century saw an entire medical subspecialty-syphilology (sometimes known as syphilography)-devoted to the study of the great disease, then known as "the great imitator." Syphilis has an entire textbook of presentations and can mimic many other infections and immune-mediated processes. At the beginning of the 20th century, the many faces of the disease led to Sir William Osler's well-known aphorism, "The physician who knows syphilis knows medicine."(2) When penicillin was discovered, and used to treat syphilis in 1943, some thought that syphilis would go by the wayside, but syphilis continued what it has been doing for so many years . . . inconspicuously infecting humans. The United States has seen the incidence of syphilis increase numerous times throughout the past 70years. Every decrease in the incidence of syphilis is followed shortly by an increase. A marked shift in the epidemiology occurred from 1990 to 2000. In the 1990s, syphilis primarily occurred in heterosexual minority groups. In the new millennium, a majority of cases of syphilis are now transmitted among men who have sex with men (MSM).(3) This contribution discusses the incidence of syphilis in the United States and the reasons these trends continue. PMID:24559556

  7. Eponyms in syphilis

    PubMed Central

    Vashisht, Deepak; Baveja, Sukriti

    2015-01-01

    Eponym has originated from the Greek word “eponymos” meaning “giving name”. It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628

  8. Eponyms in syphilis.

    PubMed

    Vashisht, Deepak; Baveja, Sukriti

    2015-01-01

    Eponym has originated from the Greek word "eponymos" meaning "giving name". It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade. PMID:26692628

  9. Oral Secondary Syphilis.

    PubMed

    Carbone, Peter N; Capra, Gregory G; Nelson, Brenda L

    2016-06-01

    Secondary syphilis develops in approximately 25 % of patients infected with the spirochete bacterium Treponema pallidum. It typically develops several weeks to several months after the primary infection, which is recognized by a painless chancre. Secondary syphilis is characterized by systemic symptoms, such as malaise and fever as well as a maculopapular rash involving the trunk and extremities including the palms and soles. Condyloma lata, which are raised, fleshy lesions, tend to develop at the site of the primary chancre. Diagnosis is achieved primarily through screening and confirmational serologic testing. Histologic findings seen in condyloma lata are largely non-specific. Therefore, a high index of suspicion should be maintained and immunohistochemical stains specific for T. pallidum should be utilized. PMID:25776279

  10. Biological basis for syphilis.

    PubMed

    Lafond, Rebecca E; Lukehart, Sheila A

    2006-01-01

    Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum subsp. pallidum. Clinical manifestations separate the disease into stages; late stages of disease are now uncommon compared to the preantibiotic era. T. pallidum has an unusually small genome and lacks genes that encode many metabolic functions and classical virulence factors. The organism is extremely sensitive to environmental conditions and has not been continuously cultivated in vitro. Nonetheless, T. pallidum is highly infectious and survives for decades in the untreated host. Early syphilis lesions result from the host's immune response to the treponemes. Bacterial clearance and resolution of early lesions results from a delayed hypersensitivity response, although some organisms escape to cause persistent infection. One factor contributing to T. pallidum's chronicity is the paucity of integral outer membrane proteins, rendering intact organisms virtually invisible to the immune system. Antigenic variation of TprK, a putative surface-exposed protein, is likely to contribute to immune evasion. T. pallidum remains exquisitely sensitive to penicillin, but macrolide resistance has recently been identified in a number of geographic regions. The development of a syphilis vaccine, thus far elusive, would have a significant positive impact on global health. PMID:16418521

  11. Experimental model of congenital syphilis.

    PubMed Central

    Kajdacsy-Balla, A; Howeedy, A; Bagasra, O

    1993-01-01

    Female LSH hamsters infected with Treponema pallidum subsp, endemicum before pregnancy or during early pregnancy transmit a form of syphilis to the fetus that is similar to human congenital syphilis. The offspring develops rhinitis, skin rash, failure to thrive, and hepatosplenomegaly. T. pallidum is detectable in their livers, spleens, and nasal secretions. Immunoglobulin M antibodies are detected in the serum. Images PMID:8335390

  12. Syphilis: antibiotic treatment and resistance.

    PubMed

    Stamm, L V

    2015-06-01

    Syphilis is a chronic, multi-stage infectious disease that is usually transmitted sexually by contact with an active lesion of a partner or congenitally from an infected pregnant woman to her fetus. Although syphilis is still endemic in many developing countries, it has re-emerged in several developed countries. The resurgence of syphilis is a major concern to global public health, particularly since the lesions of early syphilis increase the risk of acquisition and transmission of infection with human immunodeficiency virus (HIV). Because there is no vaccine to prevent syphilis, control is mainly dependent on the identification and treatment of infected individuals and their contacts with penicillin G, the first-line drug for all stages of syphilis. The emergence of clinically significant azithromycin resistance in Treponema pallidum subsp. pallidum, the syphilis agent, has resulted in treatment failures, thus precluding the routine use of this second-line drug. Information is presented here on the diagnosis and recommended antibiotic treatment of syphilis and the challenge of macrolide-resistant T. pallidum. PMID:25358292

  13. Localized lesions in secondary syphilis.

    PubMed

    Dar, Nasser Rashid; Raza, Naeem

    2008-05-01

    The clinical manifestations of secondary syphilis are variable and can mimic many skin diseases, mostly being generalized and symmetrical in distribution. Localized lesions of secondary syphilis are rarely seen in dermatology clinics. We report an unusual presentation wherein a patient had localized lesions over face and soles only. There is a need for increased awareness on the part of physicians to recognize new patterns of syphilitic infection, together with a willingness to consider the diagnosis of syphilis in patients with unusual clinical features. PMID:18541087

  14. Maternal syphilis: pathophysiology and treatment.

    PubMed Central

    Berman, Stuart M.

    2004-01-01

    Despite the long history of medical interest in syphilis and its effects on pregnancy outcome, many fundamental questions about the pathophysiology and treatment of syphilis during pregnancy remain unanswered. However, understanding has been advanced by recent scientific reports such as those which delineate the complete sequence of the genome of the syphilis spirochaete, provide a more precise description of fetal and neonate infection by use of rabbit infectivity tests and describe the gestational age distribution of fetal death secondary to syphilis. It appears that fetal syphilitic involvement progresses in a rather predictable fashion, and although there is disagreement about the optimal prenatal treatment regimen, programmatic efforts to prevent fetal death must provide seropositive pregnant women with a recommended treatment early in pregnancy, and certainly before the third trimester. PMID:15356936

  15. Considering syphilis in aseptic meningitis.

    PubMed

    Tayal, Sarup; Chadwick, David; Chawla, Girish

    2009-12-01

    Clinicians need to consider syphilis in the differential diagnosis of macular or papular rashes with neurological conditions, particularly aseptic meningitis, as early diagnosis and treatment lead to a better prognosis. PMID:20095316

  16. Gastric Syphilis and Membranous Glomerulonephritis.

    PubMed

    Roh, Min; Sohn, Joo Hyun; Kim, Tae Yeob; Kim, Sung Jong; Kim, Ji Soong; Chung, Sung Jun; Pyo, Ju Yeon; Oh, Young-Ha

    2015-05-01

    Syphilis is a chronic systemic infectious disease caused by the bacterium Treponema pallidum. Gastric involvement and nephrotic syndrome are uncommon but well documented complications of syphilis, but the co-occurrence of these two complications in the same patient is extremely rare. Thus, because of their nonspecific presentation, suspicion of gastric syphilis (GS) and nephrotic syndrome is essential for diagnosis. Patients should be investigated thoroughly and a diagnosis made based on clinical, endoscopic, and histological findings, in order to initiate appropriate therapy. We report of a 34-year-old male patient with a history of epigastric pain and a diagnosis of GS and syphilis-associated membranous glomerulonephritis confirmed by gastroscopy and kidney biopsy, who was treated successfully with penicillin G benzathine. This case report provides information on the typical features of GS that should help raise awareness of this rare disease entity among clinicians, resulting in earlier diagnosis and administration of appropriate therapy. PMID:26064828

  17. Gastric Syphilis and Membranous Glomerulonephritis

    PubMed Central

    Roh, Min; Kim, Tae Yeob; Kim, Sung Jong; Kim, Ji Soong; Chung, Sung Jun; Pyo, Ju Yeon; Oh, Young-Ha

    2015-01-01

    Syphilis is a chronic systemic infectious disease caused by the bacterium Treponema pallidum. Gastric involvement and nephrotic syndrome are uncommon but well documented complications of syphilis, but the co-occurrence of these two complications in the same patient is extremely rare. Thus, because of their nonspecific presentation, suspicion of gastric syphilis (GS) and nephrotic syndrome is essential for diagnosis. Patients should be investigated thoroughly and a diagnosis made based on clinical, endoscopic, and histological findings, in order to initiate appropriate therapy. We report of a 34-year-old male patient with a history of epigastric pain and a diagnosis of GS and syphilis-associated membranous glomerulonephritis confirmed by gastroscopy and kidney biopsy, who was treated successfully with penicillin G benzathine. This case report provides information on the typical features of GS that should help raise awareness of this rare disease entity among clinicians, resulting in earlier diagnosis and administration of appropriate therapy. PMID:26064828

  18. Syphilis: presentations in general medicine.

    PubMed

    Nyatsanza, Farai; Tipple, Craig

    2016-04-01

    Syphilis is caused by the spirochete bacteriumTreponema pallidumand can be transmitted both sexually and from mother to child.T pallidumcan infect any organ and produces a clinical disease with a relapsing and remitting course. It is not hard to see, therefore, why it is often described as the great mimic. In this review, we provide an update of modern syphilis epidemiology, clinical presentations, and testing and treatment strategies. PMID:27037391

  19. Disseminated histoplasmosis mimicking secondary syphilis.

    PubMed

    Pastor, Tony A; Holcomb, Maura J; Motaparthi, Kiran; Grekin, Sarah J; Hsu, Sylvia

    2011-01-01

    A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis. PMID:22136866

  20. Sexually Transmitted Diseases Surveillance, 2012: Syphilis

    MedlinePlus

    ... on Facebook Archive Data & Statistics Sexually Transmitted Diseases Syphilis Recommend on Facebook Tweet Share Compartir This web ... MSM accounted for 75% of P&S syphilis cases. Syphilis—All Stages (P&S, Early Latent, Late, Late Latent, ...

  1. Ocular Syphilis among HIV-Infected Individuals

    PubMed Central

    Li, Jonathan Z.; Tucker, Joseph D.; Lobo, Ann-Marie; Marra, Christina M.; Davis, Benjamin T.; Papaliodis, George N.; Felsenstein, Donna; Durand, Marlene L.; Yawetz, Sigal; Robbins, Gregory K.

    2010-01-01

    We describe a human immunodeficiency virus (HIV)–infected individual with ocular manifestations of secondary syphilis. Twelve other cases of HIV-associated ocular syphilis are also presented. Six of 12 individuals had normal cerebrospinal fluid study results, and 3 patients required retreatment within 1.5 years. In patients with HIV infection, clinicians should be vigilant for ocular syphilis despite normal cerebrospinal fluid measures and for syphilis reinfection. PMID:20604717

  2. Malignant syphilis in an immunocompetent female patient.

    PubMed

    Requena, Camila Bueno; Orasmo, Cínthia Rosane; Ocanha, Juliana Polizel; Barraviera, Silvia Regina Catharino Sartore; Marques, Mariangela Esther Alencar; Marques, Silvio Alencar

    2014-01-01

    Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient. PMID:25387504

  3. Nodular tertiary syphilis in an immunocompetent patient*

    PubMed Central

    Bittencourt, Maraya de Jesus Semblano; de Brito, Arival Cardoso; Nascimento, Bianca Angelina Macêdodo; Carvalho, Alessandra Haber; Drago, Marion Guimarães

    2016-01-01

    Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques. PMID:27579755

  4. 42 CFR 493.923 - Syphilis serology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Syphilis serology. 493.923 Section 493.923 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.923 Syphilis serology. (a) Program content and frequency of challenge. To be approved for proficiency testing in syphilis serology, a...

  5. 42 CFR 493.923 - Syphilis serology.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Syphilis serology. 493.923 Section 493.923 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.923 Syphilis serology. (a) Program content and frequency of challenge. To be approved for proficiency testing in syphilis serology, a...

  6. Nodular tertiary syphilis in an immunocompetent patient.

    PubMed

    Bittencourt, Maraya de Jesus Semblano; Brito, Arival Cardoso de; Nascimento, Bianca Angelina Macêdodo; Carvalho, Alessandra Haber; Drago, Marion Guimarães

    2016-01-01

    Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques. PMID:27579755

  7. 42 CFR 493.923 - Syphilis serology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Syphilis serology. 493.923 Section 493.923 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.923 Syphilis serology. (a) Program content and frequency of challenge. To be approved for proficiency testing in syphilis serology, a...

  8. 42 CFR 493.923 - Syphilis serology.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Syphilis serology. 493.923 Section 493.923 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.923 Syphilis serology. (a) Program content and frequency of challenge. To be approved for proficiency testing in syphilis serology, a...

  9. 42 CFR 493.923 - Syphilis serology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Syphilis serology. 493.923 Section 493.923 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.923 Syphilis serology. (a) Program content and frequency of challenge. To be approved for proficiency testing in syphilis serology, a...

  10. Did Adolf Hitler have syphilis?

    PubMed

    Retief, F P; Wessels, A

    2005-10-01

    The evidence that Adolf Hitler might have suffered from incapacitating syphilis is reviewed. Rumors that he acquired syphilis from a prostitute at the age of 20 years, with possible re-infection during World War I, can no longer be verified. Evidence is that he was sexually rather inactive throughout his life. Suggestions that Hitler's cardiac lesion and complaints such as transitory blindness, tremor of his left arm and leg, recurring abdominal pain and a skin lesion of the leg were of syphilitic aetiology cannot be supported. Hitler's progressive mental and physical deterioration after 1942, his growing paranoia, fits of rage, grandiosity and symptoms of possible dementia would fit in neurosyphilis. There are, however, also other explanations for his terminal syndrome, and evidence that repeated clinical examinations did not show the characteristic signs of dementia paralytica or tabes dorsalis, swings the balance of probability away from tertiary syphilis. PMID:16341329

  11. Anorectal syphilis mimicking Crohn's disease.

    PubMed

    Yilmaz, Mesut; Memisoglu, Reşat; Aydin, Selda; Tabak, Omur; Mete, Bilgül; Memisoglu, Necat; Tabak, Fehmi

    2011-10-01

    Anorectal syphilis, one of the great masqueraders in medicine, can be difficult to diagnose not only because of its variable symptoms but also because it is hard to think of unless a detailed history about sexual preferences and practices, including homosexuality, has been gathered. With increasing acceptance of sexual activity in our culture, despite moral and religious issues, various forms of sex have led to many different clinical conditions of sexually transmitted diseases. In this report, we describe a rare case of primary anorectal syphilis with clinical, endoscopic and histologic features that was misdiagnosed as Crohn's disease. PMID:21437679

  12. The history of syphilis in Uganda

    PubMed Central

    Davies, J. N. P.

    1956-01-01

    The circumstances of an alleged first outbreak of syphilis in Uganda in 1897 are examined and attention is drawn to certain features which render possible alternative explanations of the history of syphilis in that country. It is suggested that an endemic form of syphilis was an old disease of southern Uganda and that protective infantile inoculation was practised. The country came under the observation of European clinicians at a time when endemic syphilis was being replaced by true venereal syphilis. This process has now been completed, endemic syphilis has disappeared, and venereal syphilis is now widespread and a more serious problem than ever. This theory explains the observations of other writers and reconciles the apparent discrepancies between various reports. PMID:13404471

  13. OCULAR SYPHILIS IN A KIDNEY TRANSPLANT RECIPIENT

    PubMed Central

    ROMAO, Elen A.; BOLELLA, Valdes R.; NARDIN, Maria Estela P.; HABIB-SIMAO, Maria Lucia; FURTADO, João Marcelo; MOYSES-NETO, Miguel

    2016-01-01

    We present a case of ocular syphilis after a renal transplantation involving progressive vision loss without clinically identifiable ocular disease. Electroretinography showed signs of ischemia, especially in the internal retina. A serological test was positive for syphilis. Lumbar puncture revealed lymphocytic meningitis and a positive serologic test for syphilis in the cerebrospinal fluid. The patient was treated with penicillin, and had a quick vision improvement. In the case of transplant recipients, clinicians should always consider the diagnosis of ocular syphilis in cases with unexplained visual acuity decrement, as this condition may cause serious complications if not treated. PMID:27253748

  14. OCULAR SYPHILIS IN A KIDNEY TRANSPLANT RECIPIENT.

    PubMed

    Romao, Elen A; Bolella, Valdes R; Nardin, Maria Estela P; Habib-Simao, Maria Lucia; Furtado, João Marcelo; Moyses-Neto, Miguel

    2016-01-01

    We present a case of ocular syphilis after a renal transplantation involving progressive vision loss without clinically identifiable ocular disease. Electroretinography showed signs of ischemia, especially in the internal retina. A serological test was positive for syphilis. Lumbar puncture revealed lymphocytic meningitis and a positive serologic test for syphilis in the cerebrospinal fluid. The patient was treated with penicillin, and had a quick vision improvement. In the case of transplant recipients, clinicians should always consider the diagnosis of ocular syphilis in cases with unexplained visual acuity decrement, as this condition may cause serious complications if not treated. PMID:27253748

  15. Syphilis. A tale of twisted treponemes.

    PubMed Central

    Flores, J L

    1995-01-01

    Despite the widespread availability of effective treatment, the incidence of primary and secondary syphilis in the United States is on the rise. In addition, syphilis is occurring in a substantial number of patients infected with the human immunodeficiency virus (HIV), thus adding to the complexities of diagnosis and treatment. Primary syphilis represents a disseminated infection, often accompanied by abnormalities of the cerebrospinal fluid, that may pass unrecognized and progress to the myriad manifestations of secondary syphilis. The diagnosis of syphilis in patients with mucosal or skin lesions may be made by darkfield examination; once lesions have resolved, serologic tests are required. Patients with latent syphilis may have asymptomatic neurosyphilis and risk progression to tertiary disease. The diagnosis of asymptomatic neurosyphilis is necessary to determine the optimal treatment of patients with latent disease. The diagnosis of active neurosyphilis generally requires an inflammatory cerebrospinal fluid profile and a reactive cerebrospinal fluid VDRL test. Syphilis is common in HIV-infected patients, who may have an altered antibody response to infection and an apparent increased incidence of neurologic complications. The preferred treatment at all stages is penicillin, which is also the only recommended therapy for neurosyphilis. The optimal treatment of syphilis in HIV-infected patients is unknown. Images Figure 1. PMID:8553639

  16. Cardiovascular syphilis with coronary stenosis and aneurysm.

    PubMed

    Tewari, Satyendra; Moorthy, Nagaraja

    2014-01-01

    Cardiovascular manifestations of tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation, and coronary ostial stenosis. Coronary ostial lesions have been detected in as many as 26% of patients with syphilitic aortitis. However nonostial coronary stenosis and coronary aneurysms in same patient is rarely described in cardiovascular syphilis. PMID:25634420

  17. Syphilis: An Old Disease With Present-Day Implications.

    PubMed

    McNeil, Candice J; Bachmann, Laura H

    2016-01-01

    Syphilis continues to be a burden on the public health system. While men who have sex with men and HIV-infected individuals are the most affected populations, syphilis rates have also increased in reproductive-aged women, resulting in concurrent increases in congenital syphilis. Prompt diagnosis and treatment are requisite components of syphilis control. PMID:27621352

  18. [Injury by skull osteolytic secundary syphilis].

    PubMed

    Alessandro, Lucas; Camporro, Julieta Piar; Arakaki, Naomi; Orellana, Nora; Mora, Claudia Andrea

    2016-04-01

    Bone involvement of syphilis can be observed in tertiary and congenital syphilis. It is infrequent during the secondary stage. The skull is the most affected bone in secondary syphilis, and its most frequent form of presentation is proliferative osteitis. If the skull is affected, headache is usual and can be as intense as in meningitis. Osteolyitic lesions may be seen in complimentary imaging studies, with a moth eaten aspect. These lesions raise concern over a number of differential diagnoses, among which are infectious, inflammatory and neoplastic diseases. The definitive diagnosis is made by bone biopsy of the compromised bone. Molecular techniques in the affected tissues increases diagnostic performance. There is no standardized treatment protocol for syphilis since there are no guidelines available. We report a case of a 19 year old female, presenting with a unique osteolytic lesion in the skull due to secondary syphilis. PMID:27315003

  19. Syphilis surveillance in France, 2000-2003.

    PubMed

    Couturier, E; Michel, A; Janier, M; Dupin, N; Semaille, C

    2004-12-01

    This article describes syphilis trends, characteristics of patients from 2000 to 2003 in France and trends of the benzylpenicillin benzathine 2.4 million UI sales from 2001 to 2003. The ongoing surveillance system for syphilis case reporting since 2001 has been set up in volunteer settings, mostly public settings where STI treatment is offered. Clinical case reporting is complemented by sexual behavioural data based on a self-administered questionnaire. From 2000 to 2003, 1089 syphilis cases were reported in France, increasing from 37 cases in 2000 to 428 in 2003. Overall, 96% of syphilis cases were in men with a mean age of 36.5 years and 70% of whom were born in France. The proportion of syphilis cases with HIV co-infection decreased over time from 60% in 2000 to 33% in 2003. The most affected area by the syphilis epidemic is the Ile-de-France region, mainly the city of Paris. The greatest proportion of syphilis cases diagnosed in men who have sex with men (MSM) were in the Ile-de-France region, where they made up 87% of cases, compared with 75% in other regions. Among the patients who completed the self-administered questionnaire on sexual behaviour, 83% reported having casual sex partners in the 3 months prior to their syphilis diagnosis. Trends in the sales of benzylpenicillin benzathine 2.4 million UI in private pharmacies are similar to those observed in the surveillance system, and increased between 2001 and 2003. In conclusion, syphilis transmission is still ongoing in France in 2003 and the role of unprotected oral sex in the transmission of syphilis should be emphasised. PMID:15677855

  20. [Syphilis as a chronic systemic infection].

    PubMed

    Nesterenko, V G; Akovbian, V A; Semenova, E N; Vavilova, L M; Iudina, T I

    2006-01-01

    During the last STDs'epidemic in Russia (1994 - 2004) over 2.7 min people have been infected with syphilis. At present the structure of syphilis morbidity is characterized by 37% of latent forms, including 1.5% late latency. The increased level of late latency may result from: an ever-growing number of those with asymptomatic syphilis; disorderly and self-dependent usage of antibacterial preparations; spread of the virus chronic infections (herpes, hepatitis B, C) altering the macroorganism immune response; alcohol and drug abuse which decreases the efficacy of specific therapy. In general, chronization of the syphilitic infection may be caused by antigenically inert treponemal cell surface; paucity of outer membrane protein; residence of treponemas within an immunoprotective niche; uncompleted phagocytosis of treponemes with macrophages. Syphilis remains an "infectio magna" and demands thorough attention to all diagnostic and therapeutic procedures on every stage of the disease. PMID:16941889

  1. Oral syphilis: a series of 5 cases.

    PubMed

    Hertel, Moritz; Matter, Daniel; Schmidt-Westhausen, Andrea M; Bornstein, Michael M

    2014-02-01

    Syphilis is an infectious, usually sexually transmitted, disease caused by Treponema pallidum, subspecies pallidum. Because of the increasing prevalence in Europe during the past few years, dentists could be confronted with patients with oral manifestations of syphilis. Because oral lesions are highly contagious, it is vital to make the correct diagnosis quickly to initiate the proper therapy and to interrupt the chain of infection. We present the cases of 5 patients with syphilis-related oral lesions. These cases are representative because of their clinical presentation, age, and gender distribution and the diagnostic approach. The aim of the present report is to emphasize the importance of the dentist knowing and identifying syphilis in different stages to diagnose the disease and institute treatment at an early stage. PMID:24045192

  2. Early syphilis affects markers of HIV infection.

    PubMed

    Kotsafti, Ourania; Paparizos, Vassilios; Kourkounti, Sofia; Chatziioannou, Argiro; Nicolaidou, Electra; Kapsimali, Violetta; Antoniou, Christina

    2016-08-01

    The objective of this study was to investigate if early syphilis infection affects markers of HIV infection; CD4 T cells and viral load (VL). A retrospective study was performed on 160 HIV-positive patients (111 receiving antiretroviral therapy [ART] and 49 without ART). Early syphilis diagnosis was made in HIV patients during their follow-up at the HIV/AIDS Unit at a Greek Dermatology and Venereology Unit. The patients' blood tests were available at the time of diagnosis, as well as before and 12 weeks after early syphilis diagnosis. CD4 T cell counts and VL levels were measured. It was found that syphilis infection had a negative impact on the CD4 T cell counts in both groups, with reduced CD4 T cell counts observed in 84.6% (99/111) and 79.5% (39/49) of patients receiving and not receiving ART, respectively. After treatment for syphilis, CD4 T cell counts returned to pre-treatment levels in most patients, especially those receiving ART. There was a slight and transient VL increase. Patients receiving ART had a 27% increase in VL, compared to 71.4% among patients not receiving ART. Although the VL increase was slight (41-14,000 copies/ml) in the group under treatment, 4-5% (5/111) patients did not return to pre-treatment levels. Moreover, viral mutations associated with treatment resistance were identified in these patients. Early syphilis accelerates and complicates the progression of HIV infection. Early diagnosis and treatment of syphilis may prevent infection-associated complications in most instances. Consequently, prevention of syphilis and other sexually transmitted infections is of great importance for patients infected with HIV. PMID:26113517

  3. Secondary Syphilis With Hepatitis and Nephrotic Syndrome: A Rare Concurrence

    PubMed Central

    Makker, Jasbir; Bajantri, Bharat; Nayudu, Suresh Kumar

    2016-01-01

    Syphilis, a chronic multisystem disease, is caused by a spirochete, Treponema pallidum. Clinical presentation may expand to several stages including primary, secondary and latent syphilis, which may present as early or late syphilis. Nephrotic syndrome and acute hepatitis are well-known complications of secondary syphilis. To the best of our knowledge, secondary syphilis with coexisting renal and hepatic complications has rarely been reported. Here we present a rare case of concurrent nephrotic syndrome and acute hepatitis in a patient with secondary syphilis. PMID:27298666

  4. Secondary Syphilis With Hepatitis and Nephrotic Syndrome: A Rare Concurrence.

    PubMed

    Makker, Jasbir; Bajantri, Bharat; Nayudu, Suresh Kumar

    2016-07-01

    Syphilis, a chronic multisystem disease, is caused by a spirochete, Treponema pallidum. Clinical presentation may expand to several stages including primary, secondary and latent syphilis, which may present as early or late syphilis. Nephrotic syndrome and acute hepatitis are well-known complications of secondary syphilis. To the best of our knowledge, secondary syphilis with coexisting renal and hepatic complications has rarely been reported. Here we present a rare case of concurrent nephrotic syndrome and acute hepatitis in a patient with secondary syphilis. PMID:27298666

  5. Syphilis in pregnancy and congenital syphilis in Amazonas State, Brazil: an evaluation using database linkage.

    PubMed

    Soeiro, Claudia Marques de Oliveira; Miranda, Angélica Espinosa; Saraceni, Valeria; Santos, Marcelo Cordeiro dos; Talhari, Sinesio; Ferreira, Luiz Carlos de Lima

    2014-04-01

    This study analyzes notification of syphilis in pregnancy and congenital syphilis in Amazo- nas State, Brazil, from 2007 to 2009 and verifies underreporting in databases in the National Information System on Diseases of Notification (SINAN) and the occurrence of perinatal deaths associated with congenital syphilis and not reported in the Mortality Information System (SIM). This was a cross-sectional study with probabilistic record linkage between the SINAN and SIM. There were 666 reports of syphilis in pregnant women, including 224 in 2007 (3.8/1,000), 244(4.5/1,000) in 2008, and 198(4.0/1,000) in 2009. The study found 486 cases of congenital syphilis, of which 153 in 2007 (2.1/1,000), 193 in 2008 (2.6/1,000), and 140 in 2009 (2.0/1,000). After linkage of the SINAN databases, 237 pregnant women (35.6%) had cases of congenital syphilis reported. The SIM recorded 4,905 perinatal deaths, of which 57.8% were stillbirths. Probabilistic record linkage between SIM and SINAN-Congenital Syphilis yielded 13 matched records. The use of SINAN and SIM may not reflect the total magnitude of syphilis, but provide the basis for monitoring and analyzing this health problem, with a view towards planning and management. PMID:24896047

  6. Syphilis

    MedlinePlus

    ... Patients Procedure for Accessing Lab Services Data Package Requirements AIDS Therapies Resource Guide In Vitro Efficacy Evaluations ... Assurances to Users Application and Approval Process User Requirements Malaria Vaccine Production Services Data Sharing and Release ...

  7. Syphilis

    MedlinePlus

    ... Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental Disabilities Ear Nose & Throat Emotional Problems Eyes Fever From Insects or Animals Genitals and Urinary Tract Glands & Growth ...

  8. Syphilis

    MedlinePlus

    ... Fitness Diseases & Conditions Infections Q&A School & Jobs Drugs & Alcohol Staying Safe Recipes En Español Making a Change – Your Personal Plan Hot Topics Meningitis Choosing Your Mood Prescription Drug Abuse Healthy School Lunch Planner How Can I ...

  9. Syphilis

    PubMed Central

    Miller, James N.; Nelson, James R.; Reisner, Ronald M.; Turner, Jerrold A.

    1971-01-01

    This is the transcription of the regular teaching conferences in Infectious Diseases held weekly at Horbor General Hospital, Torrance. The transcription was edited by Drs. Jerrold Turner, Irwin Ziment and Lucien B. Guze. PMID:5563817

  10. Syphilis on the rise: A prolonged syphilis outbreak among HIV-infected patients in Northern Greece

    PubMed Central

    Tsachouridou, Olga; Skoura, Lemonia; Christaki, Eirini; Kollaras, Panagiotis; Sidiropoulou, Eleni; Zebekakis, Pantelis; Vakirlis, Efstratios; Margariti, Apostolia; Metallidis, Symeon

    2016-01-01

    Introduction Sexually transmitted diseases (STDs) are a major public health issue in Europe. Numerous outbreaks of syphilis have been described recently and an increased prevalence of high-risk sexual practices has raised concern about the transmission of HIV and other STDs. Similarly, an increase in sexually transmitted infections has been recorded in Northern Greece. Methods This report describes a recent outbreak of syphilis in people living with HIV. The demographic, clinical, and serologic data of HIV patients diagnosed with syphilis were recorded and analyzed. Data on syphilis incidence from the general population was also compared to HIV patients’ data. Results Fifty-eight HIV-patients of the Infectious Diseases Unit of a tertiary hospital (5.2%) were diagnosed with syphilis during a three-year period (2008-2010). Highly active antiretroviral therapy (HAART) and coexistence of other STDs were independent predictors of syphilis (OR: 2.4, 95CI%: 1.26, 4.63, p=0.008; OR: 9.4, 95%CI: 4.49, 19.64, p<0.001, respectively). Origin from a country other than Greece (p=0.005), and homosexual contact (p=0.003), were separate risk factors for syphilis in the general population in the same area. Conclusion Diagnosis of a sexually transmitted disease in an HIV patient is a crucial clinical event that should trigger the clinician’s suspicion for high-risk sexual behavior. Sexual health assessments should be a routine process for HIV patients. PMID:27622160

  11. Cross-reactivity between Lyme and syphilis screening assays: Lyme disease does not cause false-positive syphilis screens.

    PubMed

    Patriquin, Glenn; LeBlanc, Jason; Heinstein, Charles; Roberts, Catherine; Lindsay, Robbin; Hatchette, Todd F

    2016-03-01

    Increased rates of Lyme disease and syphilis in the same geographic area prompted an assessment of screening test cross-reactivity. This study supports the previously described cross-reactivity of Lyme screening among syphilis-positive sera and reports evidence against the possibility of false-positive syphilis screening tests resulting from previous Borrelia burgdorferi infection. PMID:26707064

  12. Malignant syphilis in an AIDS patient.

    PubMed

    dos Santos, T R; de Castro, I J; Dahia, M M B; de Azevedo, M C V M; da Silva, G A R; Motta, R N; da Cunha Pinto, J; de Almeida Ferry, F R

    2015-04-01

    Malignant syphilis is an uncommon, but not unknown, ulcerative variation of secondary syphilis. The lesions typically begin as papules, which quickly evolve to pustules and then to ulcers with elevated edges and central necrosis. It is usually, but not mandatory, found in patients with some level of immunosuppression, such as HIV patients, when the TCD4(+) cell count is >200 cells/mm(3). Despite the anxiety the lesions cause, this form of the disease has a good prognosis. The general symptoms disappear right after the beginning of treatment, and lesions disappear over a variable period. This study reports the case of a 27-year-old man who has been HIV positive for 6 years, uses antiretroviral therapy incorrectly, has a TCD4(+) cell count of 340 cells/mm(3), a VDRL of 1:128 and itchy disseminated hyperchromic maculopapular lesions with rupioid crusts compatible with malignant syphilis. PMID:25408098

  13. [Treatment of syphilis with malaria or heat].

    PubMed

    Verhave, Jan Peter

    2016-01-01

    Until the end of the Second World War, syphilis was a common sexually transmitted infection. This stigmatising infectious disease caused mental decline, paralysis and eventually death. The history of syphilis was given public attention because of 'malaria therapy', which had been applied from the First World War onwards in patients with paralytic dementia. In 1917, the Austrian physician Julius Wagner-Jauregg (1857-1940) induced fever in these patients by infecting them with malaria parasites; in 1927, he received the Nobel Prize for his discovery of the healing properties of malarial fever. One source, not cited anywhere, is an interview that the American bacteriologist and science writer/medical journalist Paul de Kruif conducted with Wagner-Jauregg in 1930. The reporting of this meeting, and De Kruif's later involvement in the mechanical heat treatment of patients with syphilis, form the inspiration for this article. When penicillin became available, both treatments became obsolete. PMID:27165455

  14. Nodular secondary syphilis in a woman.

    PubMed

    Glatz, M; Achermann, Y; Kerl, K; Bosshard, P P; Cozzio, A

    2013-01-01

    We report the case of a 21-year-old woman with symmetrically distributed, ulcerated nodules and plaques on the face, neck and arms. Initial differential diagnoses included pyoderma or sarcoidosis based on the clinical presentation and histopathology with non-caseating granulomas. After inefficient treatment with topical and systemic fusidic acid and steroids, we diagnosed nodular secondary syphilis owing to positive serology and immunohistochemical staining of Treponema pallidum in lesional skin. After treatment with benzathine penicillin, skin lesions improved and antibody titres declined significantly within 3 months. Nodular skin lesions in secondary syphilis are rare with 15 reported cases within the last 20 years. Furthermore, the granulomatous histology is often misleading. Our patient's case suggests that the physicians should be aware of syphilis as a possible differential diagnosis also in patients outside a high-risk population for sexually transmitted diseases and with an unusual clinical presentation. PMID:23661656

  15. Congenital syphilis: subtle presentation of fulminant disease.

    PubMed

    Bennett, M L; Lynn, A W; Klein, L E; Balkowiec, K S

    1997-02-01

    The incidence of congenital syphilis has experienced a fourfold to fivefold increase in 6 years. It is a completely preventable disease whose clinical spectrum ranges from asymptomatic infection, to fulminant sepsis, to death. Congenital syphilis was diagnosed in a 6-week-old infant whose mother was negative for the disease by prenatal screen. The otherwise well child presented with a generalized, papulosquamous eruption of 3 weeks' duration but within hours multisystem failure developed from overwhelming treponemal sepsis. Factors related to increased incidence, problems in serodiagnosis, manifestations of the early versus late forms of the disease, and recommendations for evaluation and treatment are illustrated by this patient and are discussed. PMID:9039217

  16. Preventing congenital syphilis - a regional audit of syphilis in pregnant women seen in Genitourinary Medicine services.

    PubMed

    Hussey, J; Mitchell, L; Hew, Y; Foster, K; Waldram, A

    2014-05-01

    Genitourinary case records of 42 pregnant women with syphilis were reviewed as part of a regional audit following the re-emergence of congenital syphilis in the north east of England. National standards, from the British Association of Sexual Health and HIV guidelines on managing syphilis in pregnancy, were met in the majority of cases with 69% being treated according to national guidance and all cases completing treatment. Locally developed standards on multidisciplinary working and communication were met less well, with particular issues regarding the documentation of pregnancy outcomes in GUM records and communication between specialities being highlighted. A regional good practice guide has been developed and implemented to address standards not met, reduce adverse outcomes and prevent future cases of congenital syphilis. PMID:24285598

  17. [Maternal syphilis and congenital syphilis in Latin America: big problem, simple solution].

    PubMed

    Valderrama, Julia; Zacarías, Fernando; Mazin, Rafael

    2004-09-01

    From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1% and to range from 1.00% in Peru to 6.21% in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1000 live births in El Salvador to 12.0 per 1000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5% to 15%. Factors that determine the persistence of congenital syphilis as public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care, and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination. PMID:15507190

  18. The Julius Rosenwald Fund syphilis seroprevalence studies.

    PubMed

    Roy, B

    1996-05-01

    In 1929 the Julius Rosenwald Fund, in conjunction with the Public Health Service (PHS), sponsored a syphilis seroprevalence study in the South characterized as a humanitarian effort to benefit the health of rural African Americans. The study reported extraordinarily high rates of positive Wassermann tests, even among children. Despite the unreliability and nonspecificity of this test, modern authors continue to indict these subjects as syphilitic. However, there was no consistent relationship between syphilis and a positive Wassermann test. Additional treponemal pathogens that potentially caused false-positive tests could explain the results. After public outcry to the Tuskegee Syphilis Experiment, the Rosenwald study acquired new significance. It was used as evidence to bolster the argument that Tuskegee was a consequence of humanitarian motives that became captive to misguided methods of researchers at the Venereal Disease Division of the PHS. Humanitarianism implies the acknowledgement of a right invested in the recipient; health is an end in itself. However, African Americans were necessary as a source of cheap labor for competition in the world cotton markets and as a restraint on the market value of white labor in manufacturing. The administrative structure of the PHS, not zealous individuals, adopted utilitarianism as its paradigm for human research. Syphilis seroprevalence was a calculated use of public health as a means to economic development. PMID:8667443

  19. Syphilis: clinical presentation, diagnosis and treatment.

    PubMed

    Peate, Ian

    Syphilis is a sexually transmitted infection that is increasing in the U.K. If left untreated it can have a number of potentially devastating health-related sequelae. However, effective treatment is available. Nurses working in various healthcare settings should be aware of the signs and symptoms of the infection to make a prompt diagnosis and appropriate referral for treatment. PMID:18069500

  20. The Julius Rosenwald Fund syphilis seroprevalence studies.

    PubMed Central

    Roy, B.

    1996-01-01

    In 1929 the Julius Rosenwald Fund, in conjunction with the Public Health Service (PHS), sponsored a syphilis seroprevalence study in the South characterized as a humanitarian effort to benefit the health of rural African Americans. The study reported extraordinarily high rates of positive Wassermann tests, even among children. Despite the unreliability and nonspecificity of this test, modern authors continue to indict these subjects as syphilitic. However, there was no consistent relationship between syphilis and a positive Wassermann test. Additional treponemal pathogens that potentially caused false-positive tests could explain the results. After public outcry to the Tuskegee Syphilis Experiment, the Rosenwald study acquired new significance. It was used as evidence to bolster the argument that Tuskegee was a consequence of humanitarian motives that became captive to misguided methods of researchers at the Venereal Disease Division of the PHS. Humanitarianism implies the acknowledgement of a right invested in the recipient; health is an end in itself. However, African Americans were necessary as a source of cheap labor for competition in the world cotton markets and as a restraint on the market value of white labor in manufacturing. The administrative structure of the PHS, not zealous individuals, adopted utilitarianism as its paradigm for human research. Syphilis seroprevalence was a calculated use of public health as a means to economic development. PMID:8667443

  1. THE IMMUNOPATHOBIOLOGY OF SYPHILIS: THE MANIFESTATIONS AND COURSE OF SYPHILIS ARE DETERMINED BY THE LEVEL OF DELAYED-TYPE HYPERSENSITIVITY

    PubMed Central

    Carlson, J. Andrew; Dabiri, Ganary; Cribier, Bernard; Sell, Stewart

    2013-01-01

    Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. While there has been a significant reduction of tertiary disease, and recognition of facilitative interactions with HIV infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and more importantly, activation of macrophages by sensitized CD4 T-cells. The Bacillus Calmette Guerin (BCG) vaccination can enhance DTH and has been shown to produce a low, but measurable beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response. PMID:21694502

  2. Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

    PubMed Central

    Domingues, Rosa Maria Soares Madeira; Szwarcwald, Celia Landmann; Souza, Paulo Roberto Borges; Leal, Maria do Carmo

    2014-01-01

    OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional

  3. Current Status of Syphilis Vaccine Development: Need, Challenges, Prospects

    PubMed Central

    Cameron, Caroline E.; Lukehart, Sheila A.

    2013-01-01

    Syphilis is a multistage disease caused by the invasive spirochete Treponema pallidum subsp. pallidum. Despite inexpensive and effective antibiotic therapy, syphilis remains a prevalent disease in developing countries and has re-emerged as a public health threat in developed nations. In addition to the medical burden imparted by infectious syphilis, congenital syphilis is considered the most significant infectious disease affecting fetuses and newborns worldwide, and individuals afflicted with syphilis have an enhanced risk for HIV transmission and acquisition. The global disease burden of syphilis and failure of decades of public health efforts to stem the incidence of disease highlight the need for an effective syphilis vaccine. Although challenges associated with T. pallidum research have impeded understanding of this pathogen, the existence of a relevant animal model has enabled insight into the correlates of disease protection. Complete protection against infection has been achieved in the animal model using an extended immunization regimen of γ-irradiated T. pallidum, demonstrating the importance of treponemal surface components in generation of protective immunity and the feasibility of syphilis vaccine development. Syphilis is a prime candidate for development of a successful vaccine due to the (1) research community’s accumulated knowledge of immune correlates of protection; (2) existence of a relevant animal model that enables effective pre-clinical analyses; (3) universal penicillin susceptibility of T. pallidum which enhances the attractiveness of clinical vaccine trials; and (4) significant public health benefit a vaccine would have on reduction of infectious/congenital syphilis and HIV rates. Critical personnel, research and market gaps need to be addressed before the goal of a syphilis vaccine can be realized, including recruitment of additional researchers to the T. pallidum research field with a proportional increase in research funding

  4. Current status of syphilis vaccine development: need, challenges, prospects.

    PubMed

    Cameron, Caroline E; Lukehart, Sheila A

    2014-03-20

    Syphilis is a multistage disease caused by the invasive spirochete Treponema pallidum subsp. pallidum. Despite inexpensive and effective antibiotic therapy, syphilis remains a prevalent disease in developing countries and has re-emerged as a public health threat in developed nations. In addition to the medical burden imparted by infectious syphilis, congenital syphilis is considered the most significant infectious disease affecting fetuses and newborns worldwide, and individuals afflicted with syphilis have an enhanced risk for HIV transmission and acquisition. The global disease burden of syphilis and failure of decades of public health efforts to stem the incidence of disease highlight the need for an effective syphilis vaccine. Although challenges associated with T. pallidum research have impeded understanding of this pathogen, the existence of a relevant animal model has enabled insight into the correlates of disease protection. Complete protection against infection has been achieved in the animal model using an extended immunization regimen of γ-irradiated T. pallidum, demonstrating the importance of treponemal surface components in generation of protective immunity and the feasibility of syphilis vaccine development. Syphilis is a prime candidate for development of a successful vaccine due to the (1) research community's accumulated knowledge of immune correlates of protection; (2) existence of a relevant animal model that enables effective pre-clinical analyses; (3) universal penicillin susceptibility of T. pallidum which enhances the attractiveness of clinical vaccine trials; and (4) significant public health benefit a vaccine would have on reduction of infectious/congenital syphilis and HIV rates. Critical personnel, research and market gaps need to be addressed before the goal of a syphilis vaccine can be realized, including recruitment of additional researchers to the T. pallidum research field with a proportional increase in research funding

  5. Syphilis hospitalisations in Portugal over the last decade.

    PubMed

    Sousa-Pinto, B; Freitas, A; Lisboa, C

    2016-02-01

    Although several studies have reported an increase of syphilis incidence over the last decade in Western Europe, information concerning syphilis epidemiology in Portugal remains scarce. Therefore, we sought to characterise acquired syphilis-associated hospitalisations in Portugal according to demographic and clinical data. We used a database containing all hospitalisations that occurred in mainland Portugal public hospitals with discharges between 2000 and 2014. We analysed all hospitalisations associated with ICD-9-CM codes 091-097.x (corresponding to acquired syphilis diagnosis) concerning inpatients' gender, age and comorbidities. The median length of stay and in-hospital mortality rates were also studied. Between 2000 and 2014, there were a total of 8974 syphilis-related hospitalisations in mainland Portugal. The rate of acquired syphilis hospitalisations per 100,000 inhabitants increased by 33 % during the studied period. Syphilis hospitalisation rates increased by 70 % in males and 139 % among patients aged over 55 years. On the other hand, they declined by 10 % in females and 20 % among patients younger than 55 years old. The percentage of syphilis episodes presenting cardiovascular and neuropsychiatric comorbidities increased, while the percentage of syphilis episodes presenting HIV co-infection decreased by 69 %. A fatal outcome was reported in 5 % of episodes; 4.6 % of them had acquired syphilis as the main reason for hospitalisation. This study illustrates that, despite being a preventable infection, syphilis remains a public health problem. The analysis of hospitalisation and administrative data helps to understand syphilis epidemiology and provides a supplement to traditional case notifications. PMID:26581424

  6. The Tuskegee Syphilis Experiment: biotechnology and the administrative state.

    PubMed

    Roy, B

    1995-01-01

    The central issue of the Tuskegee Syphilis Experiment was property: property in the body and intellectual property. Once removed from the body, tissue and body fluids were not legally the property of the Tuskegee subjects. Consequently, there was not a direct relationship between a patient and research that used his sera. The Public Health Service (PHS) was free to exercise its property right in Tuskegee sera to develop serologic tests for syphilis with commercial potential. To camouflage the true meaning, the PHS made a distinction between direct clinical studies and indirect studies of tissue and body fluids. This deception caused all reviews to date to limit their examination to documents labeled by the PHS as directly related to the Tuskegee Syphilis Experiment. This excluded other information in the public domain. Despite the absence of a clinical protocol, this subterfuge led each to falsely conclude that the Tuskagee Syphilis Experiment was a clinical study. Based on publications of indirect research using sera and cerebrospinal fluid, this article conceives a very history of the Tuskagee Syphilis Experiment. Syphilis could only cultivate in living beings. As in slavery, the generative ability of the body made the Tuskegee subjects real property and gave untreated syphilis and the sera of the Tuskegee subjects immense commercial value. Published protocols exploited the Tuskegee Syphilis Experiment to invent and commercialize biotechnology for the applied science of syphilis serology. PMID:7869408

  7. Clinical aspects of congenital syphilis with Hutchinson’s triad

    PubMed Central

    Pessoa, Larissa; Galvão, Virgilio

    2011-01-01

    Congenital syphilis is an infectious disease caused by Treponema pallidum transmitted by infected mother to her baby during pregnancy. Late congenital syphilis is recognised with 2 or more years after birth. One of the main aspects is observed with the triad of Hutchinson, characterised by the presence of interstitial keratitis, eighth nerve deafness and Hutchinson’s teeth. This manuscript reports a case of late congenital syphilis presenting with Hutchinson’s triad at an age of 7 years. These clinical features are related to syphilis present during pregnancy and at birth, however they commonly become apparent after 5-years of age. PMID:22670010

  8. Syphilis and human immunodeficiency virus co-infection.

    PubMed Central

    Funnyé, Allen S.; Akhtar, Abbasi J.

    2003-01-01

    Co-infection of syphilis and AIDS has profound implications for the African American community. The purpose of this review is to: evaluate the historical background of HIV and syphilis and their similarities in pathogenesis; review the epidemiology of syphilis and HIV co-infection, and implications for continued prevention efforts; examine the effect of syphilis on HIV transmission and acquisition; and, to examine the effects of HIV infection on syphilis transmission, diagnostic and serologic changes, clinical course, and treatment. The prevalence of HIV is higher in those with syphilis; moreover, the prevalence of HIV and syphilis co-infection is highest in African Americans. There may be humoral and cellular immune similarities. HIV may affect the transmission of syphilis, alter its serologic diagnosis, and accelerate and change the clinical course and response to treatment. In conclusion, combined infection of HIV and syphilis may alter the clinical presentation and course of either disease. There are historical and immunologic similarities and the high prevalence in African Americans compared to other groups is of great importance for prevention efforts. PMID:12793793

  9. Recurrent tamponade and aortic dissection in syphilis.

    PubMed

    Stansal, Audrey; Mirault, Tristan; Rossi, Aude; Dupin, Nicolas; Bruneval, Patrick; Bel, Alain; Azarine, Arshid; Minozzi, Catherine; Deman, Anne Laure; Messas, Emmanuel

    2013-11-01

    Syphilitic cardiovascular disease has been described since the 19th century, mainly on autopsy series. Major clinical manifestations are aortic aneurysm, aortic insufficiency, and coronary ostial stenosis. The diagnosis of syphilitic cardiovascular disease is based mainly on positive serologic tests and overt clinical manifestations. We present here a rare and unusual clinical presentation of a tertiary syphilis with recurrent tamponade and type B aortic dissection, whose positive diagnosis was made by polymerase chain reaction on pericardial fluid analysis. PMID:24182507

  10. Unusual late nodular presentation of secondary syphilis.

    PubMed

    Lanjouw, E; van der Meijden, W I; den Hollander, J C; Neumann, H A M

    2009-04-01

    A 20-year-old man presented with a five-week history of an eruption of papules and nodules disseminated over his body and face. We propose that this patient has a late form of secondary syphilis with a nodular, granulomatous inflammation in urgent need of treatment. Otherwise late irreversible sequelae could develop and unwanted possible further sexual transmission could take place. PMID:19304976

  11. Ocular syphilis: an alarming infectious eye disease

    PubMed Central

    Shen, Jie; Feng, Liguo; Li, Yumin

    2015-01-01

    Background: To describe the clinical manifestations and ancillary examination outcomes of ocular syphilis in Southeast China. Materials and methods: This is a retrospective, nonrandom case study. Demographic information, serum and cerebrospinal fluid (CSF) test results, and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. Results: The study examined 21 eyes of 13 patients (average age 50.3 ± 5.9 (range 37-61) years). HIV co-infection was found in one patient. The most common manifestation was chorioretinitis (52.4%). Disc hyperfluorescence (66.7%) and persistent dark spots (91.7%) were the most common findings on FFA and ICGA, respectively. The inner segment/outer segment junction (IS/OS) loss was the most frequent manifestation (86.7%). Among the six patients with confirmed neurosyphilis, the average CSF protein level was 528.8 ± 327.1 mg/L. Visual acuity (VA) was improved in 8 of 13 eyes (61.5%) after treatment. Conclusions: The manifestations of ocular syphilis can mimic any eye disease. Chorioretinitis was the most common finding in this case series. “Leopard spots” was the characteristic manifestation on FFA. IS/OS loss was the most common finding in patients with posterior uveitis on SD-OCT. Lumbar puncture can contribute to the diagnosis of neurosyphilis. Treatment for ocular syphilis was effective in these patients. PMID:26221328

  12. Serological tests for syphilis in Saudi Arabia.

    PubMed Central

    Hossain, A

    1986-01-01

    A total of 6684 sera were initially screened for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Reactive sera from either or both these tests were tested for confirmation by the fluorescent treponemal antibody-absorbed (FTA-ABS) test. VDRL biological false positive reactors were detected in 0.5% of the total sera examined, with 0.4% and 0.8%, respectively, obtained in pregnant women and blood donors. Eight sera (0.1%) were found to be positive in the TPHA test alone. An overall positivity of 2.7% for syphilis was detected, with a 0.85% positivity in antenatal patients. Infection with T pallidum seemed to be more common in men than in women (1.6:1) and predominated in the age group 20-39 years. Serological testing of sera from 26 mother and infant pairs allowed one case of congenital syphilis to be detected by FTA-ABS (IgM) and identified VDRL biological false positivity in seven infants. PMID:3770753

  13. Balanoposthitis and Penile Edema: Atypical Manifestations of Primary Syphilis.

    PubMed

    Rovira-López, Roger; García-Martínez, Pablo; Martín-Ezquerra, Gemma; Pujol, Ramon M; Aventín, Daniel López

    2015-09-01

    The typical finding in primary syphilis stage is a unique, painless chancre with indurated borders. We report a case of primary syphilis presenting as erosive and crusted balanoposthitis with an underlying chancre, penile edema, and bilateral inguinal lymphadenopathy in a heterosexual man. PMID:26267879

  14. Strong Country Level Correlation between Syphilis and HSV-2 Prevalence

    PubMed Central

    Kenyon, Chris Richard; Tsoumanis, Achilleas

    2016-01-01

    Background. Syphilis is curable but Herpes Simplex Virus-2 (HSV-2) is not. As a result, the prevalence of syphilis but not HSV-2 may be influenced by the efficacy of national STI screening and treatment capacity. If the prevalence of syphilis and HSV-2 is found to be correlated, then this makes it more likely that something other than differential STI treatment is responsible for variations in the prevalence of both HSV-2 and syphilis. Methods. Simple linear regression was used to evaluate the relationship between national antenatal syphilis prevalence and HSV-2 prevalence in women in two time periods: 1990–1999 and 2008. Adjustments were performed for the laboratory syphilis testing algorithm used and the prevalence of circumcision. Results. The prevalence of syphilis was positively correlated with that of HSV-2 for both time periods (adjusted correlations, 20–24-year-olds: 1990–99: R2 = 0.54, P < 0.001; 2008: R2 = 0.41, P < 0.001 and 40–44-year-olds: 1990–99: R2 = 0.42, P < 0.001; 2008: R2 = 0.49, P < 0.001). Conclusion. The prevalence of syphilis and HSV-2 is positively correlated. This could be due to a common set of risk factors underpinning both STIs. PMID:27069710

  15. Elimination and reintroduction of primary and secondary syphilis.

    PubMed Central

    Williams, L A; Klausner, J D; Whittington, W L; Handsfield, H H; Celum, C; Holmes, K K

    1999-01-01

    OBJECTIVES: This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. METHODS: Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. RESULTS: During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were sero-positive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. CONCLUSIONS: As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem. PMID:10394323

  16. Neuro syphilis: Portrayals by Sir Arthur Conan Doyle

    PubMed Central

    Somasundaram, O.

    2009-01-01

    The developments in neuro syphilis in the 19th century are integral parts of the history of psychiatry. The delineation of various aspects of neuro syphilis by Sir Arthur Conan Doyle in three of his stories is discussed in brief. PMID:19881059

  17. 42 CFR 493.1207 - Condition: Syphilis serology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Syphilis serology. 493.1207 Section 493.1207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES....1207 Condition: Syphilis serology. If the laboratory provides services in the subspecialty of...

  18. 42 CFR 493.835 - Standard; Syphilis serology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Standard; Syphilis serology. 493.835 Section 493.835 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.835 Standard; Syphilis serology. (a) Failure to attain an overall testing event...

  19. 42 CFR 493.835 - Standard; Syphilis serology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Standard; Syphilis serology. 493.835 Section 493.835 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.835 Standard; Syphilis serology. (a) Failure to attain an overall testing event...

  20. 42 CFR 493.835 - Standard; Syphilis serology.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Syphilis serology. 493.835 Section 493.835 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.835 Standard; Syphilis serology. (a) Failure to attain an overall testing event...

  1. 42 CFR 493.1207 - Condition: Syphilis serology.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Syphilis serology. 493.1207 Section 493.1207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES....1207 Condition: Syphilis serology. If the laboratory provides services in the subspecialty of...

  2. 42 CFR 493.1207 - Condition: Syphilis serology.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Syphilis serology. 493.1207 Section 493.1207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES....1207 Condition: Syphilis serology. If the laboratory provides services in the subspecialty of...

  3. 42 CFR 493.1207 - Condition: Syphilis serology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Syphilis serology. 493.1207 Section 493.1207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES....1207 Condition: Syphilis serology. If the laboratory provides services in the subspecialty of...

  4. 42 CFR 493.1207 - Condition: Syphilis serology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Syphilis serology. 493.1207 Section 493.1207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES....1207 Condition: Syphilis serology. If the laboratory provides services in the subspecialty of...

  5. 42 CFR 493.835 - Standard; Syphilis serology.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Syphilis serology. 493.835 Section 493.835 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.835 Standard; Syphilis serology. (a) Failure to attain an overall testing event...

  6. 42 CFR 493.835 - Standard; Syphilis serology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Standard; Syphilis serology. 493.835 Section 493.835 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.835 Standard; Syphilis serology. (a) Failure to attain an overall testing event...

  7. A case of secondary syphilis presenting as multiple pulmonary nodules.

    PubMed

    Kim, Se Joong; Lee, Ju-Han; Lee, Eung-Seok; Kim, Il-Hwan; Park, Hyung Joo; Shin, Chol; Kim, Je Hyeong

    2013-03-01

    Syphilis is a sexually transmitted disease caused by Treponema pallidum. The prevalence of this disease has recently increased worldwide. However, pulmonary involvement in secondary syphilis is extremely rare. A 51-year-old heterosexual male patient presented with multiple pulmonary nodules with reactive serology from the Venereal Disease Research Laboratory test and positive fluorescent treponemal antibody absorption testing. A hematogenous metastatic malignancy was suspected and an excisional lung biopsy was performed. Histopathological examination showed only central necrosis with abscess and plasma cell infiltration, but no malignant cells. The patient reported sexual contact with a prostitute 8 weeks previously and a penile lesion 6 weeks earlier. Physical examination revealed an erythematous papular rash on the trunk. Secondary syphilis with pulmonary nodules was suspected, and benzathine penicillin G, 2.4 million units, was administered. Subsequently, the clinical signs of syphilis improved and the pulmonary nodules resolved. The final diagnosis was secondary syphilis with pulmonary nodular involvement. PMID:23526483

  8. Epidemic Profile of Maternal Syphilis in China in 2013

    PubMed Central

    Dou, Lixia; Wang, Xiaoyan; Wang, Fang; Wang, Qian; Qiao, Yaping; Su, Min; Jin, Xi; Qiu, Jie; Song, Li; Wang, Ailing

    2016-01-01

    Objective. The aim of this study was to investigate the epidemiological characteristics and adverse pregnancy outcomes of pregnant women with syphilis infection in China. Methods. Data were from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Women who were registered in the system and delivered in 2013 were included in the analysis. Results. A total of 15884 pregnant women with syphilis infection delivered in China in 2013. 79.1% of infected women attended antenatal care at or before 37 gestational weeks; however, 55.4% received no treatment or initiated the treatment after 37 gestational weeks. 14.0% of women suffered serious adverse pregnancy outcomes including stillbirth/neonatal death, preterm delivery/low birth weight, or congenital syphilis in newborns. High maternal titer (≥1 : 64) and late treatment (>37 gestational weeks)/nontreatment were significantly associated with increased risk of congenital syphilis and the adjusted ORs were 1.88 (95% CI 1.27 to 2.80) and 3.70 (95% CI 2.36 to 5.80), respectively. Conclusion. Syphilis affects a great number of pregnant women in China. Large proportions of women are not detected and treated at an early pregnancy stage. Burden of adverse pregnancy outcomes is high among infected women. Comprehensive interventions still need to be strengthened to improve uptake of screening and treatment for maternal syphilis. PMID:26981537

  9. Pathology of congenital syphilis in rabbits.

    PubMed Central

    Froberg, M K; Fitzgerald, T J; Hamilton, T R; Hamilton, B; Zarabi, M

    1993-01-01

    We have developed a model for congenital syphilis in the rabbit. This report provides additional information on newborn tissue pathology in animals that were infected in utero. A total of 35 pregnancies were evaluated, each containing 6 to 12 newborns. In the infected group, the mortality was approximately 50%; of the live newborns, half appeared normal and half were hyperreflexic, weak, and runty. Gross pathology in the sickly newborns was quite prevalent and involved enlarged spleens with isolated spots of necrosis; enlarged livers that were overtly congested and hemorrhagic and had numerous granular, white spots; and brains with hemorrhage in the occipital area. Histopathology was apparent in different tissues. Lymphocytes, plasma cells, and vacuolated macrophages were prominent in livers, spleens, brains, and bones. A few actively motile treponemes were visualized by dark-field microscopy within extracts of spleen and within cerebrospinal fluid. Low numbers of treponemes were also demonstrated in sections of brain and liver by using the Warthin-Starry silver stain technique. Blood hematocrits were decreased, and extramedullary hematopoiesis was prominent within spleens and livers; this is consistent with anemia. This rabbit model exhibits many of the same pathologic features commonly found in human congenital syphilis. Images PMID:8406873

  10. [Syphilis in Ferrara in the nineteenth century].

    PubMed

    Angelini, Lauretta; Guidi, Enrica; Contini, Carlo

    2009-06-01

    In this article the authors highlight the behaviour of government authorities in the nineteenth century in Italy and especially in Ferrara to implement those measures deemed necessary to stem the spread of syphilis in epidemic form through the control of prostitution. Albeit discontinuously and until 1865, corrupted and infected women in Ferrara were assisted and treated by charitable institutions (Congregation of Charity, the Congregation of the Ladies of St. Vincent and the Sisters of Charity at the complex St. Mary of Consolation) since the Ferrara public hospital (Arcispedale S. Anna) could not accept or treat infected prostitutes for economic reasons and lack of beds. Subsequently, the hospital only treated prostitutes free of charge if they bore a certificate of poverty. The other infected prostitutes were sent to the sifilicomio in Modena. The authors also study mortality from syphilis in Ferrara from 1813 to 1899 in order to detect any significant differences according to age, sex and professional status and attempt to identify the stage of the disease (primary, secondary and tertiary), according to the terminology used by the doctors of that time. PMID:19602927

  11. Optic neuropathy secondary to syphilis in an HIV negative patient.

    PubMed

    Berrozpe-Villabona, C; Santos-Bueso, E; Bañeros-Rojas, P; Aguilar Munoa, S; Saenz-Francés, F; Díaz-Valle, D; Martínez-de-la-Casa, J M; García-Feijoo, J

    2016-02-01

    Ocular syphilis is a resurgent clinical condition due to unsafe sexual practices. It has been reported in both immunocompromised and immunocompetent patients, but in HIV positive patients, it is more likely to exhibit a more aggressive course and adopt atypical clinical patterns such as optic nerve involvement. Herein we report an atypical case of optic neuritis secondary to syphilis in an HIV negative patient. This case highlights the importance of considering syphilis in the differential diagnosis of ocular inflammation and of obtaining HIV serology, since both diseases share common risk factors. PMID:26868532

  12. Cannibalism and contagion: framing syphilis in counter-reformation Italy.

    PubMed

    Eamon, W

    1998-02-01

    The outbreak of syphilis in Europe elicited a variety of responses concerning the disease's origins and cure. In this essay, I examine the theory of the origins of syphilis advanced by the 16th-century Italian surgeon Leonardo Fioravanti. According to Fioravanti, syphilis was not new but had always existed, although it was unknown to the ancients. The syphilis epidemic, he argued, was caused by cannibalism among the French and Italian armies during the siege of Naples in 1494. Fioravanti's strange and novel theory is connected with his view of disease as corruption of the body caused by eating improper foods. His theory of bodily pollution, a metaphor for the corruption of society, coincided with Counter-Reformation concepts about sin and the social order. PMID:11620327

  13. Syphilis and MSM (Men Who Have Sex with Men)

    MedlinePlus

    ... its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has ... a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There ...

  14. A case of rupioid syphilis masquerading as aggressive cutaneous lymphoma.

    PubMed

    Braue, Jonathan; Hagele, Thomas; Yacoub, Abraham Tareq; Mannivanan, Suganya; Sokol, Lubomir; Glass, Frank; Greene, John N

    2015-01-01

    Secondary syphilis has been known since the late 19th century as the great imitator; however, some experts now regard cutaneous lymphoma as the great imitator of skin disease. Either disease, at times an equally fastidious diagnosis, has reported to mimic each other even. It is thus vital to consider these possibilities when presented with a patient demonstrating peculiar skin lesions. No other manifestation of secondary syphilis may pose such quandary as a rare case of rupioid syphilis impersonating cutaneous lymphoma. We present such a case, of a 36-year-old HIV positive male, misdiagnosed with aggressive cutaneous lymphoma, actually exhibiting rupioid syphilis thought secondary to immune reconstitution inflammatory syndrome (IRIS). PMID:25960854

  15. [The atypical course of syphilis in HIV infection].

    PubMed

    Mahrle, G; Rasokat, H; Kurz, K; Steigleder, G K

    1989-05-15

    We report on 3 HIV patients showing atypical courses of syphilis. Both the history and serology of the first patient proved a recent re-infection with T. pallidum, whereas the histopathological findings corresponded to an advanced stage of the disease (S II-III). The second patient showed the clinical picture of syphilis maligna with slowly converting and slightly positive serological reactions. The third patient had a refractory syphilis and an early relapse. Our observations suggest that syphilis might take an unusual course in HIV patients. Considering our total HIV clientèle (800 patients greater than or equal to WR 2) the frequency of these atypical cases must be rated very low (0.38%). PMID:2741530

  16. Oral Syphilis: A Reemerging Infection Prompting Clinicians' Alertness

    PubMed Central

    Dybeck Udd, Sebastian; Lund, Bodil

    2016-01-01

    Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated. PMID:27293914

  17. Oral Syphilis: A Reemerging Infection Prompting Clinicians' Alertness.

    PubMed

    Dybeck Udd, Sebastian; Lund, Bodil

    2016-01-01

    Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated. PMID:27293914

  18. The Great Pretender: Rectal Syphilis Mimic a Cancer

    PubMed Central

    Pisani Ceretti, Andrea; Virdis, Matteo; Maroni, Nirvana; Arena, Monica; Masci, Enzo; Magenta, Alberto; Opocher, Enrico

    2015-01-01

    Rectal syphilis is a rare expression of the widely recognised sexual transmitted disease, also known as the great imitator for its peculiarity of being confused with mild anorectal diseases because of its vague symptoms or believed rectal malignancy, with the concrete risk of overtreatment. We present the case of a male patient with primary rectal syphilis, firstly diagnosed as rectal cancer; the medical, radiological, and endoscopic features are discussed below. PMID:26451271

  19. Reemergence of Syphilis in Martinique, 2001–2008

    PubMed Central

    Rollin, Bruno; Pierre-François, Sandrine; Abel, Sylvie; Desbois, Nicole; Richard, Pascale; Hochedez, Patrick; Théodose, Raphaëlle; Quist, Danielle; Hélénon, Raymond; Derancourt, Christian; Cavelier, Annick; Liautaud, Bernard

    2010-01-01

    Syphilis reemerged in Martinique in 2004 and initially affected 3 HIV-infected patients. By March 2008, syphilis was diagnosed for 37 men and 18 women. As of October 31, 2009, this outbreak had not yet been brought under control. It initially affected mainly men who had sex with men before it spread to heterosexual persons, minority group members, and crack cocaine users. PMID:20031052

  20. Secondary syphilis presenting with aortitis and coronary ostial occlusion.

    PubMed

    Chadwick, John A; MacNab, Anita; Sarma, Jaydeep; Ray, Simon; Kadir, Isaac; Muldoon, Eavan G

    2016-03-01

    Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection. PMID:26670911

  1. Ocular syphilis in patients with Human Immunodeficiency Virus infection.

    PubMed

    Mitchell, John P; Huang, Lynn L; Rosberger, Daniel F

    2015-06-01

    As Acquired Immunodeficiency Disease (AIDS) turns thirty-years old, much progress has been made. 56,000 new cases of the Human Immunodeficiency Virus (HIV) infection are expected in Americans this year. At least half or more will be in African Americans. Reports of the association between syphilis and HIV infection are well documented. We present a case of bilateral optic neuritis and panuveitis as the initial presentation in a previously undiagnosed patient with human immunodeficiency virus (HIV) and syphilis. PMID:27269502

  2. Syphilis presenting as isolated cervical lymphadenopathy: two related cases.

    PubMed

    van Crevel, Reinout; Grefte, Johanna M M; van Doorninck, Damiaen; Sturm, Patrick

    2009-01-01

    Two young adult brothers, with no apparent risk for sexually transmitted infections (STI), presented with unilateral cervical lymphadenitis. Syphilis was diagnosed by fine-needle aspiration cytology in one case, and subsequent serology and revision of a resected lymph node in the second case. Clinicians should have a high index of suspicion and a low diagnostic threshold in patients with unexplained lymphadenopathy, even in the absence of a history of primary syphilis, or obvious risk for STI. PMID:18649948

  3. A report on syphilis control in Turkey

    PubMed Central

    Christiansen, Sven

    1954-01-01

    This report presents the results of a six-month survey of the nature and extent of venereal diseases in Turkey which was undertaken by the author, on behalf of WHO, at the request of the Turkish Government. The first part of the report outlines the present venereal-disease-control system and includes descriptions of the work undertaken by public authorities, hospitals and dispensaries, mobile venereal-disease-control teams, and laboratories; in the second part, the author enumerates certain recommendations for the intensification of the current control programme. These recommendations are particularly concerned with the control of syphilis (since the incidence of other venereal diseases in Turkey is of very secondary importance), and with the expansion, standardization, and co-ordination of serodiagnostic facilities and services. It is suggested that there might be a gradual intensification and reorientation of the present programme. A proposed plan of operations for an eight-year period is described. PMID:13182590

  4. Lupus or syphilis? That is the question!

    PubMed

    Duarte, Joana Azevedo; Henriques, Celia Coelho; Sousa, Carolina; Alves, José Delgado

    2015-01-01

    A 47-year-old man presented with fever, a maculopapular rash of the palms and soles, muscular weakness, weight loss, faecal incontinence, urinary retention and mental confusion with 1 month of evolution. Neurological examination revealed paraparesis and tactile hypoesthesia with distal predominance, and no sensory level. Laboratory investigations revealed a venereal disease research laboratory (VDRL) titre of 1/4 and Treponema pallidum haemagluttin antigen (TPHA) of 1/640, positive anti-nuclear antibodies of 1/640 and nephrotic proteinuria (3.6 g/24 h). Lumbar puncture excluded neurosyphilis, due to the absence of TPHA and VDRL. The diagnosis of systemic lupus erythematosus (SLE) was established and even though transverse myelitis as a rare presentation of SLE has a poor outcome, the patient improved with cyclophosphamide, high-dose corticosteroids and hydroxychloroquine. A diagnosis of secondary syphilis was also established and the patient was treated with intramuscular benzathine penicillin G. PMID:26045520

  5. Towards the Elimination of Syphilis in a Small Developing Country

    PubMed Central

    Mungrue, Kameel; Edwards, Jeffrey; Fyzul, Azizah; Boodhai, Billy; Narinesingh, Adita; Nanlal, Shasta

    2015-01-01

    Objective. To describe the current epidemiological features of syphilis and congenital syphilis in Trinidad, 2009–2012. Methods. All laboratory confirmed syphilis cases diagnosed through a vertical program in the Ministry of Health, between 1/1/2009 and 31/12/2012, were identified. All relevant data were collected including address which was geocoded and mapped using ArcGIS 10.0 (Esri). Both spatial techniques and standardized incidence ratios were used to determine hot spots. Results. The annual cumulative incidence rate for syphilis remains high varying from 39 per 100 000 population in 2009 to 29 per 100 000 in 2012. We identified 3 “hot spots,” in urban areas of Trinidad. Young men and particularly young women in childbearing age 15–35 living in urban high density populations were commonly infected groups. Conclusion. The incidence of syphilis continues to be very high in Trinidad. New initiatives will have to be formulated in order to attain the global initiative to eradicate syphilis by 2015. PMID:26316981

  6. Liver involvement in HIV-infected patients with early syphilis.

    PubMed

    Palacios, R; Navarro, F; Narankiewicz, D; Marcos, M; Jiménez-Oñate, F; de la Torre, J; Santos, J

    2013-01-01

    The aim of the paper is to analyse the prevalence of liver involvement and related factors in HIV-infected patients with early syphilis (<2 years). Liver involvement was defined as an elevation above normal ranges of alanine transaminase, aspartate aminotransferase, gamma-glutamyltransferase and/or alkaline phosphatase during early syphilis, or doubling of previous levels in patients with liver enzyme elevation before syphilis. We undertook a multicentre study and of the 147 cases, 86.4% were men who had sex with men, and the diagnoses of syphilis and HIV infection were coincident in 48 (32.7%). Liver involvement was detected in 45 (30.6%) and the only related factor was a rapid plasma reagin (RPR) titre ≥1/64 (odds ratio 3.76; 95% confidence interval 1.3-10.5; P = 0.012). In conclusion, liver involvement occurs in around one-third of HIV-infected patients with early syphilis and is associated with high RPR levels. Syphilis should be included in the differential diagnosis of liver enzyme elevation in HIV-infected patients. PMID:23467288

  7. A mathematical model of syphilis transmission in an MSM population.

    PubMed

    Saad-Roy, C M; Shuai, Zhisheng; van den Driessche, P

    2016-07-01

    Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum, and is a sexually transmitted disease with multiple stages. A model of transmission of syphilis in an MSM population (there has recently been a resurgence of syphilis in such populations) that includes infection stages and treatment is formulated as a system of ordinary differential equations. The control reproduction number is calculated, and it is proved that if this threshold parameter is below one, syphilis dies out; otherwise, if it is greater than one, it is shown that there exists a unique endemic equilibrium and that for certain special cases, this equilibrium is globally asymptotically stable. Using data from the literature on MSM populations, numerical methods are used to determine the variation and robustness of the control reproduction number with respect to the model parameters, and to determine adequate treatment rates for syphilis eradication. By assuming a closed population and no return to susceptibility, an epidemic model is obtained. Final outbreak sizes are numerically determined for various parameter values, and its variation and robustness to parameter value changes is also investigated. Results quantify the importance of early treatment for syphilis control. PMID:27071977

  8. Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations.

    PubMed

    Watts, Paula J; Greenberg, Harry L; Khachemoune, Amor

    2016-07-01

    Syphilis is an ancient disease that has re-emerged in the last decade. It is prevalent among men who have sex with men and has increased in incidence with certain ethnic groups. It usually presents as primary or secondary syphilis and can progress to tertiary syphilis if not treated. Primary syphilis will classically manifest as a single, painless ulcer with smooth, clean, and raised borders on the genitals or less often on the oral mucosa. Unusual primary syphilis cases have been reported and can be easily misdiagnosed with a resulting delay of treatment. Secondary syphilis is a systemic disease, wherein the treponemes have disseminated to various organ systems, typically presenting with characteristic mucocutaneous lesions. Tertiary syphilis has a higher rate of morbidity and mortality; as such, the aim of this article is to provide the readers with tools to recognize early syphilis and prevent its progression to late stages. In this review, we present a likely case of unusual primary syphilis mimicking herpes progenitalis as well as a compilation of all atypical cases of primary syphilis from 1973 to 2015. We will also review the differential diagnosis, management, and recommendations for each stage of syphilis. PMID:26756536

  9. Correlates of syphilis seropositivity and risk for syphilis-associated adverse pregnancy outcomes among women attending antenatal care clinics in the Democratic Republic of Congo.

    PubMed

    Taylor, Melanie M; Ebrahim, Shahul; Abiola, Nadine; Kinkodi, Didine Kaba; Mpingulu, Minlangu; Kabuayi, Jean Pierre; Ekofo, Felly; Newman, Daniel R; Peterman, Thomas A; Kamb, Mary L; Sidibe, Kassim

    2014-09-01

    Screening and treatment for syphilis among pregnant women is the primary means of prevention of congenital syphilis. Sentinel surveillance for syphilis can inform these prevention efforts. We reviewed antenatal syphilis screening results to assess trends and to identify correlates of seropositivity among women attending antenatal care clinics in the Democratic Republic of Congo during 2011. Syphilis seropositivity among the 17,669 women attending the antenatal care clinics during 2011 was 4.2% (range 0.4%-16.9%). Syphilis seropositivity was significantly higher among women attending rural clinics (5.0%) as compared to urban clinics (3.0%) and those tested in antenatal care clinics in the provinces of Equateur (7.6%) and Orientale (7.7%) as compared to other provinces (p < 0.001). Based on the antenatal care syphilis seroprevalence and national pregnancy estimates, we estimate that approximately 128,591 pregnant women countrywide would have tested seropositive for syphilis during 2011. Over 85,000 adverse pregnancy outcomes would have resulted from these maternal infections, assuming prenatal syphilis diagnosis and treatment were not available. The prevalence of syphilis was highest in rural areas, but exceeded 1% in every area, indicating a need to assure screening and treatment throughout Democratic Republic of Congo. These sentinel surveillance estimates can be used to guide national congenital syphilis prevention efforts. PMID:24452733

  10. Social determinants of syphilis in South China: the effect of sibling position on syphilis and sexual risk behaviours

    PubMed Central

    Tucker, Joseph D; Young, Darwin; Yang, Ligang; Yang, Bin; Adimora, Adaora A

    2013-01-01

    Objective This study evaluated the relationship between sibling position and sexual risk based on behavioural and syphilis infection data from sexually transmitted infection (STI) patients in South China. Design A cross-sectional study examining sexual behaviours and syphilis infection. Setting 4 STI clinics in the Pearl River Delta of South China. Participants 1792 Chinese men and women attending STI clinics. Primary outcome measures STI history, syphilis infection defined as positive non-treponemal and treponemal tests. Results Among all clinic patients, 824 (46.3%) were first-born, 354 (19.9%) were middle-born and 602 (33.8%) were final-born. Middle-born individuals had a higher percentage of reported STI history (44.7% compared to 34.7%, p<0.001) and syphilis infection (9.7% compared to 4.9%, p=0.01) among men (n=1163) compared to other sibling positions in bivariate analyses, but not in the final multivariate model. The relationship between sibling position and syphilis was independent of income and education level. There was no trend observed between middle-born position and female sexual risk behaviours (n=626). Higher education was significantly associated with syphilis among women and men in respective multivariate models. Conclusions This study suggests that middle-born men in China may have an increased sexual risk compared to other sibling positions. As Chinese family and social structures change, a more thorough understanding of how demographic factors influence sexual risk behaviours is needed. PMID:23793689

  11. Syphilis at the Crossroad of Phylogenetics and Paleopathology

    PubMed Central

    de Melo, Fernando Lucas; de Mello, Joana Carvalho Moreira; Fraga, Ana Maria; Nunes, Kelly; Eggers, Sabine

    2010-01-01

    The origin of syphilis is still controversial. Different research avenues explore its fascinating history. Here we employed a new integrative approach, where paleopathology and molecular analyses are combined. As an exercise to test the validity of this approach we examined different hypotheses on the origin of syphilis and other human diseases caused by treponemes (treponematoses). Initially, we constructed a worldwide map containing all accessible reports on palaeopathological evidences of treponematoses before Columbus's return to Europe. Then, we selected the oldest ones to calibrate the time of the most recent common ancestor of Treponema pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue in phylogenetic analyses with 21 genetic regions of different T. pallidum strains previously reported. Finally, we estimated the treponemes' evolutionary rate to test three scenarios: A) if treponematoses accompanied human evolution since Homo erectus; B) if venereal syphilis arose very recently from less virulent strains caught in the New World about 500 years ago, and C) if it emerged in the Americas between 16,500 and 5,000 years ago. Two of the resulting evolutionary rates were unlikely and do not explain the existent osseous evidence. Thus, treponematoses, as we know them today, did not emerge with H. erectus, nor did venereal syphilis appear only five centuries ago. However, considering 16,500 years before present (yBP) as the time of the first colonization of the Americas, and approximately 5,000 yBP as the oldest probable evidence of venereal syphilis in the world, we could not entirely reject hypothesis C. We confirm that syphilis seems to have emerged in this time span, since the resulting evolutionary rate is compatible with those observed in other bacteria. In contrast, if the claims of precolumbian venereal syphilis outside the Americas are taken into account, the place of origin remains unsolved. Finally, the endeavor of

  12. Recent Trends in the Serologic Diagnosis of Syphilis

    PubMed Central

    Singh, Ameeta E.

    2014-01-01

    Complexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests. PMID:25428245

  13. ON THE ORIGIN OF THE HUMAN TREPONEMATOSES (PINTA, YAWS, ENDEMIC SYPHILIS AND VENEREAL SYPHILIS).

    PubMed

    HACKETT, C J

    1963-01-01

    A close relationship between the four human treponematoses is suggested by their clinical and epidemiological characteristics and by such limited knowledge of the treponemes as there is at present. No treponeme of this group (except for that of the rabbit) is known other than in man, but the human treponemes probably arose long ago from an animal infection. The long period of infectiousness of pinta suggests that it may have been the earliest human treponematosis. It may have been spread throughout the world by about 15 000 B.C., being subsequently isolated in the Americas when the Bering Strait was flooded. About 10 000 B.C. in the Afro-Asian land mass environmental conditions might have favoured treponeme mutants leading to yaws; from these, about 7000 B.C., endemic syphilis perhaps developed, to give rise to venereal syphilis about 3000 B.C. in south-west Asia as big cities developed there. Towards the end of the fifteenth century A.D. a further mutation may have resulted in a more severe venereal syphilis in Europe which, with European exploration and geographical expansion, was subsequently carried throughout the then treponemally uncommitted world. These suggestions find some tentative support in climatic changes which might have influenced the selection of those treponemes which still survive in humid or arid climates. Venereal transmission would presumably remove the treponeme from the direct influence of climate. The author makes a plea for further investigation of many aspects of this subject while this is still possible. PMID:14043755

  14. Histopathologic ear findings of syphilis: a temporal bone study.

    PubMed

    Hızlı, Ömer; Hızlı, Pelin; Kaya, Serdar; Monsanto, Rafael da Costa; Paparella, Michael M; Cureoglu, Sebahattin

    2016-09-01

    To the best of our knowledge, histopathologic studies of syphilitic ears have generally focused on hydropic changes; so far, no such studies have investigated peripheral vestibular otopathology using differential interference contrast microscopy, in patients with syphilis. For this study, we examined 13 human temporal bone samples from 8 patients with a history of syphilis. Using conventional light microscopy, we performed qualitative histopathologic assessment. In addition, using differential interference contrast microscopy, we performed type I and type II vestibular hair cell counts on each vestibular sense organ with minimal autolysis; in which the neuroepithelium was oriented perpendicular to the plane of section. We then compared vestibular hair cell densities (cells per 0.01 mm² surface area) in the syphilis group vs. the control group. In the syphilis group, we observed precipitate in the endolymphatic or perilymphatic spaces in 1 (7.7 %) of the samples and endolymphatic hydrops in eight (61.5 %) of the samples. Hydrops involved the cochlea (four samples) and/or saccule (four samples). In addition, the syphilis group experienced a significant loss of type II vestibular hair cells in the maculae of the utricle and saccule, and in the cristae of the lateral and posterior semicircular canals, as compared with the control group (P < 0.05). PMID:26573155

  15. Diagnostic approaches in unsuspected oral lesions of syphilis.

    PubMed

    Siqueira, C S; Saturno, J L; de Sousa, S C O M; da Silveira, F R X

    2014-12-01

    Awareness of the increased prevalence of syphilis is essential for early diagnosis and treatment, and to prevent the spread of the disease. Although serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, biopsy of unsuspected oral lesions is not uncommon in the routine oral pathology laboratory. In these cases, histopathological characteristics are likely to indicate the possibility of syphilis, and an immunohistochemical reaction can confirm it. The aim of the present study was to highlight the histological features and test the efficacy of immunohistochemistry in the detection of Treponema pallidum in oral lesions biopsied with the assumption of a non-syphilitic disease. Thirty-nine tissue samples from patients for whom the possibility of syphilis was suggested on the basis of histopathological findings, were retrieved from the surgical oral pathology service files and submitted to immunohistochemical staining for T. pallidum. The study was approved by the institutional ethics committee. Eighteen of the tissue samples were positive for T. pallidum. Following this, the contributing clinicians were contacted to check whether they had asked for serological examinations when the diagnostic report was received; for all 18 positive cases, the clinicians confirmed that the patients had tested positive at that time. This study shows the importance of clinical-pathological correlation and the value of immunohistochemistry in the diagnosis of unsuspected syphilis. PMID:25305698

  16. An estimate of syphilis incidence in Eastern Europe

    PubMed Central

    Herbert, Liam J.; Middleton, Stephen I.

    2012-01-01

    Aim Eastern Europe experienced epidemic levels of syphilis after the collapse of the Soviet Union. Presently data are less comprehensive outside the European Union (EU) and European Free Trade Association (EFTA). This review aims to identify published papers with suitable data to estimate a regional burden of disease for syphilis in the 19 member countries of Eastern Europe. Methods A systematic literature review was conducted to identify published data relating to syphilis incidence in Eastern Europe through Web of Knowledge, PubMed and Google Scholar databases in addition to the latest surveillance report from the European Center for Disease Prevention and Control. A total of 381 papers fitted our search criteria; 30 papers were subjected to full text analysis. Results Seven papers were included in this study and provided useable data for 13 out of 19 member countries. There was a high level of heterogeneity observed in the incidence rates from the member countries. Gross, population weighted and geographically subdivided incidence rate estimates were carried out but the comprehensiveness of some of the included data is doubtful. Conclusions Despite the limits of the data, the incidence of syphilis in Eastern Europe is still substantially larger than that observed in the EU15 countries. This indicates that efforts to control syphilis in Eastern Europe can be enhanced; however, such goals would require significant investment in infrastructure, technology and surveillance mechanisms. PMID:23198131

  17. [Syphilis. Part 1: Introduction, pathology and clinical aspects].

    PubMed

    Gross, G; Flaig, B; Rode, S

    2013-10-01

    In Germany more than 3,500 people become infected with syphilis annually. As elsewhere in Western Europe there is a low level endemicity with a concentration among population subgroups with high rates of partner exchange, such as men who have sex with other men. In Germany after initially reduced numbers of cases, the incidence rate has increased after the turn of the millennium. In 2011 the incidence reached 4.5 cases per 100,000 inhabitants, which is the highest incidence since the introduction of the Infection Protection Act of 2001. Syphilis, like other sexually transmitted infections and diseases with its manifold clinical manifestations and complex diagnostics, is a large global problem for public health systems. The recent resurgence of syphilis presents a challenge for all physicians but particularly for dermatologists and venereologists because the skin and adjacent mucous membranes are initially affected. Rapid diagnosis, differential diagnosis, consequent treatment and monitoring can cure the disease. Prevention of misdiagnosis is essential otherwise severe, sometimes fatal cardiovascular complications, neurosyphilis and transfer to unborn and newborn children can occur. The synergy of syphilis and sexually transmitted human immunodeficiency virus (HIV) is of special importance. Syphilis together with genital herpes and other sexually transmitted genital and oral ulcers is an important pacemaker for HIV. PMID:24150827

  18. UK national guidelines on the management of syphilis 2015.

    PubMed

    Kingston, M; French, P; Higgins, S; McQuillan, O; Sukthankar, A; Stott, C; McBrien, B; Tipple, C; Turner, A; Sullivan, A K; Radcliffe, Keith; Cousins, Darren; FitzGerald, Mark; Fisher, Martin; Grover, Deepa; Higgins, Stephen; Kingston, Margaret; Rayment, Michael; Sullivan, Ann

    2016-05-01

    These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline. PMID:26721608

  19. Syphilis: using modern approaches to understand an old disease

    PubMed Central

    Ho, Emily L.; Lukehart, Sheila A.

    2011-01-01

    Syphilis is a fascinating and perplexing infection, with protean clinical manifestations and both diagnostic and management ambiguities. Treponema pallidum subsp. pallidum, the agent of syphilis, is challenging to study in part because it cannot be cultured or genetically manipulated. Here, we review recent progress in the application of modern molecular techniques to understanding the biological basis of this multistage disease and to the development of new tools for diagnosis, for predicting efficacy of treatment with alternative antibiotics, and for studying the transmission of infection through population networks. PMID:22133883

  20. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012

    PubMed Central

    Zhang, Xingyu; Zhang, Tao; Pei, Jiao; Liu, Yuanyuan; Li, Xiaosong; Medrano-Gracia, Pau

    2016-01-01

    Background The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. Methods In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). Results The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. Conclusion Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis. PMID:26901682

  1. Syphilis Infection: An Uncommon Etiology of Infectious Nonimmune Fetal Hydrops with Anemia.

    PubMed

    Fuchs, Florent; Michaux, Katell; Rousseau, Céline; Ovetchkine, Philippe; Audibert, François

    2016-01-01

    An increased prevalence of syphilis has been observed in many developed countries over the last decade. During pregnancy, syphilis can affect the fetus through development of nonspecific symptoms such as microcephaly, ascites, hepatosplenomegaly, dilated and echogenic bowel, placentomegaly, and, uncommonly, fetal hydrops. Congenital syphilis also leads to hematologic abnormalities such as anemia, thrombocytopenia, leukopenia, and leukocytosis. We present a case of nonimmune fetal hydrops with anemia related to syphilis infection. Diagnosis was confirmed by a maternal serological test and microbiological testing on amniotic fluid, umbilical cord, and placental tissues. The patient was treated with penicillin and the fetus received an intrauterine red blood cell transfusion, but fetal death occurred shortly after. Such a presentation is mostly related to parvovirus B19, and syphilis etiology is poorly mentioned because physicians have rarely seen early congenital syphilis in the past. However, given the increasing prevalence of this disease in the adult population, clinicians should remain alert to the various presentations of congenital syphilis. PMID:25138225

  2. Modelling the cost‐effectiveness of introducing rapid syphilis tests into an antenatal syphilis screening programme in Mwanza, Tanzania

    PubMed Central

    Vickerman, P; Peeling, R W; Terris‐Prestholt, F; Changalucha, J; Mabey, D; Watson‐Jones, D; Watts, C

    2006-01-01

    Objectives A study found screening (with rapid plasma reagin (RPR)) pregnant women for maternal syphilis was cost‐effective in Mwanza, Tanzania. Recently, four rapid point‐of‐care (POC) syphilis tests were evaluated in Mwanza, and found to have reasonable sensitivity/specificity. This analysis estimates the relative cost‐effectiveness of using these POC tests in the Mwanza syphilis screening intervention. Methods Empirical cost and epidemiological data were used to model the potential benefit of using POC tests instead of RPR. Reductions in costs relating to training, supplies, and equipment were estimated, and any changes in impact due to test sensitivity were included. Additional modelling explored how the results vary with prevalence of past infection, misclassified RPR results, and if not all women return for treatment. Results The cost‐effectiveness of using POC tests is mainly dependent on their cost and sensitivity for high titre active syphilis (HTAS). Savings due to reductions in training and equipment are small. Current POC tests may save more disability‐adjusted life years (DALYs) than the RPR test in Mwanza, but the test cost needs to be syphilis, false RPR‐positives, and past infections. Discussion Although the price of most POC tests needs to be reduced to make them as cost‐effective as RPR, their simplicity and limited requirements for electricity/equipment suggest their use could improve the coverage of antenatal syphilis screening in developing countries. PMID:17215276

  3. Experimental congenital syphilis: guinea pig model.

    PubMed Central

    Wicher, K; Baughn, R E; Wicher, V; Nakeeb, S

    1992-01-01

    Neonates born to female guinea pigs of either a highly susceptible (C4D) or a resistant (Albany) strain, infected prior to or during pregnancy with a single dose of Treponema pallidum, showed in their sera from the first day of life immunoglobulin M (IgM) antibodies to T. pallidum, circulating immune complexes consisting of IgM antibodies and treponemal antigens, and IgM rheumatoid factor. Although the animals were asymptomatic for a 6-month observation period, several lines of evidence indicated that they were infected in utero. Molecular analysis of whole sera, purified serum IgM fraction, or dissociated immune complexes demonstrated IgM reactivity against one (47 kDa) or more of several T. pallidum peptides (15, 17, 37, 42, 45, and 87 kDa) recognized as integral membrane components. Sequential analysis of the neonates' sera by immunoblot and enzyme-linked immunosorbent assay, using alcohol-treated T. pallidum, T. phagedenis biotype Reiter, and T. vincentii, demonstrated early IgM antibodies followed 3 to 4 months later by IgG2- and IgG1-specific antibodies to T. pallidum. Moreover, an infectivity test done in five rabbits with pooled tissue extracts prepared from liveborn or stillborn animals evoked a seroconversion in two rabbits (reactive Venereal Disease Research Laboratory and fluorescent treponemal antibody tests), suggesting the presence of T. pallidum in the organs. Sera from neonates born to either T. phagedenis biotype Reiter-injected mothers or three normal pregnant females were all serologically negative. The model offers new possibilities for exploration of factors responsible for asymptomatic infection often observed in human congenital syphilis. Images PMID:1729190

  4. A decade of reorientation in the treatment of venereal syphilis

    PubMed Central

    Idsoe, O.; Guthe, T.; Christiansen, Sven; Krag, P.; Cutler, J. C.

    1954-01-01

    As experience with penicillin in the treatment of venereal syphilis has grown over the last decade, this drug, used without adjuvants, has become increasingly widely accepted as being effective, convenient, non-toxic, and relatively inexpensive. Metal chemotherapy required the use of repeated subcurative doses over a long period of time and was essentially suppressive in character; penicillin can be given in the form of repository preparations which ensure a treponemacidal blood-level of long duration. These can be given in large single doses or in repeated smaller doses; the therapeutic results will not vary whichever of these procedures is used. In the first part of this paper, the authors discuss the effect of penicillin and the time factor, the choice of penicillin preparation, the mode of administration, and the reaction to infection with Treponema pallidum. In the second part, they consider the present status of penicillin therapy in venereal syphilis, dealing with the principles of follow-up and control; with the treatment of early, latent, late, and congenital syphilis; and with the treatment of incubating syphilis and contacts. PMID:13182586

  5. Performance Evaluation of the Elecsys Syphilis Assay for the Detection of Total Antibodies to Treponema pallidum

    PubMed Central

    Enders, Martin; Hunjet, Andrea; Gleich, Michael; Imdahl, Roland; Mühlbacher, Annelies; Schennach, Harald; Chaiwong, Kriangsak; Sakuldamrongpanich, Tasanee; Turhan, Ajda; Sertöz, Rüchan; Wolf, Eva; Mayer, Wolfgang; Tao, Chuanmin; Wang, Lan Lan; Semprini, Simona

    2014-01-01

    Syphilis is a health problem of increasing incidence in recent years that may have severe complications if not diagnosed and treated at an early stage. There are many diagnostic tests available for syphilis, but there is no gold standard, and diagnosis therefore usually relies upon a combination of tests. In this multicenter study, we evaluated the treponemal Elecsys syphilis assay for use in the diagnosis of syphilis in routine samples, i.e., when syphilis is suspected or during antenatal or blood donation screening. The sensitivity and specificity of the Elecsys syphilis assay were compared head to head with those of other treponemal assays used in routine clinical practice and were assessed in potentially cross-reactive samples from patients with Epstein-Barr virus, HIV, and Lyme disease. In a total of 8,063 syphilis-negative samples collected from routine diagnostic requests and blood donations, the Elecsys syphilis assay had a specificity of 99.88%. In 928 samples previously identified as syphilis positive, the sensitivity was 99.57 to 100% (the result is presented as a range depending on whether four initially indeterminate samples are included in the assessment). The specificity of the Elecsys syphilis assay in patients with other infections was 100%; no false-positive samples were identified. PMID:25355799

  6. Performance evaluation of the Elecsys syphilis assay for the detection of total antibodies to Treponema pallidum.

    PubMed

    Enders, Martin; Hunjet, Andrea; Gleich, Michael; Imdahl, Roland; Mühlbacher, Annelies; Schennach, Harald; Chaiwong, Kriangsak; Sakuldamrongpanich, Tasanee; Turhan, Ajda; Sertöz, Rüchan; Wolf, Eva; Mayer, Wolfgang; Tao, Chuanmin; Wang, Lan Lan; Semprini, Simona; Sambri, Vittorio

    2015-01-01

    Syphilis is a health problem of increasing incidence in recent years that may have severe complications if not diagnosed and treated at an early stage. There are many diagnostic tests available for syphilis, but there is no gold standard, and diagnosis therefore usually relies upon a combination of tests. In this multicenter study, we evaluated the treponemal Elecsys syphilis assay for use in the diagnosis of syphilis in routine samples, i.e., when syphilis is suspected or during antenatal or blood donation screening. The sensitivity and specificity of the Elecsys syphilis assay were compared head to head with those of other treponemal assays used in routine clinical practice and were assessed in potentially cross-reactive samples from patients with Epstein-Barr virus, HIV, and Lyme disease. In a total of 8,063 syphilis-negative samples collected from routine diagnostic requests and blood donations, the Elecsys syphilis assay had a specificity of 99.88%. In 928 samples previously identified as syphilis positive, the sensitivity was 99.57 to 100% (the result is presented as a range depending on whether four initially indeterminate samples are included in the assessment). The specificity of the Elecsys syphilis assay in patients with other infections was 100%; no false-positive samples were identified. PMID:25355799

  7. Factors associated with syphilis infection: a comprehensive analysis based on a case-control study.

    PubMed

    Xiao, Y; Li, S-L; Lin, H-L; Lin, Z-F; Zhu, X-Z; Fan, J-Y; Gao, K; Zhang, H-L; Lin, L-R; Liu, L-L; Tong, M-L; Niu, J-J; Yang, T-C

    2016-04-01

    This study aimed to comprehensively evaluate factors that influence the likelihood of syphilis infection from risk-taking behaviours and medical conditions. A retrospective case-control study was conducted by enrolling 664 syphilis inpatients (excluding 11 congenital syphilis patients) and 800 sex- and age-matched controls. Medical histories, clinical data and patient interview data were collected and subjected to logistic regression analyses. The prevalence of syphilis in the study population was 3·9% (675/17,304). By univariate analysis, syphilis infection was associated with migration between cities, marital status, smoking, reproductive history, hypertension, elevated blood urea nitrogen (BUN) and infection with hepatitis B virus (HBV) (P < 0·05). A high rate of syphilis-HBV co-infection was observed in HIV-negative patients and further research revealed an association between syphilis and specific HBV serological reactivity. Syphilis was also associated with the frequency, duration and status of tobacco use. Multivariate analysis indicated that syphilis infection was independently associated with migration between cities [adjusted odds ratio (aOR) 1·368, 95% confidence interval (CI) 1·048-1·785], current smoking (aOR 1·607, 95% CI 1·177-2·195), elevated BUN (aOR 1·782, 95% CI 1·188-2·673) and some serological patterns of HBV infection. To prevent the spread of infectious diseases, inpatients and blood donors should be tested for HIV, syphilis, HBV and HCV simultaneously. PMID:26467944

  8. The epidemiology of infectious syphilis in the Republic of Ireland.

    PubMed

    Cronin, M; Domegan, L; Thornton, L; Fitzgerald, M; Hopkins, S; O'Lorcain, P; Creamer, E; O'Flanagan, D

    2004-12-01

    In response to the increasing numbers of syphilis cases reported among men having sex with men (MSM) in Dublin, an Outbreak Control Team (OCT) was set up in late 2000. The outbreak peaked in 2001 and had largely ceased by late 2003. An enhanced syphilis surveillance system was introduced to capture data from January 2000. Between January 2000 and December 2003, 547 cases of infectious syphilis were notified in Ireland (415 were MSM). Four per cent of cases were diagnosed with HIV and 15.4% of cases were diagnosed with at least one other STI (excluding HIV) within the previous 3 months. The mean number of contacts reported by male cases in the 3 months prior to diagnosis was 4 (range 0-8) for bisexual contacts and 6 for homosexual contacts (range 1-90). Thirty one per cent of MSM reported having had recent unprotected oral sex and 15.9% of MSM reported having had recent unprotected anal sex. Sixteen per cent of cases reported having had sex abroad in the three months prior to diagnosis. The results suggest that risky sexual behaviour contributed to the onward transmission of infection in Dublin. The outbreak in Dublin could be seen as part of a European-wide outbreak of syphilis. The rates of co-infection with HIV and syphilis in Ireland are comparable with rates reported from other centres. There is a need to improve surveillance systems in order to allow real time evaluation of interventions and ongoing monitoring of infection trends. PMID:15677853

  9. The Global Epidemiology of Syphilis in the Past Century – A Systematic Review Based on Antenatal Syphilis Prevalence

    PubMed Central

    Kenyon, Chris Richard; Osbak, Kara; Tsoumanis, Achilleas

    2016-01-01

    Background How can we explain the uneven decline of syphilis around the world following the introduction of penicillin? In this paper we use antenatal syphilis prevalence (ASP) to investigate how syphilis prevalence varied worldwide in the past century, and what risk factors correlate with this variance. Methods 1) A systematic review using PubMed and Google Scholar was conducted to identify countries with published data relating to ASP estimates from before 1952 until the present. Eleven countries were identified (Canada, Denmark, Finland, India, Japan, Norway, Singapore, South Africa, United States of America (USA), United Kingdom (UK) and Zimbabwe). The ASP epidemic curve for each population was depicted graphically. In South Africa and the USA, results are reported separately for the black and white populations. 2) National antenatal syphilis prevalence estimates for 1990 to 1999 and 2008 were taken from an Institute for Health Metrics and Evaluation database on the prevalence of syphilis in low risk populations compiled for the Global Burden of Diseases study and from a recent review paper respectively. National ASPs were depicted graphically and regional median ASPs were calculated for both time periods. 3) Linear regression was used to test for an association between ASP in 1990–1999 and 2008 and four risk factors (efficacy of syphilis screening/treatment, health expenditure, GDP per capita and circumcision prevalence). WHO world regions were included as potential explanatory variables. Results In most populations, ASP dropped to under 1% before 1960. In Zimbabwe and black South Africans, ASP was high in the pre-penicillin period, dropped in the post-penicillin period, but then plateaued at around 6% until the end of the 20th century when ASP dropped to just above 1%. In black Americans, ASP declined in the post penicillin period, but plateaued at 3–5% thereafter. ASP was statistically significantly higher in sub-Saharan Africa in 1990–1999 and 2008

  10. Perspectives of low-income African Americans on syphilis and HIV: implications for prevention.

    PubMed

    Okwumabua, J O; Glover, V; Bolden, D; Edwards, S

    2001-11-01

    Infectious syphilis disproportionately affects African Americans living in poverty in metropolitan areas in the southeastern United States. In this population, where syphilis persists, the rates of HIV and AIDS are also persistently high. In an effort to facilitate the design of more effective prevention programs, the present investigation employed focus groups to obtain information from low-income African Americans concerning the determinants of high rates of syphilis and HIV/AIDS in their communities. The subjects were 36 African American men and women ages 18 to 56 residing in metropolitan Memphis and surrounding Shelby County, Tennessee. Overall, the authors found significant lack of awareness of the magnitude of HIV/AIDS and syphilis in African American communities and lack of knowledge about the etiology and transmission of syphilis. The investigation points to the important role of women and partnerships of community organizations in preventing the spread of HIV, syphilis, and other sexually transmitted diseases in this population. PMID:11688197

  11. [Ocular Syphilis Complicated with HIV Infection: A Report of 3 Cases].

    PubMed

    Fukushima, Kazuaki; Yanagisawa, Naoki; Sasaki, Shugo; Sekiya, Ryoko; Sekiya, Noritaka; Suganuma, Akihiko; Ajisawa, Atsushi; Imamura, Akifumi

    2016-05-01

    We present 3 cases of ocular syphilis in patients who had been newly diagnosed as having HIV. All the patients had only complained of ophthalmologic symptoms at the time of their initial visit. Treatment with penicillin was successful, resulting in no significant sequelae. Ocular syphilis may lead to reduced visual acuity or even blindness if left untreated. However, the diagnosis may be challenging, since patients may lack symptoms that are commonly observed in cases with primary and secondary syphilis. Considering the recent increase in the number of syphilis patients, clinicians should be aware of ocular syphilis and should have a high index of suspicion for syphilis in any patient at risk so as to ensure a prompt diagnosis. PMID:27529966

  12. Evaluation of the BioPlex 2200 Syphilis System as a First-Line Method of Reverse-Sequence Screening for Syphilis Diagnosis

    PubMed Central

    Nardini, Paola; Foschi, Claudio; Moroni, Alessandra; D'Antuono, Antonietta; Bacchi Reggiani, Letizia; Cevenini, Roberto

    2013-01-01

    Despite recent technological advances, the diagnosis of syphilis remains a challenging enterprise. Actually, most high-volume laboratories have adopted the “reverse algorithm” due several factors, including the potential to automate testing. Recently, immunoassays processed on random-access systems have been proposed as screening tests. The purpose of this study was to evaluate diagnostic performances of BioPlex 2200 Syphilis IgG and BioPlex 2200 Syphilis IgM, tests based on Multiplex Flow technology, in comparison with the performance of Architect Syphilis TP, a chemiluminescent immunoassay for the detection of IgG and/or IgM anti-Treponema pallidum antibodies. A retrospective study was performed with a panel of 100 blood donor sera, a panel of 350 clinical and laboratory-characterized syphilitic sera, and 170 samples obtained from subjects with potentially interfering conditions. Moreover, 200 unselected samples submitted to the Microbiology Laboratory of St. Orsola Hospital in Bologna for routine screening for syphilis were evaluated. As confirmatory tests, T. pallidum hemagglutination and Western blot assays were used. Considering the IgG Western blot (WB) assay to be the gold standard method, BioPlex 2200 Syphilis IgG specificity was far higher than Architect Syphilis TP specificity (89.7% versus 78.4%, respectively), whereas the sensitivity was 100% for both automated methods. Compared to the IgM WB assay, BioPlex 2200 Syphilis IgM performed with a specificity of 94.9%, whereas the sensitivity was 84.8%. Considering the excellent ease of use and automation, the high sample throughput and its valuable analytical performances, BioPlex Syphilis 2200 IgG could represent a suitable choice for high-volume laboratories. BioPlex Syphilis 2200 IgM could be considered a good addition to IgG testing for uncovering active infections. PMID:23697575

  13. Evaluation of Elecsys Syphilis Assay for Routine and Blood Screening and Detection of Early Infection

    PubMed Central

    Kremastinou, J.; Polymerou, V.; Lavranos, D.; Aranda Arrufat, A.; Harwood, J.; Martínez Lorenzo, M. J.; Ng, K. P.; Queiros, L.; Vereb, I.

    2016-01-01

    Treponema pallidum infections can have severe complications if not diagnosed and treated at an early stage. Screening and diagnosis of syphilis require assays with high specificity and sensitivity. The Elecsys Syphilis assay is an automated treponemal immunoassay for the detection of antibodies against T. pallidum. The performance of this assay was investigated previously in a multicenter study. The current study expands on that evaluation in a variety of diagnostic settings and patient populations, at seven independent laboratories. The samples included routine diagnostic samples, blood donation samples, samples from patients with confirmed HIV infections, samples from living organ or bone marrow donors, and banked samples, including samples previously confirmed as syphilis positive. This study also investigated the seroconversion sensitivity of the assay. With a total of 1,965 syphilis-negative routine diagnostic samples and 5,792 syphilis-negative samples collected from blood donations, the Elecsys Syphilis assay had specificity values of 99.85% and 99.86%, respectively. With 333 samples previously identified as syphilis positive, the sensitivity was 100% regardless of disease stage. The assay also showed 100% sensitivity and specificity with samples from 69 patients coinfected with HIV. The Elecsys Syphilis assay detected infection in the same bleed or earlier, compared with comparator assays, in a set of sequential samples from a patient with primary syphilis. In archived serial blood samples collected from 14 patients with direct diagnoses of primary syphilis, the Elecsys Syphilis assay detected T. pallidum antibodies for 3 patients for whom antibodies were not detected with the Architect Syphilis TP assay, indicating a trend for earlier detection of infection, which may have the potential to shorten the time between infection and reactive screening test results. PMID:27358468

  14. A case of secondary syphilis mimicking palmoplantar psoriasis in HIV infected patient.

    PubMed

    Bittencourt, Maraya de Jesus Semblano; Brito, Arival Cardoso de; Nascimento, Bianca Angelina Macêdo do; Carvalho, Alessandra Haber; Nascimento, Manoel Dias do

    2015-01-01

    Due to diverse clinical and histopathological presentations, diagnosis of secondary syphilis can occasionally prove challenging. Variable clinical presentations of secondary syphilis in HIV disease may result in an incorrect diagnosis and an inappropriate treatment regimen. Similarly, the histology of secondary syphilitic lesions may show considerable variation, depending on the clinical morphology of the eruption. We report a case of secondary syphilis in an HIV infected patient with cutaneous palmoplantar lesions simulating palmoplantar psoriasis. PMID:26312721

  15. A longitudinal evaluation of Treponema pallidum PCR testing in early syphilis

    PubMed Central

    2012-01-01

    Background Syphilis is a growing public health problem among men who have sex with men (MSM) globally. Rapid and accurate detection of syphilis is vital to ensure patients and their contacts receive timely treatment and reduce ongoing transmission. Methods We evaluated a PCR assay for the diagnosis of Treponema pallidum using swabs of suspected early syphilis lesions in longitudinally assessed MSM. Results We tested 260 MSM for T pallidum by PCR on 288 occasions: 77 (26.7%) had early syphilis that was serologically confirmed at baseline or within six weeks, and 211 (73.3%) remained seronegative for syphilis. Of 55 men with primary syphilis, 49 were PCR positive, giving a sensitivity of 89.1% (95% CI: 77.8%-95.9%) and a specificity of 99.1% (95% CI: 96.5%-99.9%). Of 22 men with secondary syphilis, 11 were PCR positive, giving a sensitivity of 50% (95% CI: 28.2%-71.8%) and a specificity of 100% (95% CI: 66.4%-71.8%). Of the 77 syphilis cases, 43 (56%) were HIV positive and the sensitivity and specificity of the PCR test did not vary by HIV status. The PCR test was able to detect up to five (10%) primary infections that were initially seronegative, including one HIV positive man with delayed seroconversion to syphilis (72 to 140 days) and one HIV positive man who did not seroconvert to syphilis over 14 months follow-up. Both men had been treated for syphilis within a week of the PCR test. Conclusions T pallidum PCR is a potentially powerful tool for the early diagnosis of primary syphilis, particularly where a serological response has yet to develop. PMID:23241398

  16. Evaluation of Elecsys Syphilis Assay for Routine and Blood Screening and Detection of Early Infection.

    PubMed

    Kremastinou, J; Polymerou, V; Lavranos, D; Aranda Arrufat, A; Harwood, J; Martínez Lorenzo, M J; Ng, K P; Queiros, L; Vereb, I; Cusini, M

    2016-09-01

    Treponema pallidum infections can have severe complications if not diagnosed and treated at an early stage. Screening and diagnosis of syphilis require assays with high specificity and sensitivity. The Elecsys Syphilis assay is an automated treponemal immunoassay for the detection of antibodies against T. pallidum The performance of this assay was investigated previously in a multicenter study. The current study expands on that evaluation in a variety of diagnostic settings and patient populations, at seven independent laboratories. The samples included routine diagnostic samples, blood donation samples, samples from patients with confirmed HIV infections, samples from living organ or bone marrow donors, and banked samples, including samples previously confirmed as syphilis positive. This study also investigated the seroconversion sensitivity of the assay. With a total of 1,965 syphilis-negative routine diagnostic samples and 5,792 syphilis-negative samples collected from blood donations, the Elecsys Syphilis assay had specificity values of 99.85% and 99.86%, respectively. With 333 samples previously identified as syphilis positive, the sensitivity was 100% regardless of disease stage. The assay also showed 100% sensitivity and specificity with samples from 69 patients coinfected with HIV. The Elecsys Syphilis assay detected infection in the same bleed or earlier, compared with comparator assays, in a set of sequential samples from a patient with primary syphilis. In archived serial blood samples collected from 14 patients with direct diagnoses of primary syphilis, the Elecsys Syphilis assay detected T. pallidum antibodies for 3 patients for whom antibodies were not detected with the Architect Syphilis TP assay, indicating a trend for earlier detection of infection, which may have the potential to shorten the time between infection and reactive screening test results. PMID:27358468

  17. Evolution of the syphilis epidemic among men who have sex with men.

    PubMed

    Solomon, Marc M; Mayer, Kenneth H

    2015-04-01

    Syphilis has existed for millenni, but its epidemiology was only recently linked to men who have sex with men (MSM) after the introduction of penicillin in the 1940s; the syphilis epidemic became concentrated within the MSM community in subsequent decades. The HIV/AIDS epidemic in the 1980s led to a surge of new syphilis cases and revealed the potentiation between HIV and syphilis, as evidenced by a shift in the natural history of neurosyphilis. In response, MSM revolutionised their sexual behaviour by implementing community-driven seroadaptive strategies to stem HIV transmission. The Centers for Disease Control in the US called for the elimination of syphilis in the late 1990s since the rates had fallen sharply but this effort was overtaken by a resurgence of global outbreaks among MSM in the 2000s, many of which were linked to methamphetamine use and sexual networking websites. Syphilis remains highly prevalent today, especially among MSM and individuals infected with HIV, and it continues to present a significant public health conundrum. Innovative syphilis prevention strategies are warranted. MSM engaging in high-risk behaviour such as condomless anal receptive intercourse, sex with multiple partners or recreational drug use should be routinely screened for syphilis infection; they should also be counselled about the limits of seroadaptive behaviours and HIV pre-exposure prophylaxis as they relate to syphilis transmission. PMID:25514173

  18. Evolution of the syphilis epidemic among men who have sex with men

    PubMed Central

    Solomon, Marc M.; Mayer, Kenneth H.

    2014-01-01

    Syphilis has existed for millenni, but its epidemiology was only recently linked to men who have sex with men (MSM) after the introduction of penicillin in the 1940s; the syphilis epidemic became concentrated within the MSM community in subsequent decades. The HIV/AIDS epidemic in the 1980s led to a surge of new syphilis cases and revealed the potentiation between HIV and syphilis, as evidenced by a shift in the natural history of neurosyphilis. In response, MSM revolutionised their sexual behaviour by implementing community-driven seroadaptive strategies to stem HIV transmission. The Centers for Disease Control in the US called for the elimination of syphilis in the late 1990s since the rates had fallen sharply but this effort was overtaken by a resurgence of global outbreaks among MSM in the 2000s, many of which were linked to methamphetamine use and sexual networking websites. Syphilis remains highly prevalent today, especially among MSM and individuals infected with HIV, and it continues to present a significant public health conundrum. Innovative syphilis prevention strategies are warranted. MSM engaging in high-risk behaviour such as condomless anal receptive intercourse, sex with multiple partners or recreational drug use should be routinely screened for syphilis infection; they should also be counselled about the limits of seroadaptive behaviours and HIV pre-exposure prophylaxis as they relate to syphilis transmission. PMID:25514173

  19. Syphilis: a review and update of this 'new' infection of the '90s.

    PubMed

    Buckley, H B

    1992-08-01

    Reported cases of primary, secondary and congenital syphilis are reaching epidemic proportions in the United States. Several factors have been associated with this increase, including budget reductions for syphilis-control programs, the growing use of cocaine among women of childbearing age and the practice of trading sex with multiple partners for illegal drugs. This article reviews the pathogenesis, clinical stages and presentation, serologic testing, treatment, and pertinent patient education for syphilis. Recommendations for the identification and prevention of syphilis are provided. PMID:1501792

  20. Dental Stigmata of Congenital Syphilis: A Historic Review With Present Day Relevance.

    PubMed

    Nissanka-Jayasuriya, Eranga H; Odell, Edward W; Phillips, Carina

    2016-09-01

    Syphilis was the first sexually transmitted disease to be diagnosed in childhood. Most developed countries controlled syphilis effectively after the 1950s and congenital syphilis became rare. Since the late 1990s there has been a resurgence of syphilis in developed and developing countries and the WHO estimates that at least half a million infants die of congenital syphilis every year. The earliest reference to the dental manifestations of congenital syphilis was by Sir Jonathan Hutchinson, Assistant Surgeon at The London Hospital in 1861. Three main dental defects are described in congenital syphilis; Hutchinson's incisors, Moon's molars or bud molars, and Fournier's molars or mulberry molars. Although many physicians, dentists, and pathologists in developed countries will be aware of the dental features of syphilis, most will never have seen a case or made the diagnosis. The purpose of this article is to review some of the history of congenital syphilis, remind healthcare professionals of the features, and bring to their attention that the changes are still prevalent and that milder cases can be mistaken for other causes of hypoplasia. PMID:26897633

  1. Prosthetic rehabilitation of palatal perforation in a patient with ‘syphilis: the great imitator’

    PubMed Central

    Murthy, Varsha; Vaithilingam, Yuvraj; Livingstone, David; Pillai, Ajay

    2014-01-01

    Syphilis is a sexually transmissible disease caused by treponema palladium, a microaerophilic spirochete. Syphilis may progress from primary to tertiary stage if left unnoticed and untreated. Dentists should be vigilant and suspect sexually transmitted infections such as syphilis in the differential diagnosis of oral inflammatory or ulcerative lesions with palatal perforation. Moreover, it is imperative that dentists should have knowledge about its stages, characteristic features, oral presentation and prosthetic rehabilitation. This case report describes a case of tertiary syphilis with palatal perforation and the prosthetic rehabilitation of the defect with a prosthetic obturator. PMID:24891485

  2. Musculoskeletal involvement of syphilis – a forgotten lesson

    PubMed Central

    Gomez, Jesus Vallejo; Molnar, Szabolcs Lajos; Val, Sami Mansour; Arnal, Rafael Gracia

    2012-01-01

    Syphilis is a sexually transmitted disease with a myriad of presentation and called ‘the great impostor’ for the variety of the symptoms. As a venereal disease it is transmissible mainly by sexual contact with infectious lesions but can spread by blood contamination. Without treatment it progresses through early and late syphilis. Since the introduction of penicillin its prevalence has strongly dropped but was never eradicated entirely. As the frequency and the progression are largely controlled there are several symptoms which are not common and can be a difficult differential diagnostic problem nowadays. The authors present a case where decades passed between the primary event and the actual hospitalisation with fever of unknown origin and coexistent swollen joint deformities. The patient was not treated entirely from his primary event and later, psoriasis was settled as a diagnosis, which was the cause of neglecting the secondary phase’s skin lesions. PMID:22787187

  3. [The symbolic geopolitics of syphilis: an essay in historical anthropology].

    PubMed

    Carrara, S

    The article analyzes certain scientific ideas that Brazilian physicians, and particularly syphilologists, have held about this disease. During the 1920's especially, these specialists constructed a uniquely Brazilian version of the disease as they debated with foreign specialists on the origins, symptoms, and incidence of syphilis in Brazil. In their formulations, syphilis became a kind of natural symbol through which they expressed their desires to play a leading role within the international scientific community and put forth efforts to earn Brazil a new status in the world ranking of nations contesting the notion that Brazil was forever doomed to backwardness and barbarism because it was a tropical country with a racially mixed population. PMID:11625109

  4. Lack of effectiveness of ofloxacin against experimental syphilis in rabbits.

    PubMed

    Une, T; Nakajima, R; Otani, T; Katami, K; Osada, Y; Otani, M

    1987-09-01

    Ofloxacin, a new pyridone-carboxylic acid derivative, was evaluated in experimental syphilis in rabbits in comparison with penicillin G. Experimental syphilis was established by intradermal injection of Treponema pallidum subsp. pallidum Nichols. Ten days after infection, the dermal lesions were characterized by syphilitic papula accompanied with central necrosis. These animals were subsequently treated either with ofloxacin twice a day at an oral dose of 10 mg/kg or with penicillin G once a day at an intramuscular dose of 10,000 U/kg for 21 consecutive days. In penicillin G-treated animals, the dermal lesions became smaller as early as day 3 of treatment and almost disappeared during the therapy. In marked contrast to remarkable efficacy of penicillin G was further development of the lesions in ofloxacin-treated animals, showing no difference in pathological manifestations as compared to untreated animals. The results of nontreponemal serologic test correlated well with the response of animals to treatment. PMID:3325066

  5. Congenital syphilis and glomerulonephritis with evidence for immune pathogenesis

    PubMed Central

    Wiggelinkhuizen, J.; Kaschula, R. O. C.; Uys, C. J.; Kuijten, R. H.; Dale, J.

    1973-01-01

    In 3 infants with congenital syphilis the dominant clinical manifestation of syphilitic kidney disease was the nephrotic syndrome. Mesangioendothelial proliferation was present in 2 cases and mixed proliferative glomerulonephritis with crescent formation in the third. The severity of the clinical and histopathological abnormalities could be related to the apparent duration of the illness. In all 3 cases immune complex deposition could be shown within and along the epithelial aspect of the glomerular basement membrane on light, electron, and immunofluorescent microscopy. These features, together with a reduced total serum haemolytic complement, suggest an immune pathogenesis of the glomerulonephritis associated with early congenital syphilis. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5 PMID:4267344

  6. Nodular mucinosis misdiagnosed as non-responsive secondary syphilis.

    PubMed

    Patrício, Catarina; Campos, Sara; João, Alexandre; Serrão, Vasco

    2015-01-01

    A previously healthy 24-year-old man presented with an erythematous, non-pruritic and painless papulonodular skin rash affecting the trunk, upper arms (excluding palms), neck, face, forehead and scalp. He had a penile ulcer for the past 2 weeks, almost healed at the time of observation. The patient tested positive for syphilis and HIV-1; he claimed being negative for HIV 6 months earlier. As the palms were not affected, we performed a skin biopsy for the differential diagnosis between secondary lues and acute HIV seroconversion reaction. Benzathine penicillin (2,400,000 units) was administrated and antiretroviral therapy started. Although the skin biopsy was compatible with secondary syphilis, there was no change in the skin rash 3 weeks after the first penicillin administration. Another 2 doses of penicillin were given but 4 weeks later the rash persisted. A second biopsy revealed a mucinous skin infiltration, compatible with nodular mucinosis. PMID:26311009

  7. Yellowish dots in the retina: a finding of ocular syphilis?

    PubMed

    Rodrigues, Renan Albert Mendonça; Nascimento, Heloisa Moraes do; Muccioli, Cristina

    2014-10-01

    Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study. PMID:25494381

  8. Laboratory diagnosis and interpretation of tests for syphilis.

    PubMed Central

    Larsen, S A; Steiner, B M; Rudolph, A H

    1995-01-01

    The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose. PMID:7704889

  9. The syphilis problem in Asir province, Saudi Arabia

    PubMed Central

    El Ghoroury, A. A.

    1954-01-01

    A combined national and international venereal disease team began activities in Saudi Arabia in November 1952, moving from Mecca to Asir province in May 1953, where it remained for two months examining and treating various groups of the population. A total of 309 cases of syphilis among a population of approximately 3,000 at Abha was given complete clinical and serological examination and treatment with PAM, in doses varying from 2.4 to 6.0 million units. Serological tests were made on 2,359 blood samples. Only one primary lesion was found; but secondary lesions were quite common, amounting to 5.8% of all cases treated, while tertiary lesions represented 12.6% of all cases treated and 67.2% of all clinical cases. Considerable variations in the prevalence of syphilis were noted among the different quarters of the town of Abha and among different tribes and villages. All the age-groups were more or less equally affected, but the females generally showed a higher positivity-rate than the males. All these features—together with the low social, economic, and sanitary standards of the population and many prevalent social habits, such as the use of common eating and drinking implements — would seem to indicate that the syphilis met in Asir, and locally known as “shadjar”, “balash”, “fringi”, “mabrouk”, or “wardi”, should be included with the endemic treponematoses met with elsewhere in the world. PMID:13182591

  10. A new enhanced antibiotic treatment for early and late syphilis.

    PubMed

    Drago, Francesco; Ciccarese, Giulia; Broccolo, Francesco; Sartoris, Giulia; Stura, Paola; Esposito, Susanna; Rebora, Alfredo; Parodi, Aurora

    2016-06-01

    The objective of this study was to evaluate the efficacy of an enhanced treatment regimen for syphilis with the addition of doxycycline and ceftriaxone to the conventional benzathine penicillin G (BPG) treatment. Sixty-nine syphilis patients were recruited and were randomly assigned to two groups: group 1 (38 patients) received standard therapy and group 2 (31 patients) received the enhanced therapy. All patients were followed-up for at least 12 months. Patients underwent physical examination and serology every 6 months as well as echocardiography and neurological examination every year. A three- to four-fold decline in the initial Venereal Disease Research Laboratory (VDRL) titre within 6 months after therapy was considered as serological cure. At 12 months, 68% of patients in group 1 and 100% in group 2 were serologically cured (P=0.002). During follow-up, no patients in group 2 experienced complications related to syphilis. In contrast, one patient in group 1 developed neurosyphilis. In conclusion, the enhanced treatment is more effective than standard treatment and results in a higher and faster cure rate. Moreover, it provides treponemicidal antibiotic levels in the cerebrospinal fluid, thereby preventing possible late complications. PMID:27436469

  11. Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

    PubMed Central

    Southwick, K. L.; Blanco, S.; Santander, A.; Estenssoro, M.; Torrico, F.; Seoane, G.; Brady, W.; Fears, M.; Lewis, J.; Pope, V.; Guarner, J.; Levine, W. C.

    2001-01-01

    OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this

  12. Prevalence of syphilis among antenatal clinic attendees in Karachi: Imperative to begin universal screening in Pakistan

    PubMed Central

    Shah, SA; Kristensen, S; Memon, MA; Usman, G; Ghazi, A; John, R; Sathiakumar, N; Vermund, SH

    2013-01-01

    Objectives Sexually transmitted infections are thought by some to be rare in socially conservative Muslim countries. Little is known about prevalence of syphilis in Pakistani women from the general population. We determined syphilis prevalence in a multi-center cross-sectional study of low risk pregnant women in Karachi, Pakistan. Methods We administered a structured questionnaire and obtained a blood sample for syphilis serology (rapid plasma reagin test with Treponema pallidum hemagglutination assay confirmation) from all women giving informed consent over six weeks in 2007. Results The prevalence of confirmed syphilis was less than one percent (0.9%; 95%CI: 0.4, 1.8) in a sample size of 800 women recruited from three urban sites (≈1% refusal rate). Women who lived in an area where male drug use is prevalent (Ibrahim Hyderi Hospital) had 1% (1.5%) higher prevalence rates than women from the other two sites 0.5%. Conclusions We documented higher-than-expected syphilis seroprevalence rates in a low risk population of antenatal clinic attendees in Pakistan. Bridge populations for syphilis may include drug users, who are usually married, and Hijras or their clients. Hijras are transgender and/or transvestite men who may provide sex for money to men. In accordance with our results, the national policy for syphilis control in Pakistan should be modified to include universal syphilis screening in antenatal clinics with subsequent partner notification. PMID:22356034

  13. Don’t Forget What You Can’t See: A Case of Ocular Syphilis

    PubMed Central

    Lee, Monica I.; Lee, Annie W.C.; Sumsion, Sean M.; Gorchynski, Julie A.

    2016-01-01

    This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM). This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The patient’s history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. Ocular manifestations of syphilis can present at any stage of syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss. PMID:27429702

  14. Tonsillar Syphilis: an Unusual Site of Infection Detected by Treponema pallidum PCR.

    PubMed

    Smith, John R M; Tsang, Raymond S W; Kadkhoda, Kamran

    2015-09-01

    With the reemergence of syphilis, it is important that both clinical and public health practitioners recognize the various clinical manifestations of this disease (formerly known as "the great imitator") and become familiar with the newer diagnostic tests. Here we report the first case of tonsillar syphilis diagnosed by PCR. PMID:26179306

  15. Seven years of undiagnosed syphilis: a missed opportunity for mother and child.

    PubMed

    Oomeer, Soonita; Alagaratnam, Jasmini; Lyall, Hermione; Gurtin, Deniz; Goldmeier, David

    2015-11-01

    We report the case of congenital syphilis diagnosed in a 7-year-old child after her 32-year-old mother was investigated for neurosyphilis. Our case illustrates the importance of antenatal syphilis screening and the need for a clear referral and management pathway for women with positive serology to ensure cases such as ours do not occur in the future. PMID:25505040

  16. Don't Forget What You Can't See: A Case of Ocular Syphilis.

    PubMed

    Lee, Monica I; Lee, Annie W C; Sumsion, Sean M; Gorchynski, Julie A

    2016-07-01

    This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM). This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The patient's history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. Ocular manifestations of syphilis can present at any stage of syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss. PMID:27429702

  17. Tonsillar Syphilis: an Unusual Site of Infection Detected by Treponema pallidum PCR

    PubMed Central

    Smith, John R. M.; Tsang, Raymond S. W.

    2015-01-01

    With the reemergence of syphilis, it is important that both clinical and public health practitioners recognize the various clinical manifestations of this disease (formerly known as “the great imitator”) and become familiar with the newer diagnostic tests. Here we report the first case of tonsillar syphilis diagnosed by PCR. PMID:26179306

  18. Evaluation of SD BIOLINE Syphilis 3.0 for Rapid Diagnosis of Syphilis: Report from a Regional Sexually Transmitted Infection Reference Laboratory in North India

    PubMed Central

    Mehra, Bhanu; Bhattar, Sonali; Saxena, Shikhar; Rawat, Deepti; Bhalla, Preena

    2016-01-01

    Background: Serology is considered the mainstay of syphilis diagnosis. The limitations of the traditional serological methods and the advent and availability of novel immunochromatographic assays have led to the widespread application of rapid point-of-care procedures as screening tools for syphilis. However, these tests have not been extensively evaluated. This study was designed to evaluate the performance of a rapid syphilis diagnostic test known as SD BIOLINE Syphilis 3.0 (SD Biostandard Diagnostics Private Limited, Gurgaon, Haryana, India). Materials and Methods: A panel comprising of 50 venereal disease research laboratory reactive and 50 nonreactive sera was tested using SD BIOLINE Syphilis 3.0. The performance of the test was evaluated using IMMUTREP Treponema pallidum hemagglutination assay (TPHA) (OMEGA Diagnostics Limited, Scotland, United Kingdom) as the reference standard and sensitivity, specificity, and negative and positive predictive values were calculated. Results: The sensitivity, specificity, and positive and negative predictive values of SD BIOLINE Syphilis 3.0 were 92.86% (confidence interval of 95%: 80.52–98.50%), 98.28% (90.76-99.96%), 97.50% (86.84–99.94%), and 95.00% (86.08–98.96%), respectively, compared to TPHA as the gold standard. Conclusion: Keeping in view the high sensitivity and specificity of SD BIOLINE Syphilis 3.0, we conclude that the test can be used as a tool for rapid on-site diagnosis of syphilis and as an alternative to TPHA for detection of antibodies to Treponema pallidum. PMID:27013811

  19. Social network investigation of a syphilis outbreak in Ottawa, Ontario

    PubMed Central

    D’Angelo-Scott, H; Cutler, J; Friedman, D; Hendriks, A; Jolly, AM

    2015-01-01

    BACKGROUND: The incidence of syphilis in Ottawa, Ontario, has risen substantially since 2000 to six cases per 100,000 in 2003, again to nine cases per 100,000 in 2007, and recently rose to 11 cases per 100,000 in 2010. The number of cases reported in the first quarter of 2010 was more than double that in the first quarter of 2009. OBJECTIVE: In May 2010, the Ontario Ministry of Health and Long Term Care requested the assistance of the Field Epidemiology Program to describe the increase in infectious syphilis rates and to identify social network sources and prevention messages. METHODS: Syphilis surveillance data were routinely collected from January 1, 2009 to July 15, 2010, and social networks were constructed from an enhanced social network questionnaire. Univariate comparisons between the enhanced surveillance group and the remaining cases from 2009 on non-normally distributed data were conducted using Kruskal-Wallis tests and χ2 tests. RESULTS: The outbreak cases were comprised of 89% men. Seventeen of the 19 most recent cases consented to answer the questionnaire, which revealed infrequent use of condoms, multiple sex partners and sex with a same-sex partner. Information regarding social venues where sex partners were met was plotted together with sexual partnerships, linking 18 cases and 40 contacts, representing 37% of the outbreak population and connecting many of the single individuals and dyads. CONCLUSION: Uncovering the places sex partners met was an effective proxy measure of high-risk activities shared with infected individuals and demonstrates the potential for focusing on interventions at one named bar and one Internet site to reach a high proportion of the population at risk. PMID:26600816

  20. Detection of Treponema pallidum in early syphilis by DNA amplification.

    PubMed Central

    Wicher, K; Noordhoek, G T; Abbruscato, F; Wicher, V

    1992-01-01

    By using experimentally infected rabbits as a model for early syphilis, the applicability of in vitro DNA amplification was explored for detection of Treponema pallidum. It was determined that whole blood in heparin or EDTA (but not serum), lesion exudate, and punch biopsy as well as swabs of lesions are useful specimens for examination by the polymerase chain reaction. Swabs do not require special diluents, and the specimens, whether kept at room temperature or frozen, are well suited for use in the polymerase chain reaction. Images PMID:1537923

  1. Endemic syphilis in the Bakwena Reserve of the Bechuanaland Protectorate

    PubMed Central

    Murray, J. F.; Merriweather, A. M.; Freedman, M. L.

    1956-01-01

    A form of endemic syphilis exists in the Bakwena Reserve of the Bechuanaland Protectorate known by the local name of “dichuchwa”. It is similar to bejel, njovera and the endemic syphilis reported elsewhere in the world. The Government of the Protectorate, with the assistance of WHO and UNICEF, began in November 1953 a mass campaign in the Reserve to control this disease and, at the same time, to study its epidemiological, clinical, social and therapeutic aspects. The seropositivity rate in the Reserve was found to be 37%. Dichuchwa is a childhood and family disease, usually spread non-venereally. The early lesions are similar to secondary lesions of sporadic venereal syphilis, and are often followed by tertiary lesions affecting mainly the skin, nasopharynx and long bones. Primary lesions are rare but may occur under certain epidemiological conditions if the inoculum is sufficiently large; thus a mother may develop primary sores on the nipples through suckling an infected infant. Lesions of the cardiovascular and central nervous systems and congenital syphilis are also rare. Superinfection of an already infected and allergic host is probably the chief reason for the frequency of the tertiary lesions. Treatment of the disease with penicillin is very effective, and the authors believe that mass treatment of cases and contacts combined with an improvement in the standards of hygiene could eradicate the disease. ImagesFig. 61Fig. 62Fig. 63Fig. 64Fig. 74Fig. 75Fig. 76Fig. 1Fig. 2Fig. 3Fig. 16Fig. 17Fig. 18Fig. 43Fig. 44Fig. 45Fig. 7Fig. 8Fig. 9Fig. 13Fig. 14Fig. 15Fig. 31Fig. 32Fig. 33Fig. 50Fig. 51Fig. 52Fig. 53Fig. 54Fig. 55Fig. 56Fig. 34Fig. 35Fig. 36Fig. 46Fig. 47Fig. 48Fig. 49Fig. 22Fig. 23Fig. 24Fig. 10Fig. 11Fig. 12Fig. 57Fig. 58Fig. 59Fig. 60Fig. 65Fig. 66Fig. 67Fig. 19Fig. 20Fig. 21Fig. 4Fig. 5Fig. 6Fig. 68Fig. 69Fig. 70Fig. 71Fig. 72Fig. 73Fig. 37Fig. 38Fig. 39Fig. 28Fig. 29Fig. 30Fig. 25Fig. 26Fig. 27Fig. 40Fig. 41Fig. 42 PMID:13404470

  2. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis.

    PubMed

    Lago, Eleonor G

    2016-01-01

    This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy. PMID:27081586

  3. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

    PubMed Central

    2016-01-01

    This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy. PMID:27081586

  4. A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand.

    PubMed

    Coughlan, Edward; Young, Heather; Parkes, Catherine; Coshall, Maureen; Dickson, Nigel; Psutka, Rebecca; Saxton, Peter; Pink, Ramon; Adams, Katharine

    2015-04-01

    During 2012, Christchurch experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. This was accompanied by some novel trends; notably, the acquisition of infection in a younger age group, with local sexual contacts, commonly via the use of social media. This study is a report on an approach to case identification and public health communication as a component of a multifaceted outbreak response. Enhanced syphilis surveillance data on public health responses to outbreaks of sexually transmissible infections was collated and reviewed, alongside clinical records and literature. Reported outbreak response methods were adapted for the Christchurch cohort. A Facebook page was created to raise awareness of infectious syphilis, the importance of screening and where to get tested. Twenty-six males were diagnosed with infectious syphilis in 2012, an increase from previous years, of which 22 reported only male sexual contact. High use of social media used to find potential sexual contacts was reported. Enhanced syphilis surveillance characterised in detail an infectious syphilis outbreak in Christchurch. Index cases were identified, contact tracing mapping was used to identify transmission networks and social media was also used to educate the risk group. There was a decrease in infectious syphilis presentations, with no cases in the last 3 months of 2012. PMID:25493444

  5. Commercial sex venues, syphilis and methamphetamine use among female sex workers.

    PubMed

    Kang, Dianming; Liao, Meizhen; Jiang, Zhenxia; Zhang, Xijiang; Mao, Wenwen; Zhang, Ning; Tao, Xiaorun; Huang, Tao; Bi, Zhenqiang; Aliyu, Muktar; Wu, Pingsheng; Jiang, Baofa; Jia, Yujiang

    2011-06-01

    The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission. PMID:21660748

  6. The Tuskegee Syphilis Study and the scientific concept of racial nervous resistance.

    PubMed

    Crenner, Christopher

    2012-04-01

    In 1932, the U.S. Public Health Service began a study of untreated syphilis among black men in Macon County, Alabama. This project, later known as the Tuskegee Syphilis Study, became one of the most notorious ventures of twentieth-century medicine. Much has been written on it. Historians have suggested that scientific racism strongly influenced the study. But specific links between earlier racial science and the scientific conduct of the study have remained unexplored. The examination in this paper of the concept of a racially determined resistance to syphilis in the nervous system establishes such a link. Discussion of nervous resistance to syphilis appeared in the medical literature in the early twentieth century as a conjecture about the natural inferiority of blacks. White physicians used the concept to interpret racial differences in neurosyphilis as evidence of the rudimentary development of the brain. A small community of African American physicians joined other national experts in syphilis who chose to explain apparent racial differences through alternate mechanisms. But the scientific advisors to the Tuskegee Syphilis Study favored the concept of a racial resistance to neurosyphilis and steered the early design of the study to help to elucidate it. The Tuskegee Syphilis Study was an examination of untreated syphilis, but it also became a demonstration of a putative racial characteristic of syphilis long considered evidence of the natural inferiority of blacks. An examination of the concept of racial nervous resistance and its influence on the research in Macon County helps to define the influence of scientific racism on this notorious medical study. PMID:21317423

  7. The prevalence and correlates of syphilis and HIV among homosexual and bisexual men in Shijiazhuang, China.

    PubMed

    Zhang, Shao-Hui; Liu, Shu-Jun; Hu, Ling-Ling; Li, Jie-Fang; Liu, Li-Hua; Wei, Ning

    2016-02-01

    Bisexual men (men who have sex with men and women) are potential epidemiological bridges responsible for the spread of HIV and other sexually transmitted infections from men who have sex with men only to the heterosexual population. We aimed to estimate the prevalence of syphilis and HIV and the factors associated with syphilis infection among men who have sex with men and women and men who have sex with men only from Shijiazhuang, China. In 2011-2013, a cross-sectional cohort of 427 men who have sex with men was recruited by a snowball sampling method and tested for syphilis and HIV. Chi square and logistic regression were performed to identify syphilis risk factors. Among the 427 men who have sex with men, 71 (16.6%) cases were syphilis-positive and 16 cases (3.7%) were HIV-positive. The proportions of men who have sex with men and women and men who have sex with men only in the total sample were 31.4% and 68.6%, respectively. Men who have sex with men and women exhibited double the syphilis prevalence of men who have sex with men only and were more likely to practice insertive anal sex. Higher education level, being married, having more male partners, and both receptive and insertive anal sex roles were associated with syphilis among men who have sex with men and women. Residing in suburban areas, being married, being HIV positive, and an absence of desire to change sexual orientation were associated with syphilis among men who have sex with men only. Therefore, men who have sex with men and women represent an important sub-group in the syphilis epidemic and further interventions should be developed to reduce risk among different sub-sets of men who have sex with men. PMID:25725492

  8. [HIV infection, gonorrhea and syphilis from Thailand to Norway].

    PubMed

    Aavitsland, P; Nilsen, O

    1999-10-30

    Thailand, a popular tourist destination for Norwegians, is experiencing an increasing epidemic of HIV infection. We used the Norwegian surveillance system for communicable diseases to assess the connections between the Norwegian and Thai epidemics. Before 1999, 1,869 cases of HIV-infection had been reported in Norway. From 1993 to 1998, 1,334 cases of gonorrhoea and 62 cases of syphilis were reported. We studied cases with a Thai patient or source partner and cases acquired in Thailand. 56 (3%) of HIV-infection cases, 64 (5%) of gonorrhoea cases and two (3%) of syphilis cases were connected to Thailand. All the Norwegians who acquired HIV in Thailand were males, with a median age of 39. Eight of them were diagnosed in 1998 as compared to 16 during the previous ten-year period. 21 Thai women and seven males were diagnosed with HIV infection in Norway, eight in 1998 and 20 in the previous ten-year period. The Norwegian HIV epidemic is influenced by the Thai epidemic. Norwegian men are infected in Thailand during holidays. Thai women come with their Norwegian partner to Norway and later discover their HIV status. We recommend raising the awareness of the Thai epidemic among Norwegian tourists. Immigrants to Norway from highly endemic countries should be offered HIV counselling and testing. PMID:10592752

  9. Syphilis as a Cause of Thoracic Aortic Aneurysm.

    PubMed

    Roberts, William C; Barbin, Clay M; Weissenborn, Matthew R; Ko, Jong M; Henry, A Carl

    2015-10-15

    In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm. PMID:26307174

  10. Papulonodular secondary syphilis: a rare clinic presentation confirmed by serologic and histologic exams.

    PubMed

    Veasey, John Verrinder; Lellis, Rute Facchini; Boin, Maria Fernanda Feitosa de Camargo; Porto, Pedro Loureiro; Chen, Jessica Chia Sin

    2016-04-01

    Syphilis is a sexually transmitted disease caused by Treponema pallidum and divided into three stages according to the duration of the disease: primary, secondary and tertiary. Secondary syphilis has diverse clinical presentations, such as papular-nodular lesions. This presentation is rare, with 15 cases reported in the literature over the past 20 years. We report a case of secondary syphilis with papular-nodular lesions in a healthy 63-year-old patient, who has presented treponema in immunohistochemical examination of the skin lesions. PMID:27192520

  11. Papulonodular secondary syphilis: a rare clinic presentation confirmed by serologic and histologic exams*

    PubMed Central

    Veasey, John Verrinder; Lellis, Rute Facchini; Boin, Maria Fernanda Feitosa de Camargo; Porto, Pedro Loureiro; Chen, Jessica Chia Sin

    2016-01-01

    Syphilis is a sexually transmitted disease caused by Treponema pallidum and divided into three stages according to the duration of the disease: primary, secondary and tertiary. Secondary syphilis has diverse clinical presentations, such as papular-nodular lesions. This presentation is rare, with 15 cases reported in the literature over the past 20 years. We report a case of secondary syphilis with papular-nodular lesions in a healthy 63-year-old patient, who has presented treponema in immunohistochemical examination of the skin lesions. PMID:27192520

  12. An outbreak of infectious syphilis among young heterosexuals in an English town.

    PubMed

    Welfare, W; Lacey, H; Lighton, L; Simms, I

    2011-09-01

    We describe a recent outbreak of syphilis in young heterosexuals in the north west of England. A cluster of 12 cases of syphilis (7 primary and 5 early latent) was identified in Rochdale in heterosexuals aged 20 or under. Nine were women. Five were asymptomatic at presentation. This outbreak occurred in a group not usually associated with syphilis transmission in the north west. Not all the identified cases could be linked, and so potentially this outbreak is a sentinel of a larger problem. PMID:21890550

  13. Syphilis associated with paretic neurosyphilis mimicking Reiter's syndrome in HIV-infected patients.

    PubMed

    Bastos, Thales Costa; Maia, Daniela Cristina Caetano; Gomes, Nathália Matos; Menezes, Carla Kellen da Silva; Francesconi, Valeska; Francesconi, Fabio

    2015-01-01

    HIV/syphilis co-infection is common because both conditions affect similar risk groups. HIV interferes with the natural history of syphilis, which often has atypical clinical features and nervous system involvement in the early stage of disease. We report the case of an HIV-positive patient with secondary syphilis, scaling palmoplantar keratoderma, scrotal eczema, balanitis and urethritis mimicking Reiter's syndrome. Immunohistochemistry using polyclonal antibodies against Treponema pallidum revealed the presence of spirochetes, associated with the paretic form of parenchymal neurosyphilis. The patient was given crystalline penicillin, with complete resolution of dermatological and neurological symptoms, and no sequelae. PMID:26312720

  14. A probable case of congenital syphilis from pre-Columbian Austria.

    PubMed

    Gaul, Johanna Sophia; Grossschmidt, Karl; Gusenbauer, Christian; Kanz, Fabian

    2015-01-01

    This study examines the skeletal remains of a subadult from an archeological site in Austria. Radiocarbon dating and archeological attribution indicate that this individual is of pre-Columbian origin. Most of the skeleton was recovered, and only the teeth and the orbital roofs show changes. Dental defects such as the mulberry molar and a tapered, fang-like canine suggest a diagnosis of congenital syphilis. This is the first probable case of congenital syphilis from pre-Columbian Central Europe. Our findings contribute to the pre-Columbian theory, offering counter evidence to the assumption that syphilis was carried from Columbus' crew from the New to the Old World. PMID:26482430

  15. Genetic diversity in Treponema pallidum: implications for pathogenesis, evolution and molecular diagnostics of syphilis and yaws

    PubMed Central

    Šmajs, David; Norris, Steven J.; Weinstock, George M.

    2013-01-01

    Pathogenic uncultivable treponemes, similar to syphilis-causing Treponema pallidum subspecies pallidum, include T. pallidum ssp. pertenue, T. pallidum ssp. endemicum and Treponema carateum, which cause yaws, bejel and pinta, respectively. Genetic analyses of these pathogens revealed striking similarity among these bacteria and also a high degree of similarity to the rabbit pathogen, T. paraluiscuniculi, a treponeme not infectious to humans. Genome comparisons between pallidum and non-pallidum treponemes revealed genes with potential involvement in human infectivity, whereas comparisons between pallidum and pertenue treponemes identified genes possibly involved in the high invasivity of syphilis treponemes. Genetic variability within syphilis strains is considered as the basis of syphilis molecular epidemiology with potential to detect more virulent strains, whereas genetic variability within a single strain is related to its ability to elude the immune system of the host. Genome analyses also shed light on treponemal evolution and on chromosomal targets for molecular diagnostics of treponemal infections. PMID:22198325

  16. Molecular Typing of Treponema pallidum in Denmark: A Nationwide Study of Syphilis.

    PubMed

    Salado-Rasmussen, Kirsten; Cowan, Susan; Gerstoft, Jan; Larsen, Helle Kiellberg; Hoffmann, Steen; Knudsen, Troels Bygum; Katzenstein, Terese Lea; Jensen, Jørgen Skov

    2016-03-01

    The aim of this nationwide study is to determine the strain type diversity among patients diagnosed with syphilis by PCR during a 4-year period in Denmark. Epidemiological data, including HIV status, for all patients were obtained from the Danish national syphilis registration system. Molecular strain typing was based on characterization of 3 variable treponemal genes, arp, tpr and tp0548. A total of 278 specimens from 269 patients were included. Among the fully typeable specimens (n = 197), 22 strain types were identified, with 1 type, 14d/g, accounting for 54%. The majority (93%) of the patients reported acquiring syphilis in Denmark. Among patients with concurrent HIV, 9 full strain types were identified and no difference in strain type was found by HIV status (p = 0.197). In conclusion, the majority of patients were infected in Denmark and the HIV-infected syphilis patients were diagnosed with a wide spectrum of different strain types of Treponema pallidum. PMID:26122912

  17. Asymptomatic transmission of Treponema pallidum (syphilis) through deceased donor liver transplantation.

    PubMed

    Tariciotti, L; Das, I; Dori, L; Perera, M T P R; Bramhall, S R

    2012-06-01

    A 55-year-old woman underwent liver transplantation (LT) with a graft from a deceased donor. Mandatory pre-donation investigations showed positive syphilis serology that was available only after the transplant, with high Treponema pallidum particle agglutination assay titer compatible with donor syphilis infection. Despite the institution of appropriate post-exposure prophylaxis, the recipient demonstrated latent seroconversion; however, liver graft function improved without evidence of syphilitic hepatitis or other manifestations of the disease. Through this first reported case of asymptomatic transmission of syphilis following LT, we highlight the investigations and treatment strategies for donor-derived syphilis in liver transplant recipients. This report supplements the existing limited evidence on safe use of infected grafts from syphilitic donors through appropriate post-exposure prophylaxis. PMID:22624823

  18. Recurrent Fever, Anemia, Arthralgia, and Genu Varum as Late Manifestations of Congenital Syphilis.

    PubMed

    Quaresma, Liliana; Gonçalves, Juan; Estanqueiro, Paula; Salgado, Manuel

    2015-12-01

    We report an unusual case of recurrent fever, inflammatory knee pain, genu varum, persistent anemia, and high erythrocyte sedimentation rate in a 28-month-old boy as late manifestations of congenital syphilis (CS). Despite standard penicillin treatment at the end of the first month of life, it recurred later in life, more than once. In the first relapse, manifested by a likely gumma lesion, the prior penicillin treatment plus a negative venereal disease research laboratory result unduly led to exclusion of CS. A second treatment with penicillin led to complete clinical resolution. Although rare, bow legs, recurrent fever, anemia, and inflammatory arthralgias may be manifestations of late CS. Congenital syphilis should be considered throughout early childhood, especially if history of syphilis infection is present. A negative venereal disease research laboratory result does not exclude late syphilis, present in nearly 30% of these patients. The possibility of atypical symptoms of this "great masquerader" should always be borne in mind. PMID:26587855

  19. The Great Imitator Strikes Again: Syphilis Presenting as “Tongue Changing Colors”

    PubMed Central

    Swanson, Jessica; Welch, Janna

    2016-01-01

    Syphilis is known as the great imitator, making its diagnosis in the emergency department difficult. A 29-year-old male presented with the chief complaint of “my tongue is changing colors.” A syphilis rapid plasma reagin (RPR) test resulted as positive. In primary syphilis, the chancre is the characteristic lesion. While chancres are frequently found on the external genitalia or anus, extragenital chancres arise in 2% of patients. With oral involvement, the chancre is commonly found on the lip or tongue. The patient was treated for secondary syphilis with 2.4 million units of long acting penicillin intramuscularly. On follow-up a month later, the patient's symptoms had resolved. PMID:26904314

  20. Syphilis detection: evaluation of serological screening and pilot reverse confirmatory assay algorithm in blood donors.

    PubMed

    Sommese, Linda; Paolillo, Rossella; Sabia, Chiara; Costa, Dario; De Pascale, Maria Rosaria; Iannone, Carmela; Esposito, Antonella; Schiano, Concetta; Napoli, Claudio

    2016-07-01

    Serological assays are still considered the most useful tests in the diagnosis of syphilis. Since no single serological assay is able to provide a satisfactory result, in our laboratory we have evaluated the usefulness of a commercially-available immunoblot to diagnose syphilis infection among blood donors. From October 2012 to June 2013, 4572 blood donors were screened for syphilis with an automated chemiluminescent microparticle immunoassay (CMIA). To confirm the presence of treponemal antibodies, CMIA-reactive sera were tested by standard Treponema pallidum haemagglutination assay (TPHA). In addition, an alternative confirmatory test - the immunoblot INNO-LIA assay was introduced in our laboratory. Since two additional positives among CMIA-reactive-TPHA-negative samples were found, we concluded that the INNO-LIA immunoblot allowed a better detection of syphilis compared to TPHA. A confirmatory strategy based on the use of two treponemal assays could meet the screening requirements for blood donors as well as in our centre. PMID:26068964

  1. Syphilis and HIV co-infection. Epidemiology, treatment and molecular typing of Treponema pallidum.

    PubMed

    Salado-Rasmussen, Kirsten

    2015-12-01

    The studies included in this PhD thesis examined the interactions of syphilis, which is caused by Treponema pallidum, and HIV. Syphilis reemerged worldwide in the late 1990s and hereafter increasing rates of early syphilis were also reported in Denmark. The proportion of patients with concurrent HIV has been substantial, ranging from one third to almost two thirds of patients diagnosed with syphilis some years. Given that syphilis facilitates transmission and acquisition of HIV the two sexually transmitted diseases are of major public health concern. Further, syphilis has a negative impact on HIV infection, resulting in increasing viral loads and decreasing CD4 cell counts during syphilis infection. Likewise, HIV has an impact on the clinical course of syphilis; patients with concurrent HIV are thought to be at increased risk of neurological complications and treatment failure. Almost ten per cent of Danish men with syphilis acquired HIV infection within five years after they were diagnosed with syphilis during an 11-year study period. Interestingly, the risk of HIV declined during the later part of the period. Moreover, HIV-infected men had a substantial increased risk of re-infection with syphilis compared to HIV-uninfected men. As one third of the HIV-infected patients had viral loads >1,000 copies/ml, our conclusion supported the initiation of cART in more HIV-infected MSM to reduce HIV transmission. During a five-year study period, including the majority of HIV-infected patients from the Copenhagen area, we observed that syphilis was diagnosed in the primary, secondary, early and late latent stage. These patients were treated with either doxycycline or penicillin and the rate of treatment failure was similar in the two groups, indicating that doxycycline can be used as a treatment alternative - at least in an HIV-infected population. During a four-year study period, the T. pallidum strain type distribution was investigated among patients diagnosed by PCR

  2. Genetic diversity in Treponema pallidum: implications for pathogenesis, evolution and molecular diagnostics of syphilis and yaws.

    PubMed

    Smajs, David; Norris, Steven J; Weinstock, George M

    2012-03-01

    Pathogenic uncultivable treponemes, similar to syphilis-causing Treponema pallidum subspecies pallidum, include T. pallidum ssp. pertenue, T. pallidum ssp. endemicum and Treponema carateum, which cause yaws, bejel and pinta, respectively. Genetic analyses of these pathogens revealed striking similarity among these bacteria and also a high degree of similarity to the rabbit pathogen, Treponema paraluiscuniculi, a treponeme not infectious to humans. Genome comparisons between pallidum and non-pallidum treponemes revealed genes with potential involvement in human infectivity, whereas comparisons between pallidum and pertenue treponemes identified genes possibly involved in the high invasivity of syphilis treponemes. Genetic variability within syphilis strains is considered as the basis of syphilis molecular epidemiology with potential to detect more virulent strains, whereas genetic variability within a single strain is related to its ability to elude the immune system of the host. Genome analyses also shed light on treponemal evolution and on chromosomal targets for molecular diagnostics of treponemal infections. PMID:22198325

  3. [Tertiary syphilis of the pancreas and liver in 82-year-old patient: case study].

    PubMed

    Denisova, T L; Tiul'tiaeva, L A; Lipatova, T E; Bakulev, A L; Alipova, L N; Apanasevich, A V; Bezrodnaia, L A; Borisova, E A

    2013-01-01

    It has been described a clinical case of late diagnosis of syphilis of the pancreas and liver of elderly patients. Two years before that it was wrongly diagnosed with cancer of the pancreas with liver metastases, and the patient was operated on with the imposition of cholecystostomy. It was conducted appropriate therapy and reconstructive surgery after verification of the diagnosis of syphilis of the pancreas and liver. PMID:24772875

  4. Prenatal Transmission of Syphilis and Human Immunodeficiency Virus in Brazil: Achieving Regional Targets for Elimination

    PubMed Central

    Cerda, Rodrigo; Perez, Freddy; Domingues, Rosa Maria S.M.; Luz, Paula M.; Grinsztejn, Beatriz; Veloso, Valdilea G.; Caffe, Sonja; Francke, Jordan A.; Freedberg, Kenneth A.; Ciaranello, Andrea L.

    2015-01-01

    Background. The Pan-American Health Organization has called for reducing (1) human immunodeficiency virus (HIV) mother-to-child transmission (MTCT) to ≤0.30 infections/1000 live births (LB), (2) HIV MTCT risk to ≤2.0%, and (3) congenital syphilis (CS) incidence to ≤0.50/1000 LB in the Americas by 2015. Methods. Using published Brazilian data in a mathematical model, we simulated a cohort of pregnant women from antenatal care (ANC) through birth. We investigated 2 scenarios: “current access” (89.1% receive one ANC syphilis test and 41.1% receive 2; 81.7% receive one ANC HIV test and 18.9% receive birth testing; if diagnosed, 81.0% are treated for syphilis and 87.5% are treated for HIV) and “ideal access” (95% of women undergo 2 HIV and syphilis screenings; 95% receive appropriate treatment). We conducted univariate and multivariate sensitivity analyses on key inputs. Results. With current access, we projected 2.95 CS cases/1000 LB, 0.29 HIV infections/1000 LB, 7.1% HIV MTCT risk, and 11.11 intrauterine fetal demises (IUFD)/1000 pregnancies, with significant regional variation. With ideal access, we projected improved outcomes: 1.00 CS cases/1000 LB, 0.10 HIV infections/1000 LB, HIV MTCT risk of 2.4%, and 10.65 IUFD/1000 pregnancies. Increased testing drove the greatest improvements. Even with ideal access, only HIV infections/1000 LB met elimination goals. Achieving all targets required testing and treatment >95% and reductions in prevalence and incidence of HIV and syphilis. Conclusions. Increasing access to care and HIV and syphilis antenatal testing will substantially reduce HIV and syphilis MTCT in Brazil. In addition, regionally tailored interventions reducing syphilis incidence and prevalence and supporting HIV treatment adherence are necessary to completely meet elimination goals. PMID:26180825

  5. Prenatal Transmission of Syphilis and Human Immunodeficiency Virus in Brazil: Achieving Regional Targets for Elimination.

    PubMed

    Cerda, Rodrigo; Perez, Freddy; Domingues, Rosa Maria S M; Luz, Paula M; Grinsztejn, Beatriz; Veloso, Valdilea G; Caffe, Sonja; Francke, Jordan A; Freedberg, Kenneth A; Ciaranello, Andrea L

    2015-04-01

    Background.  The Pan-American Health Organization has called for reducing (1) human immunodeficiency virus (HIV) mother-to-child transmission (MTCT) to ≤0.30 infections/1000 live births (LB), (2) HIV MTCT risk to ≤2.0%, and (3) congenital syphilis (CS) incidence to ≤0.50/1000 LB in the Americas by 2015. Methods.  Using published Brazilian data in a mathematical model, we simulated a cohort of pregnant women from antenatal care (ANC) through birth. We investigated 2 scenarios: "current access" (89.1% receive one ANC syphilis test and 41.1% receive 2; 81.7% receive one ANC HIV test and 18.9% receive birth testing; if diagnosed, 81.0% are treated for syphilis and 87.5% are treated for HIV) and "ideal access" (95% of women undergo 2 HIV and syphilis screenings; 95% receive appropriate treatment). We conducted univariate and multivariate sensitivity analyses on key inputs. Results.  With current access, we projected 2.95 CS cases/1000 LB, 0.29 HIV infections/1000 LB, 7.1% HIV MTCT risk, and 11.11 intrauterine fetal demises (IUFD)/1000 pregnancies, with significant regional variation. With ideal access, we projected improved outcomes: 1.00 CS cases/1000 LB, 0.10 HIV infections/1000 LB, HIV MTCT risk of 2.4%, and 10.65 IUFD/1000 pregnancies. Increased testing drove the greatest improvements. Even with ideal access, only HIV infections/1000 LB met elimination goals. Achieving all targets required testing and treatment >95% and reductions in prevalence and incidence of HIV and syphilis. Conclusions.  Increasing access to care and HIV and syphilis antenatal testing will substantially reduce HIV and syphilis MTCT in Brazil. In addition, regionally tailored interventions reducing syphilis incidence and prevalence and supporting HIV treatment adherence are necessary to completely meet elimination goals. PMID:26180825

  6. Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response

    PubMed Central

    Sahin, Ozlem; Ziaei, Alireza

    2016-01-01

    Purpose To describe the clinical presentation of patients diagnosed with presumed latent ocular syphilis and congenital ocular syphilis at tertiary referral center in Turkey, and to compare the clinical findings with patients described in other studies, specifically focusing on demographics and co-infections. Methods This is a retrospective study reviewing the medical records of patients diagnosed with ocular inflammation between January 2012 and June 2014 at a tertiary referral center in Turkey. Ocular syphilis was diagnosed on the basis of non-treponemal and treponemal antibody tests, and cerebrospinal fluid analysis. All the patients diagnosed with ocular syphilis were tested for human immunodeficiency virus (HIV), Toxoplasma gondii, rubella, cytomegalovirus, and herpes. Results A total of 1,115 patients were evaluated between January 2012 and June 2014, and 12 patients (1.07%) were diagnosed with ocular syphilis based on the inclusion criteria. None of the patients were seropositive for HIV. Two patients were seropositive for T. gondii-specific IgG. Clinical presentations include non-necrotizing anterior scleritis, non-necrotizing sclerokeratitis, anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, and optic neuritis. All of the patients showed clinical improvement in the level of ocular inflammation with intravenous penicillin 24 million U/day for 10 days. Three patients received additional oral methotrexate as an adjunctive therapy. Two cases received low-dose trimethoprim–sulfamethoxazole. Conclusion Ocular syphilis is an uncommon cause of ocular inflammation in HIV-negative patients. Central retinochoroiditis is the most common ocular manifestation, and it is the most common cause of visual impairment. Ocular syphilis might present associated with co-infections such as T. gondii in developing countries. Oral methotrexate might be beneficial as an adjunctive therapy for ocular syphilis in resolving the residual intraocular inflammation

  7. Clinical Outcomes of In Vitro Fertilization among Chinese Infertile Couples Treated for Syphilis Infection

    PubMed Central

    Wang, Jing; Zhao, Xiaomiao; Yuan, Ping; Fang, Tingfeng; Ouyang, Nengyong; Li, Ruiqi; Ou, Songbang; Wang, Wenjun

    2015-01-01

    To compare the clinical outcomes of infertile patients with and without syphilis after in vitro fertilization and embryo transfer (IVF-ET), in this case-control study, 320 infertile couples were enrolled and divided into syphilis (n = 160) and control groups (n = 160). The primary IVF outcomes were the clinical pregnancy rate and the birth of a healthy baby. All syphilis patients received the standard anti-syphilis treatment before undergoing IVF/ICSI. Our results showed that the endometrial thickness of the syphilis group was greater than that of the control group following hCG injection (16.9±5.4 vs. 13.0±4.7 mm, P<0.001). The numbers of normally fertilized eggs and normally cleaved fertilized eggs and the implantation rate were 6.8±4.8, 6.3±4.7 and 24.2%, respectively, for the syphilis group and 8.3±4.6, 8.1±4.6 and 34.4%, respectively, for the control group, and these values were significantly different between the groups. The clinical pregnancy rate was lower in the syphilis group compared with that in the control group (43.8% vs. 55.6%, P = 0.03). Lower offspring birth weight was observed in the infected male group compared with those in the infected female (2.7±0.4 vs. 3.0±0.4 kg, P = 0.01) and infected couple groups (2.7±0.4 vs. 3.1±0.5 kg, P = 0.007). Therefore, syphilis infection reduces the clinical pregnancy rate after IVF/ICSI. PMID:26208116

  8. Incident syphilis infection among people who inject drugs in Tijuana, Mexico.

    PubMed

    Pines, Heather A; Rusch, Melanie L; Vera, Alicia; Rangel, Gudelia; Magis-Rodriguez, Carlos; Strathdee, Steffanie A

    2015-12-01

    Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91-1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09-0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border. PMID:25614523

  9. Papulonodular secondary syphilis in a 52-year-old non-HIV heterosexual patient.

    PubMed

    Breznik, V; Potočnik, M; Miljković, J

    2010-12-01

    There has been a recent increase in the incidence of syphilis in Slovenia, similar to other countries. Secondary syphilis can manifest with various clinical and histopathological presentations. We report the case of a 52-year-old patient that presented with nonpruritic nodular lesions on the face, trunk, and insteps that clinically mimicked lymphoma or sarcoidosis. Histopathological findings showed granulomatous inflammation. The serology revealed positive non-treponemal and treponemal tests. Treatment with benzathine penicillin G was successful. PMID:21390478

  10. Tertiary syphilis presenting as hepatic bull's eye lesions.

    PubMed

    Peeters, L; Van Vaerenbergh, W; Van der Perre, C; Lagrange, W; Verbeke, M

    2005-01-01

    We report a rare case of tertiary syphilis (hepatic gummata, asymptomatic neurosyphilis and iridocyclitis) in a 47 year old female patient. Our patient suffered from a troubled sight, pain in the right hypochondrium, one enlarged submandibular lymph node, an elevated sedimentation rate, disturbed liver tests and two hepatic lesions upon abdominal computed tomography. The diagnosis was based upon a liver biopsy and a positive Treponema Pallidum haemagglutination test. The patient was treated with doxycyclin. After treatment the sedimentation rate and liver tests normalised and the hepatic lesions disappeared leaving a small 'scar' on CT-scan; at the end she still complained of a decreased sight. We conclude that syphilitic gummata of the liver have a favourable prognosis when the diagnosis is made early. One has to differentiate with hepatic abscesses, primary tumours and metastases. PMID:16432997

  11. Secondary Syphilis in Cali, Colombia: New Concepts in Disease Pathogenesis

    PubMed Central

    Cruz, Adriana R.; Pillay, Allan; Zuluaga, Ana V.; Ramirez, Lady G.; Duque, Jorge E.; Aristizabal, Gloria E.; Fiel-Gan, Mary D.; Jaramillo, Roberto; Trujillo, Rodolfo; Valencia, Carlos; Jagodzinski, Linda; Cox, David L.; Radolf, Justin D.; Salazar, Juan C.

    2010-01-01

    Venereal syphilis is a multi-stage, sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum (Tp). Herein we describe a cohort of 57 patients (age 18–68 years) with secondary syphilis (SS) identified through a network of public sector primary health care providers in Cali, Colombia. To be eligible for participation, study subjects were required to have cutaneous lesions consistent with SS, a reactive Rapid Plasma Reagin test (RPR-titer ≥1∶4), and a confirmatory treponemal test (Fluorescent Treponemal Antibody Absorption test- FTA-ABS). Most subjects enrolled were women (64.9%), predominantly Afro-Colombian (38.6%) or mestizo (56.1%), and all were of low socio-economic status. Three (5.3%) subjects were newly diagnosed with HIV infection at study entry. The duration of signs and symptoms in most patients (53.6%) was less than 30 days; however, some patients reported being symptomatic for several months (range 5–240 days). The typical palmar and plantar exanthem of SS was the most common dermal manifestation (63%), followed by diffuse hypo- or hyperpigmented macules and papules on the trunk, abdomen and extremities. Three patients had patchy alopecia. Whole blood (WB) samples and punch biopsy material from a subset of SS patients were assayed for the presence of Tp DNA polymerase I gene (polA) target by real-time qualitative and quantitative PCR methods. Twelve (46%) of the 26 WB samples studied had quantifiable Tp DNA (ranging between 194.9 and 1954.2 Tp polA copies/ml blood) and seven (64%) were positive when WB DNA was extracted within 24 hours of collection. Tp DNA was also present in 8/12 (66%) skin biopsies available for testing. Strain typing analysis was attempted in all skin and WB samples with detectable Tp DNA. Using arp repeat size analysis and tpr RFLP patterns four different strain types were identified (14d, 16d, 13d and 22a). None of the WB samples had sufficient DNA for typing. The clinical and microbiologic

  12. Fibronectin tetrapeptide is target for syphilis spirochete cytadherence

    SciTech Connect

    Thomas, D.D.; Baseman, J.B.; Alderete, J.F.

    1985-11-01

    The syphilis bacterium, Treponema pallidum, parasitizes host cells through recognition of fibronectin (Fn) on cell surfaces. The active site of the Fn molecule has been identified as a four-amino acid sequence, arg-gly-asp-ser (RGDS), located on each monomer of the cell-binding domain. The synthetic heptapeptide gly-arg-gly-asp-ser-pro-cys (GRGDSPC), with the active site sequence RGDS, specifically competed with SVI-labeled cell-binding domain acquisition by T. pallidum. Additionally, the same heptapeptide with the RGDS sequence diminished treponemal attachment to HEp-2 and HT1080 cell monolayers. Related heptapeptides altered in one key amino acid within the RGDS sequence failed to inhibit Fn cell-binding domain acquisition or parasitism of host cells by T. pallidum. The data support the view that T. pallidum cytadherence of host cells is through recognition of the RGDS sequence also important for eukaryotic cell-Fn binding.

  13. Oral manifestations of secondary syphilis in the elderly - a timely reminder for dentists.

    PubMed

    Minicucci, E M; Vieira, R A; Oliveira, D T; Marques, S A

    2013-09-01

    Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79-year-old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non-specific ulceration of the oral mucosa. After 20 days, the patient was re-evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients. PMID:23981220

  14. Evaluation of the HISCL Anti-Treponema pallidum Assay as a Screening Test for Syphilis.

    PubMed

    An, Jingna; Chen, Qixia; Liu, Qianqian; Rao, Chenli; Li, Dongdong; Wang, Tingting; Tao, Chuanmin; Wang, Lanlan

    2015-07-01

    The resurgence of syphilis in recent years has become a serious threat to public health worldwide, and the serological detection of specific antibodies against Treponema pallidum remains the most reliable method for laboratory diagnosis of syphilis. This study examined the performance of the recently launched HISCL anti-Treponema pallidum (anti-TP) assay as a screening test for syphilis in a high-volume laboratory. The HISCL anti-TP assay was tested in 300 preselected syphilis-positive samples, 704 fresh syphilis-negative samples, 48 preselected potentially interfering samples, and 30 "borderline" samples and was compared head to head with the commercially available Lumipulse G TP-N. In this study, the HISCL anti-TP assay was in perfect agreement with the applied testing algorithms with an overall agreement of 100%, comparable to that of Lumipulse G TP-N (99.63%). The sensitivity and specificity of the HISCL anti-TP assay were 100% (95% confidence interval [CI], 98.42% to 100%) and 100% (95% CI, 99.37% to 100%), respectively. Considering the excellent ease of use and automation, high throughput, and its favorable sensitivity and specificity, the HISCL anti-TP assay may represent a new choice for syphilis screening in high-volume laboratories. PMID:25972403

  15. Evaluation of the Captia enzyme immunoassays for detection of immunoglobulins G and M to Treponema pallidum in syphilis.

    PubMed Central

    Lefevre, J C; Bertrand, M A; Bauriaud, R

    1990-01-01

    Two new enzyme-linked immunosorbent assays (ELISA), one for the measurement of immunoglobulin G (IgG) (Captia Syphilis-G) and one for the measurement of IgM (Captia Syphilis-M), were evaluated for detecting antibodies to Treponema pallidum. Serum samples from 169 patients, 96 with various stages of untreated syphilis, 63 with treated syphilis, and 10 who were noninfected, were investigated. All sera were also examined by traditional treponemal and cardiolipin tests and by the fluorescent treponemal antibody absorption (FTA-ABS) test for 19S(IgM). The overall sensitivity of Captia Syphilis-G was 98.3%. The IgG ELISA was very sensitive (100%) in all stages of untreated syphilis, except in primary syphilis (82%). In all diagnostic groups of syphilis, the reactivity of Captia Syphilis-M was similar to that of the 19S(IgM) FTA-ABS test, except in reinfections, in which the IgM capture ELISA was less sensitive. False-positive IgM capture ELISA results were not found in the 10 neonates born to mothers adequately treated for syphilis. However, of six serum samples containing rheumatoid factor, two were reactive in the Captia Syphilis-M test but not in the 19S(IgM) FTA-ABS test. This indicated that the specificity of the IgM capture ELISA was not absolute. All serum samples from treated patients were reactive in the IgG ELISA, but only 15 samples were reactive in the IgM capture ELISA, which appeared to be as effective as the 19S(IgM) FTA-ABS test in monitoring the effect of treatment. Simultaneous measurement of IgG and IgM antibodies for T. pallidum by the Captia immunoassays appears to be an efficient and simple method for confirming the diagnosis of syphilis as well as for indicating whether active disease is present. PMID:2203809

  16. Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries

    PubMed Central

    Taylor, Melanie M.; Nurse-Findlay, Stephen; Zhang, Xiulei; Hedman, Lisa; Kamb, Mary L.; Broutet, Nathalie; Kiarie, James

    2016-01-01

    Background Congenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis. Methods Proportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis. Results Using current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases. Conclusion Penicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment

  17. The management of isolated positive syphilis enzyme immunoassay results in HIV-negative patients attending a sexual health clinic.

    PubMed

    Thorley, Nicola; Adebayo, Michael; Smit, Erasmus; Radcliffe, Keith

    2016-08-01

    An unconfirmed positive treponemal enzyme immunoassay (enzyme immunoassay positive, Treponema pallidum particle agglutination negative and rapid plasma reagin negative) presents a clinical challenge to distinguish early syphilis infection from false-positive results. These cases are referred for syphilis line assay (INNO-LIA) and recalled for repeat syphilis serology. We performed a retrospective audit to establish the proportion of HIV-negative cases with unconfirmed positive enzyme immunoassay results, the proportion of these cases that received an INNO-LIA test and repeat syphilis serology testing and reviewed the clinical outcomes; 0.35% (80/22687) cases had an unconfirmed positive treponemal enzyme immunoassay result. Repeat syphilis serology was performed in 80% (64/80) cases, but no additional cases of syphilis were identified. Eighty-eight per cent (70/80) received an INNO-LIA test; 14% (5/37) unconfirmed enzyme immunoassay-positive cases with no prior history of syphilis were confirmed on INNO-LIA assay, supporting a diagnosis of latent syphilis. As a confirmatory treponemal test, the INNO-LIA assay may be more useful than repeat syphilis serological testing. PMID:26637236

  18. Syphilis in HIV-Infected Mothers and Infants: Results from the NICHD/HPTN 040 Study

    PubMed Central

    Yeganeh, Nava; Watts, Heather D.; Camarca, Margaret; Soares, Gabriel; Joao, Esau; Pilotto, Jose Henrique; Gray, Glenda; Theron, Gerhard; Santos, Breno; Fonseca, Rosana; Kreitchmann, Regis; Pinto, Jorge; Mussi-Pinhata, Marisa; Ceriotto, Mariana; Machado, Daisy Maria; Veloso, Valdilea G.; Grinzstejn, Beatriz; Morgado, Mariza G; Bryson, Yvonne; Mofenson, Lynne M.; Nielsen-Saines, Karin

    2014-01-01

    Background Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates. PMID:25742089

  19. Population-based seroprevalence of HSV-2 and syphilis in Andhra Pradesh state of India

    PubMed Central

    2010-01-01

    Background Understanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India. Methods Persons 15-49 years old from 32 rural and 34 urban clusters were sampled using a stratified random method to represent adults in the high HIV prevalence Guntur district in Andhra Pradesh state. Interviews were conducted and dry blood spots were collected on 12,617 study participants. Testing for HSV-2 and syphilis was performed. Results Adjusted HSV-2 and syphilis seroprevalence rates were 4.70% and 2.08% for men and 7.07% and 1.42% for women. For men, tattooing, >3 lifetime sex partners, tobacco use, and sex with men in the past 6 months were associated with HSV-2 or syphilis (ORs, 1.66-2.95, p < 0.05). Male circumcision was positively associated with HSV-2 infection (OR, 1.37, p = 0.028) though this could be due to residual confounding. In women, greater than one lifetime partner remained significantly associated with HSV-2 in multivariate analysis (OR, 2.61; 95% CI, 1.39-4.87). Among all behavioral risk factors and other covariates in women and men, HIV infection exhibited the strongest association with HSV-2 and syphilis (ORs, 8.2-14.2, p < 0.001). The proportion of individuals with HSV-2 who were HIV infected was less than the proportion with syphilis who were HIV infected (11.8% vs. 22.7%; p = 0.001). Conclusions Nearly one in four persons surveyed in this population-based study that were seroprevalent for syphilis, were also HIV infected. Common population risk factors for syphilis, HSV-2 and HIV and high rates of co-seroprevalence suggest that HIV testing, STI testing and service strategies for these would benefit from direct linkage in India. PMID:20214795

  20. Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.

    PubMed

    Yamashita, Michiko; Fujii, Yoshiyuki; Ozaki, Keiji; Urano, Yoshio; Iwasa, Masami; Nakamura, Shingen; Fujii, Shiro; Abe, Masahiro; Sato, Yasuharu; Yoshino, Tadashi

    2015-01-01

    Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient's systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection. PMID:26449225

  1. Syphilis Time to Treatment at Publicly Funded Sexually Transmitted Disease Clinics Versus Non-Sexually Transmitted Disease Clinics--Maricopa and Pima Counties, Arizona, 2009-2012.

    PubMed

    Robinson, Candice L; Young, Lauren; Bisgard, Kristine; Mickey, Tom; Taylor, Melanie M

    2016-01-01

    Delays in syphilis treatment may contribute to transmission. We evaluated time to treatment for symptomatic patients with syphilis by clinical testing site in 2 Arizona counties. Fewer patients were tested and treated at publicly funded sexually transmitted disease clinics, but received the timeliest treatment; these clinics remain crucial to syphilis disease control. PMID:26650993

  2. Serological Response to Treatment of Syphilis with Doxycycline Compared with Penicillin in HIV-infected Individuals.

    PubMed

    Salado-Rasmussen, Kirsten; Hoffmann, Steen; Cowan, Susan; Jensen, Jørgen Skov; Benfield, Thomas; Gerstoft, Jan; Katzenstein, Terese Lea

    2016-08-23

    Serological response to treatment of syphilis with orally administered doxycycline or intramuscularly administered penicillin was assessed in patients with concurrent HIV. All HIV-infected individuals diagnosed with syphilis attending 3 hospitals in Copenhagen, Denmark were included. Odds ratios (ORs) with 95% confidence intervals (CI) associated with serological outcome were modelled using propensity-score-adjusted logistic regression analysis. In total, 202 cases were treated with doxycycline or intramuscular penicillin. At 12 months, serological failure was observed in 12 cases (15%) treated with doxycycline and in 8 cases (17%) treated with penicillin (OR 0.78 (95% CI 0.16-3.88), p = 0.76). The serological cure rate at 12 months was highest in patients with primary syphilis (100%), followed by patients with secondary (89%), early latent (71%) and late latent (67%) syphilis (p = 0.006). In conclusion, this study provides evidence for the use of doxycycline as a treatment option when treating a HIV-infected population for syphilis. PMID:26568359

  3. Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji

    PubMed Central

    Tayler-Smith, K.; Khogali, M.; Marks, G. B.

    2013-01-01

    Setting: An antenatal clinic serving a population of 47 604 in Nausori, Fiji. Objective: 1) To estimate the prevalence of anaemia, syphilis and hepatitis B in pregnant women attending their first antenatal visit; and 2) to estimate the uptake of treatment for syphilis and for the prevention of hepatitis B transmission in affected individuals. Design: Retrospective review of the clinic register and patient records for the year 2011. Results: The prevalence of anaemia, hepatitis B and syphilis were respectively 22%, 2% and 5%. Among women with syphilis, 78% of those for whom data were available received a complete course of three doses of penicillin during their pregnancy, and 83% of babies born to women with hepatitis B received hepatitis B immunoglobulin. Conclusion: The prevalence of anaemia in pregnant women has declined but remains high, and further research is required to identify the major causes of this condition in Fiji. The prevalence of syphilis has remained static, while hepatitis B has decreased over the past decade. There are some gaps in the implementation of effective interventions to manage these conditions in pregnant women. PMID:26393000

  4. Outbreak of primary and secondary syphilis--Guilford County, North Carolina, 1996-1997.

    PubMed

    1998-12-18

    In 1996 and 1997, 153 cases of primary and secondary (P&S) syphilis were reported each year in Guilford County, North Carolina, a 147% increase from the 62 cases reported in 1994 (Figure 1). The incidence of P&S syphilis in Guilford County during 1996-1997 was 40.5 cases per 100,000 persons, substantially higher than the national health objective for 2000 of four cases per 100,000 (objective 19.3). In comparison, the number of P&S syphilis cases in North Carolina declined 57% from 1994 to 1997 (Figure 1), to a rate of 10.9 per 100,000 in 1997. This report summarizes the results of an investigation conducted by the Guilford County Health Department (GCHD), the North Carolina Division of Epidemiology, and CDC, which suggest this ongoing outbreak has been associated with missed opportunities for syphilis screening and treatment in high-risk settings, increased exchange of sex for money or drugs, and substantial rates of coinfection with syphilis and human immunodeficiency virus (HIV) among those tested. PMID:9879632

  5. Comparison of Automated Treponemal and Nontreponemal Test Algorithms as First-Line Syphilis Screening Assays

    PubMed Central

    Chung, Jae-Woo; Park, Seong Yeon; Chae, Seok Lae

    2016-01-01

    Background Automated Mediace Treponema pallidum latex agglutination (TPLA) and Mediace rapid plasma reagin (RPR) assays are used by many laboratories for syphilis diagnosis. This study compared the results of the traditional syphilis screening algorithm and a reverse algorithm using automated Mediace RPR or Mediace TPLA as first-line screening assays in subjects undergoing a health checkup. Methods Samples from 24,681 persons were included in this study. We routinely performed Mediace RPR and Mediace TPLA simultaneously. Results were analyzed according to both the traditional algorithm and reverse algorithm. Samples with discordant results on the reverse algorithm (e.g., positive Mediace TPLA, negative Mediace RPR) were tested with Treponema pallidum particle agglutination (TPPA). Results Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening. The identified syphilis rate and overall false-positive rate according to the traditional algorithm were lower than those according to the reverse algorithm (0.07% and 0.05% vs. 0.64% and 0.13%, respectively). A total of 173 discordant samples were tested with TPPA by using the reverse algorithm, of which 140 (80.9%) were TPPA positive. Conclusions Despite the increased false-positive results in populations with a low prevalence of syphilis, the reverse algorithm detected 140 samples with treponemal antibody that went undetected by the traditional algorithm. The reverse algorithm using Mediace TPLA as a screening test is more sensitive for the detection of syphilis. PMID:26522755

  6. Azithromycin-Resistant Syphilis-Causing Strains in Sydney, Australia: Prevalence and Risk Factors

    PubMed Central

    Jeoffreys, Neisha; Tagg, Kaitlin; Guy, Rebecca J.; Gilbert, Gwendolyn L.; Donovan, Basil

    2014-01-01

    Azithromycin has shown high efficacy in randomized trials when used for treating infectious syphilis in Africa. However, its use in clinical practice has been limited by the development of antimicrobial drug resistance. Resistance has not previously been reported from Australasia. The aim of this study was to determine the prevalence of and risk factors for azithromycin-resistant syphilis-causing strains in Sydney, Australia. We evaluated 409 samples that were PCR positive for Treponema pallidum DNA collected between 2004 and 2011 for the presence of the A2058G mutation, which confers resistance to macrolide antibiotics such as azithromycin. Overall, 84% of samples harbored the mutation. The prevalence of the mutation increased during the study period (P trend, 0.003). We also collected clinical and demographic data on 220 patients from whom these samples had been collected to determine factors associated with the A2058G mutation; 97% were from men who have sex with men. Reporting sex in countries other than Australia was associated with less macrolide resistance (adjusted odds ratio, 0.25; 95% confidence interval, 0.09 to 0.66; P = 0.005), with other study factors showing no association (age, HIV status, recent macrolide use, stage of syphilis, or history of prior syphilis). Azithromycin cannot be recommended as an alternative treatment for syphilis in Sydney. PMID:24850356

  7. Infectious syphilis in high-income settings in the 21st century.

    PubMed

    Fenton, Kevin A; Breban, Romulus; Vardavas, Raffaele; Okano, Justin T; Martin, Tara; Aral, Sevgi; Blower, Sally

    2008-04-01

    In high-income countries after World War II, the widespread availability of effective antimicrobial therapy, combined with expanded screening, diagnosis, and treatment programmes, resulted in a substantial decline in the incidence of syphilis. However, by the turn of the 21st century, outbreaks of syphilis began to occur in different subpopulations, especially in communities of men who have sex with men. The reasons for these outbreaks include changing sexual and social norms, interactions with increasingly prevalent HIV infection, substance abuse, global travel and migration, and underinvestment in public-health services. Recently, it has been suggested that these outbreaks could be the result of an interaction of the pathogen with natural immunity, and that syphilis epidemics should be expected to intrinsically cycle. We discuss this hypothesis by examining long-term data sets of syphilis. Today, syphilis in western Europe and the USA is characterised by low-level endemicity with concentration among population subgroups with high rates of partner change, poor access to health services, social marginalisation, or low socioeconomic status. PMID:18353265

  8. Correlates of Syphilis Seroreactivity Among Pregnant Women: The HIVNET 024 Trial in Malawi, Tanzania, and Zambia

    PubMed Central

    Potter, Dara; Goldenberg, Robert L.; Read, Jennifer S.; Wang, Jing; Hoffman, Irving F.; Saathoff, Elmar; Kafulafula, George; Aboud, Said; Martinson, Francis E. A.; Dahab, Maysoon; Vermund, Sten H.

    2009-01-01

    Objective The objectives of this cross-sectional study were to determine correlates of syphilis seroprevalence among HIV-infected and -uninfected antenatal attendees in an African multisite clinical trial, and to improve strategies for maternal syphilis prevention. Results A total of 2270 (86%) women were HIV-infected and 366 (14%) were HIV-uninfected. One hundred seventy-five (6.6%) were syphilis-seropositive (7.3% among HIV-infected and 2.6% HIV-uninfected women). Statistically significant correlates included geographic site (odds ratio [OR] = 4.5, Blantyre; OR = 3.2, Lilongwe; OR = 9.0, Lusaka vs. Dar es Salaam referent); HIV infection (OR = 3.3); age 20 to 24 years (OR = 2.5); being divorced, widowed, or separated (OR = 2.9); genital ulcer treatment in the last year (OR = 2.9); history of stillbirth (OR = 2.8, one stillbirth; OR = 4.3, 2–5 stillbirths); and history of preterm delivery (OR = 2.7, one preterm delivery). Conclusion Many women without identified risk factors were syphilis-seropositive. Younger HIV-infected women were at highest risk. Universal integrated antenatal HIV and syphilis screening and treatment is essential in sub-Saharan African settings. PMID:16601659

  9. Prevalence and Incidence of Syphilis among Volunteer Blood Donors in Israel

    PubMed Central

    Vera, Leibovici; Milka, Donchin; Nurith, Strauss-Liviatan; Eilat, Shinar

    2014-01-01

    Data of 1,290,222 volunteer blood donors, in a 5-year period, was analyzed for prevalence and incidence of syphilis. Subsequent testing of donations positive in Treponema pallidum hemagglutination assay included Venereal Disease Research Laboratory and fluorescent Treponemal antibody absorption. Stepwise logistic regression model was used to identify positive syphilis serology. Prevalence of syphilis was 47 : 100,000, similar in men and women and increased significantly with age (P < 0.001). Native Israelis had the lowest prevalence rate of syphilis (21 : 100,000), while a significantly higher prevalence was found among immigrants from Africa, Eastern Europe, and South America (odds ratios of 19.0, 10.8, and 7.3, resp., P < 0.001 for each). About 33.2% of the seropositive donors had evidence of recent infection, and 66.8% had past infections. Incidence rate reached 8 : 100,000 person-years. Coinfection with HIV, HCV, and HBV was calculated as 8%, 1.88%, and 0.37% for positive donations, respectively. The data support the need to continue screening blood donors in Israel for syphilis and employ preventive measures to populations at risk, in order to improve public health, blood safety, and quality. A subsequent study to assess blood donors' knowledge, attitude, and behavior is planned. In times of global migration this information may be useful to blood services worldwide. PMID:24860686

  10. Neurosyphilis and ophthalmic syphilis in persons with negative rapid plasma reagin and positive treponemal antibody test results.

    PubMed

    Tuddenham, Susan; Obeng, Christiana; Ghanem, Khalil G

    2015-06-01

    The detection of serodiscordant syphilis test results raises several important clinical and public health questions. Based on our retrospective review, the probability of neurosyphilis in persons with serodiscordant serologies is low. The probability of ophthalmic syphilis may be higher, but we lack objective measures for that diagnosis. PMID:25970316

  11. Variations in Clinical Presentation of Ocular Syphilis: Case Series Reported From a Growing Epidemic in the United States.

    PubMed

    Marx, Grace E; Dhanireddy, Shireesha; Marrazzo, Jeanne M; Tuddenham, Susan A; Rompalo, Anne M; Leone, Peter A; Gaydos, Charlotte A; Rietmeijer, Cornelis A

    2016-08-01

    Ocular syphilis, a form of neurosyphilis, has been increasingly diagnosed in the United States. This case series summarizes the course of 6 patients recently diagnosed with ocular syphilis, emphasizing the varied sociodemographic factors and the wide range of symptoms and outcomes that are seen in patients with this disease. PMID:27419818

  12. Immune Evasion and Recognition of the Syphilis Spirochete in Blood and Skin of Secondary Syphilis Patients: Two Immunologically Distinct Compartments

    PubMed Central

    Cruz, Adriana R.; Ramirez, Lady G.; Zuluaga, Ana V.; Pillay, Allan; Abreu, Christine; Valencia, Carlos A.; La Vake, Carson; Cervantes, Jorge L.; Dunham-Ems, Star; Cartun, Richard; Mavilio, Domenico; Radolf, Justin D.; Salazar, Juan C.

    2012-01-01

    Background The clinical syndrome associated with secondary syphilis (SS) reflects the propensity of Treponema pallidum (Tp) to escape immune recognition while simultaneously inducing inflammation. Methods To better understand the duality of immune evasion and immune recognition in human syphilis, herein we used a combination of flow cytometry, immunohistochemistry (IHC), and transcriptional profiling to study the immune response in the blood and skin of 27 HIV(-) SS patients in relation to spirochetal burdens. Ex vivo opsonophagocytosis assays using human syphilitic sera (HSS) were performed to model spirochete-monocyte/macrophage interactions in vivo. Results Despite the presence of low-level spirochetemia, as well as immunophenotypic changes suggestive of monocyte activation, we did not detect systemic cytokine production. SS subjects had substantial decreases in circulating DCs and in IFNγ-producing and cytotoxic NK-cells, along with an emergent CD56−/CD16+ NK-cell subset in blood. Skin lesions, which had visible Tp by IHC and substantial amounts of Tp-DNA, had large numbers of macrophages (CD68+), a relative increase in CD8+ T-cells over CD4+ T-cells and were enriched for CD56+ NK-cells. Skin lesions contained transcripts for cytokines (IFN-γ, TNF-α), chemokines (CCL2, CXCL10), macrophage and DC activation markers (CD40, CD86), Fc-mediated phagocytosis receptors (FcγRI, FcγR3), IFN-β and effector molecules associated with CD8 and NK-cell cytotoxic responses. While HSS promoted uptake of Tp in conjunction with monocyte activation, most spirochetes were not internalized. Conclusions Our findings support the importance of macrophage driven opsonophagocytosis and cell mediated immunity in treponemal clearance, while suggesting that the balance between phagocytic uptake and evasion is influenced by the relative burdens of bacteria in blood and skin and the presence of Tp subpopulations with differential capacities for binding opsonic antibodies. They also

  13. Syphilis, leprosy, and human immunodeficiency virus coinfection: a challenging diagnosis.

    PubMed

    Souza, Claudia Fd; Bornhausen-Demarch, Eduardo; Prata, Aline G; de Andrade, Felipe C; Fernandes, Mariana P; Lopes, Marcia Ra; Nery, José Ac

    2013-08-01

    The association between syphilis, leprosy, and human immunodeficiency virus (HIV) is not well documented, and the emergence of isolated cases raises the interest and indicates that this triple coinfection can occur. We report the case of a 42-year-old man from Rio de Janeiro, Brazil, who presented with erythematous papules on the trunk, back, and upper and lower extremities; an erythematous plaque on the upper abdomen; and an erythematous violaceous plaque on the right thigh with altered sensitivity. Laboratory investigation showed a reagent VDRL test (1:512) and positive test results for Treponema pallidum hemagglutination. Treatment with benzathine penicillin (2,400,000 U intramuscularly) was started (2 doses 1 week apart). On follow-up 40 days later, the lesions showed partial improvement with persistence of the plaques on the right thigh and upper abdomen as well as a new similar plaque on the back. Further laboratory examinations showed negative bacilloscopy, positive HIV test, and histologic findings consistent with tuberculoid leprosy. The patient was started on multidrug therapy for paucibacillary leprosy with clinical improvement; the patient also was monitored by the HIV/AIDS department. We emphasize the importance of clinical suspicion for a coinfection case despite the polymorphism of these diseases as well as the precise interpretation of laboratory and histopathology examinations to correctly manage atypical cases. PMID:24087779

  14. Toluidine red unheated serum test, a nontreponemal test for syphilis.

    PubMed Central

    Pettit, D E; Larsen, S A; Harbec, P S; Feeley, J C; Parham, C E; Cruce, D D; Hambie, E A; Perryman, M W

    1983-01-01

    We have shown that a modification of the color-coded antigen developed by Kasatiya and Lambert (Appl. Microbiol. 28:317-318, 1974) can be used as a substitute for other nontreponemal antigens used in screening tests for syphilis. The antigen is based on the Venereal Disease Research Laboratory antigen, with EDTA, choline chloride, and toluidine red toner added. Performance of the toluidine red unheated serum test (TRUST) is identical to that of the rapid plasma reagin 18-mm circle card test (U.S. Department of Health, Education, and Welfare, Public Health Service Publication no. 411). In a series of preliminary evaluations, the TRUST antigen was found to be stable over a period of 6 months at 4 degrees C. In a comparison of TRUST with the rapid plasma reagin card test, the qualitative agreement was 100%, whereas agreement between these two tests and the Venereal Disease Research Laboratory slide test was 99.7%. The quantitative agreement +/- 1 twofold dilution between TRUST and the rapid plasma reagin card test was 100%; between TRUST and the Venereal Disease Research Laboratory slide test it was 75.0%; and between the rapid plasma reagin card and Venereal Disease Research Laboratory slide tests it was 60.0%. PMID:6417160

  15. Misrepresentations of the Tuskegee Study of Untreated Syphilis.

    PubMed Central

    White, Robert M.

    2005-01-01

    The Tuskegee Study of Untreated Syphilis (TSUS) is the subject of medical research, healthcare, ethics, race relations and fictitious media portrayals (e.g., movie, play). Unraveling misrepresentations about the TSUS is important because prevailing views continue to contribute to alleged mistrust of the medical system by the black community and compromised doctor-patient and researcher-participant relationships. A comparative analysis of standard TSUS information was conducted and included evidenced-based alternative information in an effort to: (a) contextualize the TSUS with accurate medical, public health and historical information and (b) balance claims of racism, nontreatment and denial of treatment. An article in the Winter 2003 Radcliffe Quarterly misrepresented the images of two historical African-American health institutions, the John A. Andrew Memorial Hospital and the Tuskegee Veterans Administration Hospital. A critical analysis challenges these pictorial misrepresentations and documents, in part, a continuing and prevailing pattern of biased misrepresentations in discussions about the TSUS. The National Medical Association (NMA) and the Journal of the National Medical Association have a history of advocacy for African-American health, a record of combating racial discrimination and a quest for truth about the status of the black community. As past NMA historical notables have performed through their advancement, service and leadership, health professionals now have the opportunity, obligation and information to educate the American community about the TSUS with evidenced-based information. Images Figure 2 Figure 3 Figure 4 Figure 5 p581-a PMID:15868777

  16. The Science behind Pre-Columbian Evidence of Syphilis in Europe: Research by Documentary

    PubMed Central

    Armelagos, George J.; Zuckerman, Molly K.; Harper, Kristin N.

    2012-01-01

    This article discusses the presentation of scientific finding via documentary and absent the process of peer-review. We use, as an example, PBS’s Syphilis Enigma, in which researchers presented novel evidence concerning the origin of syphilis that had never been reviewed by other scientists. These “findings” then entered the world of peer-reviewed literature through citations of the documentary itself or material associated with the documentary. Here, we demonstrate that the case for pre-Columbian syphilis in Europe that was made in the documentary does not withstand scientific scrutiny. We also situate this example from paleopathology within a larger trend of “science by documentary” or “science by press conference,” in which researchers seek to bypass the peer review process by presenting unvetted findings directly to the public. PMID:22499439

  17. The science behind pre-Columbian evidence of syphilis in Europe: research by documentary.

    PubMed

    Armelagos, George J; Zuckerman, Molly K; Harper, Kristin N

    2012-03-01

    This article discusses the presentation of scientific findings by documentary, without the process of peer review. We use, as an example, PBS's "The Syphilis Enigma," in which researchers presented novel evidence concerning the origin of syphilis that had never been reviewed by other scientists. These "findings" then entered the world of peer-reviewed literature through citations of the documentary itself or material associated with it. Here, we demonstrate that the case for pre-Columbian syphilis in Europe that was made in the documentary does not withstand scientific scrutiny. We also situate this example from paleopathology within a larger trend of "science by documentary" or "science by press conference," in which researchers seek to bypass the peer review process by presenting unvetted findings directly to the public. PMID:22499439

  18. Facebook-Augmented Partner Notification in a Cluster of Syphilis Cases in Milwaukee

    PubMed Central

    Oyervides, Otilio; Grande, Katarina M.; Prater, Daphne; Vann, Vannessa; Reitl, Irmine; Biedrzycki, Paul A.

    2014-01-01

    Public health professionals face many challenges in infectious disease cluster case identification and partner notification (PN), especially in populations using social media as a primary communication venue. We present a method using Facebook and social network diagram illustration to identify, link, and notify individuals in a cluster of syphilis cases in young black men who have sex with men (MSM). Use of Facebook was crucial in identifying two of 55 individuals with syphilis, and the cooperation of socially connected individuals with traditional PN methods yielded a high number of contacts per case. Integration of PN services for HIV and sexually transmitted diseases, as well as collaboration between the city and state information systems, assisted in the cluster investigation. Given that rates of syphilis and HIV infection are increasing significantly in young African American MSM, the use of social media can provide an additional avenue to facilitate case identification and notification. PMID:24385648

  19. A rare case of immune reconstitution inflammatory syndrome presenting as secondary syphilis.

    PubMed

    Khatri, Asma; Skalweit, Marion J

    2015-09-01

    Immune reconstitution syndrome has rarely been reported in the context of syphilis infection. We report a patient with AIDS (CD4 42 cells/mm(3), viral load 344,000 cp/ml), treated previously for secondary syphilis and started on an integrase inhibitor-based single-tablet antiretroviral treatment regimen. After four weeks of antiretroviral treatment, he presented with non-tender, non-blanching erythematous nodules on his chest, an elevated rapid plasma reagin (1:1024) and immune reconstitution (CD4 154 cells/mm(3), HIV-RNA 130 cp/ml). A detailed workup to exclude opportunistic infections including secondary and neurosyphilis was performed. The patient was continued on antiretroviral treatment and treated empirically for neurosyphilis given cerebrospinal lymphocytosis and dermatopathology suggesting treponemal antigen-driven B-cell hyperplasia. We favour a diagnosis of immune reconstitution in association with prior syphilis infection attributable to rapid and potent immune restoration afforded by integrase inhibitors. PMID:25311145

  20. Syphilis manifesting as a nasopharyngeal carcinoma with cervical lymphadenopathy: A case report

    PubMed Central

    PAN, XINBIN; ZHU, XIAODONG; LI, QINGDI QUENTIN

    2012-01-01

    The present case report describes a case of syphilitic lymphadenopathy and raises the awareness of the differential diagnosis of cervical lymphadenopathy. A 50-year-old male worker presented with a 6-month history of enlarged and growing lymph nodes in the right upper neck and a blood-tinged post-nasal drip. Physical examination showed multiple enlarged lymph nodes located in the right upper neck. On nasopharyngoscopy, a mass was found in the nasopharynx. The histopathology of both the nasopharyngeal mass and the enlarged lymph nodes revealed non-specific inflammation. Rapid plasma reagin test results (titer, 1:1280) and Treponema pallidum particle assay results (titer, 1:2560) were positive. Subsequently, a diagnosis of syphilis was confirmed clinically and serologically. The reaction after penicillin treatment further confirmed the syphilis diagnosis. Thus, syphilis should be considered as a possibility in the differential diagnosis of cervical lymphadenopathy. PMID:22970011

  1. Facebook-augmented partner notification in a cluster of syphilis cases in Milwaukee.

    PubMed

    Hunter, Paul; Oyervides, Otilio; Grande, Katarina M; Prater, Daphne; Vann, Vannessa; Reitl, Irmine; Biedrzycki, Paul A

    2014-01-01

    Public health professionals face many challenges in infectious disease cluster case identification and partner notification (PN), especially in populations using social media as a primary communication venue. We present a method using Facebook and social network diagram illustration to identify, link, and notify individuals in a cluster of syphilis cases in young black men who have sex with men (MSM). Use of Facebook was crucial in identifying two of 55 individuals with syphilis, and the cooperation of socially connected individuals with traditional PN methods yielded a high number of contacts per case. Integration of PN services for HIV and sexually transmitted diseases, as well as collaboration between the city and state information systems, assisted in the cluster investigation. Given that rates of syphilis and HIV infection are increasing significantly in young African American MSM, the use of social media can provide an additional avenue to facilitate case identification and notification. PMID:24385648

  2. Prevalence, incidence, and correlates of syphilis seroreactivity in multiethnic San Francisco neighborhoods.

    PubMed

    Siegel, D; Larsen, S A; Golden, E; Morse, S; Fullilove, M T; Washington, A E

    1994-11-01

    To examine the extent of infection with syphilis in an inner-city community, we determined the prevalence, incidence, and correlates of syphilis seroreactivity in a representative sample of unmarried whites, African Americans, and Hispanics living in San Francisco during 1988 to 1989 and again 1 year later in 1989 to 1990. One thousand seven hundred seventy single men and women aged 20 to 44 were surveyed in a random household sample drawn from three neighborhoods of varying geographic and cultural characteristics. Syphilitic infection was determined by testing specimens with the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP). Of blood samples available from 1262 participants from the initial survey, 32 (2.5%) were MHA-TP reactive. After adjustment for age, a reactive syphilis serology was significantly predicted (P < 0.05) by African American race, homosexual activity (men), and less education. In homosexually active men, lifetime number of male sex partners and the presence of antibody to the human immunodeficiency virus (HIV) significantly predicted syphilis seroreactivity (P < 0.01). One year later, of 841 specimens available for testing, an additional 13 (1.5%) had become MHA-TP reactive. Eleven (85%) of the new cases were in heterosexual men and women. Although San Francisco citywide incidence data indicate that syphilis may be decreasing for the city as a whole, incidence data on a community level suggests that syphilitic infection is increasing in high-risk heterosexual communities. Thus, syphilis prevention programs should rely on serologic testing at the community level to plan effective intervention strategies. PMID:7804501

  3. Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

    PubMed Central

    2011-01-01

    Background A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources. Methods The results of antenatal screening (2006-2008) were compared with data from pregnant women and newborns from other data sources. Results Each year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. The estimated annual prevalence of HIV among pregnant women was 0.05%. Prior to the introduction of screening, 5-10 children were born with HIV annually After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these, the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening. Conclusions The screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically. Previous publication [Translation from: 'Prenatale screening op hiv, hepatitis B en syphilis in Nederland effectief', published in 'The Dutch Journal of Medicine ' (NTVG, in Dutch)] PMID:21718466

  4. A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy

    PubMed Central

    Mani, Mohan Zachariah; Kanish, Bimal; Kwatra, Kanwardeep; Chaudhary, Paulina R.; Bhatia, Anuradha

    2015-01-01

    We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection. PMID:26692613

  5. Syphilis Trends among Men Who Have Sex with Men in the United States and Western Europe: A Systematic Review of Trend Studies Published between 2004 and 2015

    PubMed Central

    Abara, Winston E.; Hess, Kristen L.; Neblett Fanfair, Robyn; Bernstein, Kyle T.; Paz-Bailey, Gabriela

    2016-01-01

    Globally, men who have sex with men (MSM) are disproportionately burdened with syphilis. This review describes the published literature on trends in syphilis infections among MSM in the US and Western Europe from 1998, the period with the fewest syphilis infections in both geographical areas, onwards. We also describe disparities in syphilis trends among various sub-populations of MSM. We searched electronic databases (Medline, Embase, Global Health, PsychInfo, CAB Abstracts, CINAHL, Sociological Abstracts, Web of Science, Cochrane Library, and LILACS) for peer-reviewed journal articles that were published between January 2004 and June 2015 and reported on syphilis cases among MSM at multiple time points from 1998 onwards. Ten articles (12 syphilis trend studies/reports) from the US and eight articles (12 syphilis trend studies/reports) from Western Europe were identified and included in this review. Taken together, our findings indicate an increase in the numbers and rates (per 100,000) of syphilis infections among MSM in the US and Western Europe since 1998. Disparities in the syphilis trends among MSM were also noted, with greater increases observed among HIV-positive MSM than HIV-negative MSM in both the US and Western Europe. In the US, racial minority MSM and MSM between 20 and 29 years accounted for the greatest increases in syphilis infections over time whereas White MSM accounted for most syphilis infections over time in Western Europe. Multiple strategies, including strengthening and targeting current syphilis screening and testing programs, and the prompt treatment of syphilis cases are warranted to address the increase in syphilis infections among all MSM in the US and Western Europe, but particularly among HIV-infected MSM, racial minority MSM, and young MSM in the US. PMID:27447943

  6. Syphilis Trends among Men Who Have Sex with Men in the United States and Western Europe: A Systematic Review of Trend Studies Published between 2004 and 2015.

    PubMed

    Abara, Winston E; Hess, Kristen L; Neblett Fanfair, Robyn; Bernstein, Kyle T; Paz-Bailey, Gabriela

    2016-01-01

    Globally, men who have sex with men (MSM) are disproportionately burdened with syphilis. This review describes the published literature on trends in syphilis infections among MSM in the US and Western Europe from 1998, the period with the fewest syphilis infections in both geographical areas, onwards. We also describe disparities in syphilis trends among various sub-populations of MSM. We searched electronic databases (Medline, Embase, Global Health, PsychInfo, CAB Abstracts, CINAHL, Sociological Abstracts, Web of Science, Cochrane Library, and LILACS) for peer-reviewed journal articles that were published between January 2004 and June 2015 and reported on syphilis cases among MSM at multiple time points from 1998 onwards. Ten articles (12 syphilis trend studies/reports) from the US and eight articles (12 syphilis trend studies/reports) from Western Europe were identified and included in this review. Taken together, our findings indicate an increase in the numbers and rates (per 100,000) of syphilis infections among MSM in the US and Western Europe since 1998. Disparities in the syphilis trends among MSM were also noted, with greater increases observed among HIV-positive MSM than HIV-negative MSM in both the US and Western Europe. In the US, racial minority MSM and MSM between 20 and 29 years accounted for the greatest increases in syphilis infections over time whereas White MSM accounted for most syphilis infections over time in Western Europe. Multiple strategies, including strengthening and targeting current syphilis screening and testing programs, and the prompt treatment of syphilis cases are warranted to address the increase in syphilis infections among all MSM in the US and Western Europe, but particularly among HIV-infected MSM, racial minority MSM, and young MSM in the US. PMID:27447943

  7. [Incidence of congenital syphilis and factors associated with vertical transmission: data from the Birth in Brazil study].

    PubMed

    Domingues, Rosa Maria Soares Madeira; Leal, Maria do Carmo

    2016-06-20

    The objectives were to estimate incidence of congenital syphilis and verify factors associated with vertical transmission. A national hospital-based study was performed in 2011-2012 with 23,894 postpartum women using an in-hospital interview and data from patient charts and prenatal cards. Univariate logistic regression was performed to verify factors associated with congenital syphilis. Estimated incidence of congenital syphilis was 3.51 per 1,000 live births (95%CI: 2.29-5.37) and vertical transmission rate was 34.3% (95%CI: 24.7-45.4). Congenital syphilis was associated with lower maternal schooling, black skin color, higher rate of risk factors for prematurity, late initiation of prenatal care, fewer prenatal visits, and lower rate of prenatal serological testing. Fetal mortality was six times higher in congenital syphilis, and newborns with congenital syphilis showed higher hospital admission rates. Congenital syphilis is a persistent public health problem in Brazil and is associated with greater social vulnerability and gaps in prenatal care. PMID:27333146

  8. Finding a Needle in the Haystack: The Costs and Cost-Effectiveness of Syphilis Diagnosis and Treatment during Pregnancy to Prevent Congenital Syphilis in Kalomo District of Zambia

    PubMed Central

    Larson, Bruce A.; Lembela-Bwalya, Deophine; Bonawitz, Rachael; Hammond, Emily E.; Thea, Donald M.; Herlihy, Julie

    2014-01-01

    Background In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Methods Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. Results During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Conclusions Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack. PMID:25478877

  9. Perceptions, attitude and uptake of rapid syphilis testing services in antenatal clinics in North-Western Tanzania.

    PubMed

    Nnko, Soori; Changalucha, John; Mosha, Jacklin; Bunga, Catherine; Wamoyi, Joyce; Peeling, Rosanna; Mabey, David

    2016-06-01

    Infection with syphilis during pregnancy could cause spontaneous abortion, low birth weight and stillbirth. To prevent adverse pregnancy outcomes caused by syphilis, the World Health Organization (WHO) recommends syphilis screening and treatment of all pregnant women attending antenatal care (ANC) services. Rapid syphilis testing (RST) demonstration project was introduced at ANC clinics in Tanzania in 2009, to assess the feasibility, acceptability and its impact on uptake of syphilis screening service. Data collection was composed of in-depth interviews with health workers and pregnant women attending ANC. Additionally, from the health facility registers we extracted information on the uptake of antenatal care services, including number of pregnant women screened and treated for syphilis. Introduction of RST at health facilities was appreciated by pregnant women attending ANC and health workers. Following the introduction of RST services at ANC clinics, we observed a significant increase of the uptake of syphilis screening. Pregnant women appreciated RST service since it reduced the frequency of their visits to the health facilities and shortened the duration that they spent at the clinics. Moreover, the provision of same-day screening and treatment services helped women to save money that they would have to spend on transportation for the follow up visits. Health workers felt that RST simplified procedures to diagnose syphilis, and enabled the health workers to test and treat large numbers of clients in a shorter period of time. Our study demonstrates that, it is feasible to introduce RST service in antenatal clinics. The RST was appreciated by health workers and pregnant women, since it simplifies syphilis screening procedures, saves the time that pregnant women used to waste to wait for the results, and saves the cost that women would have to spend on transportation to come back for treatment. PMID:26685146

  10. Systematic Differences in Risk Behaviours and Syphilis Prevalence across Types of Female Sex Workers: a Preliminary Study in Liuzhou, China

    PubMed Central

    Li, Jing; Chen, Xiang-Sheng; Merli, M. Giovanna; Weir, Sharon S.; Henderson, Gail E.

    2011-01-01

    Background Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined two possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. Methods From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect socio-demographic and behavioural information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the two categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. Results The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1% respectively. Lifetime and active syphilis prevalence were higher among FSWs in the lowest price category (52.7% and 25.4% respectively) and those working in streets (69.7% and 39.8% respectively) or through telephone (46.3% and 17.0% respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street-(Adjusted odds ratio AOR 38.7, 95% CI 10.7-139.9) and telephone-based FSWs (AOR 10.8, 95% CI 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR 15.2, 95% CI 3.7-62.1) after adjusting for demographic and behavioural factors. Conclusions Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted. PMID:22337106

  11. The continuing legacy of the Tuskegee Syphilis Study: considerations for clinical investigation.

    PubMed

    Corbie-Smith, G

    1999-01-01

    The Tuskegee Study, an observational study of over 400 sharecroppers with untreated syphilis, was conducted by the U.S. Public Health Service to document the course of the disease in blacks, and racial differences in the clinical manifestations of syphilis. The men were not told they had syphilis, not given counseling on avoiding spread of the disease, and not given treatment throughout the course of the study. The study became the longest (1932-1972) nontherapeutic experiment on humans in the history of medicine, and has come to represent not only the exploitation of blacks in medical history, but the potential for exploitation of any population that may be vulnerable because of race, ethnicity, gender, disability, age or social class. It is important for physicians who will be caring for an increasingly diverse nation to understand the lasting implications of this study for their patients, but the effects of the Tuskegee Syphilis Study are demonstrated most strikingly by unsuccessful attempts at improving representation of minority patients in clinical trials. PMID:9892266

  12. Use of Treponema pallidum PCR in Testing of Ulcers for Diagnosis of Primary Syphilis1

    PubMed Central

    Sednaoui, Patrice; Lautenschlager, Stephan; Ferry, Tristan; Toutous-Trellu, Laurence; Cavassini, Matthias; Yassir, Fatima; Martinez de Tejada, Begoña; Emonet, Stéphane; Combescure, Christophe; Schrenzel, Jacques; Perneger, Thomas

    2015-01-01

    Treponema pallidum PCR (Tp-PCR) has been noted as a valid method for diagnosing syphilis. We compared Tp-PCR to a combination of darkfield microscopy (DFM), the reference method, and serologic testing in a cohort of 273 patients from France and Switzerland and found the diagnostic accuracy of Tp-PCR was higher than that for DFM. PMID:25531672

  13. Use of Treponema pallidum PCR in testing of ulcers for diagnosis of primary syphilis.

    PubMed

    Gayet-Ageron, Angèle; Sednaoui, Patrice; Lautenschlager, Stephan; Ferry, Tristan; Toutous-Trellu, Laurence; Cavassini, Matthias; Yassir, Fatima; Martinez de Tejada, Begoña; Emonet, Stéphane; Combescure, Christophe; Schrenzel, Jacques; Perneger, Thomas

    2015-01-01

    Treponema pallidum PCR (Tp-PCR) has been noted as a valid method for diagnosing syphilis. We compared Tp-PCR to a combination of darkfield microscopy (DFM), the reference method, and serologic testing in a cohort of 273 patients from France and Switzerland and found the diagnostic accuracy of Tp-PCR was higher than that for DFM. PMID:25531672

  14. A new attempt to distinguish serologically the subspecies of Treponema pallidum causing syphilis and yaws.

    PubMed Central

    Noordhoek, G T; Cockayne, A; Schouls, L M; Meloen, R H; Stolz, E; van Embden, J D

    1990-01-01

    In an effort to serologically differentiate syphilis from yaws, 69 monoclonal antibody species raised against Treponema pallidum subsp. pallidum were tested by immunoblotting for their reactivity with Treponema pallidum subsp. pertenue. All monoclonal antibodies reacted with antigens with the same molecular weight of both subspecies. Furthermore, no differences in reactivity between sera from yaws patients and from syphilis patients were found by Western blot (immunoblot) analysis of cell lysates of T. pallidum subsp. pallidum and T. pallidum subsp. pertenue. We tried to exploit the only known molecular difference between the subspecies. The subunits of the 190-kilodalton multimeric proteins TpF1 and TyF1 of T. pallidum subsp. pallidum and T. pallidum subsp. pertenue, respectively, have previously been shown to differ in one amino acid residue at position 40. In this study, no difference was found in immunoreactivity of TpF1 or TyF1 with either syphilis sera or yaws sera. Synthetic peptides based on the sequence of TpF1 and of TyF1 were used in an enzyme-linked immunosorbent assay with syphilis sera and yaws sera. Again, no difference in reactivity between the T. pallidum subsp. pallidum- and T. pallidum subsp. pertenue-derived peptides was observed. Images PMID:2199521

  15. Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88.

    PubMed Central

    Toomey, K E; Oberschelp, A G; Greenspan, J R

    1989-01-01

    Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively. PMID:2511589

  16. A Novel Quantum Dots–Based Point of Care Test for Syphilis

    PubMed Central

    2010-01-01

    One-step lateral flow test is recommended as the first line screening of syphilis for primary healthcare settings in developing countries. However, it generally shows low sensitivity. We describe here the development of a novel fluorescent POC (Point Of Care) test method to be used for screening for syphilis. The method was designed to combine the rapidness of lateral flow test and sensitiveness of fluorescent method. 50 syphilis-positive specimens and 50 healthy specimens conformed by Treponema pallidum particle agglutination (TPPA) were tested with Quantum Dot-labeled and colloidal gold-labeled lateral flow test strips, respectively. The results showed that both sensitivity and specificity of the quantum dots–based method reached up to 100% (95% confidence interval [CI], 91–100%), while those of the colloidal gold-based method were 82% (95% CI, 68–91%) and 100% (95% CI, 91–100%), respectively. In addition, the naked-eye detection limit of quantum dot–based method could achieve 2 ng/ml of anti-TP47 polyclonal antibodies purified by affinity chromatography with TP47 antigen, which was tenfold higher than that of colloidal gold–based method. In conclusion, the quantum dots were found to be suitable for labels of lateral flow test strip. Its ease of use, sensitiveness and low cost make it well-suited for population-based on-the-site syphilis screening. PMID:20672123

  17. A novel quantum dots-based point of care test for syphilis.

    PubMed

    Yang, Hao; Li, Ding; He, Rong; Guo, Qin; Wang, Kan; Zhang, Xueqing; Huang, Peng; Cui, Daxiang

    2010-01-01

    One-step lateral flow test is recommended as the first line screening of syphilis for primary healthcare settings in developing countries. However, it generally shows low sensitivity. We describe here the development of a novel fluorescent POC (Point Of Care) test method to be used for screening for syphilis. The method was designed to combine the rapidness of lateral flow test and sensitiveness of fluorescent method. 50 syphilis-positive specimens and 50 healthy specimens conformed by Treponema pallidum particle agglutination (TPPA) were tested with Quantum Dot-labeled and colloidal gold-labeled lateral flow test strips, respectively. The results showed that both sensitivity and specificity of the quantum dots-based method reached up to 100% (95% confidence interval [CI], 91-100%), while those of the colloidal gold-based method were 82% (95% CI, 68-91%) and 100% (95% CI, 91-100%), respectively. In addition, the naked-eye detection limit of quantum dot-based method could achieve 2 ng/ml of anti-TP47 polyclonal antibodies purified by affinity chromatography with TP47 antigen, which was tenfold higher than that of colloidal gold-based method. In conclusion, the quantum dots were found to be suitable for labels of lateral flow test strip. Its ease of use, sensitiveness and low cost make it well-suited for population-based on-the-site syphilis screening. PMID:20672123

  18. Dual epidemics of syphilis and methamphetamine use among drug users in Shandong Province of China.

    PubMed

    Liao, Meizhen; Kang, Dianmin; Tao, Xiaorun; Li, Jie; Qian, Yuesheng; Wang, Guoyong; Jiang, Baofa; Bi, Zhenqiang; Jia, Yujiang

    2013-01-01

    We assessed the types of drugs, the prevalence of HIV, syphilis, and its correlates among Shandong's drug users in China. Two consecutive cross-sectional surveys in 2009 and 2010 provided demographics, types of drugs, sexual and drug-use behaviors, and HIV-related services. Of the 1320 unique, eligible participants, 81.1% were male, two-thirds <35 years of age, 13.0% non-Shandong residents; in the past year, majority (96.4%) reported ever using methamphetamine, 3.4% using heroin, 8.6% using ≥2 types of these drugs and 8.0% injecting drugs, 63.8% having commercial sex. HIV and syphilis prevalence were 0.2% and 8.3%, respectively. In multivariable logistic regression analysis, syphilis was independently associated with female, non-Shandong residents, higher levels of education, and 2010. Synthetic drugs, especially methamphetamine, have become the predominant sources of drug addiction. The emerging epidemic of syphilis potentially driven by methamphetamine use underscored the urgency to implement an effective sex and substance use-related intervention. PMID:23394142

  19. The impact of syphilis mass treatment one year later: self-reported behaviour change among participants.

    PubMed

    Rekart, Michael L; Wong, Thomas; Wong, Elsie; Hutchinson, Kylie; Ogilvie, Gina

    2005-08-01

    In 2000, syphilis mass treatment using oral azithromycin was delivered to at-risk British Columbians during a sex trade-related outbreak. The initiative included education, counselling and referral. This cross-sectional, observational study examines knowledge, attitudes and self-reported behaviour after one year among mass treatment participants compared with eligible non-participants. Participants self-reported positive changes: reduction in sexual partners overall (P=0.001) and for sex workers (P<0.01), decrease in unprotected oral sex (P=0.03), knowledge of asymptomatic syphilis (P=0.02), positive attitudes to mass treatment (P=0.02) and to the street nurses (P=0.01). Increased awareness was associated with increased condom use for vaginal sex overall (P=0.02) and for sex workers (P=0.03) and increased condom use for oral sex (P=0.05). There was no difference in syphilis incidence. Syphilis outbreak interventions that include education, support and referral can result in long-term positive behaviour changes. PMID:16105193

  20. Detailed Knowledge of the Tuskegee Syphilis Study: Who Knows What? A Framework for Health Promotion Strategies

    ERIC Educational Resources Information Center

    Green, B. Lee; Li, Lin; Morris, J. Fontain; Gluzman, Rima; Davis, Jenna L.; Wang, Min Qi; Katz, Ralph V.

    2011-01-01

    This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A…

  1. Syphilis as a Sole Indicator of Sexual Abuse: Two Cases with No Intervention.

    ERIC Educational Resources Information Center

    Horowitz, Susan; Chadwick, David L.

    1990-01-01

    Two cases of suspected sexual abuse of five-year-old children with syphilis are reported. Lack of confirmation of abuse by either child or in parental interviews led to closing of the cases by Child Protection Services and continued residence by the children in their original homes. (DB)

  2. A Novel Quantum Dots-Based Point of Care Test for Syphilis

    NASA Astrophysics Data System (ADS)

    Yang, Hao; Li, Ding; He, Rong; Guo, Qin; Wang, Kan; Zhang, Xueqing; Huang, Peng; Cui, Daxiang

    2010-05-01

    One-step lateral flow test is recommended as the first line screening of syphilis for primary healthcare settings in developing countries. However, it generally shows low sensitivity. We describe here the development of a novel fluorescent POC (Point Of Care) test method to be used for screening for syphilis. The method was designed to combine the rapidness of lateral flow test and sensitiveness of fluorescent method. 50 syphilis-positive specimens and 50 healthy specimens conformed by Treponema pallidum particle agglutination (TPPA) were tested with Quantum Dot-labeled and colloidal gold-labeled lateral flow test strips, respectively. The results showed that both sensitivity and specificity of the quantum dots-based method reached up to 100% (95% confidence interval [CI], 91-100%), while those of the colloidal gold-based method were 82% (95% CI, 68-91%) and 100% (95% CI, 91-100%), respectively. In addition, the naked-eye detection limit of quantum dot-based method could achieve 2 ng/ml of anti-TP47 polyclonal antibodies purified by affinity chromatography with TP47 antigen, which was tenfold higher than that of colloidal gold-based method. In conclusion, the quantum dots were found to be suitable for labels of lateral flow test strip. Its ease of use, sensitiveness and low cost make it well-suited for population-based on-the-site syphilis screening.

  3. Bilateral facial nerve palsy as the sole initial symptom of syphilis: a case report.

    PubMed

    Ting, Chi-Hsin; Wang, Chih-Wei; Lee, Jiunn-Tay; Peng, Giia-Sheun; Yang, Fu-Chi

    2015-09-01

    Bilateral facial nerve palsy is an exceedingly rare condition and presents a diagnostic challenge. Bilateral facial nerve palsy may result from cranial trauma, congenital abnormalities, inflammation, infiltration, or infection, but is rarely associated with syphilis. Here, we report a case of syphilis in which bilateral facial nerve palsy was the only initial symptom. A 22-year-old man presented at our emergency department with isolated bilateral facial nerve palsy. Results for initial serum and cerebrospinal fluid examinations were normal, including the rapid plasma reagin titer. One week later, the patient developed rashes on the torso, palms, and soles. At this time, a high serum rapid plasma reagin titer was detected, and the Treponema pallidum particle agglutination test was positive. Once the tests were confirmed, the patient admitted to a history of unprotected sexual behavior. Penicillin G treatment was effective, and a 3-month follow-up examination demonstrated a complete recovery. We recommend that syphilis be considered when diagnosing sexually experienced young men presenting with bilateral facial nerve palsy, even in the absence of skin manifestations. Failure to recognize facial signs of syphilis could result in inappropriate management, affecting the patient's clinical outcome. PMID:26166431

  4. Syphilis? An Unusual Cause of Surgical Emergency in a Human Immunodeficiency Virus-Infected Man

    PubMed Central

    Bender Ignacio, Rachel A.; Koch, Lisa L.; Dhanireddy, Shireesha; Charmie Godornes, B.; Lukehart, Sheila A.; Marrazzo, Jeanne M.

    2015-01-01

    We report on a human immunodeficiency virus-infected man undergoing urgent anorectal surgery, with multi-centimeter fungating masses discovered inside the anus. Initial pathology was inconclusive. After the patient developed a disseminated rash postoperatively determined to be secondary syphilis, the anorectal pathology was reviewed and Treponema pallidum DNA was amplified by polymerase chain reaction from the mass. PMID:26213693

  5. Duration of syphilis symptoms at presentations in men who have sex with men in Australia: are current public health campaigns effective?

    PubMed

    Chow, E P F; Dutt, K; Fehler, G; Denham, I; Chen, M Y; Batrouney, C; Peel, J; Read, T R H; Bradshaw, C S; Fairley, C K

    2016-01-01

    The rapid rise in syphilis cases has prompted a number of public health campaigns to assist men who have sex with men (MSM) recognize and present early with symptoms. This study aimed to investigate the temporal trend of the duration of self-report symptoms and titre of rapid plasma reagin (RPR) in MSM with infectious syphilis. Seven hundred and sixty-one syphilis cases in MSM diagnosed at the Melbourne Sexual Health Centre (MSHC) from 2007-2013 were reviewed. Median duration of symptoms and RPR titres in each year were calculated. The median durations of symptoms with primary and secondary syphilis were 9 [interquartile range (IQR) 6-14] days and 14 (IQR 7-30) days, respectively. The overall median titre of RPR in secondary syphilis (median 128, IQR 64-256) was higher than in primary syphilis (median 4, IQR 1-32) and in early latent syphilis (median 32, IQR 4-64). The median duration of symptoms for primary syphilis, secondary syphilis and titre of RPR level did not change over time. Public health campaigns were not associated with a significant shorter time from onset of symptoms to treatment. Alternative strategies such as more frequent testing of MSM should be promoted to control the syphilis epidemic in Australia. PMID:26027716

  6. [Syphilis in sixteenth-century in Bologna. Health care and social assistance (Part one)].

    PubMed

    Sabbatani, S

    2006-03-01

    Syphilis arrived in Bologna in the summer of 1495, after Fornovo's battle on the Taro where Charles VIII's army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city. At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called "Ospedale di San Giobbe". It was closed in 1798, after the entry of the French army into Bologna. In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick. We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult historical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population. PMID:16794380

  7. Genital Cytomegalovirus Replication Predicts Syphilis Acquisition among HIV-1 Infected Men Who Have Sex with Men

    PubMed Central

    Gianella, Sara; Smith, Davey M.; Daar, Eric S.; Dube, Michael P.; Lisco, Andrea; Vanpouille, Christophe; Margolis, Leonid; Haubrich, Richard H.; Morris, Sheldon R.

    2015-01-01

    Objective Sexually transmitted infections (STI) are common among HIV-infected men who have sex with men (MSM). While behavioral factors are important in STI acquisition, other biological factors such as immune modulation due to chronic viral infection may further predispose to STI acquisition. Design Post Hoc analysis including data collected over 12 months of follow-up from 131 HIV-infected MSM receiving antiretroviral therapy and screened for incident bacterial STI every 3 months. Methods Genital secretions collected at baseline were used to measure herpesvirus replication and inflammatory cytokines. Baseline predictors of STI were determined using survival analysis of time to incident STI. Results All participants were seropositive for cytomegalovirus (CMV), and 52% had detectable genital CMV at baseline. Thirty-five individuals acquired STI during follow-up, sometimes with multiple pathogen (17 syphilis, 21 gonorrhea, 14 chlamydia). Syphilis acquisition was associated with genital CMV replication at baseline (19.1% CMV-shedders versus 4.8% non-shedders, p=0.03) and younger age (p=0.02). Lower seminal MCP-1 was associated with higher seminal CMV levels and with syphilis acquisition (p<0.01). For syphilis acquisition, in multivariable Cox-Proportional Hazard model adjusted hazard rates were 3.56 (95%CI:1.00–12.73) for baseline CMV replication and 2.50 (0.92–6.77) for younger age. Conclusions This post hoc analysis suggest that CMV-associated decrease in seminal MCP-1 levels might predispose HIV-infected MSM to syphilis acquisition, but not other STI. Future studies should determine underlying mechanisms and if a causal association exists. PMID:26061824

  8. Antigenic variation of TprK facilitates development of secondary syphilis.

    PubMed

    Reid, Tara B; Molini, Barbara J; Fernandez, Mark C; Lukehart, Sheila A

    2014-12-01

    Although primary syphilis lesions heal spontaneously, the infection is chronic, with subsequent clinical stages. Healing of the primary chancre occurs as antibodies against outer membrane antigens facilitate opsonophagocytosis of the bacteria by activated macrophages. TprK is an outer membrane protein that undergoes antigenic variation at 7 variable regions, and variants are selected by immune pressure. We hypothesized that individual TprK variants escape immune clearance and seed new disseminated lesions to cause secondary syphilis. As in human syphilis, infected rabbits may develop disseminated secondary skin lesions. This study explores the nature of secondary syphilis, specifically, the contribution of antigenic variation to the development of secondary lesions. Our data from the rabbit model show that the odds of secondary lesions containing predominately TprK variant treponemes is 3.3 times higher than the odds of finding TprK variants in disseminated primary lesions (odds ratio [OR] = 3.3 [95% confidence interval {CI}, 0.98 to 11.0]; P = 0.055) and that 96% of TprK variant secondary lesions are likely seeded by single treponemes. Analysis of antibody responses demonstrates significantly higher antibody titers to tprK variable region sequences found in the inoculum compared to reactivity to tprK variant sequences found in newly arising secondary lesions. This suggests that tprK variants escape the initial immune response raised against the V regions expressed in the inoculum. These data further support a role for TprK in immune evasion and suggest that the ability of TprK variants to persist despite a robust immune response is instrumental in the development of later stages of syphilis. PMID:25225245

  9. Antigenic Variation of TprK Facilitates Development of Secondary Syphilis

    PubMed Central

    Reid, Tara B.; Molini, Barbara J.; Fernandez, Mark C.

    2014-01-01

    Although primary syphilis lesions heal spontaneously, the infection is chronic, with subsequent clinical stages. Healing of the primary chancre occurs as antibodies against outer membrane antigens facilitate opsonophagocytosis of the bacteria by activated macrophages. TprK is an outer membrane protein that undergoes antigenic variation at 7 variable regions, and variants are selected by immune pressure. We hypothesized that individual TprK variants escape immune clearance and seed new disseminated lesions to cause secondary syphilis. As in human syphilis, infected rabbits may develop disseminated secondary skin lesions. This study explores the nature of secondary syphilis, specifically, the contribution of antigenic variation to the development of secondary lesions. Our data from the rabbit model show that the odds of secondary lesions containing predominately TprK variant treponemes is 3.3 times higher than the odds of finding TprK variants in disseminated primary lesions (odds ratio [OR] = 3.3 [95% confidence interval {CI}, 0.98 to 11.0]; P = 0.055) and that 96% of TprK variant secondary lesions are likely seeded by single treponemes. Analysis of antibody responses demonstrates significantly higher antibody titers to tprK variable region sequences found in the inoculum compared to reactivity to tprK variant sequences found in newly arising secondary lesions. This suggests that tprK variants escape the initial immune response raised against the V regions expressed in the inoculum. These data further support a role for TprK in immune evasion and suggest that the ability of TprK variants to persist despite a robust immune response is instrumental in the development of later stages of syphilis. PMID:25225245

  10. Syphilis and human experimentation from World War II to the present: a historical perspective and reflections on ethics.

    PubMed

    Cuerda-Galindo, E; Sierra-Valenti, X; González-López, E; López-Muñoz, F

    2014-11-01

    Even after the Nuremberg code was published, research on syphilis often continued to fall far short of ethical standards. We review post-World War II research on this disease, focusing on the work carried out in Guatemala and Tuskegee. Over a thousand adults were deliberately inoculated with infectious material for syphilis, chancroid, and gonorrhea between 1946 and 1948 in Guatemala, and thousands of serologies were performed in individuals belonging to indigenous populations or sheltered in orphanages. The Tuskegee syphilis study, conducted by the US Public Health Service, took place between 1932 and 1972 with the aim of following the natural history of the disease when left untreated. The subjects belonged to a rural black population and the study was not halted when effective treatment for syphilis became available in 1945. PMID:24461955

  11. What is the role of a full physical examination in the management of asymptomatic patients with late syphilis?

    PubMed

    Dabis, R; Radcliffe, K

    2012-12-01

    According to the British Association for Sexual Health and HIV guidelines, a full physical examination is recommended in patients with possible late syphilis. The aim of this audit was to review all cases of late syphilis diagnosed at our centre since 1994 to see if a full cardiovascular and neurological examination was documented and also to see what a full examination contributed to the management of asymptomatic patients. Of the 480 medical notes audited, 295 patients were asymptomatic of whom 288 (98%) had normal physical examinations; the rest were either not documented, declined or defaulted follow-up. Seven asymptomatic patients had positive clinical findings but these did not lead to a diagnosis of cardiovascular or neurological syphilis. This audit has shown that performing a physical examination in asymptomatic patients added no benefit in diagnosing complications of late syphilis; it would appear that the physical examination did not alter the management. PMID:23258833

  12. The Cost-Effectiveness of Syphilis Screening Among Men Who Have Sex With Men: An Exploratory Modeling Analysis.

    PubMed

    Chesson, Harrell W; Kidd, Sarah; Bernstein, Kyle T; Fanfair, Robyn Neblett; Gift, Thomas L

    2016-07-01

    We adapted a published model to estimate the costs and benefits of screening men who have sex with men for syphilis, including the benefits of preventing syphilis-attributable human immunodeficiency virus. The cost per quality-adjusted life year gained by screening was

  13. A syphilis-positive organ donor -- management of the cardiac transplant recipient: a case report and review of the literature.

    PubMed

    Marek, Aleks; Inkster, Teresa

    2012-06-01

    Syphilis as a public health problem has not been resolved. Because donor organs are scarce, Treponema pallidum seropositivity is no longer considered a contraindication to transplant. However, there is little guidance on the management and monitoring on the recipient of organs from patients with syphilis. We present a case of a patient successfully transplanted with a heart from a seropositive donor and a review of the literature. PMID:22592837

  14. Expansion of HIV and syphilis into the Peruvian Amazon: a survey of four communities of an indigenous Amazonian ethnic group

    PubMed Central

    Bartlett, Ellika C.; Zavaleta, Carol; Fernández, Connie; Razuri, Hugo; Vilcarromero, Stalin; Vermund, Sten H.; Gotuzzo, Eduardo

    2008-01-01

    Summary Background In 2004, cases of HIV and syphilis were reported in an indigenous community in the Peruvian Amazon. This study sought to determine the prevalence of HIV and syphilis in four remote communities of the same indigenous ethnic group located further from an urban center than the original community, and to identify risk factors for HIV and syphilis transmission. Methods Rapid and confirmatory tests for HIV and syphilis were performed. A questionnaire elicited demographic information, risk factors for sexually transmitted infections, and knowledge/beliefs about HIV/AIDS. Results We collected 282 blood samples and conducted interviews with 281 (99.6%) participants. The confirmed syphilis prevalence rate was 3.2% (9/282; 3.7% (5/135) for men and 2.7% (4/147) for women). The confirmed HIV prevalence rate was 0.7% (2/282), with both infections in men who had sex with men (MSM). Self-reported MSM activity was 39.7%. There was poor knowledge about HIV infection, transmission, and prevention, and low acceptance of known prevention methods. Conclusions HIV and syphilis are now prevalent in remote Amazonian communities of an indigenous group in Peru. Expansion of the HIV epidemic into the Amazon requires an urgent public health response. PMID:18760648

  15. Factors associated with HIV and syphilis co-infection among men who have sex with men in seven Chinese cities.

    PubMed

    Das, Aritra; Li, Jianjun; Zhong, Fei; Ouyang, Lin; Mahapatra, Tanmay; Tang, Weiming; Fu, Gengfeng; Zhao, Jinkou; Detels, Roger

    2015-03-01

    HIV-syphilis co-infection is often cited as a major reason behind recent resurgence in syphilis prevalence among men who have sex with men in China. Most published literatures explore factors associated with either HIV or syphilis, but not their co-infection. We analysed data from a cross-sectional survey on men who have sex with men in seven Chinese cities. Snowball sampling was used to recruit participants for the survey. Socio-demographic and behavioural predictors for HIV-syphilis mono/co-infection were examined using ordinal logistic regression. Factor scores were used to summarise (1) HIV-related knowledge and (2) access to HIV preventive services. Prevalence of HIV, syphilis, and their co-infection, among 2936 self-identified men who have sex with men, were 7.7%, 14.3%, and 2.6%, respectively. In the adjusted analysis, the significant positive correlates of poorer diagnoses (co-infection vs mono- and no infection or co- and mono-infection vs no infection) were: 30 to 39 years and ≥40 years age, education up to senior high school, unprotected anal intercourse, recent sexually transmitted infection symptoms, incorrect knowledge about routes of transmission, and access to preventive or counselling/testing services for HIV. For effective control of this dual epidemic, integrated HIV and syphilis surveillance and targeted intervention strategies for Chinese men who have sex with men are needed urgently. PMID:24737881

  16. Factors associated with HIV and syphilis co-infection among men who have sex with men in seven Chinese cities

    PubMed Central

    Das, Aritra; Li, Jianjun; Zhong, Fei; Ouyang, Lin; Mahapatra, Tanmay; Tang, Weiming; Fu, Gengfeng; Zhao, Jinkou; Detels, Roger

    2014-01-01

    HIV-syphilis co-infection is often cited as a major reason behind recent resurgence in syphilis prevalence among men who have sex with men (MSM) in China. Most published literatures explore factors associated with either HIV or syphilis, but not their co-infection. We analyzed data from a cross-sectional survey on MSM in seven Chinese cities. Snowball sampling was used to recruit participants for the survey. Socio-demographic and behavioral predictors for HIV-syphilis mono/co-infection were examined using ordinal logistic regression. Factor scores were used to summarize; 1) HIV related knowledge, and 2) access to HIV preventive services. Prevalence of HIV, syphilis, and their co-infection, among 2936 self-identified MSM, were 7.7%, 14.3%, and 2.6%, respectively. In the adjusted analysis, the significant positive correlates of poorer diagnoses (co-infection vs mono- & no infection or co- & mono-infection vs no infection) were −30 to 39 years and ≥40 years age, education up to senior high school, unprotected anal intercourse (UAI), recent STD symptoms, incorrect knowledge about routes of transmission, and access to preventive or counselling/testing services for HIV. For effective control of this dual epidemic, integrated HIV and syphilis surveillance and targeted intervention strategies for Chinese MSM are need of the hour. PMID:24737881

  17. High prevalence of syphilis among street-based female sex workers in Nanchang, China

    PubMed Central

    Tao, Xiao Hua; Jiang, Tao; Shao, Dan; Xue, Wei; Ye, Fa Shun; Wang, Ming; He, Mei Hua

    2014-01-01

    Background: Female sex workers (FSWs) play a critical role in the heterosexual transmission of human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) in China. Several studies reported that street-based FSWs have higher risk behaviors than establishment-based FSWs. Therefore, street-based FSWs should be specifically targeted for HIV and STIs intervention programs. Objectives: This study aims to investigate the prevalence rates and risk factors of HIV and syphilis among FSWs in Nanchang, China. Materials and Methods: Using convenience sampling methods, 361 street-based FSWs were recruited from August 2011 to February 2012. All participants completed an anonymous questionnaire on socioeconomic and sex behavioral information and were tested for HIV and syphilis. Risk for HIV and syphilis infection was assessed using univariate and multivariate logistic regression analyses. Results: No HIV infections were found. The prevalence rate of syphilis was 43.5%. Nearly 46.1% of street-based FSWs reported having education for no more than 6 years. Having reproductive tract infections at current visit, duration of sex work more than 5 years, indulgence in unprotected sex trade in the last time, unprotected sex trade in the last month, and unprotected sex with boyfriend or spouse in the last month were reported by 35.2%, 43.5%, 33.8%, 60.4%, and 93.1% street-based FSWs, respectively. In multivariate logistic regression analysis, having reproductive tract infections at current visit [odds ratio (OR), 12.10; 95% confidence interval (CI), 6.01-24.37], duration of sex work more than five years (OR, 4.26; 95% CI, 2.40-7.54), and unprotected sex trade in the last month (OR, 1.85; 95% CI, 1.06-3.22) were independently associated with syphilis infection. Conclusion: The prevalence rate of syphilis among street-based FSWs is very high. Most street-based FSWs in our survey had low education, long experience of commercial sex, and high rate of inconsistent condom use

  18. Western Immunoblotting with Five Treponema pallidum Recombinant Antigens for Serologic Diagnosis of Syphilis

    PubMed Central

    Sambri, Vittorio; Marangoni, Antonella; Eyer, Christina; Reichhuber, Christine; Soutschek, Erwin; Negosanti, Massimo; D'Antuono, Antonietta; Cevenini, Roberto

    2001-01-01

    Five immunodominant Treponema pallidum recombinant polypeptides (rTpN47, rTmpA, rTpN37, rTpN17, and rTpN15) were blotted onto strips, and 450 sera (200 from blood donors, 200 from syphilis patients, and 50 potentially cross-reactive) were tested to evaluate the diagnostic performance of recombinant Western blotting (recWB) in comparison with in-house whole-cell lysate antigen-based immunoblotting (wclWB) and T. pallidum hemagglutination (MHA-TP) for the laboratory diagnosis of syphilis. None of the serum specimens from blood donors or from potential cross-reactors gave a positive result when evaluated by recWB, wclWB, or MHA-TP. The evaluation of the immunoglobulin G immune response by recWB in sera from patients with different stages of syphilis showed that rTmpA was the most frequently identified antigen (95%), whereas only 41% of the specimens were reactive to rTpN37. The remaining recombinant polypeptides were recognized as follows: rTpN47, 92.5%; rTpN17, 89.5%; and rTpN15, 67.5%. The agreement between recWB and MHA-TP was 95.0% (100% with sera from patients with latent and late disease), and the concordance between wclWB and MHA-TP was 92.0%. The overall concordance between recWB and wclWB was 97.5% (100% with sera from patients with secondary and late syphilis and 94.6 and 98.6% with sera from patients with primary and latent syphilis, respectively). The overall sensitivity of recWB was 98.8% and the specificity was 97.1% with MHA-TP as the reference method. These values for sensitivity and specificity were slightly superior to those calculated for wclWB (sensitivity, 97.1%, and specificity, 96.1%). With wclWB as the standard test, the sensitivity and specificity of recWB were 98.9 and 99.3%, respectively. These findings suggest that the five recombinant polypeptides used in this study could be used as substitutes for the whole-cell lysate T. pallidum antigens and that this newly developed recWB test is a good, easy-to-use confirmatory method for the

  19. The Prevalence of Syphilis Infection and Its Associated Factors in the General Population of Rwanda: A National Household-Based Survey

    PubMed Central

    Mutagoma, Mwumvaneza; Remera, Eric; Sebuhoro, Dieudonné; Kanters, Steve; Riedel, David J.; Nsanzimana, Sabin

    2016-01-01

    Background. The prevalence of syphilis among HIV-infected people is a public health concern, but there is limited literature to describe the true burden of syphilis in resource-limited settings. We conducted this survey in 2013 to estimate the prevalence of syphilis. Methods. A cross-sectional survey. Participants were tested for syphilis and HIV. Factors associated with syphilis infection were identified. Results. The prevalence of syphilis was 0.9% (95% CI: 0.7–1.1). This prevalence was higher in the 25–49-year-old age (1.1% [95% CI: 0.8–1.3]) than in the 15–24-year-old age (0.6% (95% CI: 0.4–0.9)). Women with lower education had a higher prevalence of syphilis (1.2% (95% CI: 0.9–1.5)) compared to others (0.4% (95% CI: 0.2–0.8)). This prevalence among HIV-infected people was six times higher: 4.8% (95% CI: 2.9–7.9) compared to HIV-negative people (0.8% (95% CI: 0.6–1.0)). The prevalence of syphilis among HIV-infected females was 5.9% (95% CI: 3.4–10.0). HIV-infected or concurrent sexual partners was associated with increased syphilis prevalence with aOR = 4.2 (95% CI: 2.5–7.2) and aOR = 4.2 (95% CI: 2.8–6.5), respectively. Conclusions. The prevalence of syphilis was significantly higher among HIV-infected patients. HIV infection and concurrent sexual partners are associated with an increased prevalence of syphilis. Preventing HIV might help in preventing syphilis. PMID:27123356

  20. [Serological cardiolipid development of early syphilis treated with a single injection of benzathine-penicillin of 2,400,000 I.U].

    PubMed

    Sekkat, A; Ait Bennasser, M I; Benhayoune, T S; Derdabi, D; Sedrati, O; Nejmi, S; Baaj, A

    1983-01-01

    For one year, the authors have observed the clinical and biological development of early syphilis on 205 patients infected between 1971 and 1979 and treated by a single injection of Benzathine-Penicilline of 2,400,000 U.I. The serological negativeness has been obtained in the proportions as follow: - 91,43 p. 100 of primary syphilis (blood test positive), - 88,57 p. 100 of secondary syphilis, - 67,69 p. 100 of latent syphilis. These results compared to those obtained by other more time-consuming and expensive methods, can be considered as satisfactory. PMID:6666927

  1. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study.

    PubMed

    Seibt, Creta Elisa; Munerato, Maria Cristina

    2016-01-01

    Syphilis is an infectious disease caused by the bacterium Treponema pallidum. Syphilis has three clinical stages and may present various oral manifestations, mainly at the secondary stage. The disease mimics other more common oral mucosa lesions, going undiagnosed and with no proper treatment. Despite the advancements in medicine toward prevention, diagnosis, and treatment syphilis remains a public health problem worldwide. In this sense, dental surgeons should be able to identify the most common manifestations of the disease in the oral cavity, pointing to the role of this professional in prevention and diagnosis. This study describes a case series of seven patients with secondary syphilis presenting different oral manifestations. PMID:27208390

  2. Delayed diagnosis of ocular syphilis that manifested as retinal vasculitis and acute posterior multifocal placoid epitheliopathy.

    PubMed

    Park, Jong Hoon; Joe, Soo Geun; Yoon, Young Hee

    2013-11-01

    A 55-year-old female presented with bilateral progressive retinal vasculitis. She was on systemic and intravitreal steroids on the basis of uveitis work-up result (negative result including rapid plasma reagin), but her visual acuity continued to deteriorate to light perception only. Ocular examination showed retinal vasculitis, multiple yellow placoid lesions and severe macula edema in both eyes. Repeated work-up revealed positivity of fluorescent treponemal antibody-absorption in serum and subsequently in cerebrospinal fluid. Ocular syphilis was diagnosed. And intravenous penicillin G resulted in rapid resolution of vasculitis and macular edema. To avoid delay in the diagnosis of ocular syphilis, high index of suspicion and repeating serological tests (including both treponemal and non-treponemal tests) are warranted. PMID:24145569

  3. Panuveitis as a manifestation of ocular syphilis leading to HIV diagnosis

    PubMed Central

    Chhablani, Jay Kumar; Biswas, J.; Sudharshan, S.

    2010-01-01

    Syphilis is a rare cause of panuveitis. We present the case of a 33-year-old man who presented with diminution of vision of three months duration in his left eye (OS), without any other systemic illness. Ophthalmic examination showed features of pauveitis with dense vitreous exudates, disc pallor and sheathing of vessels on fundoscopy. A diagnosis of probable endogenous endophthalmitis was made and vitreous tap performed. Vitreous biopsy showed no growth of fungus or bacteria. Rapid plasma reagin (RPR) and Treponema pallidum hemagglutination (TPHA) test were positive. Enzyme-Linked Immuno Sorbent Assay (ELISA) and Western Blot test were then performed, which revealed concurrent HIV infection. The patient improved dramatically with intravenous penicillin therapy. HIV positive patients may present with panuveitis secondary to ocular syphilis, as the only presenting feature in HIV positive patient in absence of any other systemic features. PMID:20606871

  4. Audit of the management of the syphilis outbreak in Herefordshire 2011-2013.

    PubMed

    Cox, Joanna H; Elliott, Enid; Sivaprakasam, Venkat; Chima-Okereke, Catherine

    2015-04-01

    The objective of this audit was to evaluate a localised rural outbreak of syphilis against British Association of Sexual Health and HIV guidelines. Forty-nine cases were identified; 98% were men, and 88% were men who have sex with men (MSM). There was a low incidence of HIV co-infection (18%). All standards regarding monitoring and treatment were met, whereas the standard concerning contact tracing was narrowly missed, highlighting a number of issues and areas for improvement. This audit has highlighted that a proactive approach is necessary to identify cases of syphilis in rural communities. This is due to difficulties in outreach testing and contact tracing in the absence of designated meeting places for MSM. PMID:24912537

  5. [Tertiary syphilis diagnosed in a psychiatric unit in Buenos Aires, XXI century].

    PubMed

    Cestaro, Omar A; Calicchio, Ada D; Loidl, Fabián; Presas, Lina

    2012-01-01

    It is a common belief that syphilis, since its effective treatment, is eradicated. However, because of failure prevention and control it is still present. Therefore, we describe what happened in our service with a young patient who was admitted with a presumptive diagnosis of delusional syndrome with a history of multiple symptoms and signs that led him to wander around different specialties in many hospitals. Semiology led us to think of neurosyphilis which was confirmed by laboratory tests on blood and cerebrospinal fluid. Due was then applied in addition to psychiatric treatment for syphilis, but despite this, the patient had a torpid evolution given the lateness of his picture. In this paper we wish to make a warning to doctors about the need to consider when framing neurosyphilis differential diagnosis and thus avoid the progression of the disease. PMID:23979549

  6. Secondary syphilis with an interstitial granuloma annulare-like histopathologic pattern.

    PubMed

    Sezer, Engin; Luzar, Bostjan; Calonje, Eduardo

    2011-05-01

    A granulomatous tissue response may be observed in untreated, long-standing lesions of secondary syphilis. In addition to poorly defined granulomatous inflammation, leprosy-like sarcoidal and palisaded granulomatous inflammation has been documented in literature reports of lues. Herein, we report a 47-year-old man who presented with a 3-month history of a generalized non-pruritic macular and papular rash located on the trunk and extremities. Histopathologically, there was an interstitial arrangement of histiocytes with occasional multinucleated giant cells positioned among collagen bundles without associated necrosis, thereby closely mimicking interstitial granuloma annulare. A clue to the diagnosis was the presence of admixed plasma cells. To the best of our knowledge, this is the first reported case of secondary syphilis showing an interstitial granulomatous pattern mimicking interstitial granuloma annulare. PMID:21251035

  7. [Low seroprevalence of syphilis and HIV in refugees and asylum seekers in Germany in 2015].

    PubMed

    Jablonka, A; Solbach, P; Nothdorft, S; Hampel, A; Schmidt, R E; Behrens, G M N

    2016-07-01

    Background | Currently only estimates exist of seroprevalence of syphilis and human immunodeficiency virus (HIV) in refugees arriving in Germany during the current refugee crisis. Objectives | To assess the prevalence of syphilis and human immunodeficiency virus (HIV) in refugees arriving in northern Germany in 2015. Materials and methods | In a cross-sectional study in 790 patients from all age groups tests for serological markers of treponema pallidum and in 789 patients for human immunodeficiency virus (HIV) were performed in August 2015 in reception centers in northern Germany. Results | The overall prevalence of treponema pallidum antibodies was 0.13 % (1/790; [95 % CI: 0 - 0.4]). HIV antibodies were positive in two refugees from sub-Saharan Africa (2/789; 0.25 %, [95 % CI: 0 - 0.6]). Conclusions | This study showed a low prevalence of treponema pallidum antibodies and human immunodeficiency virus infection (HIV) in a German refugee cohort, not significantly different from German controls. PMID:27404938

  8. Evaluation of the recombinant protein TpF1 of Treponema pallidum for serodiagnosis of syphilis.

    PubMed

    Jiang, Chuanhao; Zhao, Feijun; Xiao, Jinhong; Zeng, Tiebing; Yu, Jian; Ma, Xiaohua; Wu, Haiying; Wu, Yimou

    2013-10-01

    Syphilis is a chronic infection caused by Treponema pallidum subsp. pallidum, and diagnosis with sensitive and specific methods is a challenging process that is important for its prevention and treatment. In the present study, we established a recombinant protein TpF1-based indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) and a Western blot assay for human and rabbit sera. The 20-kDa recombinant protein TpF1 was detected by Western blotting performed with sera from rabbits immunized with recombinant TpF1 and infected with the T. pallidum Nichols strain and T. pallidum clinical isolates but was not detected by Western blotting with sera from uninfected rabbits. The sensitivity of the recombinant protein was determined by screening sera from individuals with primary, secondary, latent, and congenital syphilis (n = 82). The specificity of the recombinant protein was determined by screening sera from uninfected controls (n = 30) and individuals with potentially cross-reactive infections, including Lyme disease (n = 30) and leptospirosis (n = 5). The sensitivities of TpF1-based ELISAs were 93.3%, 100%, 100%, and 100% for primary, secondary, latent, and congenital syphilis, respectively, and the specificities were all 100% for sera from uninfected controls and individuals with potentially cross-reactive infections. In Western blot assays, the sensitivities and specificities of TpF1 for human sera were all 100%. The reactivities of TpF1 with syphilitic sera were proportional to the titers of the T. pallidum particle agglutination (TPPA) assay. These data indicate that the recombinant protein TpF1 is a highly immunogenic protein in human and rabbit infections and a promising marker for the screening of syphilis. PMID:23945159

  9. Identifying the Tuskegee Syphilis Study: implications of results from recall and recognition questions

    PubMed Central

    2009-01-01

    Background This analysis assessed whether Blacks, Whites and Puerto-Rican (PR) Hispanics differed in their ability to identify the Tuskegee Syphilis Study (TSS) via open-ended questions following lead-in recognition and recall questions. Methods The Tuskegee Legacy Project (TLP) Questionnaire was administered via a Random-Digit Dial (RDD) telephone survey to a stratified random sample of Black, White and PR Hispanic adults in three U.S. cities. Results The TLP Questionnaire was administered to 1,162 adults (356 African-Americans, 313 PR Hispanics, and 493 non-Hispanic Whites) in San Juan, PR, Baltimore, MD and New York City, NY. Recall question data revealed: 1) that 89% or more of Blacks, Whites, and PR Hispanics were not able to name or definitely identify the Tuskegee Syphilis Study by giving study attributes; and, 2) that Blacks were the most likely to provide an open-ended answer that identified the Tuskegee Syphilis Study as compared to Whites and PR Hispanics (11.5% vs 6.3% vs 2.9%, respectively) (p ≤ 0.002). Even when probed by a recognition question, only a minority of each racial/ethnic group (37.1%, 26.9%, and 8.6%, for Blacks, Whites and PR Hispanics, respectively) was able to clearly identify the TSS (p < 0.001). Conclusions The two major implications of these findings for health disparity researchers are 1) that it is unlikely that detailed knowledge of the Tuskegee Syphilis Study has any current widespread influence on the willingness of minorities to participate in biomedical research, and 2) that caution should be applied before assuming that what community leaders 'know and are aware of' is equally 'well known' within their community constituencies. PMID:20015361

  10. A WHO study of treatment schedules for early syphilis in use throughout the world

    PubMed Central

    Willcox, R. R.

    1954-01-01

    Ten years have elapsed since penicillin was introduced in the treatment of syphilis. In order to appraise recent trends in syphilotherapy in the world, WHO carried out a detailed study of treatment practices in early syphilis. A questionnaire was circulated to leading venereologists and clinics in the world, and 277 replies were received from 55 countries giving particulars of 294 schedules. A total of 65.3% of the participants used penicillin alone and 28.9% used it in combination with other drugs. In North America all clinics relied solely on penicillin as against 52.2% in Europe; and procaine penicillin G in oil with aluminium monostearate (PAM) was used in 91% of clinics in the Americas and Asia and in 60.6% of European clinics. The most common dosage of penicillin in all stages of early syphilis was 4.8-6.0 million units; but appreciably larger doses were used in Europe than elsewhere, some 39.4% of schedules using 10.8 million units or more. There were single instances of 36 million units being given. Consolidation treatment was given in none of the North American clinics; seldom in Asia; by about one-third of the participants in Central and South America; and, for secondary syphilis, in 59% of European schedules. This study shows that with intensive treatment with PAM the saving in drug cost to clinics over the classical courses of arsenic and bismuth may be as much as £4 per case, but the overhead expenses are, of course, not reduced. PMID:13182588

  11. Hepatitis B, HIV, and Syphilis Seroprevalence in Pregnant Women and Blood Donors in Cameroon

    PubMed Central

    Mbah, Rahel; Rembert, Nicole J.; Tancho, Samuel; Halle-Ekane, Gregory E.; Enah, Comfort; Welty, Thomas K.; Tih, Pius M.; Tita, Alan T. N.

    2016-01-01

    Objectives. We estimated seroprevalence and correlates of selected infections in pregnant women and blood donors in a resource-limited setting. Methods. We performed a cross-sectional analysis of laboratory seroprevalence data from pregnant women and voluntary blood donors from facilities in Cameroon in 2014. Rapid tests were performed to detect hepatitis B surface antigen, syphilis treponemal antibodies, and HIV-1/2 antibodies. Blood donations were also tested for hepatitis C and malaria. Results. The seroprevalence rates and ranges among 7069 pregnant women were hepatitis B 4.4% (1.1–9.6%), HIV 6% (3.0–10.2%), and syphilis 1.7% (1.3–3.8%) with significant variability among the sites. Correlates of infection in pregnancy in adjusted regression models included urban residence for hepatitis B (aOR 2.9, CI 1.6–5.4) and HIV (aOR 3.5, CI 1.9–6.7). Blood donor seroprevalence rates and ranges were hepatitis B 6.8% (5.0–8.8%), HIV 2.2% (1.4–2.8%), syphilis 4% (3.3–4.5%), malaria 1.9%, and hepatitis C 1.7% (0.5–2.5%). Conclusions. Hepatitis B, HIV, and syphilis infections are common among pregnant women and blood donors in Cameroon with higher rates in urban areas. Future interventions to reduce vertical transmission should include universal screening for these infections early in pregnancy and provision of effective prevention tools including the birth dose of univalent hepatitis B vaccine. PMID:27578957

  12. What's new in sexually transmitted infections in the HIV care setting: focus on syphilis and gonorrhea.

    PubMed

    Marrazzo, Jeanne M

    Sexually transmitted infections are a resurgent problem in HIV disease. The number of new cases of syphilis among men who have sex with men has continued to increase, requiring renewed vigilance in screening, diagnosis, and treatment. Drug-resistant gonorrhea has prompted changes in treatment regimens and warrants continued monitoring. This article summarizes an IAS-USA continuing education webinar presented by Jeanne M. Marrazzo, MD, MPH, in January 2014. PMID:25612179

  13. Oral syphilis: report of three cases and characterization of the inflammatory cells.

    PubMed

    Strieder, Luciana Rocha; León, Jorge Esquiche; Carvalho, Yasmin Rodarte; Kaminagakura, Estela

    2015-04-01

    Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. This study reports 3 cases of syphilis and highlights the importance of identifying oral lesions for its final diagnosis. Case 1: a 48-year-old male patient presented with a bleeding ulcer in the lower lip. Overall clinical examination revealed patchy alopecia and skin target lesions. Case 2: a 61-year-old male patient presented with white spots on the lateral tongue and nodules on the dorsum of the tongue. Overall clinical examination showed erythematous target lesions on the abdomen, forearm, palms of the hand, and soles of the feet. Case 3: a 17-year-old male patient presented with an ulcerated lesion on the tongue and lymph node involvement. The following serologic tests were requested: Venereal Disease Research Laboratory, fluorescent treponemal antibody-absorption, anti-HIV-1 and anti-HIV-2, and anti-hepatitis C virus. An incisional biopsy revealed epithelial hyperplasia associated with intense and diffuse mononuclear inflammatory cell infiltration consisting mainly of plasma cells, in a perivascular and perineural distribution. The final diagnosis in the 3 patients was syphilis. Treatment consisted of 1 weekly dose of penicillin (2.4 million units, intramuscular) for 2 or 3 weeks. Immunohistochemical reactions for XIIIa, CD3, CD20, CD68, CD163, S100, CD1a, CD11c, CD83, CD138, and CD208 were performed. Clinicians should be familiarized with oral syphilis lesions in order to be able to diagnose this emerging infectious disease of variable clinical presentation. PMID:25736987

  14. Evaluation of the Recombinant Protein TpF1 of Treponema pallidum for Serodiagnosis of Syphilis

    PubMed Central

    Jiang, Chuanhao; Zhao, Feijun; Xiao, Jinhong; Zeng, Tiebing; Yu, Jian; Ma, Xiaohua; Wu, Haiying

    2013-01-01

    Syphilis is a chronic infection caused by Treponema pallidum subsp. pallidum, and diagnosis with sensitive and specific methods is a challenging process that is important for its prevention and treatment. In the present study, we established a recombinant protein TpF1-based indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) and a Western blot assay for human and rabbit sera. The 20-kDa recombinant protein TpF1 was detected by Western blotting performed with sera from rabbits immunized with recombinant TpF1 and infected with the T. pallidum Nichols strain and T. pallidum clinical isolates but was not detected by Western blotting with sera from uninfected rabbits. The sensitivity of the recombinant protein was determined by screening sera from individuals with primary, secondary, latent, and congenital syphilis (n = 82). The specificity of the recombinant protein was determined by screening sera from uninfected controls (n = 30) and individuals with potentially cross-reactive infections, including Lyme disease (n = 30) and leptospirosis (n = 5). The sensitivities of TpF1-based ELISAs were 93.3%, 100%, 100%, and 100% for primary, secondary, latent, and congenital syphilis, respectively, and the specificities were all 100% for sera from uninfected controls and individuals with potentially cross-reactive infections. In Western blot assays, the sensitivities and specificities of TpF1 for human sera were all 100%. The reactivities of TpF1 with syphilitic sera were proportional to the titers of the T. pallidum particle agglutination (TPPA) assay. These data indicate that the recombinant protein TpF1 is a highly immunogenic protein in human and rabbit infections and a promising marker for the screening of syphilis. PMID:23945159

  15. Hepatitis B, HIV, and Syphilis Seroprevalence in Pregnant Women and Blood Donors in Cameroon.

    PubMed

    Dionne-Odom, Jodie; Mbah, Rahel; Rembert, Nicole J; Tancho, Samuel; Halle-Ekane, Gregory E; Enah, Comfort; Welty, Thomas K; Tih, Pius M; Tita, Alan T N

    2016-01-01

    Objectives. We estimated seroprevalence and correlates of selected infections in pregnant women and blood donors in a resource-limited setting. Methods. We performed a cross-sectional analysis of laboratory seroprevalence data from pregnant women and voluntary blood donors from facilities in Cameroon in 2014. Rapid tests were performed to detect hepatitis B surface antigen, syphilis treponemal antibodies, and HIV-1/2 antibodies. Blood donations were also tested for hepatitis C and malaria. Results. The seroprevalence rates and ranges among 7069 pregnant women were hepatitis B 4.4% (1.1-9.6%), HIV 6% (3.0-10.2%), and syphilis 1.7% (1.3-3.8%) with significant variability among the sites. Correlates of infection in pregnancy in adjusted regression models included urban residence for hepatitis B (aOR 2.9, CI 1.6-5.4) and HIV (aOR 3.5, CI 1.9-6.7). Blood donor seroprevalence rates and ranges were hepatitis B 6.8% (5.0-8.8%), HIV 2.2% (1.4-2.8%), syphilis 4% (3.3-4.5%), malaria 1.9%, and hepatitis C 1.7% (0.5-2.5%). Conclusions. Hepatitis B, HIV, and syphilis infections are common among pregnant women and blood donors in Cameroon with higher rates in urban areas. Future interventions to reduce vertical transmission should include universal screening for these infections early in pregnancy and provision of effective prevention tools including the birth dose of univalent hepatitis B vaccine. PMID:27578957

  16. Antibiotic desensitization therapy in secondary syphilis and Listeria infection: case reports and review of desensitization therapy.

    PubMed

    Magpantay, Gil; Cardile, Anthony P; Madar, Cristian S; Hsue, Gunther; Belnap, Conrad

    2011-12-01

    Two adult cases, one of secondary syphilis and one of Listeria monocytogenes bacteremia, in which antibiotic desensitization therapy was utilized to assist treatment of active infection in the face of severe penicillin allergy. Clinical considerations are discussed that led to the decision to employ a formal desensitization procedure. Antibiotic desensitization protocols can facilitate optimal and safe antibiotic therapy in the appropriate clinical setting. PMID:22187514

  17. Seroprevalence of HIV, HBV, HCV and syphilis in blood donors in Southern Haryana.

    PubMed

    Arora, Dimple; Arora, Bharti; Khetarpal, Anshul

    2010-01-01

    Blood transfusion is an important mode of transmission of infections to recipients. The aim of the study was to assess the prevalence of transfusion-transmissible infections among blood donors. For this, a 3.5-year retrospective study, from October 2002 to April 2006 was conducted at the blood transfusion centre of Maharaja Agrasen Medical College, Agroha (Hisar) Haryana. Donors were screened for seroprevalence of HIV, HBV, HCV and syphilis. A total of 5849 donors were tested, out of which 4010 (68.6%) were replacement donors and 1839 (31.4%) were voluntary donors. The seroprevalence of HIV was 0.3% in the donors. No voluntary donor was found to be positive for HIV. The low sero-positivity among donors is attributed to pre-donation counseling in donor selection. The seroprevalence of HBV, HCV and syphilis was 1.7%, 1.0% and 0.9% respectively in total donors. The seroprevalence of hepatitis and syphilis was more in replacement donors as compared to voluntary donors. PMID:20551540

  18. Evaluation of cerebrospinal fluid in Southeast Asian refugees with reactive serologic tests for syphilis.

    PubMed Central

    Buchwald, D; Collier, A C; Lukehart, S A; Kith, P; Goldstein, E; Hooton, T M

    1996-01-01

    To determine the prevalence of cerebrospinal fluid abnormalities in Southeast Asian refugees with reactive serologic tests for syphilis, we evaluated 65 patients, 36 prospectively and 29 retrospectively, in a primary care clinic. Information was collected on history of treponemal infections, neurologic symptoms and signs, and total protein concentration, leukocyte count, and the VDRL test in the cerebrospinal fluid. Neurologic symptoms were reported by all patients for whom data were available. Abnormal neurologic signs were found or noted in medical records in 15 (42%) prospectively evaluated patients and 9 (64%) of 14 retrospectively evaluated patients for whom data were available. No patient had evidence of congenital or non-neurologic sequelae such as cutaneous or cardiovascular manifestations of syphilis. No patient had a positive cerebrospinal fluid VDRL test, 1 had more than 5 x 10(6) leukocytes per liter (5 leukocytes per mm3), and 6 (9%) had elevated total protein levels in the cerebrospinal fluid. Previous therapy for syphilis was not associated with lower serum VDRL reactions, neurologic symptoms and signs, or cerebrospinal fluid findings. In the absence of other indications, routine examination of the cerebrospinal fluid in seropositive Southeast Asian refugees who have nonspecific neurologic symptoms has a low yield, perhaps because of the high prevalence of yaws in this population, and may not be warranted. PMID:8993199

  19. Plasma cell balanitis presenting in a patient with a history of syphilis.

    PubMed

    Ezra, Navid; Binder, Scott W; Behroozan, Daniel

    2012-04-01

    Plasma cell balanitis (PCB), also knows as Zoon balanitis, is a benign asymptomatic but chronic and erosive inflammatory condition of the glans penis and prepuce that generally affects uncircumcised men in later years. Clinical presentation involves a single, shiny, well defined reddish patch. We describe the first case of PCB ever reported in a patient with a previous history of syphilis, and include a review of the current literature. A 57-year-old Hispanic man with a remote history of syphilis presented with a 6-month nonhealing, granulating ulcer of the foreskin and glans penis that had been repeatedly mistaken for syphilis and treated unsuccessfully with circumcision 3 weeks previously. Biopsy of the glans penis demonstrated sections with denuded chronic granulation tissue showing a fibrotic stroma with numerous blood vessels and a mixed inflammatory infiltrate including scattered plasma cells. It is important to differentiate PCB from a syphilitic chancre in a patient presenting with a nonhealing penile lesion. This case report demonstrates that these entities may be seen in the same patient at different times. PMID:21992223

  20. The epidemiology of HIV and syphilis among male commercial sex workers in northern Thailand.

    PubMed

    Kunawararak, P; Beyrer, C; Natpratan, C; Feng, W; Celentano, D D; de Boer, M; Nelson, K E; Khamboonruang, C

    1995-05-01

    The first confirmed case of human immunodeficiency virus (HIV) infection in Thailand was that of a Thai male commercial sex worker (CSW) in 1985. Since that time, this disease has manifested itself among injecting drug users, female sex workers, and in the general heterosexual and homosexual population. This paper reports the findings of a 5-year Thai study in which 1172 male CSWs were studied at least once. The purpose of the study was to identify the prevalence, incidence, and risk behaviors of CSWs regarding HIV and syphilis. The HIV prevalence increased from 1.4% in 1989 to 20.1% by 1993. Overall, the HIV prevalence for the 5-year period was statistically significant at 16.6%. Syphilis for this same period was 7.6% HIV infections were confirmed using enzyme-linked immunosorbent assay (ELISA). Multivariate analysis was calculated using multiple logistic regression. All CSWs in this study were provided with HIV pre-test counseling, were subjected to HIV and syphilis serology, were given condoms, and were provided with a referral for post-test counseling. Of the 1172 men seen, 219 (18.6%) were seen more than once. 27 cases of HIV infection were confirmed in the latter group (12.3%). Heterosexual men were found to be at lower risk of contracting an HIV infection than homosexual men. PMID:7639978

  1. Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study

    PubMed Central

    Liu, Hongjie; Dumenci, Levent; Morisky, Donald E; Xu, Yongfang; Li, Xiaojing; Jiang, Baofa

    2016-01-01

    Objectives This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China. Design A cross-sectional study with respondent-driven sampling (RDS). Setting A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014. Participants 1245 middle-aged female sex workers who were over 35 years old (about 400 per study site). Main outcome measures Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured. Results The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases. Conclusions In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings. PMID:27165644

  2. Sexual Behaviors and HIV/Syphilis Testing Among Transgender Individuals in China: Implications for Expanding HIV Testing Services

    PubMed Central

    Best, John; Tang, Weiming; Zhang, Ye; Han, Larry; Liu, Fengying; Huang, Shujie; Yang, Bin; Wei, Chongyi; Tucker, Joseph D.

    2015-01-01

    Background HIV and syphilis are disproportionately common among transgender individuals globally, yet few studies have investigated transgender HIV/syphilis risk and testing in low and middle-income nations. We conducted an online survey of men who have sex with men (MSM) and transgender individuals to examine sexual behaviors, and HIV/syphilis testing in China. Methods We recruited MSM and transgender individuals from two-major Chinese lesbian, gay, bisexual, and transgender (LGBT) web platforms. Chi-square and logistic regression were used to compare risk behaviors, HIV and syphilis testing history, and prevalence between transgender individuals and other MSM. Results Among the 1320 participants, 52 (3·9%) self-identified as transgender. Demographics, including education, employment, and marital status were similar between both groups, while transgender individuals were older. Condomless anal intercourse rate was comparable between the groups. Transgender individuals were less likely to report ever testing for HIV (34·6% VS 62·0%) and syphilis (15·7% VS 31·2%) with adjusted ORs of 0·36 (95% CI 0·20–0·65) and 0·42 (95% CI 0·20–0·91), respectively. We found a trend towards higher HIV prevalence among transgender individuals (11·1% VS5·7%, P=0·12). Conclusion Transgender individuals have suboptimal HIV and syphilis testing rates in China. Given the substantial risk behaviors and burden of HIV/STI in the general Chinese MSM population and lack of knowledge about transgender individuals, enhanced HIV/syphilis testing programs for transgender individuals in China are needed. PMID:25868142

  3. HIV and syphilis serostatus of antenatals in traditional Maasai pasturalist communities in Kajiado District, Kenya: 1989-1992.

    PubMed

    Valadez, J J; Loolpapit, P M; Nyangao, A; Dikir, F

    1999-04-01

    Although much research has been carried out on high risk populations, little is known about HIV prevalence in traditional rural communities who limit contact with other tribes, non-traditional tribesman and Europeans. This study considers traditional Maasai living near a high HIV transmission area. A time series analysis assessed the trend of HIV-1 and syphilis prevalences in the study area. Data consist of antenatal blood specimens (n = 2082 women) collected during 1989-1992. An estimated 100% of pregnant women residing in the study areas are included in the study. Standardized HIV-1 prevalences among women for 1989-1992 ranged between 0.95% and 2.23%. A chi 2 test for trends was not significant, analysis of age-specific prevalences revealed no significant result. Standardized syphilis prevalence varied from 1.89% to 12.82% during the 3 years. Prevalence declined in 1990, but increased significantly thereafter. A steep 1992 increase in syphilis was not associated with an increase in HIV. Chi square test for trends for age-specific syphilis was not significant. In 2082 samples only one woman was positive for both HIV and syphilis. In 4 years no increase in HIV prevalence was detected among traditional Maasai woman living near a high transmission area. No significant variation across ages was detected. However, syphilis increased sharply in one time period, 1992. Despite the low HIV prevalence among Maasai, the higher prevalence of syphilis suggests that the HIV epidemic is at an early phase and may increase soon. It may also suggest that HIV does not yet have a high prevalence at markets where Maasai sell their herds, but is concentrated at truck stops. PMID:10418300

  4. Early Syphilis Among Men Who Have Sex with Men in the US Pacific Northwest, 2008–2013: Clinical Management and Implications for Prevention

    PubMed Central

    Petrosky, Emiko; Fanfair, Robyn Neblett; Toevs, Kim; DeSilva, Malini; Schafer, Sean; Hedberg, Katrina; Braxton, Jim; Walters, Jaime; Markowitz, Lauri; Hariri, Susan

    2016-01-01

    Substantial increases in syphilis during 2008–2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis ≤1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008–2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%–69.2%) diagnosed with secondary syphilis (range: 36.2%–52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p < 0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008–2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified. PMID:27308806

  5. Early Syphilis Among Men Who Have Sex with Men in the US Pacific Northwest, 2008-2013: Clinical Management and Implications for Prevention.

    PubMed

    Petrosky, Emiko; Neblett Fanfair, Robyn; Toevs, Kim; DeSilva, Malini; Schafer, Sean; Hedberg, Katrina; Braxton, Jim; Walters, Jaime; Markowitz, Lauri; Hariri, Susan

    2016-03-01

    Substantial increases in syphilis during 2008-2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis ≤1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008-2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%-69.2%) diagnosed with secondary syphilis (range: 36.2%-52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p < 0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008-2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified. PMID:27308806

  6. Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

    PubMed

    Ghanem, Khalil G

    2015-12-15

    A panel of experts generated 8 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. Penicillin is the drug of choice to treat syphilis. Doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There is no added benefit to enhanced antimicrobial therapy when treating human immunodeficiency virus-infected persons with syphilis. If a patient misses a dose of penicillin in a course of weekly therapy for late syphilis, clinical experience suggests that an interval of 10-14 days between doses might be acceptable before restarting the sequence of injections. Pharmacologic considerations suggest that an interval of 7-9 days between doses, if feasible, may be more optimal. Missed doses are not acceptable for pregnant women. A cerebrospinal fluid examination to diagnose neurosyphilis is recommended in persons diagnosed with tertiary syphilis (eg, cardiovascular syphilis or late benign syphilis), persons with neurological signs or symptoms consistent with neurosyphilis, and asymptomatic persons whose serological titers do not decline appropriately following recommended therapy and in whom reinfection is ruled out. Infection and reinfection rates, particularly among men who have sex with men, are high. Frequent serological screening of this population appears to be the most cost-efficient intervention. The Centers for Disease Control and Prevention continues to recommend the use of the traditional rapid plasma reagin-based screening algorithm. The positive predictive value for syphilis associated with an isolated unconfirmed reactive treponemal chemiluminescence assay or enzyme immunoassay is low if the epidemiological risk and clinical probability for syphilis are low. Among pregnant women with serodiscordant serologies (positive treponemal tests and a negative nontreponemal test), the risk of

  7. Prevalence of HIV, Syphilis, HCV and Their High Risk Behaviors among Migrant Workers in Eastern China

    PubMed Central

    Wang, Qing; Zheng, Hui; Chen, Xin; Su, Jing; Peng, Zhihang; Yu, Rongbin; Wang, Ning

    2013-01-01

    Objective The goal of this study was to understand the knowledge about AIDS, identify the correlates and determine the prevalence of HIV infection, syphilis, HCV among migrant workers in Zhejiang, China. Methods A cross-sectional study using face-to-face anonymous questionnaire interviews was conducted and blood samples were collected for HIV, syphilis and Hepatitis C infection screening. Results 17,377 (92.8%) of 18,730 migrant workers approached were interviewed. Among 17,377 participants, the HIV/AIDS knowledge rate was 66.2%. A total of 12,694 (73%) of the participants reported having ever had sexual intercourse, with 30.1% of single participants reporting having had sexual intercourse. Among those respondents with sexual experiences, 7.5% admitted they had two or more sexual partners and 4.9% reported having had sex with casual (unpaid) partners in the previous 12 months, whilst 3.7% had paid for sex. More than half of those who had paid for sex (59.4%) had not used a condom every time in their sexual acts with the sex workers. Multiple logistic regression analysis indicated that high risk sexual behavior (defined as sex with a casual or commercial sex partner without using a condom consistently) was associated with being divorced or widowed (P<0.05 for single); male gender; shorter duration of stay in Zhejiang; working in factory, market or domestic service (P<0.05 for odd job); having a province of origin inside Zhejiang; and drug use. The prevalence of HIV and HCV infections were 0.02% (95% CI: 0.01%–0.06%) and 0.40% (95%CI: 0.31%–0.51%), respectively. The prevalence of syphilis among those who were sexually active was 0.55% (95% CI: 0.43%–0.70%). Risk factors for syphilis included shorter duration of stay in Zhejiang, ethnic minority status, being divorced or widowed and having had multiple sex partners. Conclusions Much greater efforts are needed to promote safer sex, and programs for the control of syphilis need to be tailored for migrant workers

  8. Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers

    PubMed Central

    Chen, Yi; Abraham Bussell, Scottie; Shen, Zhiyong; Tang, Zhenzhu; Lan, Guanghua; Zhu, Qiuying; Liu, Wei; Tang, Shuai; Li, Rongjian; Huang, Wenbo; Huang, Yuman; Liang, Fuxiong; Wang, Lu; Shao, Yiming; Ruan, Yuhua

    2016-01-01

    Abstract Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs). We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40–49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time. By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%–2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%–0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous

  9. Profile of blood donors with serologic tests reactive for the presence of syphilis in São Paulo, Brazil

    PubMed Central

    de Almeida Neto, Cesar; Murphy, Edward L.; McFarland, William; Mendrone, Alfredo; Chen, Sanny; Chamone, Dalton A.F.; Sabino, Ester C.

    2010-01-01

    BACKGROUND Syphilis screening of blood donors is a common practice worldwide, but very little is known about the meaning of a positive serologic test for syphilis in blood donors and the risk profile of these donors. The aim of this study was to determine the demographic characteristics and risk behaviors of blood donors with recent and past syphilis and their implications for blood bank testing and deferral strategies. STUDY DESIGN AND METHODS Demographic characteristics, category of donation, number of previous donations, sexual behavior, and history of sexually transmitted diseases were reviewed comparing blood donors with recent and past syphilis from January 1, 1999, to December 31, 2003. RESULTS A total of 2439 interviews were reviewed, including 2161 (88.6%) donors with past and 278 (11.4%) with recent syphilis infection. Factors associated with recent infection included younger age (≤20 years odds ratio [OR], 36.5; 95% confidence interval [CI], 15.8–84.1), two previous donations (OR, 2.7; 95% CI, 1.9–3.9), male-male sex (homosexual OR, 8.2; 95% CI, 3.2–20.8; and bisexual OR, 11.4; 95% CI, 3.6–36.3), two or more partners in the past 12 months (OR, 2.3; 95% CI, 1.3–4.0), symptoms for syphilis (OR, 4.5; 95% CI, 2.8–7.1), and human immunodeficiency virus (HIV) seropositivity (OR, 39.6; 95% CI, 4.6–339.8). Community donors were also associated with recent syphilis infection (OR, 1.5; 95% CI, 1.2–1.9) compared to replacement donors. CONCLUSION Sexual history, including male-male sex and multiple partners, were strongly associated with recent syphilis infection, which in turn was strongly associated with HIV. Continuous and vigilant surveillance that includes assessing sexual history and other factors associated with syphilis are needed to guide blood safety policies. PMID:19040599

  10. Hepatitis B, Hepatitis C, Human immunodeficiency virus and syphilis frequency among blood donors: A single center study.

    PubMed

    Yildiz, Sule Menziletoglu; Candevir, Aslihan; Kibar, Filiz; Karaboga, Gulser; Turhan, Ferda Tekin; Kis, Cem; Dincer, Suleyman; Guvenc, Birol

    2015-12-01

    We aimed to provide updated results for seroprevalence of hepatitis B, hepatitis C viruses while presenting first data for human immunodeficiency virus and syphilis seropositivity amongst blood donors in Adana, Turkey. Screening and confirmatory test results of 62,461 donors were evaluated. HBsAg, anti-HCV, anti-HIV1/2 and syphilis seropositivity was 1.92%, 0.48%, 0.20%, 0.18% respectively, based on screening tests, and 1.66%, 0.05%, 0.003%, 0.10% respectively, according to confirmatory tests. Transfusion-transmitted infections (TTI) was more prevalent in low-educated donors. HBsAg and syphilis seropositivity rates were higher in married subjects. We found that the prevalence of HBV and HCV was significantly decreased in the last two decades in Adana. Importantly, this study provides first data in HIV and syphilis seropositivity rates among blood donors in our region and both HIV and syphilis seroprevalences were found to be low compared to many regions of Turkey. However, considering the fact that increasing number of immigrants may change prevalences and trends of TTI both in Adana and in Turkey, strict monitorization and yearly reporting of TTI rates seem necessary to be able to take proactive measures. PMID:26070837

  11. Consistently Low Prevalence of Syphilis among Female Sex Workers in Jinan, China: Findings from Two Consecutive Respondent Driven Sampling Surveys

    PubMed Central

    Liao, Meizhen; Nie, Xijuan; Pan, Rongjian; Wang, Chuangxin; Ruan, Shiman; Zhang, Changqing; Kang, Dianming; Fu, Jihua; Qian, Yuesheng; Tao, Xiaorun; Zhao, Jinkou

    2012-01-01

    Background Routine surveillance using convenient sampling found low prevalence of HIV and syphilis among female sex workers in China. Two consecutive surveys using respondent driven sampling were conducted in 2008 and 2009 to examine the prevalence of HIV and syphilis among female sex workers in Jinan, China. Methods A face-to-face interview was conducted to collect demographic, behavioral and service utilization information using a structured questionnaire. Blood samples were drawn for serological tests of HIV-1 antibody and syphilis antibody. Respondent Driven Sampling Analysis Tool was used to generate population level estimates. Results In 2008 and in 2009, 363 and 432 subjects were recruited and surveyed respectively. Prevalence of syphilis was 2.8% in 2008 and 2.2% in 2009, while no HIV case was found in both years. Results are comparable to those from routine sentinel surveillance system in the city. Only 60.8% subjects in 2008 and 48.3% in 2009 reported a consistent condom use with clients during the past month. Over 50% subjects had not been covered by any HIV-related services in the past year, with only 15.6% subjects in 2008 and 13.1% in 2009 ever tested for HIV. Conclusions Despite the low prevalence of syphilis and HIV, risk behaviors are common. Targeted interventions to promote the safe sex and utilization of existing intervention services are still needed to keep the epidemic from growing. PMID:22539944

  12. The Legacy of the Tuskegee Syphilis Study: Assessing its Impact on Willingness to Participate in Biomedical Studies

    PubMed Central

    Katz, Ralph V.; Green, B. Lee; Kressin, Nancy R.; Kegeles, S. Stephen; Wang, Min Qi; James, Sherman A.; Russell, Stefanie L.; Claudio, Cristina; McCallum, Jan M.

    2009-01-01

    The phrase, legacy of the Tuskegee Syphilis Study, is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932-72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people's willingness to participate in research. Future studies should explore this. PMID:19029744

  13. Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis.

    PubMed Central

    Kilmarx, P H; Zaidi, A A; Thomas, J C; Nakashima, A K; St Louis, M E; Flock, M L; Peterman, T A

    1997-01-01

    OBJECTIVES: Syphilis in the United States is focally distributed, with high incidence rates in the South and in metropolitan areas nationwide. In this study an ecological analysis, using the county as the unit of analysis, was performed to generate hypotheses about community-level determinants of syphilis rates. METHODS: Bivariate rank correlations and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemographic characteristics (from census data) were the independent variables. RESULTS: In the multivariate regression model, sociodemographic characteristics accounted for 71% of the variation in syphilis rates among counties. With other factors accounted for, the most highly correlated characteristics were percentage non-Hispanic Black population, county location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women younger than 20 years. CONCLUSIONS: Most of the variation in syphilis rates among counties is accounted for by sociodemographic characteristics. Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health status of these populations. Images FIGURE 1 FIGURE 2 PMID:9431280

  14. Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study

    PubMed Central

    Wang, Juan; Xia, Dongyan; Sun, Yanming; Mi, Guodong; Wang, Liming

    2015-01-01

    Background This study investigated HIV and syphilis incidence among men who have sex with men (MSM) in Beijing, China. Methods An open cohort was established from September 2009 to April 2012. Participants were followed up with every three to four months after recruitment and for thirty-one months in total. Chi-square tests were used to compare demographic and behavioral characteristics between participants who were followed up with and those lost to follow up. Univariate and multivariate Cox proportional hazards regression analyses were used to examine demographic and behavioral associations with HIV and syphilis incidence. Results 69.7% (699/1,003) of the participants finished at least two follow-up surveys during the study period. Variables which corresponded to increased loss to follow-up included younger age, less education, non-identification of homosexual identity, and migrant status. A total of 1,045 person-years (PYs) and 1,016.4 PYs were followed up for HIV and syphilis incidence estimation, respectively. The HIV incidence was 5.9 per 100 PYs and 7.8 per 100 PYs for syphilis. The predictors for the high HIV incidence included unsafe anal sex, sex after drinking alcohol and STI infection. Conclusion HIV incidence increased rapidly within the cohort, but syphilis incidence remained stable and decreased. More research is needed to provide multi-pronged HIV prevention interventions among MSM in order to reduce the increasing burden of HIV and sexually transmitted infections (STIs) in China. PMID:26426271

  15. Vitros 5600 Syphilis TPA assay: evaluation of an automated chemiluminescence assay for detection of Treponema pallidum antibodies in a high prevalence setting.

    PubMed

    Van den Bossche, Dorien; Florence, Eric; Kenyon, Christopher; Van Esbroeck, Marjan

    2014-11-01

    The performance of the Syphilis TPA assay (Ortho-Clinical Diagnostics) on Vitros 5600 Integrated System was evaluated and demonstrated excellent results. Our data support the use of this assay for test confirmation in the traditional algorithm and for screening for syphilis in a routine automated laboratory setting when using the reverse algorithm. PMID:25299416

  16. Trends in Syphilis Partner Notification Among Gay, Bisexual, and Other Men who Have Sex With Men in British Columbia, 2010 to 2013.

    PubMed

    Deonarine, Andrew; Ogilvie, Gina; Montgomery, Carolyn; Makaroff, Sylvia; Holgerson, Natalie; Grennan, Troy; Gilbert, Mark; Wong, Jason

    2016-08-01

    Chart reviews of 350 randomly sampled syphilis cases of men who had sex with men in British Columbia from 2010 to 2013 revealed no change in the median number of partners per case, and an increasing proportion of partners notified by cases but fewer partners were known to be tested for syphilis. PMID:27414679

  17. Exploring venue-associated risk: a comparison of multiple partnerships and syphilis infection among women working at entertainment and service venues.

    PubMed

    Weir, Sharon S; Li, Jing; Edwards, Jessie K; Gandhi, Anisha D; Huang, Yingying; Yingying, Huang; Suchindran, Chirayath M; Chen, Xiang-Sheng

    2014-02-01

    The re-emerging syphilis epidemic in China is documented among sex workers, but little is known about STI risk among the broader group of women who work at entertainment and service venues, many of whom do not self-identify as sex workers. In 2009 in Liuzhou, China, community informants identified venues where people meet sexual partners. Characteristics of a stratified random sample of venues were collected during venue visits. Female staff at 42 venues were interviewed and tested for syphilis. The results showed that venue characteristics, worker behaviors, and syphilis prevalence differed by venue type. Service venue workers had more sexual partners, were more likely to report sex work, and more likely to have a positive syphilis test than entertainment venue workers (prevalence ratio: 5.4; 95% CI 1.4-20.6). To conclude, risk of syphilis differs by venue type and is higher at service venues, even among women who do not report commercial sex. PMID:23851672

  18. The importance of not jumping to conclusions: syphilis as an organic cause of neurological, psychiatric and endocrine presentations.

    PubMed

    Noblett, Joanne; Roberts, Emmert

    2015-01-01

    A 66-year-old Caucasian man was admitted to an acute psychiatric ward under section 2 of the Mental Health Act after presenting with auditory hallucinations and partition delusions. He had been known to mental health services since 2005 but had never been treated with psychotropic medication or given a formal psychiatric diagnosis. He was also diagnosed with hypopituitarism of unknown aetiology in 2002. In light of this presentation, his medical history was reviewed in full, hormone levels and a full delirium screen including blood borne virus and syphilis serology was completed to ensure no organic cause had been missed. The treponemal antibody was positive, and he reported no previous syphilis treatment, as such a diagnosis of neurosyphilis was performed. This case demonstrates a patient presenting with two potential complications of syphilis; psychosis and hypopituitarism where screening for this infection had not been previously considered. PMID:25716037

  19. Early syphilis. Relationship to sex, drugs, and changes in high-risk behavior from 1987-1990.

    PubMed

    Finelli, L; Budd, J; Spitalny, K C

    1993-01-01

    A case-control study was conducted to evaluate two main questions: 1) which specific sex- and drug-use behaviors are associated with the acquisition of early syphilis; and 2) whether changes in sex- and drug-use behaviors from 1987-1990 associated with acquisition of early syphilis. Risk factors associated with significant odds ratio were greater than four sex partners and lack of condom use in the past 3 months. Crack use within the past 3 months was the only specific drug-related risk factor with a significantly elevated odds ratio. However, a number of risk factors associated with both sex and drugs had significantly elevated odds ratios: number of drug-using partners, number of partners exchanging sex for drugs and money, and number of partners with whom the respondent shares sex and drugs. Risk estimates for early syphilis were uniformly higher for women as compared with men. Women appeared to be at higher risk of syphilis than men when engaged in the same high-risk activities. From 1987-1990, there was a significant change from lower-risk to higher-risk behaviors among patients. Patients showed an increase in their number of sex partners, in drug use, and in other high-risk activities. Increasing rates of syphilis can be attributed to a particular set of sex- and drug-related behaviors, and an increase in the adoption of these behaviors has probably contributed significantly to the increased rate of early syphilis in Trenton, NJ, during the period from 1987-1990. PMID:8503065

  20. Serological response to syphilis treatment in HIV‐positive and HIV‐negative patients attending sexually transmitted diseases clinics

    PubMed Central

    Ghanem, K G; Erbelding, E J; Wiener, Z S; Rompalo, A M

    2007-01-01

    Background HIV‐positive patients treated for syphilis may be at increased risk for serological failure. Objective To compare follow‐up serologies and serological responses to treatment between HIV‐positive and HIV‐negative patients attending two sexually transmitted disease (STD) clinics. Study design Existing records were reviewed from HIV‐positive patients who were diagnosed and treated for syphilis at the public STD clinics in Baltimore, Maryland, USA, between 1992 and 2000. Results of their serological follow‐up were compared with those of HIV‐negative clinic patients at the time of syphilis treatment. Failure was defined as lack of a fourfold drop in rapid plasma reagin (RPR) titre by 400 days after treatment or a fourfold increased titre between 30 and 400 days. Results Of the 450 HIV‐positive patients with syphilis, 288 (64%) did not have documented follow‐up serologies and 129 (28.5%) met the inclusion criteria; 168 (17%) of 1000 known HIV‐negative patients were similarly eligible. There were 22 failures in the HIV‐positive group and 5 in the HIV‐negative group (p<0.001). The median times to successful serological responses in both groups were 278 (95% confidence interval (CI) 209 to 350) and 126 (95% CI 108 to 157) days, respectively (p<0.001). A multivariate Cox's proportional hazards model showed an increased risk of serological failure among the HIV‐positive patients (hazards ratio 6.0, 95% CI 1.5 to 23.9; p = 0.01). Conclusion HIV‐positive patients treated for syphilis may be at higher risk of serological failure. Despite recommendations for more frequent serological follow‐up, most patients did not have documentation of serological response after standard treatment for syphilis. PMID:16943224

  1. Patient-led partner notification for syphilis: Strategies used by women accessing antenatal care in urban Bolivia.

    PubMed

    Klisch, Shannon A; Mamary, Edward; Diaz Olavarrieta, Claudia; Garcia, Sandra G

    2007-09-01

    Maternal syphilis adversely affects close to one million pregnancies worldwide every year with consequences that may include spontaneous abortion, stillbirth, neonatal death, premature birth, neurological impairment and bone deformities of the neonate. In Bolivia, the maternal syphilis rate has been estimated at 4.3% among women with live births and 26% among women with stillbirths. Partner notification is critical to the prevention of maternal re-infection and vertical transmission of syphilis. Patient-led partner notification, also known as patient referral, is the recommended starting point for partner notification programs in resource poor settings because it requires less infrastructure and provider involvement. Though patient referral requires a higher level of engagement on the part of individuals, few studies have examined, in depth, the process of patient-led notification. Further, we found no studies of this type conducted in Bolivia, a country where culturally acceptable and appropriate interventions are needed to control maternal syphilis. This study examined partner notification, for the first time, from the perspective of women accessing treatment for maternal syphilis in Bolivia. Semi-structured interviews were conducted with 18 women who had attempted or planned to attempt notifying their partner. The interview guide was designed to investigate the experience of patient-led partner notification for syphilis with particular emphasis on the strengths and capacities of the participants. Accordingly, we applied an existing theoretical model for individual empowerment in the analysis of the interviews with the participants. This emphasis on the positive, solution-finding capacities of the participants allowed us to investigate the ways in which participants took control over an aspect of concern to their health. More studies are needed which examine successful patient-led strategies for partner notification and their connections with long-term health

  2. Serum TRSUT Titer ≥1:16 Is a Predictor for Neurosyphilis Among HIV-Infected Patients With Concurrent Syphilis and No Neurological Symptoms

    PubMed Central

    Sun, Jian-Jun; Wang, Zhen-Yan; Shen, Jia-Yin; Shen, Yin-Zhong; Liu, Li; Wang, Jiang-Rong; Zhang, Ren-Fang; Lu, Hong-Zhou

    2015-01-01

    Abstract Investigating the predictors for lumbar puncture to diagnose the asymptomatic neurosyphilis among HIV and syphilis co-infected patients in Shanghai, China. Respectively, screening the medical records from August 1, 2009 to June 30, 2015. Those HIV-infected patients with concurrent syphilis who had received lumbar puncture were selected and their clinical and demographic data were recorded. Participants comprised symptomatic and asymptomatic patients. The latter ones could be further divided into 3 groups: late syphilis, early syphilis with anti-syphilis treatment failure, and early syphilis with serum toludine red unheated serum test (TRUST) ≥1:32. Both syphilis stage and anti-syphilis treatment effect were defined by common criteria, and syphilis of unknown duration was considered as late syphilis. Asymptomatic neurosyphilis was defined as neurosyphilis without neurological symptoms such as headache, cognitive dysfunction, motor deficits, auditory or ophthalmic abnormalities, and stroke. Neurosyphilis was defined as reactive cerebrospinal fluid (CSF) TRUST and/or CSF white blood cell >20 cells/μL without other reasons. Mann–Whitney test and Fisher's exact test were used for analyzing the difference between neurosyphilis and non-neurosyphilis group. Logistic regression test was performed to analyze the risk factors for neurosyphilis. In total, 170 participants were collected, and the rate of neurosyphilis was 32.35%. Among all the 105 participants without neurological symptoms, 80 patients were with late syphilis and 25 were with early syphilis. Among the early syphilis patients, 23 had a TRUST ≥1:32 and the other 2 experienced an anti-syphilis treatment failure. The differences of clinical and demographic variables between neurosyphilis and non-neurosyphilis group were not statistically significant except the serum TRUST titer (P < 0.01). From HIV/syphilis co-infected patients with or without neurological symptom, those who had neurological

  3. Ethics and experimentation on human subjects in mid-nineteenth-century France: the story of the 1859 syphilis experiments.

    PubMed

    Dracobly, Alex

    2003-01-01

    This article examines a series of experiments involving the deliberate infection of human subjects with syphilis that were performed in Paris in 1859 by Dr. Camille Gibert and Dr. Joseph Alexandre Auzias-Turenne. Using the scientific literature on syphilis, the contemporary reaction in the French medical press to Gibert's and Auzias-Turenne's experiments, and the private papers of Auzias-Turenne, this paper places these experiments within a context of scientific and professional rivalry, and seeks to show how both moral and scientific concerns shaped and limited experimental practices in mid-nineteenth-century France. PMID:12955963

  4. Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature

    PubMed Central

    Marangi, Antonio; Moretto, Giuseppe; Cappellari, Manuel; Micheletti, Nicola; Tomelleri, Giampaolo; Bovi, Paolo

    2016-01-01

    Bilateral internal carotid artery dissection is a rare entity, and its presentation may include cerebral ischemia. We describe the case of a 69-year-old man with ischemic stroke and radiological evidence of intimal flap of both internal carotid arteries suggestive for dissection. During the hospitalization, our patient was found positive for a previous syphilis infection. We conducted a review of the literature, with evidence of a few cases of ischemic stroke presumably related to a prior syphilis. The absence of major cardiovascular risk factors in our patient leads us to believe that an etiopathogenetic link may exist between these two conditions. PMID:27354805

  5. Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature.

    PubMed

    Marangi, Antonio; Moretto, Giuseppe; Cappellari, Manuel; Micheletti, Nicola; Tomelleri, Giampaolo; Bovi, Paolo

    2016-01-01

    Bilateral internal carotid artery dissection is a rare entity, and its presentation may include cerebral ischemia. We describe the case of a 69-year-old man with ischemic stroke and radiological evidence of intimal flap of both internal carotid arteries suggestive for dissection. During the hospitalization, our patient was found positive for a previous syphilis infection. We conducted a review of the literature, with evidence of a few cases of ischemic stroke presumably related to a prior syphilis. The absence of major cardiovascular risk factors in our patient leads us to believe that an etiopathogenetic link may exist between these two conditions. PMID:27354805

  6. Evaluation of immunoglobulin M western blot analysis in the diagnosis of congenital syphilis.

    PubMed Central

    Lewis, L L; Taber, L H; Baughn, R E

    1990-01-01

    Western immunoblots of solubilized Treponema pallidum antigens were reacted with sera and cerebrospinal fluid (CSF) and developed with enzyme-conjugated antibodies to immunoglobulin M (IgM). A blot was considered positive if reactions included bands at the 47-, 17-, and 15.5-kilodalton positions along with a variable pattern at other low-molecular-weight positions. Sera from 23 of 25 symptomatic infants diagnosed with congenital syphilis yielded positive reactions. Of 80 asymptomatic infants considered at risk for developing symptomatic infection, 16 exhibited IgM patterns consistent with those seen in congenital syphilis, although 5 of these 16 gave reactions that were equivocal. To exclude false-positive reactions due to IgM rheumatoid factor, sera were fractionated and the IgM fractions were retested. Only the five initially equivocal sera gave nonreactive blots with the IgM fractions, whereas all others gave more prominent reactions that were qualitatively similar to those seen in serum samples. Sera from 18 normal infants failed to show any IgM reactivity to T. pallidum antigens on Western blots. The IgM Western blot was both more sensitive and more specific than the fluorescent treponemal antibody-absorbed (IgM) test using fractionated serum. Of the 17 CSF samples from infants with symptomatic congenital syphilis, 14 showed IgM reactivity in Western blots, whereas only 12 had a reactive CSF in the Venereal Disease Research Laboratory test. Our results indicate that this technique can be used to identify both symptomatic and asymptomatic infection in infants with T. pallidum, in some cases before standard serologic studies can confirm the diagnosis. Images PMID:2179261

  7. Neelaredoxin, an iron-binding protein from the syphilis spirochete, Treponema pallidum, is a superoxide reductase.

    PubMed

    Jovanović, T; Ascenso, C; Hazlett, K R; Sikkink, R; Krebs, C; Litwiller, R; Benson, L M; Moura, I; Moura, J J; Radolf, J D; Huynh, B H; Naylor, S; Rusnak, F

    2000-09-15

    Treponema pallidum, the causative agent of venereal syphilis, is a microaerophilic obligate pathogen of humans. As it disseminates hematogenously and invades a wide range of tissues, T. pallidum presumably must tolerate substantial oxidative stress. Analysis of the T. pallidum genome indicates that the syphilis spirochete lacks most of the iron-binding proteins present in many other bacterial pathogens, including the oxidative defense enzymes superoxide dismutase, catalase, and peroxidase, but does possess an orthologue (TP0823) for neelaredoxin, an enzyme of hyperthermophilic and sulfate-reducing anaerobes shown to possess superoxide reductase activity. To analyze the potential role of neelaredoxin in treponemal oxidative defense, we examined the biochemical, spectroscopic, and antioxidant properties of recombinant T. pallidum neelaredoxin. Neelaredoxin was shown to be expressed in T. pallidum by reverse transcriptase-polymerase chain reaction and Western blot analysis. Recombinant neelaredoxin is a 26-kDa alpha(2) homodimer containing, on average, 0.7 iron atoms/subunit. Mössbauer and EPR analysis of the purified protein indicates that the iron atom exists as a mononuclear center in a mixture of high spin ferrous and ferric oxidation states. The fully oxidized form, obtained by the addition of K(3)(Fe(CN)(6)), exhibits an optical spectrum with absorbances at 280, 320, and 656 nm; the last feature is responsible for the protein's blue color, which disappears upon ascorbate reduction. The fully oxidized protein has a A(280)/A(656) ratio of 10.3. Enzymatic studies revealed that T. pallidum neelaredoxin is able to catalyze a redox equilibrium between superoxide and hydrogen peroxide, a result consistent with it being a superoxide reductase. This finding, the first description of a T. pallidum iron-binding protein, indicates that the syphilis spirochete copes with oxidative stress via a primitive mechanism, which, thus far, has not been described in pathogenic

  8. Progressive painless lower limbs weakness in a dialyzed patient: undiagnosed tertiary syphilis: a case report

    PubMed Central

    2010-01-01

    Introduction Syphilis is a sexually transmitted disease, remaining under-estimated, under-recognized due to the variability of clinical presentation and ageing of the population with chronic comorbidities. Hence, some manifestations of the past are nowadays superimposed on the course of chronic diseases. Clinical suspicion should be guided by past medical history of contracting any other sexual disease in a heterosexual person or man who has sex with man. Case presentation We describe a rare case of tertiary syphilis in a hemodialyzed diabetic patient whom was career of chronic liver disease due to the evolution of chronic hepatitis B virus infection complicated by a hepatocellular carcinoma. Initial orientation in diagnosing this rare presentation of progressive painless lower limbs weakness was attributed to possible side effects of ongoing anti viral therapy including lamivudine and adefovir. We continued administering both drugs while patient notified a spectacular improvement under Ceftriaxone therapy introduced empirically for a possible chest infection. Routine ophthalmologic examination realized in a teaching hospital, scheduled without knowing the course of late infection showed the presence of a syphilitic uveitis. Conclusion This case emphasizes the need for a high index of clinical suspicion for syphilis before the occurrence of symptoms related to its end organ damage dominated by neurosyphilis form. Early diagnosis is the key to preventing significant morbidity and mortality and improving prognosis. However, in the setting of chronic diseases such as chronic kidney diseases either before setting up methods of renal replacement therapy or under immune-suppressive therapy; clinical presentation might resemble any disease, delaying the certitude of the diagnosis by prescribing a rapid plasma reagin. PMID:20180955

  9. Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays▿

    PubMed Central

    Binnicker, M. J.; Jespersen, D. J.; Rollins, L. O.

    2011-01-01

    The diagnosis of syphilis is challenging and often relies on serologic tests to detect treponemal or nontreponemal antibodies. Recently, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories proposed an update to the syphilis serology testing algorithm, in which serum samples are first tested using a treponema-specific test and positive samples are analyzed with a nontreponemal assay. The goal of this study was to compare the performance of seven treponemal assays (BioPlex 2200 syphilis IgG [Bio-Rad, Hercules, CA], fluorescent treponemal antibody [FTA] assay [Zeus Scientific, Raritan, NJ], Treponema pallidum particle agglutination [TP-PA; Fujirebio Diagnostics, Malvern, PA], Trep-Sure enzyme immunoassay [EIA; Phoenix Biotech, Oakville, Ontario, Canada], Trep-Chek EIA [Phoenix Biotech], Trep-ID EIA [Phoenix Biotech], and Treponema ViraBlot IgG [Viramed Biotech AG, Planegg, Germany]) using serum samples (n = 303) submitted to our reference laboratory. In addition to testing with these 7 assays, all samples were tested by a rapid plasma reagin (RPR) assay and a treponemal IgM Western blot assay (Viramed ViraBlot). Compared to the FTA assay as the gold standard, the evaluated treponemal tests demonstrated comparable levels of performance, with percent agreement ranging from 95.4% (95% confidence interval, 92.3 to 97.3) for the Trep-Sure EIA to 98.4% (96.1 to 99.4) for the Trep-ID EIA. Compared to a “consensus of the test panel” (defined as at least 4 of 7 treponemal tests being in agreement), the percent agreement ranged from 95.7% (92.7 to 97.5) for Trep-Sure to 99.3% (97.5 to 99.9) for Trep-ID. These data may assist clinical laboratories that are considering implementing a treponemal test for screening or confirmatory purposes. PMID:21346050

  10. Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research

    PubMed Central

    Davis, Jenna L.; Green, B. Lee; Katz, Ralph V.

    2013-01-01

    Objectives To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research. Methods Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association. Results No association between scary beliefs and willingness or fear to participate in research was found (P>0.05). Conclusions These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks’ willingness to participate in research. PMID:22924230

  11. A review of the guidelines for the evaluation and treatment of congenital syphilis.

    PubMed

    Kwak, Jieun; Lamprecht, Catherine

    2015-05-01

    Congenital syphilis (CS) is a disease that continues to persist in the United States despite its preventable nature. Mother-to-child transmission of CS can be avoided with appropriate maternal diagnosis and treatment during the pregnancy. Diagnosing CS and determining the therapeutic course can be challenging. This review covers the recent guidelines for the diagnosis and treatment of CS and the various factors that affect management decisions. These factors include the mother's antenatal management, the infant's clinical presentation and results, laboratory and serologic testing, and more. PMID:25996197

  12. The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru

    PubMed Central

    Tang, Eric C; Segura, Eddy R; Clark, Jesse L; Sanchez, Jorge; Lama, Javier R

    2015-01-01

    Objectives Syphilis is endemic among men who have sex with men (MSM) and transgender women in Latin America. The objective of this study was to assess if those who screen positive for syphilis are receiving appropriate care and treatment. Methods We use data from the 2011 Peruvian National HIV Sentinel Surveillance to describe the syphilis care cascade among high-risk MSM and transgender women. Medical records from participants who had a positive syphilis screening test at two of the enrolment sites in Lima were reviewed to determine their subsequent course of care. Results We identified a cohort of 314 syphilis seropositive participants (median age: 30, 33.7% self-identified as transgender). Only 284/314 (90.4%) participants saw a physician for evaluation within 28 days of their positive test. Of these, 72/284 (25.4%) were asked to return for confirmatory results before deciding whether or not to start treatment; however, 45/72 (62.5%) of these participants did not follow up within 28 days. Of the people prescribed three weekly doses of penicillin, 34/63 (54%) received all three doses on time. Conclusions Many MSM and transgender women with a positive syphilis screening test are lost at various steps along the syphilis care cascade and may have persistent infection. Interventions in this population are needed to increase testing, link seropositive patients into care and ensure that they receive appropriate and timely treatment. PMID:26384725

  13. Molecular Characterization of Syphilis in Patients in Canada: Azithromycin Resistance and Detection of Treponema pallidum DNA in Whole-Blood Samples versus Ulcerative Swabs▿

    PubMed Central

    Martin, Irene E.; Tsang, Raymond S. W.; Sutherland, Karen; Tilley, Peter; Read, Ron; Anderson, Barbara; Roy, Colleen; Singh, Ameeta E.

    2009-01-01

    Although detection of Treponema pallidum DNA in whole-blood specimens of syphilis patients has been reported, it is uncertain at what stage of the disease such specimens are most suitable for the molecular diagnosis of syphilis. Also, few studies have directly compared the different gene targets for routine laboratory diagnostic usage in PCR assays. We examined 87 specimens from 68 patients attending two urban sexually transmitted disease clinics in Alberta, Canada. PCR was used to amplify the T. pallidum tpp47, bmp, and polA genes as well as a specific region of the 23S rRNA gene linked to macrolide antibiotic susceptibility. In primary syphilis cases, PCR was positive exclusively (75% sensitivity rate) in ulcerative swabs but not in blood specimens, while in secondary syphilis cases, 50% of the blood specimens were positive by PCR. Four out of 14 (28.6%) of our PCR-positive syphilis cases were found to be caused by an azithromycin-resistant strain(s). Our results confirmed that swabs from primary ulcers are the specimens of choice for laboratory diagnostic purposes. However, further research is required to determine what specimen(s) would be most appropriate for molecular investigation of syphilis in secondary and latent syphilis. PMID:19339468

  14. The epidemiological and clinical presentation of syphilis in a venereal disease centre in Paris, France. A cohort study of 284 consecutive cases over the period 2000-2007.

    PubMed

    FARHI, David; ZIZI, Nada; GRANGE, Philippe; BENHADDOU, Nadjet; GERHARDT, Philippe; AVRIL, Marie-Françoise; DUPIN, Nicolas

    2009-01-01

    Since 2000, the incidence of syphilis has risen in developed countries. An updated knowledge of syphilis features is the key for early diagnosis and treatment. Our objective was to appraise the clinical and epidemiological presentation of syphilis in Paris, France. A retrospective monocentric descriptive study of 284 consecutive syphilis cases was conducted in a venereal disease centre (Paris, France), over the period 2000-2007. Epidemiological, clinical and microbiological data were systematically collected, using standardized medical forms. Overall, 95% of the cases occurred in men (271/284), 83% in men having sex with men (MSM) (231/278), 58% in patients having more than 10 partners/year (138/240) and 19% in patients who never use a condom (49/253). At least one STD has been previously diagnosed in 79% (220/279) of the cases. In 50.5% of the cases (142/281), HIV serology was positive. Most patients had primary (82/279, 29%) or secondary (125/279, 45%) syphilis. The most frequent physical signs in primary and secondary syphilis were, respectively, a genital chancre (63/82, 77%) and a diffuse exanthema (108/125, 86%). Syphilis occurs chiefly in MSM, often in HIV-positive patients. Many patients never use condoms. These data will help provide the basis for the development of national information and screening campaigns. PMID:19703802

  15. A Quality Improvement Project to Increase Early Detection of Syphilis Infection or Re-infection in HIV-infected Men Who Have Sex With Men.

    PubMed

    Cheeks, Miyesha A; Fransua, Mesfin; Stringer, Harold G; Silva, Susan; Relf, Michael

    2016-01-01

    Our quality improvement project evaluated whether testing for syphilis every 3 to 6 months with routine HIV laboratory monitoring had an effect on early detection of asymptomatic syphilis infection/re-infection in HIV-infected men who have sex with men. Retrospective analysis of syphilis testing and infections in a sample of this population (N = 245) was conducted after establishing a change-of-practice quality improvement initiative in a not-for-profit, community-based, grant-funded clinic. We compared the clinic's annual rates of syphilis before and after intervention implementation. The detection rate was 6.6% in the preintervention practice change group and 15.5% in the postintervention group. Increased testing identified 27 syphilis cases that would not otherwise have been identified until the annual comprehensive examination. Increased testing frequency led to earlier detection of syphilis, which was clinically significant, showing a potential to decrease the number of new syphilis and HIV infections and to decrease health care expenditures. PMID:26646978

  16. Unexpectedly high prevalence of Treponema pallidum infection in the oral cavity of human immunodeficiency virus-infected patients with early syphilis who had engaged in unprotected sex practices.

    PubMed

    Yang, C-J; Chang, S-Y; Wu, B-R; Yang, S-P; Liu, W-C; Wu, P-Y; Zhang, J-Y; Luo, Y-Z; Hung, C-C; Chang, S-C

    2015-08-01

    Between 2010 and 2014, we obtained swab specimens to detect Treponema pallidum, with PCR assays, from the oral cavities of 240 patients with 267 episodes of syphilis who reported engaging in unprotected sex practices. The detected treponemal DNA was subjected to genotyping. All of the syphilis cases occurred in men who have sex with men (MSM), and 242 (90.6%) occurred in human immunodeficiency virus-infected patients. The stages of syphilis included 38 cases (14.2%) of primary syphilis of the genital region, 76 (28.5%) of secondary syphilis, 21 (7.9%) of primary and secondary syphilis, 125 (46.8%) of early latent syphilis, and seven (2.6%) others. Concurrent oral ulcers were identified in 22 cases (8.2%). Treponemal DNA was identified from the swabs of 113 patients (42.2%), including 15 (68.2%) with oral ulcers. The most common genotype of T. pallidum was 14f/f. The presence of oral ulcers was associated with identification of T. pallidum in the swab specimens (15/22 (68.2%) vs. 98/245 (40.0%)) (p = 0.01). In multivariate analysis, secondary syphilis (adjusted OR 6.79; 95% CI 1.97-23.28) and rapid plasma reagin (RPR) titres of ≥1: 32 (adjusted OR 2.23; 95% CI 1.02-4.89) were independently associated with the presence of treponemal DNA in patients without oral ulcers. We conclude that detection of treponemal DNA in the oral cavity with PCR assays is not uncommon in MSM, most of whom reported having unprotected oral sex. Although the presence of oral ulcers is significantly associated with detection of treponemal DNA, treponemal DNA is more likely to be identified in patients without oral ulcers who present with secondary syphilis and RPR titres of ≥1: 32. PMID:25964151

  17. HIV and Syphilis Co-Infection Increasing among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis

    PubMed Central

    Chow, Eric P. F.; Wilson, David P.; Zhang, Lei

    2011-01-01

    Background This study aims to estimate the magnitude and changing trends of HIV, syphilis and HIV-syphilis co-infections among men who have sex with men (MSM) in China during 2003–2008 through a systematic review of published literature. Methodology/Principal Findings Chinese and English literatures were searched for studies reporting HIV and syphilis prevalence among MSM from 2003 to 2008. The prevalence estimates were summarized and analysed by meta-analyses. Meta-regression was used to identify the potential factors that are associated with high heterogeneities in meta-analysis. Seventy-one eligible articles were selected in this review (17 in English and 54 in Chinese). Nationally, HIV prevalence among MSM increased from 1.3% during 2003–2004 to 2.4% during 2005–2006 and to 4.7% during 2007–2008. Syphilis prevalence increased from 6.8% during 2003–2004 to 10.4% during 2005–2006 and to 13.5% during 2007–2008. HIV-syphilis co-infection increased from 1.4% during 2005–2006 to 2.7% during 2007–2008. Study locations and study period are the two major contributors of heterogeneities of both HIV and syphilis prevalence among Chinese MSM. Conclusions/Significance There have been significant increases in HIV and syphilis prevalence among MSM in China. Scale-up of HIV and syphilis screening and implementation of effective public health intervention programs should target MSM to prevent further spread of HIV and syphilis infection. PMID:21857952

  18. Efforts in blood safety: Integrated approach for serological diagnosis of syphilis

    PubMed Central

    Sommese, Linda; De Pascale, Maria Rosaria; Capuano, Maria; Napoli, Claudio

    2016-01-01

    Recent efforts in transfusion medicine are focused on improving blood safety as well as establishing effective and efficient diagnostic algorithms for donor screening. To date, syphilis is a transfusion-transmitted infection re-emerged in many countries as a public health threat especially among populations at specific risk. This task requires new diagnostic tools and hemovigilance programs. The current diagnostic methodologies are debated, since presenting limitations and unresolved issues with special regard to the clinical interpretation of serological patterns, especially in asymptomatic patients and in blood donors. Furthermore, the switch from the traditional to alternative diagnostic algorithms underlines the lack of a gold standard, which has not been supported by shared guidelines. Besides, a lot of ongoing clinical trials on the performance of diagnostic assays, on the serological response associated with different pharmacological treatments, as well as on the prevention programs are currently under investigation. Here, we review the recent literature about the diagnosis of syphilis especially for low-risk populations proposing the adoption of an algorithm for blood donor screening that should satisfy the need of increasing safety for transfusion-transmitted infections in the modern blood transfusion centers. PMID:27011666

  19. Primary syphilis of the oropharynx: an unusual location of a chancre.

    PubMed

    Drago, Francesco; Ciccarese, Giulia; Cogorno, Ludovica; Tomasini, Carlo F; Cozzani, Emanuele C; Riva, Silvia F; Parodi, Aurora

    2015-08-01

    A 33-year-old man presented with a two-week history of an asymptomatic ulcer of the oropharynx and submandibular lymph nodes swelling. Laboratory examinations were normal, but serological tests revealed positivity for rapid plasma reagin, Treponema pallidum haemagglutination assay and anti-T. pallidum IgM antibodies. Since the patient denied any homosexual relationship, a biopsy of the lesion was performed, which confirmed primary syphilis. The patient received an intramuscular injection of Benzathine Penicillin G (2.4 MU) with complete resolution of the lesion. Extragenital chancres occur in at least 5% of patients with primary syphilis, and the oral mucosa is the most frequent location as a consequence of orogenital/oroanal contact with an infectious lesion. Because of their transient nature, these oral ulcerations are often underestimated by the patient or by any unsuspecting clinician. Health professionals should consider the recent sexual history of their patients and should be prepared to recognise oral and systemic manifestations of sexually transmitted infections. PMID:25193247

  20. Prevalence and associated risk factors for syphilis in women with recurrent miscarriages

    PubMed Central

    Hussain Laghari, Arshad; Sultana, Viqar; Hussain Samoo, Akhtar; Makhija, Pirbhomal; Ara, Jehan; Hira

    2014-01-01

    Objective: A Cross Sectional population based serological studies was conducted to determine the prevalence and associated risk factors for syphilis women with recurrent miscarriages. Methods: Patient’s 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating blood sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Results: Total 256 women were included in the present study. Mean age of women was 29.4 years while range was 21 to 38 years (206/256). Out of the 256 samples, 05 (1.9%) were positive for active syphilis. Majority belonged to low socioeconomic group, uneducated and had previous congenital anomaly. Conclusion: Active infection with Treponema pallidum (T.P) in women belonging to low socioeconomic level were disquieting. This is probably due to illiteracy and high proportion of unsafe sexual behavior. It is also suggestive that seropositive status is often discovered in routine serological studies during pregnancy. PMID:24772130

  1. Sexual Networks, Surveillance, and Geographical Space during Syphilis Outbreaks in Rural North Carolina

    PubMed Central

    Doherty, Irene A; Serre, Marc L; Gesink, Dionne; Adimora, Adaora A; Muth, Stephen Q; Leone, Peter A; Miller, William C

    2014-01-01

    Background Sexually transmitted infections (STIs) spread along sexual networks whose structural characteristics promote transmission that routine surveillance may not capture. Cases who have partners from multiple localities may operate as spatial network bridges, thereby facilitating geographical dissemination. We investigated the relationships between surveillance, sexual networks, and spatial bridges for syphilis outbreaks in rural counties of North Carolina. Methods We selected from the state health department’s surveillance database cases diagnosed with primary, secondary, or early latent syphilis during October 1998 - December 2002 residing in central and southeastern North Carolina, along with their sex partners, and their social contacts irrespective of infection status. We applied matching algorithms to eliminate duplicate names and create a unique roster of partnerships from which networks were compiled and graphed. Network members were differentiated by disease status and county of residence. Results In the county most affected by the outbreak, densely connected networks indicative of STI outbreaks were consistent with elevated incidence and a large case load. In other counties, the case loads were low with fluctuating incidence, but network structures suggested the presence of outbreaks. In a county with stable, low incidence and a high number of cases, the networks were sparse and dendritic, indicative of endemic spread. Outbreak counties exhibited densely connected networks within well-defined geographic boundaries and low connectivity between counties; spatial bridges did not seem to facilitate transmission. Conclusions Simple visualization of sexual networks can provide key information to identify communities most in need of resources for outbreak investigation and disease control. PMID:23007041

  2. Hepatitis C Screening in People With Human Immunodeficiency Virus: Lessons Learned From Syphilis Screening

    PubMed Central

    Wurcel, Alysse G.; Chen, Daniel D.; Fitzpatrick, Rosemary E.; Grasberger, Paula E.; Kirshner, Caleb H.; Anderson, Jordan E.; Chui, Kenneth K. H.; Knox, Tamsin A.

    2016-01-01

    Background. The incidence of hepatitis C virus (HCV) infection is increasing in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). New guidelines recommend annual screening for HCV, similar to recommendations for syphilis screening with rapid plasma reagin (RPR). Methods. This study compares the frequency of repeat HCV antibody (Ab) testing to repeat RPR testing in a retrospective chart review of 359 HCVAb-negative people living with HIV (PLWH) observed in an Infectious Diseases clinic. Patients were classified into risk groups based on sexual risk factors. Results. Although 85% of PLWH had repeat syphilis screening, less than two thirds had repeat HCVAb screening. The MSM status was associated with increased HCVAb and RPR testing (adjusted odds ratio, 2.6 and 5.9, respectively). Seven persons had incident HCV infection: 3 were MSM, and 4 had symptoms or abnormal laboratory results to prompt testing. Conclusions. Failure to find incident HCV infection in PLWH represents missed opportunities to cure HCV infection and prevent progressive liver disease. Further quality improvement studies are necessary to develop physician-focused interventions to increase HCV screening rates in PLWH. PMID:26885544

  3. Eugenics, medical education, and the Public Health Service: Another perspective on the Tuskegee syphilis experiment.

    PubMed

    Lombardo, Paul A; Dorr, Gregory M

    2006-01-01

    The Public Health Service (PHS) Study of Untreated Syphilis in the Male Negro (1932-72) is the most infamous American example of medical research abuse. Commentary on the study has often focused on the reasons for its initiation and for its long duration. Racism, bureaucratic inertia, and the personal motivations of study personnel have been suggested as possible explanations. We develop another explanation by examining the educational and professional linkages shared by three key physicians who launched and directed the study. PHS surgeon general Hugh Cumming initiated Tuskegee, and assistant surgeons general Taliaferro Clark and Raymond A. Vonderlehr presided over the study during its first decade. All three had graduated from the medical school at the University of Virginia, a center of eugenics teaching, where students were trained to think about race as a key factor in both the etiology and the natural history of syphilis. Along with other senior officers in the PHS, they were publicly aligned with the eugenics movement. Tuskegee provided a vehicle for testing a eugenic hypothesis: that racial groups were differentially susceptible to infectious diseases. PMID:16809865

  4. Efforts in blood safety: Integrated approach for serological diagnosis of syphilis.

    PubMed

    Sommese, Linda; De Pascale, Maria Rosaria; Capuano, Maria; Napoli, Claudio

    2016-01-01

    Recent efforts in transfusion medicine are focused on improving blood safety as well as establishing effective and efficient diagnostic algorithms for donor screening. To date, syphilis is a transfusion-transmitted infection re-emerged in many countries as a public health threat especially among populations at specific risk. This task requires new diagnostic tools and hemovigilance programs. The current diagnostic methodologies are debated, since presenting limitations and unresolved issues with special regard to the clinical interpretation of serological patterns, especially in asymptomatic patients and in blood donors. Furthermore, the switch from the traditional to alternative diagnostic algorithms underlines the lack of a gold standard, which has not been supported by shared guidelines. Besides, a lot of ongoing clinical trials on the performance of diagnostic assays, on the serological response associated with different pharmacological treatments, as well as on the prevention programs are currently under investigation. Here, we review the recent literature about the diagnosis of syphilis especially for low-risk populations proposing the adoption of an algorithm for blood donor screening that should satisfy the need of increasing safety for transfusion-transmitted infections in the modern blood transfusion centers. PMID:27011666

  5. Medical, demographical and social aspects of syphilis: the case of infected sex workers in Greece during Interwar.

    PubMed

    Pagratis, N; Tsiamis, C; Mandyla, M; Bampounis, C; Anoyatis-Pele, D

    2014-08-01

    The aim of this research is to present syphilis among women described as "indecent" according to the records of the Venereal Diseases Hospital "Andreas Syggros", which is located in Athens, during the period 1931-1935. In impoverished Greece of the Interwar period, factors such as criminal ignorance, or lack of information on sexually transmitted diseases (STDs) along with inadequate health controls of sex workers, resulted in a dramatic spread of syphilis, whereas "Andreas Syggros" hospital accommodated thousands of patients. The inflow of 1.300.000 Greek refugees from Asia Minor, after the Greek defeat by the Turkish army in the war of 1922, resulted in a notable change in the demographics of the country, while the combination of miserable living conditions, unemployment, economic crisis of the Interwar period, political instability and dysfunction of the State led to an increased number of illegal sex workers and syphilis outbreaks. Despite the introduction of an ad hoc Act to control STDs since 1923, the State was unable to limit the transmissibility of syphilis and to control prostitution. Unfortunately, the value of this historical paradigm is borne out by a contemporary example, i.e. the scandal of HIV seropositive sex workers in -beset by economic crisis- Greece in May 2012. It turns out that ignorance, failure to comply with the law, change in the mentality of the citizens in an economically ruined society, and most notably dysfunction of public services during periods of crisis, are all risk factors for the spread of serious infectious diseases. PMID:25068236

  6. Medical and Social Aspects of Syphilis in the Balkans from the mid-19th Century to the Interwar.

    PubMed

    Tsiamis, Costas; Vrioni, Georgia; Poulakou-Rebelakou, Effie; Gennimata, Vasiliki; Murdjeva, Mariana А; Tsakris, Athanasios

    2016-03-01

    The current study presents some aspects of syphilis in the Balkan Peninsula from the 19th century until the Interwar. Ever since the birth of modern Balkan States (Greece, Bulgaria, Turkey and Serbia), urbanization, poverty and the frequent wars have been considered the major factors conducive to the spread of syphilis. The measures against sex work and sexually transmitted diseases (STDs) were taken in two aspects, one medical and the other legislative. In this period, numerous hospitals for venereal diseases were established in the Balkan countries. In line with the international diagnostic approach and therapeutic standards, laboratory examinations in these Balkan hospitals included spirochete examination, Wassermann reaction, precipitation reaction and cerebrospinal fluid examination. Despite the strict legislation and the adoption of relevant laws against illegal sex work, public health services were unable to curb the spread of syphilis. Medical and social factors such as poverty, citizen's ignorance of STDs, misguided medical perceptions, lack of sanitary control of prostitution and epidemiological studies, are highlighted in this study. These factors were the major causes that helped syphilis spread in the Balkan countries during the 19th and early 20th century. The value of these aspects as a historic paradigm is diachronic. Failure to comply with the laws and the dysfunction of public services during periods of war or socioeconomic crises are both factors facilitating the spread of STDs. PMID:27383872

  7. Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws

    PubMed Central

    Marks, Michael; Yin, Yue-Ping; Chen, Xiang-Sheng; Castro, Arnold; Causer, Louise; Guy, Rebecca; Wangnapi, Regina; Mitjà, Oriol; Aziz, Abdul; Castro, Rita; da Luz Martins Pereira, Filomena; Taleo, Fasihah; Guinard, Jérôme; Bélec, Laurent; Tun, Ye; Bottomley, Christian; Ballard, Ronald C.; Mabey, David C.W.

    2016-01-01

    Background. The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100 000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests (RDTs) would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform (DPP) Syphilis Screen & Confirm test includes both a treponemal (T1) and nontreponemal (T2) component and may improve the accuracy of diagnosis. Methods. We conducted a metaanalysis of published and unpublished evaluations of the DPP-RDT for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity, and overall agreement of the test compared with reference laboratory tests. Results. Nine evaluations, including 7267 tests, were included. Sensitivity was higher in patients with higher titer rapid plasma reagin (≥1:16) for both the T1 (98.2% vs 90.1%, P < .0001) and the T2 component (98.2% vs 80.6%, P < .0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4%–86.1%). Agreement was highest for high-titer active infection and lowest for past infection. Conclusions. The RDT has good sensitivity and specificity of the treponemal and nontreponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titers. PMID:27217216

  8. Rapid Syphilis Testing Is Cost-Effective Even in Low-Prevalence Settings: The CISNE-PERU Experience

    PubMed Central

    Mallma, Patricia; Garcia, Patricia; Carcamo, Cesar; Torres-Rueda, Sergio; Peeling, Rosanna; Mabey, David; Terris-Prestholt, Fern

    2016-01-01

    Studies have addressed cost-effectiveness of syphilis testing of pregnant women in high-prevalence settings. This study compares costs of rapid syphilis testing (RST) with laboratory-based rapid plasma reagin (RPR) tests in low-prevalence settings in Peru. The RST was introduced in a tertiary-level maternity hospital and in the Ventanilla Network of primary health centers, where syphilis prevalence is approximately 1%. The costs per woman tested and treated with RST at the hospital were $2.70 and $369 respectively compared with $3.60 and $740 for RPR. For the Ventanilla Network the costs per woman tested and treated with RST were $3.19 and $295 respectively compared with $5.55 and $1454 for RPR. The cost per DALY averted using RST was $46 vs. $109 for RPR. RST showed lower costs compared to the WHO standard costs per DALY ($64). Findings suggest syphilis screening with RST is cost-effective in low-prevalence settings. PMID:26949941

  9. The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community.

    ERIC Educational Resources Information Center

    Thomas, Stephen B.; Quinn, Sandra Crouse

    1991-01-01

    The Tuskegee study of untreated syphilis in black males caused distrust by blacks of the public health system that has implications for Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) studies. AIDS prevention among blacks may require openness about the Tuskegee study to allay fears of repetition. (SLD)

  10. Is it useful to perform a chest X-ray in asymptomatic patients with late latent syphilis?

    PubMed

    Dabis, R; Radcliffe, K

    2011-02-01

    According to the British Association for Sexual Health and HIV (BASHH) guidelines, a chest X-ray is recommended as part of the assessment of patients with late latent syphilis to exclude cardiovascular complications. The aims of this study were firstly to audit all cases of late latent syphilis seen at our centre since 1994 and to see whether a chest X-ray was requested and secondly to assess whether performing a chest X-ray was clinically useful. Of the 456 case notes audited, 298 chest X-rays were requested; 182 (61%) were reported as normal. Results were not available for 64 (21%) and 32 (11%) patients either declined or did not attend for follow-up. There were 20 (7%) chest X-rays that were reported as abnormal, yet none of these radiological findings were consistent with the cardiovascular complications of syphilis. In view of the lack of significant chest X-ray findings in asymptomatic patients with late latent syphilis, a chest X-ray should not be requested. PMID:21427433

  11. Jarisch-Herxheimer reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy

    PubMed Central

    Tsai, Mao-Song; Yang, Chia-Jui; Lee, Nan-Yao; Hsieh, Szu-Min; Lin, Yu-Hui; Sun, Hsin-Yun; Sheng, Wang-Huei; Lee, Kuan-Yeh; Yang, Shan-Ping; Liu, Wen-Chun; Wu, Pei-Ying; Ko, Wen-Chien; Hung, Chien-Ching

    2014-01-01

    Introduction The Jarisch-Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2-g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance. With its potential anti-inflammatory activity, the impact of azithromycin on the incidence of the Jarisch-Herxheimer reaction in HIV-positive patients with early syphilis has rarely been investigated. Methods In HIV-positive patients with early syphilis, the Jarisch-Herxheimer reaction was prospectively investigated using the same data collection form in 119 patients who received benzathine penicillin G between 2007 and 2009 and 198 who received azithromycin between 2012 and 2013, when shortage of benzathine penicillin G occurred in Taiwan. Between 2012 and 2013, polymerase chain reaction (PCR) assay was performed to detect Treponema pallidum DNA in clinical specimens, and PCR restriction fragment length polymorphism of the 23S ribosomal RNA was performed to detect point mutations (2058G or A2059G) that are associated with macrolide resistance. Results The overall incidence of the Jarisch-Herxheimer reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, p<0.001). The risk increased with higher rapid plasma reagin (RPR) titres (adjusted odds ratio [AOR] per 1-log2 increase, 1.21; confidence interval [CI], 1.04–1.41), but decreased with prior penicillin therapy for syphilis (AOR, 0.37; 95% CI, 0.19–0.71) and azithromycin treatment (AOR, 0.15; 95% CI, 0.08–0.29). During the study period, 310 specimens were obtained from 198 patients with syphilis for PCR assays, from whom T. pallidum was identified in 76 patients, one of whom (1.3%) was found to be infected with T. pallidum harbouring the

  12. The girl from the church of the sacrament: a case of congenital syphilis in XVIII century Lisbon.

    PubMed

    de Souza, Sheila Mendonça; Codinha, Sonia; Cunha, Eugénia

    2006-12-01

    Syphilis is a sexually or congenitally transmitted infectious disease with an impact on the health of human populations that has undergone important cycles in different countries and periods of history. Its presence was first diagnosed in Europe in the late XIV century. In Portugal, although there are various written records of the infection in the last centuries, there are rare references to it in archeological findings (mummified bodies are also rare in Portugal). The current study describes a probable case of congenital syphilis in an 18-month-old girl buried in the Church of the Sacrament in Lisbon. Her body, dating to the XVIII century, was found mummified together with dozens of others, still not studied. Symmetrical periostitis of the long bones, osteitis, metaphyseal lesions, left knee articular, and epiphyseal destruction, and a rarefied lesion with a radiological appearance compatible with Wimberger's sign all point to a diagnosis of congenital syphilis. The diagnosis of this severe form of the infection, possibly related to the cause of death in this upper-class girl, calls attention to the disease's presence in XVIII century Lisbon and is consistent with the intense mobilization at the time in relation to the risks posed by so-called heredosyphilis. It is the first case of congenital syphilis in a child reported in archeological findings in Portugal, and can be correlated with other cases in skeletons of adults buried in cemeteries in Lisbon (in the XVI to XVIII centuries) and Coimbra (XIX century). Finally, this finding highlights the need to study the entire series of mummified bodies in the Church of the Sacrament in order to compare the paleopathological findings and existing historical documents on syphilis, so as to expand the paleoepidemiological knowledge of this infection in XVIII century Lisbon. PMID:17308818

  13. Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis

    PubMed Central

    Tobian, Aaron A.R.; Serwadda, David; Quinn, Thomas C.; Kigozi, Godfrey; Gravitt, Patti E.; Laeyendecker, Oliver; Charvat, Blake; Ssempijja, Victor; Riedesel, Melissa; Oliver, Amy E.; Nowak, Rebecca G.; Moulton, Lawrence H.; Chen, Michael Z.; Reynolds, Steven J.; Wawer, Maria J.; Gray, Ronald H.

    2009-01-01

    BACKGROUND Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men. METHODS We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2–seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months. RESULTS At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P = 0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P = 0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P = 0.44). CONCLUSIONS In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. PMID:19321868

  14. The association of gonorrhoea and syphilis with premature birth and low birthweight.

    PubMed Central

    Donders, G G; Desmyter, J; De Wet, D H; Van Assche, F A

    1993-01-01

    OBJECTIVE--Provide evidence from prospective data that Neisseria gonorrhoeae may be an important cause of premature delivery and low birth weight in areas with high prevalence of genital infections. SETTING--Department of Obstetrics and Gynaecology, Kalafong University Hospital, Pretoria, South Africa in collaboration with the Departments of Microbiology and of Gynaecology and Obstetrics, Katholieke Universiteit, Leuven, Belgium. SUBJECTS--Two hundred and fifty six consecutive black pregnant women were examined during the first antenatal visit, and one to four weeks later a second culture for N gonorrhoeae was taken at random in 67 of them. Hundred and sixty seven were analysable, 75 were lost to follow up. METHODS--After obtaining detailed clinical history, an endocervical specimen for N gonorrhoeae culture (Thayer-Martin) and C trachomatis antigen detection (Chlamydiazyme (R)) was taken. Syphilis was diagnosed when both reactive plasma protein (RPR) and T pallidum haemagglutination inhibition assay (TPHA) were positive. Prematurity was defined as delivery at less than 37 gestational weeks. RESULTS--Infection with N gonorrhoeae (n = 9) and untreated syphilis (n = 7) were both associated with prematurity and low birth weight. After multi-variate regression analysis, age-adjusted parity, late sexual debut, number of recent sexual partners, infection with N gonorrhoeae and infection with syphilis revealed significant associations with low birth weight. However, infection with C trachomatis, presence of abundant vaginal discharge, social class, Trichomonas vaginalis infection, gestational weeks at first antenatal visit and number of previous miscarriages did not reveal such an association. Attributable risk of untreated gonorrhoea for premature birth was 72% and routine cultures were cost-benefit efficient. CONCLUSIONS--At least in countries where the prevalence is high, genital infections as well as the risk factors for acquiring them (young age, late sexual debut

  15. Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China.

    PubMed

    Liao, Meizhen; Su, Shengli; Yan, Ke; Zhu, Xiaoyan; Huang, Pengxiang; Li, Jinhai; Jiang, Zhenxia; Zhang, Xijiang; Zhang, Ning; Tao, Xiaorun; Kang, Dianming; Zhao, Jinkou

    2016-03-01

    Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic. PMID:26696263

  16. Prevalence of Treponema pallidum DNA among blood donors with two different serologic tests profiles for syphilis in São Paulo, Brazil.

    PubMed

    Ferreira, S C; de Almeida-Neto, C; Nishiya, A S; Di-Lorenzo-Oliveira, C; Ferreira, J E; Alencar, C S; Levi, J E; Salles, N A; Mendrone-Junior, A; Sabino, E C

    2014-05-01

    The presence of Treponema pallidum DNA was assessed by real-time PCR in samples of blood donors with reactive serologic tests for syphilis. Treponema pallidum DNA was detected in two (1·02%) of 197 samples of VDRL>8, EIA+ and FTA-ABS+ donors, and in no sample from 80 VDRL−, EIA+ and FTA-ABS+ donors. Donors VDRL−, EIA+ and FTA-ABS+ lack demonstrable T. pallidum DNA in their blood and are unlike to transmit syphilis. Donors VDRL>8, EIA+ and FTA-ABS+ carry the risk of syphilis infectivity even in concomitance to antibodies detection. Serologic screening for syphilis may still play a role to prevent its transfusion transmission. PMID:24877236

  17. Spirochetemia due to Treponema pallidum using polymerase-chain-reaction assays in patients with early syphilis: prevalence, associated factors and treatment response.

    PubMed

    Wu, B-R; Tsai, M-S; Yang, C-J; Sun, H-Y; Liu, W-C; Yang, S-P; Wu, P-Y; Su, Y-C; Chang, S-Y; Hung, C-C

    2014-08-01

    Between 2009 and 2013, polymerase-chain-reaction assay was used to detect Treponema pallidum in the blood samples collected from 296 patients with early syphilis (241 being HIV infected) and 102 patients (34.5%) had spirochetemia. The presence of spirochetemia was associated with lower CD4 counts (per 10-cell/mm(3) decrease, adjusted odds ratio (AOR), 1.020; 95% CI, 1.006-1.036) and secondary syphilis (AOR, 4.967; 95% CI, 2.016-12.238). Patients with early latent syphilis were less likely to achieve serological response compared with those with primary or secondary syphilis (AOR, 0.317; 95% CI, 0.142-0.708). However, serological response was not affected by presence of spirochetemia or antibiotic regimens. PMID:24350785

  18. Antenatal Syphilis Screening Using Point-Of-Care Testing in Low- and Middle-Income Countries in Asia and Latin America: A Cost-Effectiveness Analysis

    PubMed Central

    Kuznik, Andreas; Muhumuza, Christine; Komakech, Henry; Marques, Elsa M. R.; Lamorde, Mohammed

    2015-01-01

    Background Untreated syphilis in pregnancy is associated with adverse clinical outcomes to the infant. In low- and middle-income countries in Asia and Latin America, 20%-30% of women are not tested for syphilis during pregnancy. We evaluated the cost-effectiveness of increasing the coverage for antenatal syphilis screening in 11 Asian and 20 Latin American countries, using a point-of-care immunochromatographic strip (ICS) test. Methods The decision analytical cost-effectiveness models reported incremental costs per disability-adjusted life years (DALYs) averted from the perspectives of the national health care payer. Clinical outcomes were stillbirths, neonatal deaths, and congenital syphilis. DALYs were computed using WHO disability weights. Costs included the ICS test, three injections of benzathine penicillin, and nurse wages. Country-specific inputs included the antenatal prevalence of syphilis and the proportion of women in the antenatal care setting that are screened for syphilis infection as reported in the 2014 WHO baseline report on global sexually transmitted infection surveillance. Country-specific data on the annual number of live births, proportion of women with at least one antenatal care visit, and per capita gross national income were also included in the model. Results The incremental cost/DALY averted of syphilis screening is US$53 (range: US$10-US$332; Prob<1*per capita GDP=99.71%) in Asia and US$60 (range: US$5-US$225; Prob<1*per capita GDP=99.77%) in Latin America. Universal screening may reduce the annual number of stillbirths by 20,344 and 4,270, neonatal deaths by 8,201 and 1,721, cases of congenital syphilis by 10,952 and 2,298, and avert 925,039 and 197,454 DALYs in the aggregate Asian and Latin American panel, respectively. Conclusion Antenatal syphilis screening is highly cost-effective in all the 11 Asian and 20 Latin American countries assessed. Our findings support the decision to expand syphilis screening in countries with currently

  19. Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study

    PubMed Central

    McGready, Rose; Kang, Joy; Watts, Isabella; Tyrosvoutis, Mary Ellen G; Torchinsky, Miriam B.; Htut, Aung Myo; Tun, Nay Win; Keereecharoen, Lily; Wangsing, Chirapat; Hanboonkunupakarn, Borimas; Nosten, François H.

    2015-01-01

    Objective: The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates. Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border. Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors. Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies. PMID:26664698

  20. Incidence of Co-Infections of HIV, Herpes Simplex Virus Type 2 and Syphilis in a Large Cohort of Men Who Have Sex with Men in Beijing, China

    PubMed Central

    Zhang, Zheng; Wang, Zixin; Qi, Xiao; Ruan, Yuhua; Zhou, Yunhua; Li, Chunrong; Luo, Fengji; Lau, Joseph T. F.

    2016-01-01

    Background The HIV-epidemic among MSM in China has worsened. In this key population, prevalence of HSV-2 and syphilis infection and co-infection with HIV is high. Methods A longitudinal study was conducted (n = 962) in Beijing, China, with three overlapping cohorts (n = 857, 757 and 760) consisting of MSM that were free from pairs of infections of concern (i.e. HIV-HSV-2, HIV-syphilis, HSV-2-syphilis) at baseline to estimate incidence of HIV, HSV-2, syphilis, and those of co-infection. Results The incidence of HIV, HSV-2 and syphilis in the overall cohort was 3.90 (95% CI = 2.37, 5.43), 7.87 (95% CI = 5.74, 10.00) and 6.06 (95% CI = 4.18, 7.94) cases per 100 person-years (PYs), respectively. The incidence of HIV-HSV-2, HIV-Syphilis and HSV-2-Syphilis co-infections was 0.30 (95% CI = 0.29, 0.88), 1.02 (95% CI = 0.13, 2.17) and 1.41 (95% CI: 0.04, 2.78) cases per 100 PYs, respectively, in the three sub-cohorts constructed for this study. Conclusions The incidence of HIV, HSV-2 and syphilis was very high and those of their co-infections were relatively high. Such co-infections have negative impacts on the HIV/STI epidemics. Prevention practices need to take such co-infections into account. PMID:26820145

  1. The Tuskegee Study of Untreated Syphilis and public perceptions of biomedical research: a focus group study.

    PubMed Central

    Bates, Benjamin R.; Harris, Tina M.

    2004-01-01

    African Americans are less likely than European Americans to participate in biomedical research. Researchers often attribute nonparticipation to the "Tuskegee effect." Using critical qualitative analysis of focus group data, we examined the public's use of the Tuskegee Study of Untreated Syphilis (TSUS) to discuss biomedical research. Our participants articulated three primary themes in relation to TSUS: 1) that TSUS made them suspicious about biomedical research; 2) that other values had to weigh against concerns about TSUS; and 3) that African Americans could take steps to resolve their concerns about TSUS. African Americans were more likely to discuss TSUS than were European Americans. African Americans did not use TSUS to express simple fear. African Americans suggested issues other than TSUS that influence the decision to participate in research. African Americans indicated specific reforms that would increase participation in research. We discuss how a better understanding of African Americans' use of TSUS can enhance research participation and allay concerns about "another Tuskegee." PMID:15303410

  2. [Suspected syphilis during pregnancy due to cross reactions in Borrelia infection].

    PubMed

    Enders, G; Biber, M; Baier, R; Hlobil, H; Wellensiek, H J

    1988-09-30

    A weakly positive titre (1:20) in the Treponema pallidum haemagglutination test and a highly positive titre (1:1280) in the fluorescence Treponema antibody absorption test, but negative result for IgM antibodies, were found in the serum of a 23-year-old pregnant woman. The cardiolipin microflocculation test was at first borderline positive, but negative on repeat. In the absence of a history of syphilis tests for Borrelia antibodies were performed. Those for antibodies against B. burgdorferi were highly positive in the ELISA test (550 units), in the indirect Borrelia immunofluorescence test 1:1280 for IgG antibodies and 1:160 for IgM antibodies. In the Borrelia-specific indirect haemagglutination test, which measures both IgG and IgM antibodies, the titres were 1:640 to 1:1280. These results confirmed the presence of an infection with B. burgdorferi and not with Treponema pallidum. PMID:3048959

  3. Viscous Dynamics of Lyme Disease and Syphilis Spirochetes Reveal Flagellar Torque and Drag

    PubMed Central

    Harman, Michael; Vig, Dhruv K.; Radolf, Justin D.; Wolgemuth, Charles W.

    2013-01-01

    The spirochetes that cause Lyme disease (Borrelia burgdorferi) and syphilis (Treponema pallidum) swim through viscous fluids, such as blood and interstitial fluid, by undulating their bodies as traveling, planar waves. These undulations are driven by rotation of the flagella within the periplasmic space, the narrow (∼20–40 nm in width) compartment between the inner and outer membranes. We show here that the swimming speeds of B. burgdorferi and T. pallidum decrease with increases in viscosity of the external aqueous milieu, even though the flagella are entirely intracellular. We then use mathematical modeling to show that the measured changes in speed are consistent with the exertion of constant torque by the spirochetal flagellar motors. Comparison of simulations, experiments, and a simple model for power dissipation allows us to estimate the torque and resistive drag that act on the flagella of these major spirochetal pathogens. PMID:24268139

  4. Results of serological tests for syphilis among Gurkhas and other high risk groups.

    PubMed

    Thin, R N; O'Rorke, C M

    1985-02-01

    Serological tests for syphilis gave more positive results in serving Gurkha (Nepali) soldiers from west Nepal than in those from east Nepal or in Gurkha recruits. The soldiers had served from four to 11 years. The source of their infection was not clear. Positive results were rather less common in black patients born in the tropics attending a genitourinary medicine in London and were similar to findings in blood donors in the West Indies. British born male patients attending a genitourinary medicine department in London had a much lower prevalence. Malay and Nepali women attending an antenatal clinic in Singapore had a higher prevalence of positive serological results than women attending an antenatal clinic in London. Nepalis, Malays, and black people born in the tropics continue to require serological screening. PMID:3910540

  5. Syphilis in renaissance Europe: rapid evolution of an introduced sexually transmitted disease?

    PubMed

    Knell, Robert J

    2004-05-01

    When syphilis first appeared in Europe in 1495, it was an acute and extremely unpleasant disease. After only a few years it was less severe than it once was, and it changed over the next 50 years into a milder, chronic disease. The severe early symptoms may have been the result of the disease being introduced into a new host population without any resistance mechanisms, but the change in virulence is most likely to have happened because of selection favouring milder strains of the pathogen. The symptoms of the virulent early disease were both debilitating and obvious to potential sexual partners of the infected, and strains that caused less obvious or painful symptoms would have enjoyed a higher transmission rate. PMID:15252975

  6. Increase in primary and secondary syphilis cases in older adults in Louisiana.

    PubMed

    Holden, Julie; Trachtman, Louis

    2011-01-01

    Sexually active young adults and adolescents experience a majority of the burden of sexually transmitted diseases in the United States and public health resources are appropriately directed at these age groups. However, sexual health of older adults is often ignored. An analysis of sexually transmitted disease surveillance data from the Louisiana Office of Public Health show that both the numbers and rates of primary and secondary syphilis cases have increased in older age groups over the past 10 years. Clinicians must be aware of increased use of erectile dysfunction drugs in older persons as a possible risk factor for sexually transmitted diseases. Clinicians must also realize that a significant number of older persons display sexually risky behavior and safe sexual health counseling is often overlooked in this population. PMID:22324089

  7. Kostas Karyotakis (1896-1928): did the great Greek suicidal poet suffer from syphilis?

    PubMed

    Kousoulis, Antonis A

    2012-05-01

    Kostas Karyotakis is one of the most important Greek poets. His works reflect his existential, pessimistic and satirical tone. He was born in Tripolis, studied Law and spent most of his life working as a public servant. Since 1922 he was aware that he was suffering from syphilis. The disease seems to be the reason why he never accepted the full love of Maria Polydouri, a Greek lyric poet. Karyotakis' conventional life and his many detachments made him feel depressed, a fact that has led many to believe that a clinical depression caused his suicidal ideation. However, the fear of neurosyphilis appears to be the most decisive factor that led to him committing suicide in Preveza. This view is supported by a poem he wrote about the disease, the words of his contemporaries and his suicidal note. PMID:22791878

  8. Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004

    PubMed Central

    Swai, Roland O; Somi G, Geofrey R; Matee, Mecky IN; Killewo, Japhet; Lyamuya, Eligius F; Kwesigabo, Gideon; Tulli, Tuhuma; Kabalimu, Titus K; Ng'ang'a, Lucy; Isingo, Raphael; Ndayongeje, Joel

    2006-01-01

    Background This paper presents the prevalence of human immunodeficiency virus (HIV) and syphilis infections among women attending antenatal clinics (ANC) in Tanzania obtained during the 2003/2004 ANC surveillance. Methods Ten geographical regions; six of them were involved in a previous survey, while the remaining four were freshly selected on the basis of having the largest population among the remaining 20 regions. For each region, six ANC were selected, two from each of three strata (urban, peri-urban and rural). Three of the sites did not participate, resulting into 57 surveyed clinics. 17,813 women who were attending the chosen clinics for the first time for any pregnancy between October 2003 and January 2004. Patient particulars were obtained by interview and blood specimens were drawn for HIV and syphilis testing. HIV testing was done anonymously and the results were unlinked. Results Of the 17,813 women screened for HIV, 1,545 (8.7% (95% CI = 8.3–9.1)) tested positive with the highest prevalence in women aged 25–34 years (11%), being higher among single women (9.7%) than married women (8.6%) (p < 0.07), and increased with level of education from 5.2% among women with no education to 9.3% among those at least primary education (p < 0.001). Prevalence ranged from 4.8% (95% CI = 3.8% – 9.8%) in Kagera to 15.3% (95% CI = 13.9% – 16.8%) in Mbeya and was; 3.7%, 4.7%, 9.1%, 11.2% and 15.3% for rural, semi-urban, road side, urban and 15.3% border clinics, respectively (p < 0.001). Of the 17,323 women screened for syphilis, 1265 (7.3% (95%CI = 6.9–7.7)) were positive, with highest prevalence in the age group 35–49 yrs (10.4%) (p < 0.001), and being higher among women with no education than those with some education (9.8% versus 6.8%) (p < 0.0001), but marital status had no influence. Prevalence ranged from 2.1% (95% CI = 1.4% – 3.0%) in Kigoma to 14.9% (95% CI = 13.3%-16.6%) in Kagera and was 16.0% (95% CI = 13.3–18.9), 10.5% (95% CI = 9.5–11

  9. Syphilis epidemiology in 1994-2013, molecular epidemiological strain typing and determination of macrolide resistance in Treponema pallidum in 2013-2014 in Tuva Republic, Russia.

    PubMed

    Khairullin, Rafil; Vorobyev, Denis; Obukhov, Andrey; Kuular, Ural-Herel; Kubanova, Anna; Kubanov, Alexey; Unemo, Magnus

    2016-07-01

    The incidence of syphilis in the Tuva Republic (geographical centre of Asia), Russia has been exceedingly high historically. No detailed examinations and no molecular investigations of Treponema pallidum strains transmitted in the Tuva Republic, or in general, in Russia, were published internationally. We examined the syphilis epidemiology in 1994-2013, and the molecular epidemiology and macrolide resistance in T. pallidum strains in 2013-2014 in the Tuva Republic. Among 95 mainly primary or secondary syphilis patients, the arp, tpr, tp0548 and 23S rRNA genes in 85 polA gene-positive genital ulcer specimens were characterized. The syphilis incidence in Tuva Republic peaked in 1998 (1562), however declined to 177 in 2013. Among the 70 (82%) completely genotyped specimens, six molecular strain types were found. Strain type 14d/f accounted for 91%, but also 14c/f, 14d/g, 14b/f, 14i/f, 9d/f, and 4d/f were identified. Two (2.4%) specimens contained the 23S rRNA A2058G macrolide resistance mutation. This is the first internationally published typing study regarding T. pallidum in Russia, performed in the Tuva Republic with the highest syphilis incidence in Russia. The two molecular strain types 4d/f and 9d/f have previously been described only in Eastern and Northern China and for the first time, macrolide-resistant syphilis was described in Russia. PMID:27102715

  10. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology. PMID:25829517

  11. Survival of Treponema pallidum in banked blood for prevention of Syphilis transmission

    PubMed Central

    Adegoke, Adeolu O.; Akanni, Olufemi E.

    2011-01-01

    Background: Every year, millions of people are exposed to avoidable, life-threatening risks through the trans-fusion of unsafe blood. Aim: To determine the survival time of Treponema pallidum in banked donor blood. Material and Methods: Two groups of male Wistar rats (group A and B) were inoculated intratesticularly with 0.5ml of artificially infected donor blood (final density of Nichols treponemes: 5×105 /ml) stored at 4°C for various periods of time. In group A, a pair each of the rats was injected every 12 hours, starting at 0 hr, up to a maximal storage time of 96 hr. In group B, the rats were injected after 72, 120, 192 and 336 hours of storage of the treponemes-blood mixture. Group C which is a control group was injected with blood only, while group D rats were injected with heat-killed treponemes suspended in blood every 12 hours. The detection of Treponema pallidum IgG/IgM was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify antibodies to Syphilis. The outcomes of interest included the proportion of Syphilis positive rats and the maximal survival hours of T. pallidum in banked blood. Results: 14 rats (77.8%) out of the 18 rats that were involved in group A developed orchitis and positive serology up to 72 hours of storage time, p<0.05. 2 rats (25%) in group B developed orchitis after 72hrs of storage time. All the 18 rats (100%) in the control group C and D showed neither clinical nor serological changes. Conclusion: It was concluded that the survival time of T. pallidum in banked donor blood lies between 72-120hrs in this study. Regardless of blood banking temperature, T. pallidum and other transfusion transmissible infections should be screened for prior to allogeneic transfusion. PMID:22540107

  12. Republication: Two Premature Neonates of Congenital Syphilis with Severe Clinical Manifestations.

    PubMed

    Akahira-Azuma, Moe; Kubota, Mai; Hosokawa, Shinichi; Kaneshige, Masao; Yasuda, Noriko; Sato, Noriko; Matsushita, Takeji

    2015-09-01

    Congenital syphilis (CS) is a public health burden in both developing and developed countries. We report two cases of CS in premature neonates with severe clinical manifestations; Patient 1 (gestational age 31 weeks, birth weight 1423 g) had disseminated idiopathic coagulation (DIC) while Patient 2 (gestational age 34 weeks and 6 days, birth weight 2299 g) had refractory syphilitic meningitis. Their mothers were single and had neither received antenatal care nor undergone syphilis screening. Both neonates were delivered via an emergency cesarean section and had birth asphyxia and transient tachypnea of newborn. Physical examination revealed massive hepatosplenomegaly. Laboratory testing of maternal and neonatal blood showed increased rapid plasma reagin (RPR) titer and positive Treponema pallidum hemagglutination assay. Diagnosis of CS was further supported by a positive IgM fluorescent treponemal antibody absorption test and large amounts of T. pallidum spirochetes detected in the placenta. Each neonate was initially treated with ampicillin and cefotaxime for early bacterial sepsis/meningitis that coexisted with CS. Patient 1 received fresh frozen plasma and antithrombin III to treat DIC. Patient 2 experienced a relapse of CS during initial antibiotic treatment, necessitating parenteral penicillin G. Treatment was effective in both neonates, as shown by reductions in RPR. Monitoring of growth and neurological development through to age 4 showed no evidence of apparent delay or complications. Without adequate antenatal care and maternal screening tests for infection, CS is difficult for non-specialists to diagnose at birth, because the clinical manifestations are similar to those of neonatal sepsis and meningitis. Ampicillin was insufficient for treating CS and penicillin G was necessary. PMID:26543391

  13. Target organs of infection in guinea pigs with acquired congenital syphilis.

    PubMed Central

    Wicher, K; Abbruscato, F; Wicher, V; Baughn, R; Noordhoek, G T

    1996-01-01

    The target organs of infection in guinea pigs with asymptomatic acquired or congenital syphilis were identified by PCR and in some cases by rabbit infectivity test (RIT). The prevalence of Treponema pallidum DNA was examined in the following seven organs: the inguinal and mesenteric lymph nodes, spleen, liver, kidney, heart, and brain. Test samples consisted of 95 organs from two genetically different strains of female guinea pigs (C4-deficient and Albany) with different susceptibilities to cutaneous infection by T. pallidum and 195 organs from their asymptomatic offspring. Twenty organs from dams of both strains injected with heat-killed T. pallidum and 19 organs from their progeny served as negative controls. The infections of mothers and neonates were documented by PCR, RIT, and serology. Though any of the organs tested could be infected, there was a spirochetal predilection for some anatomical locations, such as the lymph nodes, heart, and brain, regardless of the strain, route of maternal infection, and age. None of the 49 organs collected from control animals were positive by PCR. In infected C4-deficient dams, one to four organs were positive by PCR, whereas the organs of 7 of their 27 (25%) asymptomatic offspring were treponemal DNA negative, despite evidence of immunoglobulin M treponemal antibodies. Comparative analysis done by both PCR and RIT on a limited number of samples showed 90% agreement between results. An examination of multiple samples obtained from single organs demonstrated that even within 24 h of spirochetemia, when most organs appeared to be infected, not all samples from an individual organ were positive by PCR. A specific immunological response in guinea pigs with congenital syphilis was a more consistent parameter of vertical transmission than was an analysis of T. pallidum DNA. PMID:8757850

  14. Surface antigens of the syphilis spirochete and their potential as virulence determinants.

    PubMed Central

    Blanco, D. R.; Miller, J. N.; Lovett, M. A.

    1997-01-01

    A unique physical feature of Treponema pallidum, the venereally transmitted agent of human syphilis, is that its outer membrane contains 100-fold less membrane-spanning protein than the outer membranes of typical gram-negative bacteria, a property that has been related to the chronicity of syphilitic infection. These membrane-spanning T. pallidum rare outer membrane proteins, termed TROMPs, represent potential surface-exposed virulence determinants and targets of host immunity. Only recently has the outer membrane of T. pallidum been isolated and its constituent proteins identified. Five proteins of molecular mass 17-, 28-, 31-, 45-, and 65-kDa were outer membrane associated. The 17- and 45-kDa proteins, which are also present in greater amounts with the T. pallidum inner membrane protoplasmic cylinder complex, had been previously characterized lipoproteins and are, therefore, not membrane-spanning but rather membrane-anchored by their lipid moiety. In contrast, the 28-, 31-, and 65-kDa proteins are exclusively associated with the outer membrane. Both the purified native and an Escherichia coli recombinant outer membrane form of the 31-kDa protein, designated Tromp1, exhibit porin activity, thereby confirming the membrane-spanning outer membrane topology of Tromp1. The 28-kDa protein, designated Tromp2, has sequence characteristics in common with membrane-spanning outer membrane proteins and has also been recombinantly expressed in E. coli, where it targets exclusively to the E. coli outer membrane. The 65-kDa protein, designated Tromp3, is present in the least amount relative to Tromps1 and 2. Tromps 1, 2, and 3 were antigenic when tested with serum from infection and immune syphilitic rabbits and humans. These newly identified TROMPs provide a molecular foundation for the future study of syphilis pathogenesis and immunity. PMID:9126440

  15. Rapid Treponema pallidum Clearance from Blood and Ulcer Samples following Single Dose Benzathine Penicillin Treatment of Early Syphilis

    PubMed Central

    Tipple, Craig; Jones, Rachael; McClure, Myra; Taylor, Graham

    2015-01-01

    Currently, the efficacy of syphilis treatment is measured with anti-lipid antibody tests. These can take months to indicate cure and, as a result, syphilis treatment trials require long periods of follow-up. The causative organism, Treponema pallidum (T. pallidum), is detectable in the infectious lesions of early syphilis using DNA amplification. Bacteraemia can likewise be identified, typically in more active disease. We hypothesise that bacterial clearance from blood and ulcers will predict early the standard serology-measured treatment response and have developed a qPCR assay that could monitor this clearance directly in patients with infectious syphilis. Patients with early syphilis were given an intramuscular dose of benzathine penicillin. To investigate the appropriate sampling timeframe samples of blood and ulcer exudate were collected intensively for T. pallidum DNA (tpp047 gene) and RNA (16S rRNA) quantification. Sampling ended when two consecutive PCRs were negative. Four males were recruited. The mean peak level of T. pallidum DNA was 1626 copies/ml whole blood and the mean clearance half-life was 5.7 hours (std. dev. 0.53). The mean peak of 16S rRNA was 8879 copies/ml whole blood with a clearance half-life of 3.9 hours (std. dev. 0.84). From an ulcer, pre-treatment, 67,400 T. pallidum DNA copies and 7.08x107 16S rRNA copies were detected per absorbance strip and the clearance half-lives were 3.2 and 4.1 hours, respectively. Overall, T. pallidum nucleic acids were not detected in any sample collected more than 56 hours (range 20–56) after treatment. All patients achieved serologic cure. In patients with active early syphilis, measuring T. pallidum levels in blood and ulcer exudate may be a useful measure of treatment success in therapeutic trials. These laboratory findings need confirmation on a larger scale and in patients receiving different therapies. PMID:25700164

  16. Rapid Treponema pallidum clearance from blood and ulcer samples following single dose benzathine penicillin treatment of early syphilis.

    PubMed

    Tipple, Craig; Jones, Rachael; McClure, Myra; Taylor, Graham

    2015-02-01

    Currently, the efficacy of syphilis treatment is measured with anti-lipid antibody tests. These can take months to indicate cure and, as a result, syphilis treatment trials require long periods of follow-up. The causative organism, Treponema pallidum (T. pallidum), is detectable in the infectious lesions of early syphilis using DNA amplification. Bacteraemia can likewise be identified, typically in more active disease. We hypothesise that bacterial clearance from blood and ulcers will predict early the standard serology-measured treatment response and have developed a qPCR assay that could monitor this clearance directly in patients with infectious syphilis. Patients with early syphilis were given an intramuscular dose of benzathine penicillin. To investigate the appropriate sampling timeframe samples of blood and ulcer exudate were collected intensively for T. pallidum DNA (tpp047 gene) and RNA (16S rRNA) quantification. Sampling ended when two consecutive PCRs were negative. Four males were recruited. The mean peak level of T. pallidum DNA was 1626 copies/ml whole blood and the mean clearance half-life was 5.7 hours (std. dev. 0.53). The mean peak of 16S rRNA was 8879 copies/ml whole blood with a clearance half-life of 3.9 hours (std. dev. 0.84). From an ulcer, pre-treatment, 67,400 T. pallidum DNA copies and 7.08 x 107 16S rRNA copies were detected per absorbance strip and the clearance half-lives were 3.2 and 4.1 hours, respectively. Overall, T. pallidum nucleic acids were not detected in any sample collected more than 56 hours (range 20-56) after treatment. All patients achieved serologic cure. In patients with active early syphilis, measuring T. pallidum levels in blood and ulcer exudate may be a useful measure of treatment success in therapeutic trials. These laboratory findings need confirmation on a larger scale and in patients receiving different therapies. PMID:25700164

  17. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: A national multicenter study

    PubMed Central

    Adjei, Andrew A; Armah, Henry B; Gbagbo, Foster; Ampofo, William K; Boamah, Isaac; Adu-Gyamfi, Clement; Asare, Isaac; Hesse, Ian FA; Mensah, George

    2008-01-01

    Background Prisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in prison officers in Ghana. Methods A national multicenter cross-sectional study was undertaken on correlates of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infections in sample of prison inmates and officers from eight of ten regional central prisons in Ghana. A total of 1366 inmates and 445 officers were enrolled between May 2004 and December 2005. Subjects completed personal risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for presence of antibodies to HIV, HCV and Treponema pallidum; and surface antigen of HBV (HBsAg). These data were analyzed using both univariate and multivariate techniques. Results Almost 18% (1336) of 7652 eligible inmates and 21% (445) of 2139 eligible officers in eight study prisons took part. Median ages of inmates and officers were 36.5 years (range 16–84) and 38.1 years (range 25–59), respectively. Among inmates, HIV seroprevalence was 5.9%, syphilis seroprevalence was 16.5%, and 25.5% had HBsAg. Among officers tested, HIV seroprevalence was 4.9%, HCV seroprevalence was 18.7%, syphilis seroprevalence was 7.9%, and 11.7% had HBsAg. Independent determinants for HIV, HBV and syphilis infections among inmates were age between 17–46, being unmarried, being illiterate, female gender, being incarcerated for longer than median time served of 36 months, history of homosexuality, history of intravenous drug use, history of sharing syringes and drug paraphernalia, history of participation in paid sexual activity, and history of sexually transmitted diseases. Independent determinants for HIV, HBV, HCV and syphilis infections among officers

  18. Primary Syphilis

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  19. Congenital syphilis

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    ... blood tests: Fluorescent treponemal antibody absorbed test ( FTA-ABS ) Rapid plasma reagin ( RPR ) Venereal disease research laboratory ... include: Blindness Deafness Deformity of the face Nervous system problems When to Contact a Medical Professional Call ...

  20. Syphilis Test

    MedlinePlus

    ... highly sensitive but, since they are non-specific, false-positive results can be caused by, for example, ... it is more specific and there are fewer false positives. MHA-TP (Microhemagglutination assay)--another confirmatory method; ...

  1. Yaws, syphilis, sexuality, and the circulation of medical knowledge in the British Caribbean and the Atlantic world.

    PubMed

    Paugh, Katherine

    2014-01-01

    This history of the disease categories "yaws" and "syphilis" explores the interplay between European and African medical cultures in the early modern Atlantic world. The assertion made by both early modern and modern medical authorities, that yaws and syphilis are the same disease, prompts a case study of the history of disease that reflects on a variety of issues in the history of medicine: the use of ideas about contagion to demarcate racial and sexual difference at sites around the British Empire; the contrast between persistently holistic ideas about disease causation in the Black Atlantic and the growth of ontological theories of disease among Europeans and Euro-Americans; and the controversy over the African practice of yaws inoculation, which may once have been an effective treatment but was stamped out by plantation owners who viewed it as a waste of their enslaved laborers' valuable time. PMID:24976161

  2. Ethical issues evolving from patients’ perspectives on compulsory screening for syphilis and voluntary screening for cervical cancer in Kenya

    PubMed Central

    2014-01-01

    Background Public health aims to provide universal safety and progressive opportunities to populations to realise their highest level of health through prevention of disease, its progression or transmission. Screening asymptomatic individuals to detect early unapparent conditions is an important public health intervention strategy. It may be designed to be compulsory or voluntary depending on the epidemiological characteristics of the disease. Integrated screening, including for both syphilis and cancer of the cervix, is a core component of the national reproductive health program in Kenya. Screening for syphilis is compulsory while it is voluntary for cervical cancer. Participants’ perspectives of either form of screening approach provide the necessary contextual information that clarifies mundane community concerns. Methods Focus group discussions with female clients screened for syphilis and cancer of the cervix were conducted to elicit their perspectives of compulsory and voluntary screening. The discussions were audiotaped, transcribed and thematic content analysis performed manually to explore emerging ethics issues. Results The results indicate that real ethical challenges exist in either of the approaches. Also, participants were more concerned about the benefits of the procedure and whether their dignity is respected than the compulsoriness of screening per se. The implication is for the policy makers to clarify in the guidelines how to manage ethical challenges, while at the operational level, providers need to be judicious to minimize potential harms participants and families when screening for disease in women. Conclusions The context for mounting screening as a public health intervention and attendant ethical issues may be more complex than hitherto perceived. Interpreting emerging ethics issues in screening requires more nuanced considerations of individuals’ contextual experiences since these may be contradictory to the policy position. In

  3. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China

    PubMed Central

    Qin, Qianqian; Tang, Weiming; Ge, Lin; Li, Dongmin; Mahapatra, Tanmay; Wang, Liyan; Guo, Wei; Cui, Yan; Sun, Jiangping

    2016-01-01

    Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009–13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations. PMID:27535092

  4. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China.

    PubMed

    Qin, Qianqian; Tang, Weiming; Ge, Lin; Li, Dongmin; Mahapatra, Tanmay; Wang, Liyan; Guo, Wei; Cui, Yan; Sun, Jiangping

    2016-01-01

    Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009-13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations. PMID:27535092

  5. Seroepidemiology of HIV, syphilis and hepatitis B and C viruses among blood donors in Bangui, Central African Republic.

    PubMed

    Nambei, W S; Rawago-Mandjiza, D; Gbangbangai, E

    2016-05-01

    The aim of this study was to determine the seroprevalence of HIV, the hepatitis B and C viruses, and syphilis as well the risk factors for these diseases among blood donors in Bangui, Central Africa Republic. This cross-sectional study examined samples from donors giving blood in August and September, 2013. HIV1/2 antibodies was screened with the Determine and Unigold HIV tests. Hepatitis B surface antigens were detected by sandwich immunochromatographic methods (DIAspot HBsAg test), and antibodies to HCV by the DIAspot test strip. Syphilis was diagnosed with the VDRL and TPHA methods (Omega Diagnostic, UK). The Chi(2) test was used for statistical analysis. The study included samples from 551 individuals, 350 (63.52%) of whom were frequent volunteer donors. In all, 132 (23.95%) were infected with at least one pathogen. The overall seroprevalence rate was 8.89% for HBV, 4.72% for HCV, 4.36% for syphilis, and 5.98% for HIV. Eight patients had two concomitant infections, with HIV-HBV the most common combination. Compared to long-term volunteers, first-time donors were more often infected by at least one of the pathogens we screened for, most especially HVB (OR = 5.06; 95% CI = 4.22-7.11) and syphilis (OR = 2.05; 95% CI = 2.02-7.44). Our findings indicate the high seroprevalence of transfusion-transmitted infections in blood donated in Bangui. The most common combined infections were HIV-HBV. The most common risk factor was a family history of HBV infection, and especially, mother-child transmission. PMID:27412978

  6. Sex, Drugs (Methamphetamines), and the Internet: Increasing Syphilis Among Men Who Have Sex With Men in California, 2004–2008

    PubMed Central

    Samuel, Michael C.; Lo, Terrence; Bernstein, Kyle T.; Aynalem, Getahun; Klausner, Jeffrey D.; Bolan, Gail

    2013-01-01

    Objectives. We examined primary and secondary syphilis cases among men who have sex with men (MSM) in California, and the association of methamphetamine use and Internet use to meet sex partners (Internet use) with number of sex partners. Methods. We analyzed California surveillance data for MSM who were diagnosed with syphilis between 2004 and 2008, to assess differences in the mean number of sex partners by methamphetamine use and mutually exclusive groups of patients reporting Internet use (Internet users). Results. Large proportions of patients reported methamphetamine use (19.2%) and Internet use (36.4%). From 2006 through 2008, Adam4Adam was the most frequently reported Web site statewide, despite temporal and regional differences in Web site usage. Methamphetamine users reported more sex partners (mean = 11.7) than nonmethamphetamine users (mean = 5.6; P < .001). Internet users reported more sex partners (mean = 9.8) than non-Internet users (mean = 5.0; P < .001). Multivariable analysis of variance confirmed an independent association of methamphetamine and Internet use with increased numbers of sex partners. Conclusions. Higher numbers of partners among MSM syphilis patients were associated with methamphetamine and Internet use. Collaboration between currently stand-alone interventions targeting methamphetamine users and Internet users may offer potential advances in sexually transmitted disease control efforts. PMID:23153138

  7. The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia

    PubMed Central

    Terris-Prestholt, Fern; Vickerman, Peter; Torres-Rueda, Sergio; Santesso, Nancy; Sweeney, Sedona; Mallma, Patricia; Shelley, Katharine D.; Garcia, Patricia J.; Bronzan, Rachel; Gill, Michelle M.; Broutet, Nathalie; Wi, Teodora; Watts, Charlotte; Mabey, David; Peeling, Rosanna W.; Newman, Lori

    2015-01-01

    Objective Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women. Methods Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Results Although this analysis found screening using RPR to be relatively cheap, most (> 70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. Conclusion This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings. PMID:25963907

  8. [Seroprevalence and factors associated with human immunodeficiency virus (HIV) and syphilis in inmates in the state of Pernambuco, Brazil].

    PubMed

    de Albuquerque, Ana Cecília Cavalcanti; da Silva, Débora Maria; Rabelo, Deyse Caroline Cabral; de Lucena, Waldenia Agny Torres; de Lima, Paloma Cássia Silva; Coelho, Maria Rosângela Cunha Duarte; Tiago, Guilherme Gustavo de Brito

    2014-07-01

    Prison inmates are more vulnerable to HIV and other Sexually Transmitted Infections (STIs) due to risk factors such as needle sharing and unprotected sex with homosexuals. The aim of this work was to determine the seroprevalence and risk factors associated with the human immunodeficiency virus (HIV-1/2) and syphilis among male inmates in Caruaru, State of Pernambuco, Brazil. A cross-sectional study was performed between May and July 2011, when 1,097 inmates at a prison in Caruaru were assessed by means of interviews and blood sample collection for performing the respective tests. The prevalence was 1.19% for HIV infection and 3.92% for syphilis. HIV infection showed a statistically significant association (p <0.05), with injected drug use, homosexuality and blood transfusions. With respect to HIV status and syphilis, factors related to sex life were statistically significant (p <0.05). The prison population is a high risk group for the diseases investigated. The prevalence rates identified indicate the need to implement prevention programs, helping to contain such diseases in this particular population group. PMID:25014292

  9. Uptake of Testing for HIV and Syphilis Among Men Who Have Sex with Men in Baltimore, Maryland: 2004-2011.

    PubMed

    Said, Maria A; German, Danielle; Flynn, Colin; Linton, Sabriya L; Blythe, David; Cooley, Laura A; Balaji, Alexandra B; Oster, Alexandra M

    2015-11-01

    Men who have sex with men (MSM) in Baltimore are at disproportionately high risk for HIV and syphilis infection. Testing and diagnosis are important first steps in receiving treatment and reducing transmission. We analyzed cross-sectional data collected in 2004-2005, 2008, and 2011 among MSM not reporting a previous positive HIV test (n = 1268) in Baltimore, Maryland as part of the National HIV Behavioral Surveillance System to determine the proportion of men tested for HIV and/or syphilis within the previous 12 months and examine the extent to which opportunities for testing were being missed in health care settings. Within the previous 12 months, 54 % of men had received an HIV test; 31 % had received a syphilis test; and only 23 % of men had received testing for both. Among 979 men who did not receive both tests, 72 % had seen a health care provider in the past year, suggesting missed testing opportunities. PMID:26078117

  10. Macrolide Resistance in the Syphilis Spirochete, Treponema pallidum ssp. pallidum: Can We Also Expect Macrolide-Resistant Yaws Strains?

    PubMed

    Šmajs, David; Paštěková, Lenka; Grillová, Linda

    2015-10-01

    Treponema pallidum ssp. pallidum (TPA) causes over 10 million new cases of syphilis worldwide whereas T. pallidum ssp. pertenue (TPE), the causative agent of yaws, affects about 2.5 million people. Although penicillin remains the drug of choice in the treatment of syphilis, in penicillin-allergic patients, macrolides have been used in this indication since the 1950s. Failures of macrolides in syphilis treatment have been well documented in the literature and since 2000, there has been a dramatic increase in a number of clinical samples with macrolide-resistant TPA. Scarce data regarding the genetics of macrolide-resistant mutations in TPA suggest that although macrolide-resistance mutations have emerged independently several times, the increase in the proportion of TPA strains resistant to macrolides is mainly due to the spread of resistant strains, especially in developed countries. The emergence of macrolide resistance in TPA appears to require a two-step process including either A2058G or A2059G mutation in one copy of the 23S rRNA gene and a subsequent gene conversion unification of both rRNA genes. Given the enormous genetic similarity that was recently revealed between TPA and TPE strains, there is a low but reasonable risk of emergence and spread of macrolide-resistant yaws strains following azithromycin treatment. PMID:26217043

  11. Drug-Related Behaviors Independently Associated with Syphilis Infection among Female Sex Workers in two Mexico-U.S. Border Cities

    PubMed Central

    Loza, O.; Patterson, T.L.; Rusch, M.; Martínez, G.A.; Lozada, R.; Staines-Orozco, H.; Magis-Rodríguez, C.; Strathdee, S.A.

    2012-01-01

    AIMS To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. DESIGN Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1:8) were identified by logistic regression. SETTING Tijuana and Ciudad Juarez, two Mexican cities on the U.S. border that are situated on major drug trafficking routes and where prostitution is quasi-legal. PARTICIPANTS 914 FSWs aged ≥18 years without known HIV infection who had recent unprotected sex with clients. MEASUREMENTS Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. FINDINGS Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 37.7% had clients who injected drugs in the last 6 months, and 68.6% reported having clients from the U.S. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.80), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65), and having any U.S. clients (AOR: 2.85; 95% CI: 1.43, 5.70). CONCLUSIONS Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were more closely associated with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use. PMID:20456292

  12. Evaluation of FlaB1, FlaB2, FlaB3, and Tp0463 of Treponema pallidum for serodiagnosis of syphilis.

    PubMed

    Jiang, Chuanhao; Xiao, Jinhong; Xie, Yafeng; Xiao, Yongjian; Wang, Chuan; Kuang, Xingxing; Xu, Man; Li, Ranhui; Zeng, Tiebing; Liu, Shuanquan; Yu, Jian; Zhao, Feijun; Wu, Yimou

    2016-02-01

    Syphilis is a multistage disease caused by the invasive spirochete Treponema pallidum subsp. pallidum, and accurate diagnosis is important for the prevention and treatment of syphilis. Here, to identify appropriate diagnostic antigens for serodiagnosis of syphilis, 6 recombinant proteins were expressed in Escherichia coli and purified, including flagellins (FlaB1 [Tp0868], FlaB2 [Tp0792], and FlaB3 [Tp0870]), Tp0463, Tp0751, and Tp1038. The sensitivities were determined by screening sera from individuals with primary (n=82), secondary (n=115), latent (n=105), and congenital (n=65) syphilis. The specificities were determined by screening sera from uninfected controls (n=30) and potentially cross-reactive infections including Lyme disease (n=30), leptospirosis (n=5), and hepatitis B (n=30). Our data showed that FlaB1, FlaB2, FlaB3, Tp0463, and Tp1038 exhibited higher overall sensitivities and specificities for detecting IgG antibody, with 95.4% and 98.9%, 92.6% and 95.8%, 95.1% and 95.8%, 92.6% and 97.9%, and 95.9% and 98.9%, respectively. In contrast, Tp0751 demonstrated only an overall sensitivity of 39.2%. For comparison, the sensitivity and specificity of Architect Syphilis TP were determined to be 98.1% and 93.7%, respectively. In addition, FlaB1, FlaB2, FlaB3, and Tp0463 demonstrated excellent performance for detecting IgM antibody in primary and congenital syphilis, with sensitivities of 76.8% and 83.1%, 72.0% and 87.7%, 74.4% and 89.2%, and 64.6% and 75.3%, respectively. These results indicate that FlaB1, FlaB2, FlaB3, and Tp0463 could be as novel diagnostic candidates for serodiagnosis of syphilis. PMID:26607421

  13. HIV and Syphilis Prevalence Among Men Who Have Sex With Men: A Cross-Sectional Survey of 61 Cities in China

    PubMed Central

    Wu, Zunyou; Xu, Jie; Liu, Enwu; Mao, Yurong; Xiao, Yan; Sun, Xinhua; Liu, Yufen; Jiang, Yan; McGoogan, Jennifer M.; Dou, Zhi; Mi, Guodong; Wang, Ning; Sun, Jiangping; Liu, Zhongfu; Wang, Lu; Rou, Keming; Pang, Lin; Xing, Wenge; Xu, Juan; Wang, Shuo; Cui, Yan; Li, Zhijun; Bulterys, Marc; Lin, Wen; Zhao, Jinkou; Yip, Ray; Wu, You; Hao, Yang; Wang, Yu

    2013-01-01

    Background. Human immunodeficiency virus (HIV) has rapidly spread among men who have sex with men (MSM) in China in recent years; the magnitude of the epidemic is unclear. We sought to test 3 hypotheses: (1) The prevalence of both HIV and syphilis among MSM in China is high, (2) the 2 epidemics each have unique geographical distributions, and (3) demographic and sexual behavior characteristics are different among segments of the MSM population in China. Methods. A total of 47 231 MSM from 61 cities in China participated in a cross-sectional survey conducted from February 2008 to September 2009. Demographic and behavioral data were collected and analyzed and blood samples tested for HIV and syphilis. Three subgroups among the broader MSM sample were described. Main outcome measures were HIV and syphilis prevalence. Results. An overall prevalence of 4.9% (2314/47 231; 95% confidence interval [CI], 4.7%–5.1%) for HIV and 11.8% (5552/47 231; 95% CI, 11.5%–12.0%) for syphilis was found. Syphilis-positive MSM had the highest HIV prevalence, 12.5% (693/5552; 95% CI, 11.6%–13.4%). However, correlations between HIV and syphilis prevalence were found in only 3 of 6 geographical regions (Northwest: r = 0.82, P = .0253; East: r = 0.78, P = .0004; and South-central: r = 0.63, P = .0276). Three subgroups—nonlocal MSM, Internet-using MSM, and female-partnering MSM—were found to have different profiles of characteristics and behaviors. Conclusions. HIV and syphilis prevalences among MSM in China are high and the 2 epidemics are largely separate geographically. Three segments of the Chinese MSM population each have different demographic and sexual risk “profiles” that suggest high potential for bridging infection across geographies, generations, and sexes. PMID:23580732

  14. Safety of Benzathine Penicillin for Preventing Congenital Syphilis: A Systematic Review

    PubMed Central

    Galvao, Tais F.; Silva, Marcus T.; Serruya, Suzanne J.; Newman, Lori M.; Klausner, Jeffrey D.; Pereira, Mauricio G.; Fescina, Ricardo

    2013-01-01

    Objective To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis. Methods We searched for clinical trials or cohorts that assessed the incidence of serious adverse reactions to benzathine penicillin in pregnant women and the general population (indirect evidence). MEDLINE, EMBASE, Scopus and other databases were searched up to December 2012. The GRADE approach was used to assess quality of evidence. Absolute risks of each study were calculated along with their 95% confidence intervals (95% CI). We employed the DerSimonian and Laird random effects model in the meta-analyses. Results From 2,765 retrieved studies we included 13, representing 3,466,780 patients. The studies that included pregnant women were conducted to demonstrate the effectiveness of benzathine penicillin: no serious adverse reactions were reported among the 1,244 pregnant women included. In the general population, among 2,028,982 patients treated, 4 died from an adverse reaction. The pooled risk of death was virtually zero. Fifty-four cases of anaphylaxis were reported (pooled absolute risk = 0.002%; 95% CI: 0%–0.003% I2 = 12%). From that estimate, penicillin treatment would be expected to result in an incidence of 0 to 3 cases of anaphylaxis per 100,000 treated. Any adverse reactions were reported in 6,377 patients among 3,465,322 treated with penicillin (pooled absolute risk = 0.169%; 95% CI: 0.073%–0.265% I2 = 97%). The quality of evidence was very low. Conclusion Studies that assessed the risk of serious adverse events due to benzathine penicillin treatment in pregnant women were scarce, but no reports of adverse reactions were found. The incidence of severe adverse outcomes was very low in the general population. The risk of treating pregnant women with benzathine penicillin to prevent congenital syphilis appears very low and does not outweigh its benefits. Further research is needed to improve the

  15. Respondent-Driven Sampling of Injection Drug Users in Two U.S.–Mexico Border Cities: Recruitment Dynamics and Impact on Estimates of HIV and Syphilis Prevalence

    PubMed Central

    Brouwer, Kimberly C.; Firestone Cruz, Michelle A.; Ramos, Rebeca; Ramos, Maria Elena; Lozada, Remedios M.; Magis-Rodriguez, Carlos; Strathdee, Steffanie A.

    2006-01-01

    Respondent-driven sampling (RDS), a chain referral sampling approach, is increasingly used to recruit participants from hard-to-reach populations, such as injection drug users (IDUs). Using RDS, we recruited IDUs in Tijuana and Ciudad (Cd.) Juárez, two Mexican cities bordering San Diego, CA and El Paso, TX, respectively, and compared recruitment dynamics, reported network size, and estimates of HIV and syphilis prevalence. Between February and April 2005, we used RDS to recruit IDUs in Tijuana (15 seeds, 207 recruits) and Cd. Juárez (9 seeds, 197 recruits), Mexico for a cross-sectional study of behavioral and contextual factors associated with HIV, HCV and syphilis infections. All subjects provided informed consent, an anonymous interview, and a venous blood sample for serologic testing of HIV, HCV, HBV (Cd. Juárez only) and syphilis antibody. Log-linear models were used to analyze the association between the state of the recruiter and that of the recruitee in the referral chains, and population estimates of the presence of syphilis antibody were obtained, correcting for biased sampling using RDS-based estimators. Sampling of the targeted 200 recruits per city was achieved rapidly (2 months in Tijuana, 2 weeks in Cd. Juárez). After excluding seeds and missing data, the sample prevalence of HCV, HIV and syphilis were 96.6, 1.9 and 13.5% respectively in Tijuana, and 95.3, 4.1, and 2.7% respectively in Cd. Juárez (where HBV prevalence was 84.7%). Syphilis cases were clustered in recruitment trees. RDS-corrected estimates of syphilis antibody prevalence ranged from 12.8 to 26.8% in Tijuana and from 2.9 to 15.6% in Ciudad Juárez, depending on how recruitment patterns were modeled, and assumptions about how network size affected an individual’s probability of being included in the sample. RDS was an effective method to rapidly recruit IDUs in these cities. Although the frequency of HIV was low, syphilis prevalence was high, particularly in Tijuana. RDS

  16. Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China.

    PubMed

    Chen, Yi; Abraham Bussell, Scottie; Shen, Zhiyong; Tang, Zhenzhu; Lan, Guanghua; Zhu, Qiuying; Liu, Wei; Tang, Shuai; Li, Rongjian; Huang, Wenbo; Huang, Yuman; Liang, Fuxiong; Wang, Lu; Shao, Yiming; Ruan, Yuhua

    2016-05-01

    Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40-49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%-2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%-0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients

  17. Prevalence of syphilis infection and associations with sexual risk behaviours among HIV-positive men who have sex with men in Shanghai, China.

    PubMed

    He, Huan; Wang, Min; Zaller, Nickolas; Wang, Jun; Song, Dandan; Qu, Yuhuang; Sui, Xin; Dong, Zhengxin; Operario, Don; Zhang, Hongbo

    2014-05-01

    The aims of this study were to understand the prevalence and correlates of syphilis infection among HIV-positive men who have sex with men (MSM) in Shanghai, China. A total of 200 HIV-positive MSM participants were recruited using "snowball" sampling. Participants were tested for syphilis and completed a one-time questionnaire which included demographic characteristics, sexual behaviours with male and female sexual partners, substance use, and use of antiretroviral medications. Prevalence of syphilis infection was 16.5%. Among HIV/syphilis co-infected participants, 63.6% reported having anal sex with male partners and 24.2% did not use condoms consistently during the past six months; 66.7% reported having oral sex with male partners and 51.5% reported unprotected oral sex during the past six months. Factors associated with testing seropositive for syphilis infection included receptive anal sex with a male partner in the past six months (AOR = 12.61, 90% CI = 2.38-66.89), illicit drug use in the past six months (AOR = 11.47, 90% CI = 2.47-53.45), and use of antiretroviral medication (AOR = 4.48, 90% CI = 1.43-14.05). These data indicate a need for "positive prevention" interventions targeting HIV-positive MSM in China. PMID:24285600

  18. Is there a legacy of the U.S. Public Health Syphilis Study at Tuskegee in HIV/AIDS-related beliefs among heterosexual African-Americans and Latinos?

    PubMed

    Mays, Vickie M; Coles, Courtney N; Cochran, Susan D

    2012-01-01

    Knowledge of the US Public Health Syphilis Study at Tuskegee is sometime cited as a principal reason for the relatively low participation rates seen among racial/ethnic minorities, particularly African Americans, in biomedical research. However, only a few studies have actually explored this possibility. We use data from a random digit dial telephone survey of 510 African-Americans and 253 Latinos, age 18 to 45 years, to investigate associations between knowledge of the USPHS Syphilis Study at Tuskegee and endorsement of HIV/AIDS conspiracy theories. All respondents were drawn from an area of low-income, predominantly race-segregated inner city households in Los Angeles. Results indicate that African Americans were significantly more likely than Latinos to endorse HIV/AIDS conspiracy theories. Further, African Americans were more aware of the USPHS Syphilis Study at Tuskegee (SST). Nevertheless, 72% of African Americans and 94% of Latinos reported that they have never heard of the Syphilis Study at Tuskegee. Further, while awareness of the Syphilis Study at Tuskegee was a significant predictor of endorsing HIV/AIDS conspiracy theories, results suggest that other factors may be more important in accounting for low biomedical and behavioral study participation rates. PMID:23308036

  19. Operations research study to implement HIV and syphilis point-of-care tests and assess client perceptions in a marginalised area of Lima, Peru.

    PubMed

    Flores, Elaine C; Lluque, Maria E; Chiappe, Marina; Lino, Rosabel; Bayer, Angela M

    2015-09-01

    In Peru, a significant proportion of people tested for HIV and syphilis do not receive timely results. Our objective was to assess the institutional feasibility of implementing simultaneous HIV/syphilis point-of-care tests and client perceptions regarding these point-of-care tests. Point-of-care tests were implemented in a hospital consultation room in a marginalised zone of Lima. A time-series design was used to compare the proportion of tested clients who received timely results, with and without the point-of-care test intervention. Experience and satisfaction with point-of-care tests was evaluated with 149 people. In the 6 months without intervention, 69% and 61% of clients tested for HIV and syphilis, respectively, received their results within the required 45-minute window. During the 2-month point-of-care test intervention, all clients tested for HIV (n = 387) and syphilis (n = 398) received their results within 45 minutes. All clients surveyed were completely satisfied (52%) or satisfied (48%) with the simultaneous HIV/syphilis point-of-care test screening process. Additionally, 73% strongly agreed with the statement 'I feel satisfied with the rapid testing process.' Screening using point-of-care tests represents an important opportunity to reduce the time, resource and cost burden for users and institutions and increase the proportion of users receiving their test results in a timely manner. PMID:25258394

  20. Bias in Self-Reported Condom Use: Association Between Over-Reported Condom Use and Syphilis in a Three-Site Study in China.

    PubMed

    Liu, Hongjie; Morisky, Donald E; Lin, Xinqin; Ma, Erjian; Jiang, Baofa; Yin, Yueping

    2016-06-01

    This study examined over-reporting bias in self-reported condom use and assessed its association with syphilis. A survey was conducted among 1245 female sex workers (FSWs) in three cities in China. Respondent's over-reported condom use was defined as reporting no unprotected sex for the past 24 h but testing positive for prostate specific antigen. The proportion of prevalent syphilis and active syphilis was 23 and 10 % respectively among FSWs. The proportion of over-reported condom use with sex clients only was 27-45 % among the three study sites. The proportion of over-reported condom use with all sex partners (clients, husbands, or boyfriends) was 26-46 %. FSWs who had active or prevalent syphilis were more likely to over report condom use. Self-reported condom use may not be a valid tool to measure the efficacy of HIV/STI intervention because the bias is associated with the outcome measure, i.e., syphilis. PMID:26696262

  1. Prevention of mother-to-child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination?

    PubMed Central

    Wu, Dadong; Hawkes, Sarah; Buse, Kent

    2015-01-01

    Objective The present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20 years prior to 2010. Methods We undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010. Results We identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization. Conclusion A dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas. PMID:25968490

  2. The difference between HIV and syphilis prevalence and incidence cases: results from a cohort study in Nanjing, China, 2008-2010.

    PubMed

    Tang, Weiming; Babu, Giridhara R; Li, Jianjun; Zhang, Ye; Fu, Gengfeng; Huan, Xiping; Tucker, Joseph D; Zhao, Jinkou; Detels, Roger

    2015-08-01

    The available estimates of incidence and prevalence of syphilis among men who have sex with men (MSM) in Mainland China are high. We used respondent-driven sampling to recruit MSM in the study population. The participants were followed up to monitor the incidence and change of risk behaviours. A face-to-face interview was used to collect information about high-risk behaviours, demographics and recreational drug use. To test the difference between prevalent and incident cases, two nested matched case-control studies were carried out. The cases were the HIV or syphilis positives found at baseline and during follow-up. We used density sampling to sample six controls for each case. Our results indicate that compared to incident cases, prevalent cases had a higher proportion of reported unprotected anal intercourse for both HIV and syphilis. Regression analysis indicated that unprotected anal intercourse was the main risk factor among HIV-prevalent cases but not in HIV-incident cases. These differences could possibly be explained by the implementation of the risk reduction interventions. Syphilis was not a risk factor for HIV-prevalent cases but was highly associated with HIV-incident cases. Tailored interventions addressing unprotected anal intercourse and other risk factors can help to reduce the prevalence and incidence of HIV and syphilis. PMID:25249593

  3. Detailed Knowledge of the Tuskegee Syphilis Study: Who Knows What? A Framework for Health Promotion Strategies

    PubMed Central

    Green, B. Lee; Li, Lin; Morris, J. Fontain; Gluzman, Rima; Davis, Jenna L.; Wang, Min Qi; Katz, Ralph V.

    2011-01-01

    This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents’ level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks’ scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research. PMID:21482701

  4. [Cancer or syphilis laryngis, politics or diagnostic failure--problems of Emperor Frederick's III disease].

    PubMed

    Betlejewski, Stanisław; Betlejewski, Andrzej

    2008-01-01

    The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported. In spite of fact, that the German laryngologists the patient's pathologic changes diagnosed as laryngeal cancer in early stage, the ultimate diagnosis was made too late for surgery to have any effect. This delay was due to the differences in opinions between the attending laryngologists; particularly between that of the English prominent laryngologist Morell Mackenzie and the Germans, prof. Gerhardt and prof. Bergmann. The roles of the British Queen Victoria as well as her daughter, the wife of Prince Frederick, the princess Victoria, in decisions about the treatment of the disease, are discussed. The behavior and the personality of Sir Morell Mackenzie played also a very important role in the course of the disease. Some medical facts and symptoms render it probable that syphilis was the underlying reason for the development of cancer. Crown Prince Frederick was a pipe smoker for at least 30 years before he died at the age of 57 years, so it may be possible, that the Emperor's laryngeal cancer was induced by tobacco. There are some suggestions, that the premature death of the King of Prussia and German Emperor Frederick III could be a critical turning point in European's history. PMID:19205539

  5. A mgl-like operon in Treponema pallidum, the syphilis spirochete.

    PubMed

    Porcella, S F; Popova, T G; Hagman, K E; Penn, C W; Radolf, J D; Norgard, M V

    1996-10-24

    A 38-kDa lipoprotein of Treponema pallidum subsp. pallidum (T. pallidum), the syphilis spirochete, previously was identified as a putative homolog of E. coli MglB [Becker et al. (1994) Infect. Immun. 62, 1381-1391]. In the present study, genome walking in regions adjacent to the T. pallidum 38-kDa lipoprotein gene has identified three contiguous genes (tp-mglB [formerly tpp38], tp-mglA, and tp-mglC) which appear to comprise a mgl-like operon in T. pallidum. A prominent transcript corresponding to tp-mglB, the first gene of the operon which encodes the carbohydrate receptor, is synthesized by T. pallidum along with lesser abundant transcript(s) corresponding to the entire T. pallidum mgl operon. An active promoter 135 bp upstream of tp-mglB is believed to direct mRNA synthesis for the operon. This is the first membrane protein-encoding operon of T. pallidum for which a putative function (glucose import) has been assigned. Furthermore, by analogy with E. coli MglB which interacts with the sensory transducer Trg to induce a chemotactic response, it is possible that T. pallidum also contains a homolog of E. coli Trg or other methyl-accepting chemotaxis proteins. The existence of a mgl operon in T. pallidum thus may have important implications with respect to T. pallidum survival, tissue dissemination, and sensory transduction during virulence expression. PMID:8921855

  6. The Binary Protein Interactome of Treponema pallidum – The Syphilis Spirochete

    PubMed Central

    Goll, Johannes; Häuser, Roman; McKevitt, Matthew T.; Palzkill, Timothy; Uetz, Peter

    2008-01-01

    Protein interaction networks shed light on the global organization of proteomes but can also place individual proteins into a functional context. If we know the function of bacterial proteins we will be able to understand how these species have adapted to diverse environments including many extreme habitats. Here we present the protein interaction network for the syphilis spirochete Treponema pallidum which encodes 1,039 proteins, 726 (or 70%) of which interact via 3,649 interactions as revealed by systematic yeast two-hybrid screens. A high-confidence subset of 991 interactions links 576 proteins. To derive further biological insights from our data, we constructed an integrated network of proteins involved in DNA metabolism. Combining our data with additional evidences, we provide improved annotations for at least 18 proteins (including TP0004, TP0050, and TP0183 which are suggested to be involved in DNA metabolism). We estimate that this “minimal” bacterium contains on the order of 3,000 protein interactions. Profiles of functional interconnections indicate that bacterial proteins interact more promiscuously than eukaryotic proteins, reflecting the non-compartmentalized structure of the bacterial cell. Using our high-confidence interactions, we also predict 417,329 homologous interactions (“interologs”) for 372 completely sequenced genomes and provide evidence that at least one third of them can be experimentally confirmed. PMID:18509523

  7. Cardiovascular syphilis complicated by Lower thoracic and upper abdominal aneurysm - A rare case report.

    PubMed

    Gayathri, K; Shankar, S Vijay; Venkatesan, S; Kalaivani, S

    2016-01-01

    A 50-year-old male presented with left lower abdominal pain, visible pulsation below xiphoid process, and tenderness in the left iliac fossa for the past 10 days. Chest X-ray revealed blunting of left cardiophrenic angle. Echocardiogram revealed descending thoracic aortic pseudoaneurysm. Contrast-enhanced computed tomography of the chest and abdomen revealed dissecting aneurysm of lower thoracic and upper abdominal aorta. Thoracoabdominal aortogram revealed erosion of D12 vertebra and infected aneurysm of adjacent thoracoabdominal aorta. Serum venereal disease research laboratory assay was positive in 1:4 dilution Treponema pallidum hemagglutination assay was positive. The patient was treated with Injection procaine penicillin for 20 days undercover of steroids. Cerebrospinal fluid analysis was normal. Aortic aneurysm repair with reconstruction was done. Histopathology was in favor of syphilitic etiology. This case is being presented as descending thoracic and upper abdominal aortic aneurysm due to syphilis complicated by dissection and erosion of vertebral body is rare and has not been reported nowadays to the best of our knowledge. PMID:27190418

  8. The genome of Treponema pallidum: new light on the agent of syphilis.

    PubMed

    Weinstock, G M; Hardham, J M; McLeod, M P; Sodergren, E J; Norris, S J

    1998-10-01

    Treponema pallidum subsp, pallidum, the causative agent of the sexually transmitted disease syphilis, is a fastidious, microaerophilic obligate parasite of humans. This bacterium is one of the few prominent infectious agents that has not been cultured continuously in vitro and consequently relatively little is known about its virulence mechanisms at the molecular level. T. pallidum therefore represented an attractive candidate for genomic sequencing. The complete genome sequence of T. pallidum has now been completed and comprises 1,138,006 base pairs containing 1041 predicted protein coding sequences. An important goal of this project is to identify possible virulence factors. Analysis of the genome indicates a number of potential virulence factors including a family of 12 proteins related to the Msp protein of Treponema denticola, a number of putative hemolysins, as well as several other classes of proteins of interest. The results of this analysis are reviewed in this article and indicate the value of whole genome sequences for rapidly advancing knowledge of infectious agents. PMID:9862125

  9. Cardiovascular syphilis complicated by Lower thoracic and upper abdominal aneurysm – A rare case report

    PubMed Central

    Gayathri, K.; Shankar, S. Vijay; Venkatesan, S.; Kalaivani, S.

    2016-01-01

    A 50-year-old male presented with left lower abdominal pain, visible pulsation below xiphoid process, and tenderness in the left iliac fossa for the past 10 days. Chest X-ray revealed blunting of left cardiophrenic angle. Echocardiogram revealed descending thoracic aortic pseudoaneurysm. Contrast-enhanced computed tomography of the chest and abdomen revealed dissecting aneurysm of lower thoracic and upper abdominal aorta. Thoracoabdominal aortogram revealed erosion of D12 vertebra and infected aneurysm of adjacent thoracoabdominal aorta. Serum venereal disease research laboratory assay was positive in 1:4 dilution Treponema pallidum hemagglutination assay was positive. The patient was treated with Injection procaine penicillin for 20 days undercover of steroids. Cerebrospinal fluid analysis was normal. Aortic aneurysm repair with reconstruction was done. Histopathology was in favor of syphilitic etiology. This case is being presented as descending thoracic and upper abdominal aortic aneurysm due to syphilis complicated by dissection and erosion of vertebral body is rare and has not been reported nowadays to the best of our knowledge. PMID:27190418

  10. Clinical and pathologic diagnosis and different diagnosis of syphilis cervical lymphadenitis

    PubMed Central

    Yuan, Yufen; Zhang, Xinlian; Xu, Nan; Wang, Libo; Li, Fangchao; Zhang, Ping; Miao, Lanfang; Yang, Haijun

    2015-01-01

    Purpose: To study the clinical pathologic characteristics and differential diagnosis of syphilitic cervical lymphadenitis, and to improve the rate of its diagnosis and treatment. Methods: Retrospectively analyzed the clinical history, Trepone pallidum-ELISA (TP-ELISA), rapid plasma regain test (RPR) and routine pathological examination of the patient diagnosed as syphilis lymphadenitis. And review related literatures. Results: The main clinical presentation was multiple palpable cervical lymph nodes. The multiple nodes were hard, fixed, and the major diameter of the larger one was 2 cm. The main pathological changes included: the capsule was significantly thickened; reactive hyperplasia of lymphoid follicular with sky star phenomenon; occlusive endovasculitis; perivascular inflammation; the proliferation of epithelioid histiocytes can form granulomas with few multinucleated giant cells; few necrosis. TP-ELISA and RPR were positive. Conclusions: The pathological changes of syphilitic lymphadenitis have a variety of performance with relatively specific and suggestive alterations which requires a combination of clinical history and laboratory test before the diagnosis, and the clinicians can reduce misdiagnosis and missed diagnosis of the disease by increasing vigilance of it. PMID:26722588

  11. Detailed knowledge of the Tuskegee syphilis study: who knows what? A framework for health promotion strategies.

    PubMed

    Green, B Lee; Li, Lin; Morris, J Fontain; Gluzman, Rima; Davis, Jenna L; Wang, Min Qi; Katz, Ralph V

    2011-12-01

    This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents' level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks' scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research. PMID:21482701

  12. Cavernous sinus syndrome, an atypical presentation of tertiary syphilis: case report and review of the literature.

    PubMed

    Noel, Colin B; Moeketsi, Khulile; Kies, Bryan

    2011-01-01

    Cavernous sinus syndrome is rarely caused by tertiary syphilitic infection. To our knowledge only two other cases of cavernous sinus syndrome caused by syphilis have been reported in the literature. We report a case of a 62-year-old female who presented with a mass in the cavernous sinus, which was initially diagnosed as a meningioma radiologically, necessitating a biopsy for diagnostic confirmation. Clinical features of syphilitic aortitis and subsequent positive neurosyphilis laboratory results lead to the suspicion of a gumma infiltrating the cavernous sinus. Empirical treatment with penicillin in an attempt to defer the need for biopsy led to both significant clinical improvement and radiological resolution. This confirmed the diagnosis of a syphilitic gumma in the cavernous sinus. In this paper we emphasize the rarity of cavernous sinus syndrome as a result of syphilitic infection, highlight the diagnostic difficulties using current serological and radiological measures, and propose treating intracerebral mass lesions in serum positive cases empirically prior to more invasive measures. PMID:20884116

  13. Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features

    PubMed Central

    Singh, Ameeta E.; Romanowski, Barbara

    1999-01-01

    Syphilis is a chronic disease with a waxing and waning course, the manifestations of which have been described for centuries. It occurs worldwide, and the incidence varies significantly with geographic location. Transmission is mainly by sexual contact. The causative organism, Treponema pallidum, was first described in 1905, but because of the inability to culture the organism and the limitations of direct microscopy, serologic testing is the mainstay of laboratory diagnosis. The disease has been arbitrarily divided into several stages. The primary stage is defined by a chancre at the site of inoculation. The secondary stage is characterized by a polymorphic rash, lymphadenopathy, and other systemic manifestations. A variable asymptomatic latent period follows, which for epidemiologic purposes is divided into early (<1 year) and late (>1 year) stages. The early stages (primary, secondary, and early latent) are potentially infectious. The tertiary stage is the most destructive and is marked by cardiovascular and neurologic sequelae and gummatous involvement of any organ system. Congenital infection may result in protean early or late manifestations. Unlike many other bacteria causing infectious diseases, the organism remains sensitive to penicillin, and this remains the mainstay of therapy. PMID:10194456

  14. High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis.

    PubMed

    Lu, Haikong; Li, Kang; Gong, Weimin; Yan, Limeng; Gu, Xin; Chai, Ze; Guan, Zhifang; Zhou, Pingyu

    2015-02-01

    The preferred drugs for the treatment of syphilis, benzathine and procaine penicillin, have not been available in Shanghai for many years, and currently, the incidence of syphilis is increasing. Alternative antibiotics for patients with syphilis during the benzathine and procaine penicillin shortage include macrolides. The failure of macrolide treatment in syphilis patients has been reported in Shanghai, but the reason for this treatment failure remains unclear. We used polymerase chain reaction technology to detect a 23S rRNA A2058G mutation in Treponema pallidum in 109 specimens from syphilis patients. The use of azithromycin/erythromycin in the syphilis patients and the physicians' prescription habits were also assessed based on two questionnaires regarding the use of macrolides. A total of 104 specimens (95.4%) were positive for the A2058G mutation in both copies of the 23S rRNA gene, indicating macrolide resistance. A questionnaire provided to 122 dermatologists showed that during the penicillin shortage, they prescribed erythromycin and azithromycin for 8.24±13.95% and 3.21±6.37% of their patients, respectively, and in the case of penicillin allergy, erythromycin and azithromycin were prescribed 15.24±22.89% and 7.23±16.60% of the time, respectively. A second questionnaire provided to the syphilis patients showed that 150 (33.7%), 106 (23.8%) and 34 (7.6%) individuals had used azithromycin, erythromycin or both, respectively, although the majority did not use the drugs for syphilis treatment. Our findings suggest that macrolide resistance in Treponema pallidum is widespread in Shanghai. More than half of the syphilis patients had a history of macrolide use for other treatment purposes, which may have led to the high prevalence of macrolide resistance. Physicians in China are advised to not use azithromycin for early syphilis. PMID:26038763

  15. High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis

    PubMed Central

    Lu, Haikong; Li, Kang; Gong, Weimin; Yan, Limeng; Gu, Xin; Chai, Ze; Guan, Zhifang; Zhou, Pingyu

    2015-01-01

    The preferred drugs for the treatment of syphilis, benzathine and procaine penicillin, have not been available in Shanghai for many years, and currently, the incidence of syphilis is increasing. Alternative antibiotics for patients with syphilis during the benzathine and procaine penicillin shortage include macrolides. The failure of macrolide treatment in syphilis patients has been reported in Shanghai, but the reason for this treatment failure remains unclear. We used polymerase chain reaction technology to detect a 23S rRNA A2058G mutation in Treponema pallidum in 109 specimens from syphilis patients. The use of azithromycin/erythromycin in the syphilis patients and the physicians' prescription habits were also assessed based on two questionnaires regarding the use of macrolides. A total of 104 specimens (95.4%) were positive for the A2058G mutation in both copies of the 23S rRNA gene, indicating macrolide resistance. A questionnaire provided to 122 dermatologists showed that during the penicillin shortage, they prescribed erythromycin and azithromycin for 8.24±13.95% and 3.21±6.37% of their patients, respectively, and in the case of penicillin allergy, erythromycin and azithromycin were prescribed 15.24±22.89% and 7.23±16.60% of the time, respectively. A second questionnaire provided to the syphilis patients showed that 150 (33.7%), 106 (23.8%) and 34 (7.6%) individuals had used azithromycin, erythromycin or both, respectively, although the majority did not use the drugs for syphilis treatment. Our findings suggest that macrolide resistance in Treponema pallidum is widespread in Shanghai. More than half of the syphilis patients had a history of macrolide use for other treatment purposes, which may have led to the high prevalence of macrolide resistance. Physicians in China are advised to not use azithromycin for early syphilis. PMID:26038763

  16. Screening for asymptomatic lymphogranuloma venereum co-infection in men who have sex with men newly diagnosed with HIV, hepatitis C or syphilis.

    PubMed

    Pallawela, Sns; Bradshaw, D; Hodson, L; Rehill, K; Wong, F; Rockwood, N; Gedela, K; Hardie, J; Price, H; Alexander, S; McLean, K; Dean, G; Smith, A; Sullivan, A K

    2016-07-01

    Patients diagnosed with lymphogranuloma venereum have high rates of co-infection with HIV, syphilis and hepatitis C. The aim of this enhanced surveillance was to screen all men who have sex with men (MSM) newly diagnosed with HIV, syphilis or hepatitis C for co-infection with asymptomatic lymphogranuloma venereum as part of the recommended sexual health screen. Of the 145 patients screened, 21 patients were diagnosed with rectal Chlamydia trachomatis, one with both rectal and urethral chlamydia and six with urethral chlamydia. One rectal chlamydia-positive sample, when tested, was equivocal for lymphogranuloma venereum. Our data suggested that there was not a pool of asymptomatic lymphogranuloma venereum infection in MSM recently diagnosed with HIV, hepatitis C and syphilis. However, there have been recent reports of an increased incidence of asymptomatic lymphogranuloma venereum, raising the question whether lymphogranuloma venereum should be screened for in high risk asymptomatic MSM. The prevalence of asymptomatic rectal chlamydia infections was 19%. PMID:26158451

  17. Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody.

    PubMed

    Fukuda, Hidetsugu; Takahashi, Misaki; Kato, Keiichi; Oharaseki, Toshiaki; Mukai, Hideki

    2015-05-01

    Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase. PMID:25708895

  18. High incidence of HIV and syphilis among migrant men who have sex with men in Beijing, China: a prospective cohort study

    PubMed Central

    Mao, Hengyi; Ma, Wenzhe; Lu, Hongyan; Wang, Lu; Zheng, Hui; Zhu, Yingying; Peng, Zhihang; Yu, Rongbin; Wang, Ning

    2014-01-01

    Objectives The purpose of the study was to investigate the incidence of HIV and syphilis and their related factors, as well as to examine the predictors associated with seroconversion among migrant men who have sex with men (MSM) in Beijing, China. Design Prospective cohort study. Setting Beijing, China. Participants 511 HIV-negative migrant MSM. Primary and secondary outcome measures Sociodemographic and behavioural information of participants, HIV and syphilis incidence rates, and factors associated with HIV/syphilis seroconversion and cohort retention. Results Of the 511 participants, 60.3% (308) and 52.4% (273) were retained at the 4- and 8-month follow-up visits, respectively. The HIV and syphilis incidence rates were 7.83 (95% CI 4.48 to 12.72) and 11.11 (95% CI 6.47 to 17.80) per 100 person-years, respectively. HIV seroconversion was significantly associated with ‘had first anal intercourse at age 15 or younger’ (adjusted HR (aHR) 9.20, 95% CI 1.94 to 43.56) and ‘ever had group sex’ (aHR 4.30, 95% CI 1.40 to 13.18). Bisexual orientation (aHR 5.09, 95% CI 1.02 to 25.57) was significantly associated with syphilis seroconversion. Predictors associated with both 4- and 8-month retention rates included age ≥25 years old and living in Beijing for more than 1 year. Conclusions The high incidence of HIV and syphilis among migrant MSM is a cause for concern. A comprehensive strategy should be implemented to maintain a higher retention rate among migrant MSM. PMID:25227626

  19. Conventional systemic treatments associated with therapeutic sites of local lesions of secondary syphilis in the oral cavity in patients with AIDS.

    PubMed

    Giovani, Elcio Magdalena; de Paula Neto, Edson Rodrigues; Vieira, Bruno Caputo; de Andrade, Daniela Miranda Richarte

    2012-01-01

    Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions. PMID:23422616

  20. Rates of HIV, syphilis, and HCV infections among different demographic groups of female sex workers in Guangxi China: Evidence from 2010 national sentinel surveillance data

    PubMed Central

    Zhou, Yuejiao; Li, Xiaoming; Zhang, Chen; Tan, Guangjie; Stanton, Bonita; Zhang, Xiaojuan; Cui, Yan

    2014-01-01

    To examine the prevalence of HIV, syphilis, and hepatitis C virus (HCV) infections by demographic characteristics and identify the subgroups of female sex workers (FSW) who are at a higher risk of the infections. Secondary analysis of the 2010 National Sentinel Surveillance (NSS) data was conducted in the current study. A total of 12,622 FSW recruited from 35 NSS sites in Guangxi, China were included in the analysis. FSW were tested for HIV, syphilis, and HCV. The overall prevalence of HIV, syphilis, and HCV infections were 1.0%, 6.1% and 1.0%, respectively. The prevalence of HIV and syphilis infections were significantly higher among women who aged 40 years or older, worked in small commercial sex venues or on street, divorced or widowed, or no formal schooling. A very high HIV infection prevalence (8.2%) was observed among a small number of cross-border foreign FSW (n=49). The prevalence of HCV infection did not differ by most of the demographic characteristics. Living in other provinces or being a Zhuang-ethnic served as protective factors for HCV. The multivariable analyses confirmed the results of bivariate results suggesting higher prevalence of HIV and syphilis infections among FSW who were older, divorced or widowed, or no formal schooling. Future HIV intervention prevention efforts among FSW need to pay particular attention to these women in order to effectively curtail the infections among this most-at-risk population as well as to prevent the further spread of HIV and syphilis to other populations. PMID:23438031

  1. A negative nontreponemal and/or specific antitreponemal IgM test does not exclude active infectious syphilis: evidence from a rabbit infectivity test

    PubMed Central

    Lin, Li-Rong; Tong, Man-Li; Gao, Kun; Zhu, Xiao-Zhen; Fan, Jin-Yi; Zheng, Wei-Hong; Li, Shu-Lian; Lin, Hui-Ling; Liu, Li-Li; Yang, Tian-Ci

    2016-01-01

    Abstract Background: The diagnostic criteria for active infectious syphilis in the clinic are important matter of controversy and debate. So far, clinicians habitually do use the negative results of the nontreponemal and/or the specific antitreponemal IgM as the evidences of disease-free or active infection-free status. Method: We present a case study involving a patient who was admitted to Zhongshan Hospital because of cerebral infarct. Clinical examination indicated he had a history of latent syphilis with negative nontreponemal and specific antitreponemal IgM tests. The cerebrospinal fluid sample from the patient was inoculated into seronegative New Zealand rabbit. Results: Motile Treponema pallidum was detected by a rabbit infectivity test in the patient's cerebrospinal fluid. This syphilis strain was confirmed by DNA subtyping form of “centers for disease control subtype/tp0548 sequence type”, and the strain type was 14d/f. Treatment with benzathine penicillin provided no apparent benefit, but treatment with aqueous crystalline penicillin G, especially recommended for neurosyphilis, led to disease regression. No evidence of cerebral infarct was observed during a 2-year follow-up period. Conclusion: The definitive differential diagnosis of active infectious syphilis should be reconsidered. Moreover, selecting the appropriate penicillin preparation is important because T pallidum can reside in sequestered sites. It is necessary to treat a patient with known invasion of the central nervous system with aqueous crystalline penicillin G, if previous treatment for syphilis failed and patients had some clinical neurological presentation that is otherwise unexplained, but that could represent neurosyphilis. Additional studies are needed to confirm the results in other syphilis patients. PMID:27495107

  2. A Decline in HIV and Syphilis Epidemics in Chinese Female Sex Workers (2000–2011): A Systematic Review and Meta-Analysis

    PubMed Central

    Yang, Zongxing; Su, Junwei; Peng, Xiaorong; Wu, Nanping

    2013-01-01

    Background Female sex workers (FSWs) play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, the trends in HIV and syphilis epidemics in Chinese FSWs in the period after 2000 are unclear to date. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was followed. Seven databases were searched for published peer-reviewed articles. The incidence of HIV and syphilis in FSWs in different time periods, provinces and workplaces in China were separately pooled by meta-analysis. Correlation analysis was conducted between HIV and syphilis incidence and study time, respectively. Results After 1,662 articles were screened, 190 published papers were included in the final analysis. Estimated HIV prevalence was 0.284% (95% CI: 0.080–0.488%) in the period 2000–2002, 0.211% (95% CI: 0.149–0.273%) in 2003–2005, 0.242% (95% CI: 0.190–0.294%) in 2006–2008 and 0.041% (95% CI: 0.024–0.058%) in 2009–2011. The corresponding syphilis prevalence was 9.669% (95% CI: 7.810–11.529%), 4.970% (95% CI: 4.384–5.556%), 4.404% (95% CI: 4.032–4.775%) and 3.169% (95% CI: 2.738–3.600%), respectively. Spearman rank correlation coefficients were −0.165 (p = 0.002) between HIV prevalence and study time, and −0.209 (p = 0.000) between syphilis prevalence and study time. The combined HIV prevalence was 0.318% (95% CI: 0.156–0.479%) in medium and high-tier workplaces and 0.393% (95% CI: 0.176–0.610%) in low-tier workplaces. The corresponding syphilis prevalence was 3.216% (95% CI: 2.192–4.240%) and 13.817% (95% CI: 10.589–17.044%), respectively. Conclusions Our data suggested a decline in HIV and syphilis epidemics in FSWs in China on a national level during the study period (2000–2011). FSWs in low-tier workplaces should be given more attention in the future to ensure they are included in prevention programs for HIV and sexually transmitted diseases. PMID:24349288

  3. Bridging the Epidemic: A Comprehensive Analysis of Prevalence and Correlates of HIV, Hepatitis C, and Syphilis, and Infection among Female Sex Workers in Guangxi Province, China

    PubMed Central

    Chen, Yi; Shen, Zhiyong; Morano, Jamie P.; Khoshnood, Kaveh; Wu, Zunyou; Lan, Guanghua; Zhu, Qiuying; Zhou, Yuejiao; Tang, Shuai; Liu, Wei; Chen, Jie; Tang, Zhenzhu

    2015-01-01

    Introduction Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi. Methods The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection. Results HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74). Conclusions This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010–2012. PMID:25723548

  4. Syphilis and human experimentation from the first appearance of the disease to World War II: a historical perspective and reflections on ethics.

    PubMed

    Cuerda-Galindo, E; Sierra-Valentí, X; González-López, E; López-Muñoz, F

    2014-10-01

    Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there. PMID:24268559

  5. Risk factors for HIV and syphilis infection among male sex workers who have sex with men: a cross-sectional study in Hangzhou, China, 2011

    PubMed Central

    Luo, Yan; Zhu, Chunyan; Chen, Shuchang; Geng, Qingshan; Fu, Rong; Li, Xiting; Xu, Ke; Cheng, Jie; Ding, Jianming

    2015-01-01

    Objective To investigate the prevalence and risk factors of HIV and syphilis infection among men who have sex with men (MSM) in male sex workers (MSW). Design Cross-sectional survey. Setting Hangzhou, China. Participants 259 MSW in MSM were recruited by respondent-driven sampling from May 2011 to December 2011.The inclusion criteria were: (1) age ≥18 years; (2) engaging in sex with men in the previous year and (3) willing to cooperate in the implementation of the study. Outcome measures HIV-related knowledge, high-risk behaviour and condom use. Results Among these MSW in MSM, 23.2% were infected with HIV and/or syphilis, 8.9% were infected only with HIV, 12.7% only with syphilis and 1.5% with HIV/syphilis co-infection; 96.6% sold sex to males, 8.9% bought sex from males and 15.4% sold sex to females; 49.0% had non-commercial sex behaviours with males and 24.3% with females. The rate of condom use while having commercial sex with clients was 86.9% and 53.3% (selling anal and oral sex to males, respectively), 95.5% (buying sex from males) and 77.5% (selling sex to females), respectively. Regarding their non-commercial sex behaviour, the rate of condom use was 77.2% (with males) and 49.2% (with females), respectively. Multivariate analysis showed that age >30 years (OR 1.055; 95% CIs 1.015 to 1.095) and having ≥10 non-commercial male sex partners (OR, 1.573; 95% CI 1.018 to 2.452) were significantly associated with HIV/syphilis infection, while heterosexuality (OR, 0.238; 95% CI 0.066 to 0.855) was significantly associated with a low HIV/syphilis infection rate. Conclusions The MSW in MSM population in Hangzhou has a high prevalence of HIV/syphilis infection, poor perceived risks of HIV and more engagement in unsafe sex with its clients and partners, in addition to a low rate of condom use. These risk factors may account for their relatively high infection rate of HIV/syphilis. PMID:25922096

  6. Would Targeting Increase Efficiency of Syphilis Partner Services Programs?—Data From New York City, Philadelphia, Texas, and Virginia

    PubMed Central

    Hoots, Brooke E.; Lewis, Felicia M.T.; Anschuetz, Greta; Schillinger, Julia A.; Blank, Susan; Foskey, Tammy; Stover, Jeffrey A.; Peterman, Thomas A.

    2016-01-01

    Background Targeted partner notification (PN), or limiting PN to groups in which efforts are most successful, has been suggested as a potentially cost-effective alternative to providing PN for all syphilis case-patients. The purpose of this study was to identify index case characteristics associated with highest yield partner elicitation and subsequent case finding to determine whether some groups could be reasonably excluded from PN efforts. Methods We examined index case characteristics and PN metrics from syphilis case management records of 4 sexually transmitted disease control programs—New York City, Philadelphia, Texas, and Virginia. Partner elicitation was considered successful when a case-patient named 1 or more partners during interview. Case finding was considered successful when a case-patient had 1 or more partners who were tested and had serologic evidence of syphilis exposure. Associations between case characteristics and proportion of pursued case-patients with successful partner elicitation and case finding were evaluated using χ2 tests. Results Successful partner elicitation and new case finding was most likely for index case-patients who were younger and diagnosed at public sexually transmitted disease clinics. However, most characteristics of index case-patients were related to success at only a few sites, or varied in the direction of the relationship by site. Other than late latent case-patients, few demographic groups had a yield far below average. Conclusions If implemented, targeted PN will require site-specific data. Sites may consider eliminating PN for late latent case-patients. The lack of demographic groups with a below average yield suggests that sites should not exclude other groups from PN. PMID:24825340

  7. Prevalence and risk factors associated with HIV infection, hepatitis and syphilis in a state prison of São Paulo.

    PubMed

    El Maerrawi, Ilham; Carvalho, Heráclito Barbosa

    2015-02-01

    Given the importance of the control of sexually transmitted infections in the general population and specifically in the prison system, we rolled out this cross-sectional study in 2007. Standard questionnaires and blood samples were accessed among 680 prisoners. The protocol was approved by the Ethics Committee. We determined the following seroprevalences: HIV, 1.8% (95%CI = 0.1-3.3); HBV, 21.0% (95%CI = 17.8-25.1); HBV, 5.3% (95%CI = 3.5-7.6) and syphilis 5.3% (95%CI = 3.5-7.6). Logistic regression identified significant associations with (p < 0.05): HIV: injectable drug use (OR = 15.4), age over 30 years (OR = 13.3), cocaine use (OR = 5.4) and crack-cocaine use (OR = 5.2); HBV: injectable drug use (OR = 3.4), history of previous sexually transmitted infection (OR = 2.3), age over 30 years (OR = 1.9) and more than 5 years in prison (OR = 2.2); HCV: injectable drug use (OR = 9.65), marijuana use in prison (OR = 2.9) and age over 30 years (OR = 8.4) and for syphilis: homosexual relationship (OR = 7.8) and previous syphilis reported (OR = 7.7). These prevalences remain high when compared to the general population, however, HIV infection had decreased compared with previous studies in prisoners while the other studied infections remained unchanged. Preventive actions to reduce sexual and parenteral risk have been advocated. However, measures capable of controlling these infections still have not made an impact. PMID:24733152

  8. Molecular Subtyping of Treponema pallidum during a Local Syphilis Epidemic in Men Who Have Sex with Men in Melbourne, Australia

    PubMed Central

    Ryan, Norbert; Fyfe, Janet; Leslie, David E.

    2012-01-01

    Treponema pallidum is the causative agent of syphilis, a sexually transmitted infection of significant public health importance. Since 2000 there has been a marked increase in the number of cases of syphilis infections notified in Victoria, Australia, with the majority of cases occurring in men who have sex with men (MSM) and the highest incidence being in HIV-infected MSM. The molecular subtyping method described by Pillay et al. (A. Pillay et al., Sex. Transm. Dis. 25:408–414, 1998) has been used in this study to determine the diversity of T. pallidum subtypes circulating locally and to look for any relationship between T. pallidum subtypes and HIV status over a 6-year period (2004 to 2009). Treponema pallidum DNA was detected in 303 patient specimens (n = 3,652), and full subtyping profiles were obtained from 90 of these (from 88 patients). A total of 11 T. pallidum subtypes were identified: types 14e (28, 31.1%), 14d (15, 16.7%), 14k (13, 14.4%), 14p (12, 13.3%), 14i (7, 7.8%) 14b (6, 6.7%), 14l (5, 5.6%), and 12i, 13b, 13i, and 13e (1 each, 1.1%). This study showed a similar level of variation among circulating T. pallidum strains compared with that in other studies using the same methodology. A different mix of strains and different predominating strains have been found at each geographical study location, with type 14e emerging as the predominant local strain in Victoria. There was no detectable trend between T. pallidum subtypes and the specimen collection site or stage of syphilis (where known), nor was there any relationship between particular strains and HIV status. PMID:22422857

  9. Prevalence and sociodemographic risk factors of chlamydia, gonorrhoea and syphilis: a national multicentre STI survey in New Caledonia, 2012

    PubMed Central

    Corsenac, Philippe; Noël, Martine; Rouchon, Bernard; Hoy, Damian; Roth, Adam

    2015-01-01

    Objectives To estimate prevalence and identify sociodemographic risk factors for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Treponema pallidum infections in New Caledonia. Method A national cross-sectional survey was undertaken using a three-stage random sampling of general practice surgeries and public dispensaries. Participants were included through opportunistic screening and using a systematic step for selection. The study sample was weighted to the general population aged 18–49 years. Prevalence and risk factors were calculated by logistic regression. Results CT was the most common sexually transmitted infection, with a prevalence of 9% (95% CI 6.6% to %11.4), followed by NG 3.5% (95% CI 1.9% to 5.1%), previous or latent syphilis 3% (95% CI 1.7% to 4.3%), NG and CT co-infection 2.1% (95% CI 0.8% to 3.3%) and active syphilis 0.4% (95% CI 0.0% to 0.9%). Being from a young age group (18–25 years), being single, having a low level of education and province of residence were all associated with higher prevalence of all three STIs. Being of Melanesian origin was associated with higher prevalence of both CT and NG. There was a significant interaction between ethnic group and province of residence for prevalence of CT. Female gender was associated with higher prevalence of CT. Conclusions The prevalence of CT was similar to estimates from other healthcare-based surveys from the Pacific, but higher for NG and lower for active syphilis infection. All sexually transmitted infections estimates were much higher than those found in population-based surveys from Europe and the USA. The sociodemographic risk factors identified in this study will help guide targeted prevention and control strategies in New Caledonia. PMID:26353867

  10. Evaluation of different confirmatory algorithms using seven treponemal tests on Architect Syphilis TP-positive/RPR-negative sera.

    PubMed

    Jonckheere, S; Berth, M; Van Esbroeck, M; Blomme, S; Lagrou, K; Padalko, E

    2015-10-01

    The Architect Syphilis TP is considered to be a suitable screening test due to its high sensitivity and full automation. According to the International Union against Sexually Transmitted Infections (IUSTI) 2014 guidelines, however, positive screening tests need confirmation with Treponema pallidum particle agglutination (TP.PA). Among Architect-positive results, samples with a negative non-treponemal test present the major diagnostic challenge. In this multicenter study, we investigated if other, preferable less labor-intensive treponemal tests could replace TP.PA. A total of 178 rapid plasma reagin (RPR)-negative sera with an Architect value between 1 and 15 S/CO were prospectively selected in three centers. These sera were analyzed with TP.PA and six alternative treponemal tests: three immunoblots and three tests on random-access analyzers. The diagnostic performance of the treponemal tests differed substantially, with the overall agreement between the six alternative tests ranging from 44.6 to 82.0%. Based on TP.PA as the gold standard, the INNO-LIA IgG blot, the BioPlex 2200 IgG, and the Syphilis TPA showed a high sensitivity, while the EUROLINE-WB IgG blot, recomLine Treponema IgG blot, and the Chorus Syphilis screen showed a high specificity. However, an Architect cut-off of 5.6 S/CO can serve as an alternative for these confirmatory treponemal tests in case of an RPR-negative result. Treponemal tests show poor agreement in this challenging group of Architect-positive/RPR-negative sera. The most optimal algorithm is obtained by assigning sera with an Architect value >5.6 S/CO as true-positives and sera with a value between 1 and 5.6 S/CO as undetermined, requiring further testing with TP.PA. PMID:26187433

  11. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta‐analysis

    PubMed Central

    Weiss, H A; Thomas, S L; Munabi, S K; Hayes, R J

    2006-01-01

    Objectives Male circumcision is associated with reduced risk of HIV infection. This may be partly because of a protective effect of circumcision on other sexually transmitted infections (STI), especially those causing genital ulcers, but evidence for such protection is unclear. Our objective was to conduct a systematic review and meta‐analyses of the associations between male circumcision and infection with herpes simplex virus type 2 (HSV‐2), Treponema pallidum, or Haemophilus ducreyi. Methods Electronic databases (1950–2004) were searched using keywords and text terms for herpes simplex, syphilis, chancroid, ulcerative sexually transmitted diseases, or their causative agents, in conjunction with terms to identify epidemiological studies. References of key articles were hand searched, and data were extracted using standardised forms. Random effects models were used to summarise relative risk (RR) where appropriate. Results 26 articles met the inclusion criteria. Most syphilis studies reported a substantially reduced risk among circumcised men (summary RR = 0.67, 95% confidence interval (CI) 0.54 to 0.83), although there was significant between study heterogeneity (p = 0.01). The reduced risk of HSV‐2 infection was of borderline statistical significance (summary RR = 0.88, 95% CI 0.77 to 1.01). Circumcised men were at lower risk of chancroid in six of seven studies (individual study RRs: 0.12 to 1.11). Conclusions This first systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis. There is less association with HSV‐2. Potential male circumcision interventions to reduce HIV in high risk populations may provide additional benefit by protecting against other STI. PMID:16581731

  12. Test Positivity for Chlamydia, Gonorrhea and Syphilis Infection Among a Cohort of Individuals Released from Jail in Marion County, Indiana

    PubMed Central

    Wiehe, Sarah E.; Barai, Nikita; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis

    2014-01-01

    Background Individuals entering jails have high rates of sexually transmitted infections (STI) but there are few data on STI in the post-incarceration period. This study aimed to describe rates of chlamydia, gonorrhea and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. Methods We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003–2008 (N=118,670). We linked county jail and public health data to identify individuals with positive STI test results in the one-year following release from jail. Rates per 100,000 individuals and cox proportional hazard analyses were performed for each STI, stratified by demographic, STI and jail characteristics. Results We found significantly higher rates of STI in this cohort than in the general population, with rates in the one-year following release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared to rates in the general population. Characteristics most associated with increased risk of a positive STI test among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. Conclusions This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population. PMID:25504298

  13. Expression of CXCL2 in the serum and cerebrospinal fluid of patients with HIV and syphilis or neurosyphilis.

    PubMed

    Tsai, Hung-Chin; Ye, Shin-Yu; Lee, Susan Shin-Jung; Wann, Shue-Ren; Chen, Yao-Shen

    2014-06-01

    The potential mechanisms for blood-brain barrier damage and the diagnosis of neurosyphilis in HIV patients co-infected with syphilis (HIV-S) are unclear. The aim of the study was to determine the expression of CXCL2 in the serum and cerebrospinal fluid (CSF) of HIV-S patients. A total of 34 HIV patients and 7 controls were enrolled in a HIV clinical cohort for diagnosis of neurosyphilis in Taiwan. Serum and CSF concentrations of CXCL2 were determined by ELISA. Neurosyphilis was defined as a CSF white blood cell count of ≧20 cells/μl or a reactive CSF Venereal Disease Research Laboratory (VDRL). Demographics and medical histories were collected. All the patients with HIV-S were males. Most (80%) had sex with men (MSM) and serum rapid plasma reagin (RPR) titers of ≧1:32. The medium age was 37 (range 21-68) years. The medium CD4 T cell counts at the time of the diagnosis of syphilis were 299 (range 92-434) cells/μl. Eight patients (24%) had neurosyphilis based on a reactive CSF VDRL test (n = 5) or increased CSF white blood cell counts of ≧20 cells/μl (n = 3). The concentrations of CSF CXCL2 were significantly higher in patients with HIV and neurosyphilis as compared to HIV with syphilis, HIV, and controls (p = 0.012). There were no significant differences in serum concentrations between the four groups. There was a correlation between CSF CXCL2 concentrations with neurosyphilis (p = 0.017), CSF white blood cell count (p = 0.001), and CSF protein levels (p = 0.005). The CSF level of CXCL2 can be used to distinguish those with or without neurosyphilis in HIV infected patients. PMID:24419746

  14. Seroprevalence and correlates of HIV, syphilis, and hepatitis B and C virus among intrapartum patients in Kabul, Afghanistan

    PubMed Central

    Todd, Catherine S; Ahmadzai, Malalay; Atiqzai, Faridullah; Miller, Suellen; Smith, Jeffrey M; Ghazanfar, Syed Alef Shah; Strathdee, Steffanie A

    2008-01-01

    Background Little current information is available for prevalence of vertically-transmitted infections among the Afghan population. The purpose of this study is to determine prevalence and correlates of human immunodeficiency virus (HIV), syphilis, and hepatitis B and C infection among obstetric patients and model hepatitis B vaccination approaches in Kabul, Afghanistan. Methods This cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood rapid testing with serum confirmation for antibodies to HIV, T. pallidum, and HCV, and HBsAg. Descriptive data and prevalence of infection were calculated, with logistic regression used to identify correlates of HBV infection. Modeling was performed to determine impact of current and birth dose vaccination strategies on HBV morbidity and mortality. Results Among 4452 women, prevalence of HBsAg was 1.53% (95% CI: 1.18 – 1.94) and anti-HCV was 0.31% (95% CI: 0.17 – 0.53). No cases of HIV or syphilis were detected. In univariate analysis, HBsAg was associated with husband's level of education (OR = 1.13, 95% CI: 1.01 – 1.26). Modeling indicated that introduction of birth dose vaccination would not significantly reduce hepatitis-related morbidity or mortality for the measured HBsAg prevalence. Conclusion Intrapartum whole blood rapid testing for HIV, syphilis, HBV, and HCV was acceptable to patients in Afghanistan. Though HBsAg prevalence is relatively low, periodic assessments should be performed to determine birth dose vaccination recommendations for this setting. PMID:18798996

  15. Prevalence of HIV, Herpes Simplex Virus-2, and Syphilis in male sex partners of pregnant women in Peru

    PubMed Central

    Clark, Jesse L; Konda, Kelika A; Munayco, Cesar V; Pún, Monica; Lescano, Andres G; Leon, Segundo R; Pajuelo, Jose; Suarez-Ognio, Luis; Klausner, Jeffrey D; Coates, Thomas J; Cáceres, Carlos F

    2008-01-01

    Background: Sexually active heterosexual men may represent an important risk factor for HIV infection and STI transmission to their female partners and unborn children, though little is known about the prevalence of STIs in this population. We sought to determine the prevalence of HIV, herpes simplex virus type 2 (HSV-2), and syphilis infection and associated risk behaviors among male sex partners of pregnant women in Peru. Methods: Survey and seroprevalence data were collected from 1,835 male partners of pregnant women in four cities in Peru. Serum was tested for antibodies to HIV, HSV-2, and syphilis. Results: Among the 1,835 male participants, HIV prevalence was 0.8% (95% CI = 0.5–1.4%), HSV-2 16.0% (95% CI = 14.3–17.8%), and syphilis 1.6% (95% CI = 1.0–2.2%). Additionally, 11.0% reported a lifetime history of intercourse with men, and 37.1% with female sex workers. Unprotected intercourse with men during the previous year was reported by 0.9% and with female sex workers by 1.2%. Conclusion: Pregnant women's sex partners reported lifetime sexual contact with core risk groups, had an elevated prevalence of HSV-2, and demonstrated the potential to spread HIV and other STIs to their partners. Though the prevalence of HIV in the population was not significantly higher than observed in other samples of heterosexuals in Peru, the risk of HIV transmission to their female partners may be exacerbated by their increased prevalence of HSV-2 infection. Further study of heterosexual populations is necessary to fully understand the epidemiology of HIV/STIs in Latin America. PMID:18284696

  16. Laboratory Evaluation of a Dual-Path Platform Assay for Rapid Point-of-Care HIV and Syphilis Testing.

    PubMed

    Leon, S R; Ramos, L B; Vargas, S K; Kojima, N; Perez, D G; Caceres, C F; Klausner, J D

    2016-02-01

    We assessed the laboratory performance of the Chembio dual-path platform HIV-syphilis rapid immunodiagnostic test and electronic reader for detection of HIV and Treponema pallidum antibodies in 450 previously characterized serum specimens. For visual or electronic reader HIV antibody detection, the sensitivity was 100% and the specificity was 98.7%. For visual T. pallidum antibody detection, the test sensitivity was 94.7% and the specificity was 100.0%; with the electronic reader, the sensitivity was 94.7% and the specificity was 99.7%. PMID:26659215

  17. Misinformation and misbeliefs in the Tuskegee Study of Untreated Syphilis fuel mistrust in the healthcare system.

    PubMed Central

    White, Robert M.

    2005-01-01

    The Tuskegee Study of Untreated Syphilis (TSUS) is an important issue in research, healthcare, ethics and race relations. The assumed consequences of knowledge of this study on the African-American community include mistrust of the healthcare system. In the July 2005 issue of the Journal of the National Medical Association, Brandon, Isaac and LaVeist (the authors), who were at the Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, reported the results of black-white differences in awareness of and knowledge about the TSUS and the effect of that awareness and knowledge on medical mistrust. The study surveyed blacks, whites and others in the Baltimore, MD community about their knowledge of and attitudes about the TSUS. The respondents who were aware of the TSUS were asked survey items to assess specific factual information about the TSUS. The respondents who were not aware of the TSUS were read a brief description of the TSUS taken from the CDC website. Both groups were asked if a similar study was possible today. The authors performed a regression analysis of mistrust of medical care based on race, knowledge of the TSUS and demographic variables. The editorial identified and explained challenges in the article, i.e., challenges in calculations, demographic analysis by race, knowledge of TSUS, cultural sensitivity and methodology. The authors miscalculated the "similar proportions" of blacks and whites who were aware of the TSUS; the recalculated proportions, favoring whites, were different than reported by others. There was no demographic analysis by race in their article--also different than other published reports. Most respondents--blacks and whites--who were aware of the TSUS at baseline answered incorrectly the author-selected questions about the TSUS, particularly the fact-based question of whether the TSUS researchers gave syphilis to the men-not dissimilar to one other report. The source for TSUS information (the CDC

  18. Cryo-Electron Tomography Elucidates the Molecular Architecture of Treponema pallidum, the Syphilis Spirochete▿ †

    PubMed Central

    Izard, Jacques; Renken, Christian; Hsieh, Chyong-Ere; Desrosiers, Daniel C.; Dunham-Ems, Star; La Vake, Carson; Gebhardt, Linda L.; Limberger, Ronald J.; Cox, David L.; Marko, Michael; Radolf, Justin D.

    2009-01-01

    Cryo-electron tomography (CET) was used to examine the native cellular organization of Treponema pallidum, the syphilis spirochete. T. pallidum cells appeared to form flat waves, did not contain an outer coat and, except for bulges over the basal bodies and widening in the vicinity of flagellar filaments, displayed a uniform periplasmic space. Although the outer membrane (OM) generally was smooth in contour, OM extrusions and blebs frequently were observed, highlighting the structure's fluidity and lack of attachment to underlying periplasmic constituents. Cytoplasmic filaments converged from their attachment points opposite the basal bodies to form arrays that ran roughly parallel to the flagellar filaments along the inner surface of the cytoplasmic membrane (CM). Motile treponemes stably attached to rabbit epithelial cells predominantly via their tips. CET revealed that T. pallidum cell ends have a complex morphology and assume at least four distinct morphotypes. Images of dividing treponemes and organisms shedding cell envelope-derived blebs provided evidence for the spirochete's complex membrane biology. In the regions without flagellar filaments, peptidoglycan (PG) was visualized as a thin layer that divided the periplasmic space into zones of higher and lower electron densities adjacent to the CM and OM, respectively. Flagellar filaments were observed overlying the PG layer, while image modeling placed the PG-basal body contact site in the vicinity of the stator-P-collar junction. Bioinformatics and homology modeling indicated that the MotB proteins of T. pallidum, Treponema denticola, and Borrelia burgdorferi have membrane topologies and PG binding sites highly similar to those of their well-characterized Escherichia coli and Helicobacter pylori orthologs. Collectively, our results help to clarify fundamental differences in cell envelope ultrastructure between spirochetes and gram-negative bacteria. They also confirm that PG stabilizes the flagellar motor

  19. Cryo-electron tomography elucidates the molecular architecture of Treponema pallidum, the syphilis spirochete.

    PubMed

    Izard, Jacques; Renken, Christian; Hsieh, Chyong-Ere; Desrosiers, Daniel C; Dunham-Ems, Star; La Vake, Carson; Gebhardt, Linda L; Limberger, Ronald J; Cox, David L; Marko, Michael; Radolf, Justin D

    2009-12-01

    Cryo-electron tomography (CET) was used to examine the native cellular organization of Treponema pallidum, the syphilis spirochete. T. pallidum cells appeared to form flat waves, did not contain an outer coat and, except for bulges over the basal bodies and widening in the vicinity of flagellar filaments, displayed a uniform periplasmic space. Although the outer membrane (OM) generally was smooth in contour, OM extrusions and blebs frequently were observed, highlighting the structure's fluidity and lack of attachment to underlying periplasmic constituents. Cytoplasmic filaments converged from their attachment points opposite the basal bodies to form arrays that ran roughly parallel to the flagellar filaments along the inner surface of the cytoplasmic membrane (CM). Motile treponemes stably attached to rabbit epithelial cells predominantly via their tips. CET revealed that T. pallidum cell ends have a complex morphology and assume at least four distinct morphotypes. Images of dividing treponemes and organisms shedding cell envelope-derived blebs provided evidence for the spirochete's complex membrane biology. In the regions without flagellar filaments, peptidoglycan (PG) was visualized as a thin layer that divided the periplasmic space into zones of higher and lower electron densities adjacent to the CM and OM, respectively. Flagellar filaments were observed overlying the PG layer, while image modeling placed the PG-basal body contact site in the vicinity of the stator-P-collar junction. Bioinformatics and homology modeling indicated that the MotB proteins of T. pallidum, Treponema denticola, and Borrelia burgdorferi have membrane topologies and PG binding sites highly similar to those of their well-characterized Escherichia coli and Helicobacter pylori orthologs. Collectively, our results help to clarify fundamental differences in cell envelope ultrastructure between spirochetes and gram-negative bacteria. They also confirm that PG stabilizes the flagellar motor

  20. Usefulness in clinical practice of a point-of-care rapid test for simultaneous detection of nontreponemal and Treponema pallidum-specific antibodies in patients suffering from documented syphilis.

    PubMed

    Guinard, Jérôme; Prazuck, Thierry; Péré, Hélène; Poirier, Claire; LeGoff, Jérôme; Boedec, Erwan; Guigon, Aurélie; Day, Nesrine; Bélec, Laurent

    2013-12-01

    The usefulness of a point-of-care immunochromatographic dual test for the simultaneous detection of both nontreponemal and Treponema pallidum-specific antibodies (Chembio Diagnostics Systems Inc., Medford, NY, USA) was assessed in various situations related to syphilis, by reference to conventional syphilis serology. Thawed sera were obtained from 100 adults including 36 primary syphilis, 6 secondary syphilis, 6 re-infection, 9 recently-treated syphilis, and 43 old syphilis. Doubtful reactivities for the treponemal line were considered positive; doubtful reactivities for the nontreponemal line were considered positive only when the treponemal line was present. The sensitivity, the specificity, and its concordance to gold standard serology of treponemal line were high, around 90%. The sensitivity of nontreponemal line was 96.3%, its specificity 76.7%, and its concordance 83.4%. In conclusion, the dual rapid test from Chembio Diagnostics Systems Inc. is useful for rapid point-of-care diagnosis in the various situations encountered with patients suffering from syphilis. PMID:23999937

  1. The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.

    PubMed

    Thomas, S B; Quinn, S C

    1991-11-01

    The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable. PMID:1951814

  2. Treponema pallidum (syphilis) antigen TpF1 induces angiogenesis through the activation of the IL-8 pathway

    PubMed Central

    Pozzobon, Tommaso; Facchinello, Nicola; Bossi, Fleur; Capitani, Nagaja; Benagiano, Marisa; Di Benedetto, Giulietta; Zennaro, Cristina; West, Nicole; Codolo, Gaia; Bernardini, Marialina; Baldari, Cosima Tatiana; D’Elios, Mario Milco; Pellegrini, Luca; Argenton, Francesco; de Bernard, Marina

    2016-01-01

    Over 10 million people every year become infected by Treponema pallidum and develop syphilis, a disease with broad symptomatology that, due to the difficulty to eradicate the pathogen from the highly vascularized secondary sites of infection, is still treated with injections of penicillin. Unlike most other bacterial pathogens, T. pallidum infection produces indeed a strong angiogenic response whose mechanism of activation, however, remains unknown. Here, we report that one of the major antigen of T. pallidum, the TpF1 protein, has growth factor-like activity on primary cultures of human endothelial cells and activates specific T cells able to promote tissue factor production. The growth factor-like activity is mediated by the secretion of IL-8 but not of VEGF, two known angiogenic factors. The pathogen’s factor signals IL-8 secretion through the activation of the CREB/NF-κB signalling pathway. These findings are recapitulated in an animal model, zebrafish, where we observed that TpF1 injection stimulates angiogenesis and IL-8, but not VEGF, secretion. This study suggests that the angiogenic response observed during secondary syphilis is triggered by TpF1 and that pharmacological therapies directed to inhibit IL-8 response in patients should be explored to treat this disease. PMID:26728351

  3. The origin and antiquity of syphilis revisited: an appraisal of Old World pre-Columbian evidence for treponemal infection.

    PubMed

    Harper, Kristin N; Zuckerman, Molly K; Harper, Megan L; Kingston, John D; Armelagos, George J

    2011-01-01

    For nearly 500 years, scholars have argued about the origin and antiquity of syphilis. Did Columbus bring the disease from the New World to the Old World? Or did syphilis exist in the Old World before 1493? Here, we evaluate all 54 published reports of pre-Columbian, Old World treponemal disease using a standardized, systematic approach. The certainty of diagnosis and dating of each case is considered, and novel information pertinent to the dating of these cases, including radiocarbon dates, is presented. Among the reports, we did not find a single case of Old World treponemal disease that has both a certain diagnosis and a secure pre-Columbian date. We also demonstrate that many of the reports use nonspecific indicators to diagnose treponemal disease, do not provide adequate information about the methods used to date specimens, and do not include high-quality photographs of the lesions of interest. Thus, despite an increasing number of published reports of pre-Columbian treponemal infection, it appears that solid evidence supporting an Old World origin for the disease remains absent. PMID:22101689

  4. Antigenic variation in Treponema pallidum: TprK sequence diversity accumulates in response to immune pressure during experimental syphilis1

    PubMed Central

    Giacani, Lorenzo; Molini, Barbara J.; Kim, Eric Y.; Godornes, B. Charmie; Leader, B. Troy; Tantalo, Lauren C.; Centurion-Lara, Arturo; Lukehart, Sheila A.

    2010-01-01

    Pathogens that cause chronic infections often employ antigenic variation to evade the immune response and persist in the host. In Treponema pallidum (T. pallidum), the causative agent of syphilis, the TprK antigen undergoes variation of seven variable regions (V1-V7) by nonreciprocal recombination of silent donor cassettes with the tprK expression site. These V regions are the targets of the host humoral immune response during experimental infection. The present study addresses the causal role of the acquired immune response in the selection of TprK variants in two ways: 1) by investigating TprK variants arising in immunocompetent vs immunosuppressed hosts, and 2) by investigating the effect of prior specific immunization on selection of TprK variants during infection. V region diversity, particularly in V6, accumulates more rapidly in immunocompetent rabbits than in pharmacologically immunosuppressed rabbits (treated with weekly injections of methylprednisolone acetate). In a complementary experiment, rabbits pre-immunized with V6 region synthetic peptides had more rapid accumulation of V6 variant treponemes than control rabbits. These studies demonstrate that the host immune response selects against specific TprK epitopes expressed on T. pallidum, resulting in immune selection of new TprK variants during infection, confirming a role for antigenic variation in syphilis. PMID:20190145

  5. Treponema pallidum putative novel drug target identification and validation: rethinking syphilis therapeutics with plant-derived terpenoids.

    PubMed

    Dwivedi, Upendra N; Tiwari, Sameeksha; Singh, Priyanka; Singh, Swati; Awasthi, Manika; Pandey, Veda P

    2015-02-01

    Syphilis, a slow progressive and the third most common sexually transmitted disease found worldwide, is caused by a spirochete gram negative bacteria Treponema pallidum. Emergence of antibiotic resistant T. pallidum has led to a search for novel drugs and their targets. Subtractive genomics analyses of pathogen T. pallidum and host Homo sapiens resulted in identification of 126 proteins essential for survival and viability of the pathogen. Metabolic pathway analyses of these essential proteins led to discovery of nineteen proteins distributed among six metabolic pathways unique to T. pallidum. One hundred plant-derived terpenoids, as potential therapeutic molecules against T. pallidum, were screened for their drug likeness and ADMET (absorption, distribution, metabolism, and toxicity) properties. Subsequently the resulting nine terpenoids were docked with five unique T. pallidum targets through molecular modeling approaches. Out of five targets analyzed, D-alanine:D-alanine ligase was found to be the most promising target, while terpenoid salvicine was the most potent inhibitor. A comparison of the inhibitory potential of the best docked readily available natural compound, namely pomiferin (flavonoid) with that of the best docked terpenoid salvicine, revealed that salvicine was a more potent inhibitor than that of pomiferin. To the best of our knowledge, this is the first report of a terpenoid as a potential therapeutic molecule against T. pallidum with D-alanine:D-alanine ligase as a novel target. Further studies are warranted to evaluate and explore the potential clinical ramifications of these findings in relation to syphilis that has public health importance worldwide. PMID:25683888

  6. Treponema pallidum (syphilis) antigen TpF1 induces angiogenesis through the activation of the IL-8 pathway.

    PubMed

    Pozzobon, Tommaso; Facchinello, Nicola; Bossi, Fleur; Capitani, Nagaja; Benagiano, Marisa; Di Benedetto, Giulietta; Zennaro, Cristina; West, Nicole; Codolo, Gaia; Bernardini, Marialina; Baldari, Cosima Tatiana; D'Elios, Mario Milco; Pellegrini, Luca; Argenton, Francesco; de Bernard, Marina

    2016-01-01

    Over 10 million people every year become infected by Treponema pallidum and develop syphilis, a disease with broad symptomatology that, due to the difficulty to eradicate the pathogen from the highly vascularized secondary sites of infection, is still treated with injections of penicillin. Unlike most other bacterial pathogens, T. pallidum infection produces indeed a strong angiogenic response whose mechanism of activation, however, remains unknown. Here, we report that one of the major antigen of T. pallidum, the TpF1 protein, has growth factor-like activity on primary cultures of human endothelial cells and activates specific T cells able to promote tissue factor production. The growth factor-like activity is mediated by the secretion of IL-8 but not of VEGF, two known angiogenic factors. The pathogen's factor signals IL-8 secretion through the activation of the CREB/NF-κB signalling pathway. These findings are recapitulated in an animal model, zebrafish, where we observed that TpF1 injection stimulates angiogenesis and IL-8, but not VEGF, secretion. This study suggests that the angiogenic response observed during secondary syphilis is triggered by TpF1 and that pharmacological therapies directed to inhibit IL-8 response in patients should be explored to treat this disease. PMID:26728351

  7. Syphilis 1855 and HIV-AIDS 2007: Historical reflections on the tendency to blame human anatomy for the action of micro-organisms.

    PubMed

    Darby, Robert

    2015-01-01

    In this paper, I discuss the parallels between responses to syphilis in nineteenth century Britain and HIV/AIDS in contemporary Africa. In each case, an incurable disease connected with sexual behaviour aroused fear, stigmatisation and moralistic responses, as well as a desperate scramble to find an effective means of control. In both cases, circumcision of adult males, and then of children or infants, was proposed as the key tactic. In the ensuing debates over the effectiveness and propriety of this approach, three questions occupied health authorities in both Victorian Britain and the contemporary world: (1) Were circumcised men at significantly lower risk of these diseases? (2) If there was evidence pointing to an affirmative answer, was it altered anatomy or different behaviour that explained the difference? (3) Given that circumcision was a surgical procedure with attendant risks of infection, was it possible that circumcision spread syphilis or HIV? I show that in both situations the answers to these questions were inconclusive, argue that circumcision played little or no role in the eventual control of syphilis and suggest that attention to nineteenth century debates may assist contemporary policy-makers to avoid the treatment dead-ends and ethical transgressions that marked the war on syphilis. PMID:25268631

  8. Comparison of the diagnostic accuracy of a rapid immunochromatographic test and the rapid plasma reagin test for antenatal syphilis screening in Mozambique.

    PubMed Central

    Montoya, Pablo J.; Lukehart, Sheila A.; Brentlinger, Paula E.; Blanco, Ana J.; Floriano, Florencia; Sairosse, Josefa; Gloyd, Stephen

    2006-01-01

    OBJECTIVE: Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods. We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) test and the rapid plasma reagin (RPR) test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy. METHODS: We included test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique. We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory. We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status. FINDINGS: For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility. The sensitivity of the RPR at the health facility was 70.7%. Specificity and positive and negative predictive values showed a similar pattern. The ICS outperformed RPR in all comparisons (P<0.001). CONCLUSION: The diagnostic accuracy of the ICS compared favourably with that of the gold standard. The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories. PMID:16501726

  9. Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature.

    PubMed

    Ali, Robert; Perez-Downes, Julio; Baidoun, Firas; Al Turk, Bashar; Isache, Carmen; Mohan, Girish; Perniciaro, Charles

    2016-01-01

    Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of "malignant" syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering. PMID:27313920

  10. Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature

    PubMed Central

    Al Turk, Bashar; Mohan, Girish

    2016-01-01

    Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of “malignant” syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering. PMID:27313920

  11. Whole Genome Sequence of the Treponema pallidum subsp. endemicum Strain Bosnia A: The Genome Is Related to Yaws Treponemes but Contains Few Loci Similar to Syphilis Treponemes

    PubMed Central

    Zobaníková, Marie; Čejková, Darina; Fulton, Lucinda L.; Chen, Lei; Giacani, Lorenzo; Centurion-Lara, Arturo; Bruisten, Sylvia M.; Sodergren, Erica; Weinstock, George M.; Šmajs, David

    2014-01-01

    Background T. pallidum subsp. endemicum (TEN) is the causative agent of bejel (also known as endemic syphilis). Clinical symptoms of syphilis and bejel are overlapping and the epidemiological context is important for correct diagnosis of both diseases. In contrast to syphilis, caused by T. pallidum subsp. pallidum (TPA), TEN infections are usually spread by direct contact or contaminated utensils rather than by sexual contact. Bejel is most often seen in western Africa and in the Middle East. The strain Bosnia A was isolated in 1950 in Bosnia, southern Europe. Methodology/Principal Findings The complete genome of the Bosnia A strain was amplified and sequenced using the pooled segment genome sequencing (PSGS) method and a combination of three next-generation sequencing techniques (SOLiD, Roche 454, and Illumina). Using this approach, a total combined average genome coverage of 513× was achieved. The size of the Bosnia A genome was found to be 1,137,653 bp, i.e. 1.6–2.8 kbp shorter than any previously published genomes of uncultivable pathogenic treponemes. Conserved gene synteny was found in the Bosnia A genome compared to other sequenced syphilis and yaws treponemes. The TEN Bosnia A genome was distinct but very similar to the genome of yaws-causing T. pallidum subsp. pertenue (TPE) strains. Interestingly, the TEN Bosnia A genome was found to contain several sequences, which so far, have been uniquely identified only in syphilis treponemes. Conclusions/Significance The genome of TEN Bosnia A contains several sequences thought to be unique to TPA strains; these sequences very likely represent remnants of recombination events during the evolution of TEN treponemes. This finding emphasizes a possible role of repeated horizontal gene transfer between treponemal subspecies in shaping the Bosnia A genome. PMID:25375929

  12. Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation

    PubMed Central

    Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Mumba, Grace Tembo; Gill, Michelle M.; Strasser, Susan; Peeling, Rosanna W.; Terris-Prestholt, Fern

    2015-01-01

    Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider’s perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in

  13. Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

    PubMed

    Shelley, Katharine D; Ansbro, Éimhín M; Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Tembo Mumba, Grace; Gill, Michelle M; Strasser, Susan; Peeling, Rosanna W; Terris-Prestholt, Fern

    2015-01-01

    Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider's perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in

  14. The Rationalization of Unethical Research: Revisionist Accounts of the Tuskegee Syphilis Study and the New Zealand "Unfortunate Experiment".

    PubMed

    Paul, Charlotte; Brookes, Barbara

    2015-10-01

    Two studies, widely condemned in the 1970s and 1980s-the Tuskegee study of men with untreated syphilis and the New Zealand study of women with untreated carcinoma in situ of the cervix-received new defenses in the 21st century. We noted remarkable similarities in both the studies and their defenses. Here we evaluate the scientific, political, and moral claims of the defenders. The scientific claims are largely based on incomplete or misinterpreted evidence and exaggeration of the uncertainties of science. The defenders' political arguments mistakenly claim that identity politics clouded the original critiques; in fact such politics opened the eyes of the public to exploitation. The moral defenses demonstrate an overreliance on codes of conduct and have implications for research ethics today. PMID:26270295

  15. Purification, crystallization and preliminary X-ray analysis of TP0435 (Tp17) from the syphilis spirochete Treponema pallidum

    PubMed Central

    Brautigam, Chad A.; Deka, Ranjit K.; Norgard, Michael V.

    2013-01-01

    Syphilis, caused by the bacterial spirochete Treponema pallidum, remains a prominent sexually transmitted infection worldwide. Despite sequencing of the genome of this obligate human pathogen 15 years ago, the functions of a large number of the gene products of T. pallidum are still unknown, particularly with respect to those of the organism’s periplasmic lipoproteins. To better understand their functions, a structural biology approach has been pursued. To this end, the soluble portion of the T. pallidum TP0435 lipoprotein (also known as Tp17) was cloned, hyper-expressed in Escherichia coli and purified to apparent homogeneity. The protein crystals obtained from this preparation diffracted to 2.4 Å resolution and had the symmetry of space group R3. In the hexagonal setting, the unit-cell parameters were a = b = 85.7, c = 85.4 Å. PMID:23545658

  16. Serodiagnosis of syphilis by enzyme-linked immunosorbent assay with purified recombinant Treponema pallidum antigen 4D.

    PubMed

    Radolf, J D; Lernhardt, E B; Fehniger, T E; Lovett, M A

    1986-06-01

    An enzyme-linked immunosorbent assay (ELISA) for syphilis has been developed that detects IgG antibody to purified recombinant Treponema pallidum surface antigen 4D. The 4D ELISA was capable of detecting 25 ng of 4D antigen-specific antibody. Neither 172 nonsyphilitic sera nor 20 false-positive sera in the Venereal Disease Research Laboratory test reacted in the 4D ELISA. The sensitivity of the 4D ELISA was comparable to that of the adsorbed fluorescent treponemal antibody test in primary, secondary, and latent disease. Most sera from patients with yaws or pinta were also reactive, a result indicating that a 4D antigen-like molecule also exists in the closely related pathogenic treponemes Treponema pertenue and Treponema carateum. PMID:3517186

  17. HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling.

    PubMed

    Moayedi-Nia, Saeedeh; Bayat Jozani, Zahra; Esmaeeli Djavid, Gholamreza; Entekhabi, Fatemeh; Bayanolhagh, Saeed; Saatian, Minoo; Sedaghat, Abbas; Nikzad, Rana; Jahanjoo Aminabad, Fatemeh; Mohraz, Minoo

    2016-04-01

    To find out the prevalence of HIV, HCV, HBV, HSV, and syphilis infections among female sex workers (FSWs) in Tehran, a cross-sectional study by using respondent-driven sampling (RDS) method was conducted. From December 2012 to April 2013 FSWs in Tehran were recruited. Inclusion criteria consisted of trading sex during the 12 months prior to this study and selling sex for at least 6 months in participants' lifetime. Among 161 consenting participants, 5% were infected with HIV. Moreover, 8.1% of FSWs were HCV positive, 37.9% were of HSV type1/type2, 1.2% of participants were infected with HBV, and none of the participants were infected with syphilis. HIV-positive participants were significantly more likely to be co-infected with HSV type1/type2, be younger, have more sexual partners and especially more clients during seven days prior to this study and report more history of having at least one of sexually transmitted infections symptoms in 12 months prior the study. In the multiple logistic regression analysis, being infected with HSV and also being under 25 years of age were found to be independently associated with HIV infection. Compared with the prevalence of HIV among general population of Tehran, relatively high prevalence of HIV and other viral infections among FSWs should be considered. All in all, it is critical to commence effective counter-measures for this high-risk group if the aim is to prevent spreading of these viruses to general population. PMID:26565671

  18. Whole Genome Sequence of Treponema pallidum ssp. pallidum, Strain Mexico A, Suggests Recombination between Yaws and Syphilis Strains

    PubMed Central

    Pětrošová, Helena; Zobaníková, Marie; Čejková, Darina; Mikalová, Lenka; Pospíšilová, Petra; Strouhal, Michal; Chen, Lei; Qin, Xiang; Muzny, Donna M.; Weinstock, George M.; Šmajs, David

    2012-01-01

    Background Treponema pallidum ssp. pallidum (TPA), the causative agent of syphilis, and Treponema pallidum ssp. pertenue (TPE), the causative agent of yaws, are closely related spirochetes causing diseases with distinct clinical manifestations. The TPA Mexico A strain was isolated in 1953 from male, with primary syphilis, living in Mexico. Attempts to cultivate TPA Mexico A strain under in vitro conditions have revealed lower growth potential compared to other tested TPA strains. Methodology/Principal Findings The complete genome sequence of the TPA Mexico A strain was determined using the Illumina sequencing technique. The genome sequence assembly was verified using the whole genome fingerprinting technique and the final sequence was annotated. The genome size of the Mexico A strain was determined to be 1,140,038 bp with 1,035 predicted ORFs. The Mexico A genome sequence was compared to the whole genome sequences of three TPA (Nichols, SS14 and Chicago) and three TPE (CDC-2, Samoa D and Gauthier) strains. No large rearrangements in the Mexico A genome were found and the identified nucleotide changes occurred most frequently in genes encoding putative virulence factors. Nevertheless, the genome of the Mexico A strain, revealed two genes (TPAMA_0326 (tp92) and TPAMA_0488 (mcp2-1)) which combine TPA- and TPE- specific nucleotide sequences. Both genes were found to be under positive selection within TPA strains and also between TPA and TPE strains. Conclusions/Significance The observed mosaic character of the TPAMA_0326 and TPAMA_0488 loci is likely a result of inter-strain recombination between TPA and TPE strains during simultaneous infection of a single host suggesting horizontal gene transfer between treponemal subspecies. PMID:23029591

  19. Treponema pallidum Putative Novel Drug Target Identification and Validation: Rethinking Syphilis Therapeutics with Plant-Derived Terpenoids

    PubMed Central

    Tiwari, Sameeksha; Singh, Priyanka; Singh, Swati; Awasthi, Manika; Pandey, Veda P.

    2015-01-01

    Abstract Syphilis, a slow progressive and the third most common sexually transmitted disease found worldwide, is caused by a spirochete gram negative bacteria Treponema pallidum. Emergence of antibiotic resistant T. pallidum has led to a search for novel drugs and their targets. Subtractive genomics analyses of pathogen T. pallidum and host Homo sapiens resulted in identification of 126 proteins essential for survival and viability of the pathogen. Metabolic pathway analyses of these essential proteins led to discovery of nineteen proteins distributed among six metabolic pathways unique to T. pallidum. One hundred plant-derived terpenoids, as potential therapeutic molecules against T. pallidum, were screened for their drug likeness and ADMET (absorption, distribution, metabolism, and toxicity) properties. Subsequently the resulting nine terpenoids were docked with five unique T. pallidum targets through molecular modeling approaches. Out of five targets analyzed, D-alanine:D-alanine ligase was found to be the most promising target, while terpenoid salvicine was the most potent inhibitor. A comparison of the inhibitory potential of the best docked readily available natural compound, namely pomiferin (flavonoid) with that of the best docked terpenoid salvicine, revealed that salvicine was a more potent inhibitor than that of pomiferin. To the best of our knowledge, this is the first report of a terpenoid as a potential therapeutic molecule against T. pallidum with D-alanine:D-alanine ligase as a novel target. Further studies are warranted to evaluate and explore the potential clinical ramifications of these findings in relation to syphilis that has public health importance worldwide. PMID:25683888

  20. Seroprevalence of syphilis amongst pregnant women attending antenatal clinics in a rural hospital in north west Ethiopia.

    PubMed Central

    Azeze, B; Fantahun, M; Kidan, K G; Haile, T

    1995-01-01

    OBJECTIVE--To determine the seroprevalence of syphilis in pregnant women attending antenatal care clinics in a rural hospital in Ethiopia and describe their characteristics so that timely and effective care can be offered. SUBJECTS--Pregnant women attending antenatal care clinics at a rural hospital. METHODS--A cross sectional study was conducted at a rural hospital in north west Ethiopia in September 1994. Data were collected on socio demographic characteristics and past history of sexually transmitted diseases of antenatal care attenders from the records of the hospital. Sera from these pregnant women were examined for syphilis using the VDRL test. VDRL positivity was cross tabulated with socio demographic variables and past history of sexually transmitted diseases. RESULTS--Two hundred and seventy pregnant women were included in the study. Median age of the respondents was 25.2 years. A substantial majority were orthodox Christians (97.4%) and married (92.6%). Town dwellers constituted 58.2% of the antenatal care attenders. Only 4.7% of the women started attending antenatal care clinics during the first trimester. Thirty seven women (13.7%) were found to be VDRL positive. Past history of sexually transmitted diseases was significantly associated with VDRL positivity (p < 0.05). CONCLUSIONS--High VDRL positivity rate is observed in this study. Certain risk factors may be responsible for current and past episodes of sexually transmitted diseases. There is a need for improvement of antenatal care activities at different levels of health care. Appropriate strategies should be devised for prevention and control of sexually transmitted diseases in women of reproductive age groups and the general population. PMID:8566970

  1. Using electronic readers to monitor progress toward elimination of mother-to-child transmission of HIV and syphilis: An opinion piece.

    PubMed

    Wedderburn, Catherine J; Murtagh, Maurine; Toskin, Igor; Peeling, Rosanna W

    2015-06-01

    Electronic readers and smartphones have the potential to standardize the interpretation of rapid diagnostic tests (RDTs) and provide timely surveillance program data. RDTs are widely used for HIV and are being increasingly used for syphilis screening in pregnant women. Following the WHO initiative for the validation of elimination of mother-to-child transmission of HIV and syphilis, there is a need for more extensive testing and data monitoring. However, access to timely and accurate data can be challenging once testing is decentralized as data quality at remote sites is often difficult to verify. Electronic RDT readers can help to ensure quality and allow automated data transmission, creating an opportunity for real-time surveillance to inform control strategies and assess intervention impact. Furthermore, by linking the data to existing supply chain management software, stockouts can be minimized. The present opinion piece looks at the opportunities and challenges of using these tools within national elimination programs. PMID:25983212

  2. The Epidemic of HIV, Syphilis, Chlamydia and Gonorrhea and the Correlates of Sexual Transmitted Infections among Men Who Have Sex with Men in Jiangsu, China, 2009

    PubMed Central

    Fu, Geng-Feng; Jiang, Ning; Hu, Hai-Yang; Mahapatra, Tanmay; Yin, Yue-Ping; Mahapatra, Sanchita; Wang, Xiao-Liang; Chen, Xiang-Sheng; Babu, Giridhar R.; Xu, Xiao-Qin; Ding, Ping; Qiu, Tao; Liu, Xiao-Yan; Guo, Hongxiong; Huan, Xi-Ping; Tang, Weiming

    2015-01-01

    Background In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. Methods In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. Results In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24). Conclusion Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too. PMID:25775451

  3. Immunoglobulin G subclasses of fluorescent anti-Treponema pallidum antibodies: evidence for sequential development of specific anti-T. pallidum immunoglobulin G responses in patients with early syphilis.

    PubMed Central

    van der Sluis, J J; van Reede, E C; Boer, M

    1986-01-01

    The development of immunoglobulin G (IgG) subclass-specific anti-Treponema pallidum antibodies during the course of syphilis in humans was studied with sera from 50 untreated male patients. The patients were divided into five diagnosis groups. In the fluorescent treponemal antibody test, which delineates the presence of cross-reacting antibodies, as well as specific antitreponema antibodies, IgG1, IgG2, and IgG3 subclass antibodies were already present during the seronegative primary stage. Specific antibodies, which were detected by the fluorescent treponemal antibody absorption test, were first present during the serotype-variable primary stage. These antibodies were almost exclusively of the IgG1 and IgG3 subclasses. In later stages, antibodies of other subclasses were detectable. Titration of IgG1 antitreponema antibodies in three electrophoretically different IgG fractions revealed an asymmetric distribution in these fractions during primary syphilis. The antibodies were largely confined to the most basic fraction during primary syphilis. A sudden change in the distribution was noted between the end of the primary stage and the secondary stage; an even distribution of IgG1 antitreponema antibodies existed in the late latent stage. These findings confirm and extend previous results from our laboratory. The development of antibodies detected by both tests is discussed in terms of a sequential stimulation of the immune system due to the presence of an extracellular layer covering the treponemas or, alternatively, in terms of a suppression of the immune response during early syphilis. PMID:3531229

  4. Resequencing of Treponema pallidum ssp. pallidum Strains Nichols and SS14: Correction of Sequencing Errors Resulted in Increased Separation of Syphilis Treponeme Subclusters

    PubMed Central

    Strouhal, Michal; Čejková, Darina; Zobaníková, Marie; Mikalová, Lenka; Sodergren, Erica; Weinstock, George M.; Šmajs, David

    2013-01-01

    Background Treponema pallidum ssp. pallidum (TPA), the causative agent of syphilis, is a highly clonal bacterium showing minimal genetic variability in the genome sequence of individual strains. Nevertheless, genetically characterized syphilis strains can be clearly divided into two groups, Nichols-like strains and SS14-like strains. TPA Nichols and SS14 strains were completely sequenced in 1998 and 2008, respectively. Since publication of their complete genome sequences, a number of sequencing errors in each genome have been reported. Therefore, we have resequenced TPA Nichols and SS14 strains using next-generation sequencing techniques. Methodology/Principal Findings The genomes of TPA strains Nichols and SS14 were resequenced using the 454 and Illumina sequencing methods that have a combined average coverage higher than 90x. In the TPA strain Nichols genome, 134 errors were identified (25 substitutions and 109 indels), and 102 of them affected protein sequences. In the TPA SS14 genome, a total of 191 errors were identified (85 substitutions and 106 indels) and 136 of them affected protein sequences. A set of new intrastrain heterogenic regions in the TPA SS14 genome were identified including the tprD gene, where both tprD and tprD2 alleles were found. The resequenced genomes of both TPA Nichols and SS14 strains clustered more closely with related strains (i.e. strains belonging to same syphilis treponeme subcluster). At the same time, groups of Nichols-like and SS14-like strains were found to be more distantly related. Conclusion/Significance We identified errors in 11.5% of all annotated genes and, after correction, we found a significant impact on the predicted proteomes of both Nichols and SS14 strains. Corrections of these errors resulted in protein elongations, truncations, fusions and indels in more than 11% of all annotated proteins. Moreover, it became more evident that syphilis is caused by treponemes belonging to two separate genetic subclusters. PMID

  5. First Report of the 23S rRNA Gene A2058G Point Mutation Associated With Macrolide Resistance in Treponema pallidum From Syphilis Patients in Cuba.

    PubMed

    Noda, Angel A; Matos, Nelvis; Blanco, Orestes; Rodríguez, Islay; Stamm, Lola Virginia

    2016-05-01

    This study aimed to assess the presence of macrolide-resistant Treponema pallidum subtypes in Havana, Cuba. Samples from 41 syphilis patients were tested for T. pallidum 23S rRNA gene mutations. Twenty-five patients (61%) harbored T. pallidum with the A2058G mutation, which was present in all 8 subtypes that were identified. The A2059G mutation was not detected. PMID:27100771

  6. Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil.

    PubMed

    Brignol, Sandra; Dourado, Inês; Amorim, Leila D; Kerr, Lígia Regina Franco Sansigolo

    2015-05-01

    Social, individual, and programmatic vulnerability of men who have sex with men (MSM) in the context of the HIV epidemic and other sexually transmitted infections (STI) is a reality in many countries. The survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis in Men Who Have Sex with Men in 10 Brazilian Cities selected 383 MSM in the city of Salvador, Bahia State, Brazil, using the respondent driven sampling (RDS) technique. Individual vulnerability early sexual initiation (51%), average of eight sex partners, and unprotected receptive anal sex with casual (32%) and steady partners (45%) and positive rapid tests HIV (6.5%) and syphilis (9%). Social vulnerability young adults (80%), black race/skin color (91%), mean monthly family income of BRL 1,000.00, and personal history of discrimination (57%). Programmatic factors no previous HIV test (63%) and no access to lubricant gel (88%). The study showed a profile of vulnerability and the urgent need for interventions and STI prevention in the MSM population in Salvador, in addition to high prevalence rates for HIV and syphilis. PMID:26083178

  7. Erythematous candidiasis leading to systemic manifestations of human immunodeficiency virus co-infection with secondary syphilis: A diagnostic and therapeutic dilemma

    PubMed Central

    Suvirya, Swastika; Gandhi, Rahul; Agarwal, Jyotsana; Patil, Ranjitkumar

    2015-01-01

    The intensification of human immunodeficiency virus (HIV) and rising frequency of immunocompromised individuals have resulted in a resurgence of opportunistic infections. The most common opportunistic oral fungal infection in HIV-positive individuals is oral candidiasis. The classical presentation is as white scrapable form called as thrush, which is easily diagnosed and treated. The clinician is presented with a diagnostic and management dilemma when these lesions appear in new facades such as erythematous candidiasis, the latter's prevalence with HIV and AIDS being well established. In this case report, we present a case of Erythematous Candidiasis, which was associated with type 1 HIV co-infected with syphilis. We highlight the diagnostic importance of a naive looking manifestation of the tongue which was followed by a series of challenging presentations of secondary syphilis. Since the patient had a negative Veneral Disease Research Laboratory and left us with a management dilemma, the article also features the importance of prozone phenomenon (seen in 2% cases of secondary syphilis), and it's higher association with HIV co-infected individuals. With confusing clinical oral manifestations associated with these diseases, the dentist might be the first person to encounter such lesions, who should be able to recognize erythematous candidiasis and correlate them with the underlying pathology. PMID:26430379

  8. High prevalence of HIV and syphilis among men who have sex with men recruited by respondent-driven sampling in a city in Eastern China.

    PubMed

    Huan, Xiping; Hao, Chun; Yan, Hongjing; Guan, Wenhui; Xu, Xiaoqin; Yang, Haitao; Wang, Na; Zhang, Min; Tang, Weimin; Gu, Jing; Lau, Joseph T F

    2015-03-01

    Increasing prevalence of sexually transmitted diseases (STD) was reported among men who have sex with men (MSM) in China. A total of 407 MSMs were recruited by respondent-driven sampling (RDS) from May to July 2008 in Nanjing, China. Face-to-face interviews were conducted to collect information on demographic and risk behaviors; blood samples were collected for HIV and syphilis antibodies testing. The adjusted HIV and syphilis prevalence were, respectively, 7.3% (confidence interval [CI] = 2.6%-10.2%) and 14.4% (95% CI = 9.3%-21.1%). Recruiting male sex partners mostly from saunas and receptive anal intercourse with men in the last 6 months were independently associated with positive HIV status. Risk factors for positive syphilis status included being older than 28 years, low level of HIV-related knowledge, having been a male sex worker, and having unprotected anal sex with casual male sex partners in the past 6 months. High HIV/STD prevalence was detected. HIV/STD prevention strategies are urgently warranted. PMID:23536234

  9. Doxycycline Prophylaxis to Reduce Incident Syphilis among HIV-Infected Men who have Sex with Men who Continue to Engage in High Risk Sex: A Randomized, Controlled Pilot Study

    PubMed Central

    Bolan, Robert K.; Beymer, Matthew R.; Weiss, Robert E.; Flynn, Risa P.; Leibowitz, Arleen A.; Klausner, Jeffrey D.

    2014-01-01

    Background Incident syphilis infections continue to be especially prevalent among a core group of HIV-infected men who have sex with men (MSM). Because of synergy between syphilis and HIV infections, innovative means for controlling incident syphilis infections are needed. Methods Thirty MSM who had syphilis twice or more since their HIV diagnosis were randomized to receive either daily doxycycline prophylaxis or contingency management (CM) with incentive payments for remaining free of sexually transmitted diseases (STDs). Subjects were tested for the bacterial STDs gonorrhea (NG), chlamydia (CT) and syphilis at Weeks 12, 24, 36 and 48 and completed a behavioral risk questionnaire during each visit to assess number of partners, condom use and drug use since the last visit. Generalized linear mixed models were used to analyze differences between arms in STD incidence and risk behaviors at follow-up. Results Doxycycline arm subjects were significantly less likely to test positive for any selected bacterial STD during 48 weeks of follow-up (OR: 0.27; CI: 0.09-0.83) compared to CM arm subjects (p = 0.02).There were no significant self-reported risk behavior differences between the Doxycycline and CM arms at follow-up. Conclusions Daily doxycycline taken prophylactically was associated with a decreased incidence of NG, CT, or syphilis incident infections among a core group of HIV-infected MSM at high risk for these infections. Safe and effective biomedical tools should be included in the efforts to control transmission of syphilis, especially in this population. A randomized clinical trial should be conducted to confirm and extend these findings. PMID:25585069

  10. Burden of HIV and Syphilis: A Comparative Evaluation between Male Sex Workers and Non-Sex-Worker Men Who Have Sex with Men in Urban China

    PubMed Central

    Tang, Weiming; Mahapatra, Tanmay; Liu, Fengying; Fu, Gengfeng; Yang, Bin; Tucker, Joseph D.; Zhao, Jinkou; Detels, Roger

    2015-01-01

    Background The increasing burden of sexually transmitted infections (STIs) including HIV and syphilis among male sex workers (MSWs) is a major global concern. The aim of our study was to evaluate the difference between MSWs and non-commercial MSMs in China. Methods During 2008-09, in a cross-sectional study, 2618 adult MSM were recruited through respondent-driven and snowball sampling from seven cities of China. Information regarding socio-demographics, risk behaviors, HIV-related knowledge and STI-related symptoms were collected and participants were tested for HIV and syphilis. Results Among 2618 participating MSM, 9.97% sold sex to males. HIV prevalence was 7.45% (6.13% among MSWs and 7.59% among non-MSW MSM) and syphilis prevalence was 14.32% (10.73% for MSWs and 14.72% for non-MSW MSM). Compared to non-MSW MSM, MSWs were more likely to be younger (adjusted odds ratio: aOR = 0.91, 95% confidence interval: 95%CI=0.88-0.93), never married (aOR = 4.38, 95% CI = 2.38-6.80), less educated, heterosexual (aOR = 13.04, 95% CI = 6.08-27.95), less knowledgeable regarding HIV (aOR = 0.70, 95% CI=0.51-0.96), experiencing symptoms of STI (aOR = 2.16, 95% CI = 1.47-3.19), engaging in condomless vaginal intercourse (aOR = 2.16, 95% CI = 1.47-3.19) and less likely to engage in condomless anal intercourse (aOR = 0.62, 95% CI = 0.46-0.85). Conclusions High HIV and syphilis prevalence warranted urgent intervention targeting MSWs as a separate sentinel group for efficient surveillance owing to their different distribution from non-MSW MSM. Although male sex workers and non-commercial homosexuals have similar rates of HIV and syphilis, MSWs have different characteristics which should be considered in designing intervention programs targeting them. PMID:25961721

  11. Correlation of Immunity in Experimental Syphilis with Serum-Mediated Aggregation of Treponema pallidum Rare Outer Membrane Proteins

    PubMed Central

    Lewinski, Michael A.; Miller, James N.; Lovett, Michael A.; Blanco, David R.

    1999-01-01

    We have previously shown by freeze-fracture electron microscopy that serum from infection-immune syphilitic rabbits aggregates the low-density membrane-spanning Treponema pallidum rare outer membrane proteins (TROMPs). The purpose of this study was to determine if a relationship could be demonstrated between acquired immunity in experimental rabbit syphilis, serum complement-dependent treponemicidal antibody, and antibody directed against TROMPs as measured by the aggregation of TROMP particles. Three groups of T. pallidum-infected rabbits were treated curatively with penicillin at 9 days, 30 days, and 6 months postinfection to generate various degrees of immunity to challenge reinfection. Sera from rabbits completely susceptible to localized and disseminated reinfection possessed a low titer of treponemicidal antibody (≤1:1 in killing ≥50% of a treponemal suspension) and showed a correspondingly low level of TROMP aggregation (16.5% of the total number of outer membrane particles counted) similar to normal serum controls (13.4%); the number of particles within these aggregates never exceeded three. Sera from partially immune rabbits, which were susceptible to local reinfection but had no evidence of dissemination, showed an increase in the titer of treponemicidal antibody (1:16) compared to the completely susceptible group (≤1:1). Although no significant increase was observed in the total number of TROMP particles aggregated (18.9%) compared to the number in controls (13.4%), approximately 15% of these aggregates did exhibit a significant increase in the number of particles per aggregate (4 to 5 particles) compared to controls (≤3 particles), indicating a measurable increase in anti-TROMP antibody. Finally, sera from rabbits completely immune to both local and disseminated reinfection possessed both high titers of treponemicidal antibody (1:128) and significant aggregation of TROMP (88.6%); approximately 50% of these aggregates contained four to six

  12. Humoral immunity in experimental syphilis. II. The relationship of neutralizing factors in immune serum to acquired resistance.

    PubMed

    Bishop, N H; Miller, J N

    1976-07-01

    Evidence for a humoral mechanism in immunity to experimental syphilis was provided by the demonstration of immune rabbit serum factor(s) capable of inactivating virulent Treponema pallidum, Nichols strain, in an in vitro-in vivo neutralization test. After intratesticular infection, rabbits were bled periodically and their resistance to reinfection was determined by challenge with T. pallidum. The results of challenge showed that resistance to reinfection begins to develop by 11 days after infection, becomes complete by 3 months, and persists for at least 2 years. In the neutralization test, a mixture of treponemal suspension and serum from the infected animals was incubated anaerobically at 34 degrees C and the virulence of the treponemes was determined by intradermal inoculation into normal rabbits. Complete inactivation of treponemes by immune serum required heat-stable and heat-labile (56 degrees C, 30 min) serum components and 16 hr of incubation, and was accelerated by pre-incubation of the treponemes for 4 hr with nonimmune serum but not by 100 mug/ml of added lysozyme. Serum-neutralizing activity, first demonstrable 1 month postinfection, was quantitated by a neutralizing endpoint (NEP). A relatively close quantitative correlation was shown between the development of resistance to symptomatic reinfection and the appearance and persistence of both TPI antibody and neutralizing serum factor(s). The nature of the serum factor(s), the mechanism of treponemal inactivation, and the application of the test in assessing the immune status are discussed. PMID:778262

  13. Protection against syphilis correlates with specificity of antibodies to the variable regions of Treponema pallidum repeat protein K.

    PubMed

    Morgan, Cecilia A; Lukehart, Sheila A; Van Voorhis, Wesley C

    2003-10-01

    Syphilis has been recognized as a disease since the late 1400s, yet there is no practical vaccine available. One impediment to the development of a vaccine is the lack of understanding of multiple reinfections in humans despite the development of robust immune responses during the first episode. It has been shown that the Treponema pallidum repeat protein K (TprK) differs in seven discrete variable (V) regions in isolates and that the antibody response during infection is directed to these V regions. Immunization with TprK confers significant protection against infection with the homologous strain. We hypothesize that the antigenic diversity of TprK is involved in immune evasion, which contributes to the lack of heterologous protection. Here, using the rabbit model, we show a correlation between limited heterologous protection and tprK diversity in the challenge inoculum. We demonstrate that antibody responses to the V regions of one TprK molecule show limited cross-reactivity with heterologous TprK V regions. PMID:14500480

  14. Research Challenges and Bioethics Responsibilities in the Aftermath of the Presidential Apology to the Survivors of the U. S. Public Health Services Syphilis Study at Tuskegee

    PubMed Central

    Mays, Vickie M.

    2013-01-01

    In 1997 President William Clinton issued an apology to the living male survivors of the U.S. Public Health Syphilis Study at Tuskegee. While the apology became the focus for many, little attention has been paid going forward to two very important recommendations by President Clinton that accompanied the apology. President Clinton pointed out that it is through the remembering of the shameful past of the Syphilis Study at Tuskegee that we can build a better present and a better future for the nation. Second, President Clinton directed the Secretary of Health and Human Services to work in partnership with higher education to prepare training materials for medical researchers as well as postgraduate fellowships to train bioethicists to build on core ethical principles of respect for individuals, justice, and informed consent, and how to use these principles effectively in racial/ethnic minority populations, especially African Americans. This article examines bioethical research challenges left in the wake of the U.S. Public Health Syphilis Study at Tuskegee and the presidential apology. This manuscript raises for consideration the inclusion of these issues in health care reform and the implementation of the Affordable Care Act. It asks: What is the right or good thing to do? What are our obligations to one another? Two challenges are examined: 1) Conducting research with African Americans without knowledge of bioethics specific to this population; and 2) The ethical dilemma of conducting research that does not adequately take into account the diversity within the Black population that is a contributing factor in health disparities. Training and policy recommendations responsive to President Clinton’s Apology are presented. PMID:23878499

  15. Identification of the Treponema pallidum subsp. pallidum TP0092 (RpoE) Regulon and Its Implications for Pathogen Persistence in the Host and Syphilis Pathogenesis

    PubMed Central

    Denisenko, Oleg; Tompa, Martin; Centurion-Lara, Arturo

    2013-01-01

    Bacteria often respond to harmful environmental stimuli with the induction of extracytoplasmic function (ECF) sigma (σ) factors that in turn direct RNA polymerase to transcribe specific groups of response genes (or regulons) to minimize cellular damage and favor adaptation to the changed extracellular milieu. In Treponema pallidum subsp. pallidum, the agent of syphilis, the TP0092 gene is predicted to code for the pathogen's only annotated ECF σ factor, homologous to RpoE, known in Escherichia coli to control a key transduction pathway for maintenance of envelope homeostasis in response to external stress and cell growth. Here we have shown that TP0092 is highly transcribed during experimental syphilis. Furthermore, TP0092 transcription levels significantly increase as infection progresses toward immune clearance of the pathogen, suggesting a role for TP0092 in helping T. pallidum respond to harmful stimuli in the host environment. To investigate this hypothesis, we determined the TP0092 regulon at two different time points during infection using chromatin immunoprecipitation followed by high-throughput sequencing. A total of 22 chromosomal regions, all containing putative TP0092-binding sites and corresponding to as many T. pallidum genes, were identified. Noteworthy among them are the genes encoding desulfoferrodoxin and thioredoxin, involved in detoxification of reactive oxygen species (ROS). Because T. pallidum does not possess other enzymes for ROS detoxification, such as superoxide dismutase, catalase, or glutathione peroxidase, our results suggest that the TP0092 regulon is important in protecting the syphilis spirochete from damage caused by ROS produced at the site of infection during the inflammatory response. PMID:23243302

  16. Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera

    PubMed Central

    Bala, Manju; Toor, Aman; Malhotra, Meenakshi; Kakran, Monika; Muralidhar, Sumathi; Ramesh, V.

    2012-01-01

    Background and Objectives: Biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test used for diagnosis of syphilis is a cause for concern. The use of the VDRL as a screening procedure is challenged by some studies. The aim of this study is to determine the prevalence of BFP reactions in different subject groups and to assess the usefulness of Treponema pallidum hemagglutination (TPHA) test in low titre VDRL reactive sera. Materials and Methods: A total of 5785 sera from sexually transmitted diseases (STD) clinic attendees, antenatal clinic attendees, husbands of antenatal cases, peripheral health centres attendees (representing community population) and from patients referred from different OPDs/wards were screened for BFP reactions by the VDRL test. Sera reactive in the VDRL test were confirmed by the TPHA test. Results: Out of 80 qualitative VDRL reactive sera, 68 had <1:8 titre on quantitation and TPHA was positive in 59 samples, indicating BFP reactivity in 0.2% in all the subject groups. BFP was nil in the community population. The male-to-female ratio of BFP reactions was 2:1. VDRL and TPHA positivity was highest (76%) in the age group of 20-29 years. The seroprevalence of syphilis varied from 0.4% to 3.5% in different patient groups. Conclusions: The results of this study highlight that the TPHA positivity was high (86.8%) in sera with VDRL titre less than 1:8. Therefore, for the diagnosis of syphilis, it is recommended that a confirmatory test such as TPHA should be performed on all sera with a reactive VDRL regardless of its titre. PMID:23188934

  17. Evaluation of Macrolide Resistance and Enhanced Molecular Typing of Treponema pallidum in Patients with Syphilis in Taiwan: a Prospective Multicenter Study

    PubMed Central

    Wu, Hsiu; Chang, Sui-Yuan; Lee, Nan-Yao; Huang, Wen-Chi; Wu, Bing-Ru; Yang, Chia-Jui; Liang, Shiou-Haur; Lee, Chen-Hsiang; Ko, Wen-Chien; Lin, Hsi-Hsun; Chen, Yen-Hsu; Liu, Wen-Chun; Su, Yi-Ching; Hsieh, Chia-Yin; Wu, Pei-Ying

    2012-01-01

    Studies of macrolide resistance mutations and molecular typing using the newly proposed enhanced typing system for Treponema pallidum isolates obtained from HIV-infected patients in the Asia-Pacific region are scarce. Between September 2009 and December 2011, we conducted a survey to detect T. pallidum using a PCR assay using clinical specimens from patients with syphilis at six major designated hospitals for HIV care in Taiwan. The T. pallidum strains were genotyped by following the enhanced molecular typing methodology, which analyzed the number of 60-bp repeats in the acidic repeat protein (arp) gene, T. pallidum repeat (tpr) polymorphism, and the sequence of base pairs 131 to 215 in the tp0548 open reading frame of T. pallidum. Detection of A2058G and A2059G point mutations in the T. pallidum 23S rRNA was performed with the use of restriction fragment length polymorphism (RFLP). During the 2-year study period, 211 clinical specimens were obtained from 136 patients with syphilis. T. pallidum DNA was isolated from 105 (49.8%) of the specimens, with swab specimens obtained from chancres having the highest yield rate (63.2%), followed by plasma (49.4%), serum (35.7%), and cerebrospinal fluid or vitreous fluid (18.2%) specimens. Among the 40 fully typed specimens, 11 subtypes of T. pallidum were identified. Subtype 14f/f (18 isolates) was the most common isolates, followed by 14f/c (3), 14b/c (3), and 14k/f (3). Among the isolates examined for macrolide resistance, none had the A2058G or A2059G mutation. In conclusion, we found that type 14 f/f was the most common T. pallidum strain in this multicenter study on syphilis in Taiwan and that none of the isolates exhibited 23S rRNA mutations causing resistance to macrolides. PMID:22518868

  18. HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area of China

    PubMed Central

    Pan, Stephen W.; Song, Benli; Liu, Qianping; Xu, Yunan; Dong, Hui; Xing, Hui; Shao, Yiming; Ruan, Yuhua

    2014-01-01

    Objective To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China. Design Before and after harm reduction program study. Methods Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics. Results The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41–1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76–22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61–1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09–0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98–1.90). Conclusions Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China. PMID:24416319

  19. Narrative constructions of health care issues and policies: the case of President Clinton's apology-by-proxy for the Tuskegee syphilis experiment.

    PubMed

    Carmack, Heather J; Bates, Benjamin R; Harter, Lynn M

    2008-06-01

    The Tuskegee Syphilis Experiment (TSE) has shaped African Americans' views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton's attempt to restore African Americans' trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies. PMID:18256910

  20. Changes in HIV and syphilis prevalence among female sex workers from three serial cross-sectional surveys in Karnataka state, South India

    PubMed Central

    Isac, Shajy; Ramesh, B M; Rajaram, S; Washington, Reynold; Bradley, Janet E; Reza-Paul, Sushena; Beattie, Tara S; Blanchard, James F; Moses, Stephen

    2015-01-01

    Objectives This paper examined trends over time in condom use, and the prevalences of HIV and syphilis, among female sex workers (FSWs) in South India. Design Data from three rounds of cross-sectional surveys were analysed, with HIV and high-titre syphilis prevalence as outcome variables. Multivariable analysis was applied to examine changes in prevalence over time. Setting Five districts in Karnataka state, India. Participants 7015 FSWs were interviewed over three rounds of surveys (round 1=2277; round 2=2387 and round 3=2351). Women who reported selling sex in exchange for money or gifts in the past month, and aged between 18 and 49 years, were included. Interventions The surveys were conducted to monitor a targeted HIV prevention programme during 2004–2012. The main interventions included peer-led community outreach, services for the treatment and prevention of sexually transmitted infections, and empowering FSWs through community mobilisation. Results HIV prevalence declined significantly from rounds 1 to 3, from 19.6% to 10.8% (adjusted OR (AOR)=0.48, p<0.001); high-titre syphilis prevalence declined from 5.9% to 2.4% (AOR=0.50, p<0.001). Reductions were observed in most substrata of FSWs, although reductions among new sex workers, and those soliciting clients using mobile phones or from home, were not statistically significant. Condom use ‘always’ with occasional clients increased from 73% to 91% (AOR=1.9, p<0.001), with repeat clients from 52% to 86% (AOR=5.0, p<0.001) and with regular partners from 12% to 30% (AOR=4.2, p<0.001). Increased condom use was associated with exposure to the programme. However, condom use with regular partners remained low. Conclusions The prevalences of HIV infection and high-titre syphilis among FSWs have steadily declined with increased condom use. Further reductions in prevalence will require intensification of prevention efforts for new FSWs and those soliciting clients using mobile phones or from home, as well as

  1. HIV and Syphilis Testing Preferences among Men Who Have Sex with Men in South China: A Qualitative Analysis to Inform Sexual Health Services

    PubMed Central

    Lee, Ramon; Lo, Elaine J.; Yang, Li Gang; Yang, Bin; Peeling, Rosanna W.; Tucker, Joseph D.

    2015-01-01

    Background Health services for men who have sex with men (MSM) are inadequate in many areas around the world. HIV and syphilis test uptake remain suboptimal among MSM in China and many other regions. To inform the development of more comprehensive sexually transmitted disease (STD) testing programs among MSM, we collected descriptive data on MSM testing practices and preferences. Methods MSM in two large urban Chinese cities were recruited through community-based organizations and clinics to participate in semi-structured interviews. We purposively sampled MSM across a range of sociodemographic characteristics and testing history, and assessed preferences for HIV and syphilis testing in the context of facilitators and barriers to testing and previous testing experiences. Each interview transcript was coded and thematically analyzed using Atlas.ti 7.0. Results 35 MSM were interviewed. Confidentiality and privacy were the most important factors influencing participants’ decisions about whether and where to get tested. Men preferred rapid testing (results available within 30 minutes) compared to conventional tests where results take several hours or days to return. Participants described concerns about quality and accuracy of rapid tests offered in non-clinical settings such as community-based organizations. Men preferred testing service providers who were MSM-friendly, non-discriminatory, and medically trained. Preferred service center environments included: convenient but discrete location, MSM-friendly atmosphere, and clean/standard medical facilities. Conclusion Our data highlight the need for HIV/syphilis testing services that are confidential and inclusive of MSM. Rapid testing in decentralized (i.e. peripheral health facilities and community-level, non-clinical venues) settings provides an opportunity to reach individuals who have not been tested before, but must be accompanied by quality assurance systems and technical competence. Implementation research

  2. Footprint of Positive Selection in Treponema pallidum subsp. pallidum Genome Sequences Suggests Adaptive Microevolution of the Syphilis Pathogen

    PubMed Central

    Centurion-Lara, Arturo; Jeffrey, Brendan M.; Le, Hoavan T.; Molini, Barbara J.; Lukehart, Sheila A.; Sokurenko, Evgeni V.; Rockey, Daniel D.

    2012-01-01

    In the rabbit model of syphilis, infection phenotypes associated with the Nichols and Chicago strains of Treponema pallidum (T. pallidum), though similar, are not identical. Between these strains, significant differences are found in expression of, and antibody responses to some candidate virulence factors, suggesting the existence of functional genetic differences between isolates. The Chicago strain genome was therefore sequenced and compared to the Nichols genome, available since 1998. Initial comparative analysis suggested the presence of 44 single nucleotide polymorphisms (SNPs), 103 small (≤3 nucleotides) indels, and 1 large (1204 bp) insertion in the Chicago genome with respect to the Nichols genome. To confirm the above findings, Sanger sequencing was performed on most loci carrying differences using DNA from Chicago and the Nichols strain used in the original T. pallidum genome project. A majority of the previously identified differences were found to be due to errors in the published Nichols genome, while the accuracy of the Chicago genome was confirmed. However, 20 SNPs were confirmed between the two genomes, and 16 (80.0%) were found in coding regions, with all being of non-synonymous nature, strongly indicating action of positive selection. Sequencing of 16 genomic loci harboring SNPs in 12 additional T. pallidum strains, (SS14, Bal 3, Bal 7, Bal 9, Sea 81-3, Sea 81-8, Sea 86-1, Sea 87-1, Mexico A, UW231B, UW236B, and UW249C), was used to identify “Chicago-“ or “Nichols -specific” differences. All but one of the 16 SNPs were “Nichols-specific”, with Chicago having identical sequences at these positions to almost all of the additional strains examined. These mutations could reflect differential adaptation of the Nichols strain to the rabbit host or pathoadaptive mutations acquired during human infection. Our findings indicate that SNPs among T. pallidum strains emerge under positive selection and, therefore, are likely to be functional in

  3. Footprint of positive selection in Treponema pallidum subsp. pallidum genome sequences suggests adaptive microevolution of the syphilis pathogen.

    PubMed

    Giacani, Lorenzo; Chattopadhyay, Sujay; Centurion-Lara, Arturo; Jeffrey, Brendan M; Le, Hoavan T; Molini, Barbara J; Lukehart, Sheila A; Sokurenko, Evgeni V; Rockey, Daniel D

    2012-01-01

    In the rabbit model of syphilis, infection phenotypes associated with the Nichols and Chicago strains of Treponema pallidum (T. pallidum), though similar, are not identical. Between these strains, significant differences are found in expression of, and antibody responses to some candidate virulence factors, suggesting the existence of functional genetic differences between isolates. The Chicago strain genome was therefore sequenced and compared to the Nichols genome, available since 1998. Initial comparative analysis suggested the presence of 44 single nucleotide polymorphisms (SNPs), 103 small (≤3 nucleotides) indels, and 1 large (1204 bp) insertion in the Chicago genome with respect to the Nichols genome. To confirm the above findings, Sanger sequencing was performed on most loci carrying differences using DNA from Chicago and the Nichols strain used in the original T. pallidum genome project. A majority of the previously identified differences were found to be due to errors in the published Nichols genome, while the accuracy of the Chicago genome was confirmed. However, 20 SNPs were confirmed between the two genomes, and 16 (80.0%) were found in coding regions, with all being of non-synonymous nature, strongly indicating action of positive selection. Sequencing of 16 genomic loci harboring SNPs in 12 additional T. pallidum strains, (SS14, Bal 3, Bal 7, Bal 9, Sea 81-3, Sea 81-8, Sea 86-1, Sea 87-1, Mexico A, UW231B, UW236B, and UW249C), was used to identify "Chicago-" or "Nichols -specific" differences. All but one of the 16 SNPs were "Nichols-specific", with Chicago having identical sequences at these positions to almost all of the additional strains examined. These mutations could reflect differential adaptation of the Nichols strain to the rabbit host or pathoadaptive mutations acquired during human infection. Our findings indicate that SNPs among T. pallidum strains emerge under positive selection and, therefore, are likely to be functional in nature. PMID

  4. Serological markers for treponemal infection in children in rural Kilimanjaro, Tanzania: evidence of syphilis or non-venereal treponematoses?

    PubMed Central

    Klouman, E; Masenga, E J; Sam, N E

    1997-01-01

    OBJECTIVE: To determine the seroprevalence of treponemal infection and possible risk factors among children aged 0-14 in the general population of a rural Tanzanian village. METHODS: The survey was conducted as a part of a cross section study of a total village population on HIV and sexually transmitted disease. Among 1708 registered children aged 0-14, the 553 first attending were tested for treponemal infection with both rapid plasma reagin test (RPR) and Treponema pallidum Haemagglutination test (TPHA). These children belonged to a household cohort--also including their parents, siblings, and other household members--with 1339 members; 1224 (91.4% participated in the survey and 82.1% of these were tested for treponemal infection. RESULTS: The overall prevalence for the TPHA test was 6.4% among girls and 1.1% among boys (odds ratio, OR = 6.5; 95% confidence interval, CI: 1.9-22.3). The sex difference was most pronounced in the age group 10-14; 11.1% among girls versus 1.0% among boys (OR = 12.8; CI: 1.6-101.9). Among the 20 children who were TPHA positive, we found two cases of active, congenital syphilis. There was a lack of association between positive serology in children and positive serology in their parents. CONCLUSION: The highly significant predominance of girls testing positive for TPHA, and the concomitant lack of association between parents' and children's serostatus might point to sexual transmission as being the most common route of transmission of treponemal infection in girls during childhood in this village. The sources of infection for the seropositive girls are possibly found outside the family. PMID:9582474

  5. Comparison of an automated rapid plasma reagin (RPR) test with the conventional RPR card test in syphilis testing

    PubMed Central

    Lee, Jong-Han; Lim, Chae Seung; Lee, Min-Geol; Kim, Hyon-Suk

    2014-01-01

    Objective We compared the automated non-treponemal reagin (rapid plasma reagin (RPR)) test with the conventional RPR card test for usefulness in clinical applications. Setting A comparative study of laboratory methods using clinical specimens in a single institute. Participants A total of 112 serum samples including 59 Treponema pallidum particle agglutination (TPPA)-positive and 53 TPPA-negative specimens were evaluated. Outcome measures HiSens Auto RPR LTIA (HBI, Anyang, Korea) was compared with Macro-Vue RPR Card Tests (Becton Dickinson BD Microbiology Systems, Sparks, Maryland, USA). Treponemal-specific tests were performed by Serodia TPPA assay (Fujirebio, Tokyo, Japan). The percentage agreement, κ value and overall sensitivity and specificity of the two RPR tests were compared. Seroconversion rates after treatment were also compared for each RPR test. Results The percentage agreement between the two RPR tests was 78.6% (κ 0.565; 95% CI 0.422 to 0.709). Sensitivity and specificity of the automated RPR test relative to the TPPA test was 52.5% (95% CI 39.1% to 65.7%) and 94.3% (95% CI 84.3% to 98.8%), respectively, while the same values for the conventional RPR card test were 86.4% (95% CI 75% to 93.9%) and 94.3% (95% CI 84.3% to 98.8%), respectively. The conventional RPR card test showed overall higher positivity than the automated RPR test, whereas the automated RPR test showed higher seroconversion (43.5%, 10/23) than the conventional RPR card test (4.3%, 1/23) in treated patients. Conclusions The automated RPR test showed overall lower sensitivity than the conventional RPR test based on the treponemal test, but higher seroconversion after treatment. The automated RPR test could be used to monitor treatment response, especially in the reverse screening algorithm in syphilis testing. PMID:25552608

  6. Sensitivity and specificity of an enzyme-linked immunosorbent assay using the recombinant DNA-derived Treponema pallidum protein TmpA for serodiagnosis of syphilis and the potential use of TmpA for assessing the effect of antibiotic therapy.

    PubMed Central

    Ijsselmuiden, O E; Schouls, L M; Stolz, E; Aelbers, G N; Agterberg, C M; Top, J; van Embden, J D

    1989-01-01

    The recombinant DNA-derived Treponema pallidum membrane protein TmpA, purified from Escherichia coli K-12, was used in an enzyme-linked immunosorbent assay (ELISA) to evaluate its suitability in a screening test for syphilis and to monitor the effect of antibiotic treatment. The sensitivity of the TmpA ELISA was 76% for primary syphilis, 100% for secondary syphilis, and 98% for early latent syphilis. All except 1 of 15 serum samples positive for yaws were positive in this test. A specificity of 99.6% was found by testing more than 938 donor samples. The sensitivity and specificity of the TmpA ELISA are comparable to that of the T. pallidum hemagglutination assay, and therefore the test may be useful for the diagnosis of untreated syphilis. After antibiotic treatment, the level of anti-TmpA antibodies in sera of syphilis patients dropped sharply within 1 year. Thus, TmpA might be a useful antigen for monitoring successful treatment of syphilis. PMID:2643617

  7. Lessons learned from integrating simultaneous triple point-of-care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala.

    PubMed

    Smith, Adriana; Sabidó, Meritxell; Camey, Elsy; Batres, Anabelle; Casabona, Jordi

    2015-06-01

    Mother-to-child-transmission of HIV, syphilis, and hepatitis B virus (HBV) remains a challenge in Guatemala, especially in rural regions. A triple antenatal screening program for these infections using point-of-care (POC) testing offered through outreach teams was implemented in the municipality of Puerto de San José. One year following program implementation, antenatal care coverage increased to 99.6% (32.5% increase, P<0.001), testing uptake increased to 50.3% for HIV and syphilis (143.9% (P<0.001) and 1.3% (P=0.89) increase, respectively), and HBV testing increased from 0 to 42.2%. Lessons learned showed that, despite the expansion of triple antenatal POC screening in rural Guatemala, a shortage of healthcare workers and poor supply chain management limited screening uptake. Moreover, training is essential to help health workers overcome their fear of communicating positive results and improve partner notification. Engagement of community health workers was essential to build local capacity and facilitate community acceptance. PMID:25968489

  8. Quarantine as a public health measure against an emerging infectious disease: syphilis in Zurich at the dawn of the modern era (1496–1585)

    PubMed Central

    Gall, Gabriella Eva Cristina; Lautenschlager, Stephan; Bagheri, Homayoun C.

    2016-01-01

    Syphilis is considered as one of the most devastating sexually transmitted diseases in human history. Based on historical records, the “Böse Blattern” (German for “Evil Pocks”) spread through Europe after 1495 and shared symptoms with what we know today as syphilis. Many cities took measures to protect their population. Here, transliterations of archival documents from the 15th and 16th century (provided in the appendix) are used to trace the steps taken by the governing authorities in Zurich to deal with this emerging infectious disease. One of the central measures taken by the city was to establish a quarantine facility referred to as the “Blatternhaus”. The city doctors, including the well-known physician and naturalist Conrad Gessner, oversaw the obligatory quarantine and treatment of patients with symptoms. Treatment could range from better nutrition, herbal remedies and skin ointments to aggressive heat therapy and “smoking”. Furthermore, the affliction was suspected as a sexually acquired disease, hence prostitutes and infected foreigners were extradited from the city. Meanwhile, the church used its social influence to promote a more “Christian” behavior. In several respects, the public health measures taken in the 16th century against a new and menacing epidemic do not diverge in their basic rationale from approaches used during the 20th century and today. PMID:27303653

  9. Quarantine as a public health measure against an emerging infectious disease: syphilis in Zurich at the dawn of the modern era (1496-1585).

    PubMed

    Gall, Gabriella Eva Cristina; Lautenschlager, Stephan; Bagheri, Homayoun C

    2016-01-01

    Syphilis is considered as one of the most devastating sexually transmitted diseases in human history. Based on historical records, the "Böse Blattern" (German for "Evil Pocks") spread through Europe after 1495 and shared symptoms with what we know today as syphilis. Many cities took measures to protect their population. Here, transliterations of archival documents from the 15(th) and 16(th) century (provided in the appendix) are used to trace the steps taken by the governing authorities in Zurich to deal with this emerging infectious disease. One of the central measures taken by the city was to establish a quarantine facility referred to as the "Blatternhaus". The city doctors, including the well-known physician and naturalist Conrad Gessner, oversaw the obligatory quarantine and treatment of patients with symptoms. Treatment could range from better nutrition, herbal remedies and skin ointments to aggressive heat therapy and "smoking". Furthermore, the affliction was suspected as a sexually acquired disease, hence prostitutes and infected foreigners were extradited from the city. Meanwhile, the church used its social influence to promote a more "Christian" behavior. In several respects, the public health measures taken in the 16(th) century against a new and menacing epidemic do not diverge in their basic rationale from approaches used during the 20(th) century and today. PMID:27303653

  10. Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers’ Perspectives on Testing, Training and Quality Assurance

    PubMed Central

    Ansbro, Éimhín M.; Gill, Michelle M.; Reynolds, Joanna; Shelley, Katharine D.; Strasser, Susan; Sripipatana, Tabitha; Ncube, Alexander Tshaka; Tembo Mumba, Grace; Terris-Prestholt, Fern; Peeling, Rosanna W.; Mabey, David

    2015-01-01

    Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new

  11. Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers' Perspectives on Testing, Training and Quality Assurance.

    PubMed

    Ansbro, Éimhín M; Gill, Michelle M; Reynolds, Joanna; Shelley, Katharine D; Strasser, Susan; Sripipatana, Tabitha; Tshaka Ncube, Alexander; Tembo Mumba, Grace; Terris-Prestholt, Fern; Peeling, Rosanna W; Mabey, David

    2015-01-01

    Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new

  12. Are Treponema pallidum Specific Rapid and Point-of-Care Tests for Syphilis Accurate Enough for Screening in Resource Limited Settings? Evidence from a Meta-Analysis

    PubMed Central

    Jafari, Yalda; Peeling, Rosanna W.; Shivkumar, Sushmita; Claessens, Christiane; Joseph, Lawrence; Pai, Nitika Pant

    2013-01-01

    Background Rapid and point-of-care (POC) tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP) specific reference standards. Methods Five electronic databases (1980–2012) were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit. Results In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI) for the sensitivities of popular tests were: i) Determine, 90.04% (80.45, 95.21), ii) SD Bioline, 87.06% (75.67, 94.50), iii) VisiTect, 85.13% (72.83, 92.57), and iv) Syphicheck, 74.48% (56.85, 88.44), while specificities were: i) Syphicheck, 99.14% (96.37, 100), ii) Visitect, 96.45% (91.92, 99.29), iii) SD Bioline, 95.85% (89.89, 99.53), and iv) Determine, 94.15% (89.26, 97.66). In whole blood samples, sensitivities were: i) Determine, 86.32% (77.26, 91.70), ii) SD Bioline, 84.50% (78.81, 92.61), iii) Syphicheck, 74.47% (63.94, 82.13), and iv) VisiTect, 74.26% (53.62, 83.68), while specificities were: i) Syphicheck, 99.58% (98.91, 99.96), ii) VisiTect, 99.43% (98.22, 99.98), iii) SD Bioline, 97.95%(92.54, 99.33), and iv) Determine, 95.85% (92.42, 97.74). Conclusions Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource

  13. Hepatitis C-seroconversion within three to six months after having contracted clinical syphilis and/or lymphogranuloma venereum rectitis in five homosexually active, HIV seropositive men.

    PubMed

    Pelgrom, J M; Vogelaers, D; Colle, I

    2008-01-01

    Five Human Immunodeficiency Virus (HIV) seropositive homosexually active men experienced hepatitis C-seroconversion in the period between September 2004 and January 2007 at a single HIV Reference Center (University Hospital Ghent, Belgium). There was no history of intravenous drug use. All had unprotected anal sex with multiple other HIV seropositive men in the recent past. All of them had clinical syphilis and/or lymphogranuloma venereum rectitis within three to six months before the hepatitis C-seroconversion was detected. This confirms the observations in other case reports and studies originating from the Netherlands, France, the United Kingdom and Germany, illustrating sexual transmission of hepatitis C virus (HCV) infection in this high-risk group. Physicians should be aware of the persistent high-risk behaviour in a subgroup of HIV seropositive homosexually active men and perform intensive sexual counselling and screening for other sexually transmitted diseases, including HCV, during medical follow-up. PMID:19186567

  14. Elimination of mother-to-child transmission of HIV and syphilis: A dual approach in the African Region to improve quality of antenatal care and integrated disease control.

    PubMed

    Newman Owiredu, Morkor; Newman, Lori; Nzomo, Theresa; Conombo Kafando, Ghislaine; Sanni, Saliyou; Shaffer, Nathan; Bucagu, Maurice; Peeling, Rosanna; Mark, Jennifer; Diop Toure, Isseu

    2015-06-01

    The World Health Organization's (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother-to-child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights-based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries. PMID:25963908

  15. [From the Belle Époque to the city of vice: the fight against syphilis in Belém, Pará, 1921-1924].

    PubMed

    Henrique, Márcio Couto; Amador, Luiza Helena Miranda

    2016-01-26

    This article analyzes the fight against syphilis in Belém, capital of the Brazilian state of Pará, between 1921 and 1924. When Instituto de Profilaxia e Doenças Venéreas (Institute for Prophylaxis and Venereal Diseases) was founded, headed by Dr. Heraclídes de Souza Araújo, many restrictions were imposed on prostitution in a bid to make prostitutes partners in the city's sanitation reform. The documents produced by the institute and published in newspapers of the day reveal the various clashes that occurred between doctors, the civil police force, and prostitutes, highlighting the prostitutes' attitudes to state intervention in their activities. PMID:27276041

  16. Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru.

    PubMed

    Verre, Michael C; Peinado, Jesus; Segura, Eddy R; Clark, Jesse; Gonzales, Pedro; Benites, Carlos; Cabello, Robinson; Sanchez, Jorge; Lama, Javier R

    2014-10-01

    The association of socialization patterns with unprotected anal intercourse (UAI) and HIV/STI prevalence remains underexplored in men who have sex with men (MSM) and transgender women (TW) in developing country settings. We evaluated the correlation of UAI, HIV, and syphilis with MSM/TW venue attendance and social network size among high-risk MSM and TW in Peru according to self-reported sexual identity. Frequency of venue attendance and MSM/TW social network size were lowest among heterosexual MSM and highest among TW respondents. Attendance (frequent or occasional) at MSM/TW venues was associated with increased odds of insertive UAI among heterosexual participants. Frequent venue attendance was associated with increased odds of receptive UAI among gay/homosexual, bisexual, and TW participants. Further investigation of the differing socialization patterns and associations with HIV/STI transmission within subgroups of Peruvian MSM and TW will enable more effective prevention interventions for these populations. PMID:24788782

  17. Socialization Patterns and Their Association with Unprotected Anal Intercourse, HIV, and Syphilis Among High-Risk Men Who Have Sex with Men and Transgender Women in Peru

    PubMed Central

    Verre, MC; Peinado, J; Segura, ER; Clark, JC; Gonzales, P; Benites, C; Cabello, R; Sanchez, J; Lama, JR

    2014-01-01

    The association of socialization patterns with unprotected anal intercourse (UAI) and HIV/STI prevalence remains underexplored in men who have sex with men (MSM) and transgender women (TW) in developing country settings. We evaluated the correlation of UAI, HIV, and syphilis with MSM/TW venue attendance and social network size among high-risk MSM and TW in Peru according to self-reported sexual identity. Frequency of venue attendance and MSM/TW social network size were lowest among heterosexual MSM and highest among TW respondents. Attendance (frequent or occasional) at MSM/TW venues was associated with increased odds of insertive UAI among heterosexual participants. Frequent venue attendance was associated with increased odds of receptive UAI among gay/homosexual, bisexual, and TW participants. Further investigation of the differing socialization patterns and associations with HIV/STI transmission within subgroups of Peruvian MSM and TW will enable more effective prevention interventions for these populations. PMID:24788782

  18. Whole Genome Sequences of Three Treponema pallidum ssp. pertenue Strains: Yaws and Syphilis Treponemes Differ in Less than 0.2% of the Genome Sequence

    PubMed Central

    Chen, Lei; Pospíšilová, Petra; Strouhal, Michal; Qin, Xiang; Mikalová, Lenka; Norris, Steven J.; Muzny, Donna M.; Gibbs, Richard A.; Fulton, Lucinda L.; Sodergren, Erica; Weinstock, George M.; Šmajs, David

    2012-01-01

    Background The yaws treponemes, Treponema pallidum ssp. pertenue (TPE) strains, are closely related to syphilis causing strains of Treponema pallidum ssp. pallidum (TPA). Both yaws and syphilis are distinguished on the basis of epidemiological characteristics, clinical symptoms, and several genetic signatures of the corresponding causative agents. Methodology/Principal Findings To precisely define genetic differences between TPA and TPE, high-quality whole genome sequences of three TPE strains (Samoa D, CDC-2, Gauthier) were determined using next-generation sequencing techniques. TPE genome sequences were compared to four genomes of TPA strains (Nichols, DAL-1, SS14, Chicago). The genome structure was identical in all three TPE strains with similar length ranging between 1,139,330 bp and 1,139,744 bp. No major genome rearrangements were found when compared to the four TPA genomes. The whole genome nucleotide divergence (dA) between TPA and TPE subspecies was 4.7 and 4.8 times higher than the observed nucleotide diversity (π) among TPA and TPE strains, respectively, corresponding to 99.8% identity between TPA and TPE genomes. A set of 97 (9.9%) TPE genes encoded proteins containing two or more amino acid replacements or other major sequence changes. The TPE divergent genes were mostly from the group encoding potential virulence factors and genes encoding proteins with unknown function. Conclusions/Significance Hypothetical genes, with genetic differences, consistently found between TPE and TPA strains are candidates for syphilitic treponemes virulence factors. Seventeen TPE genes were predicted under positive selection, and eleven of them coded either for predicted exported proteins or membrane proteins suggesting their possible association with the cell surface. Sequence changes between TPE and TPA strains and changes specific to individual strains represent suitable targets for subspecies- and strain-specific molecular diagnostics. PMID:22292095

  19. Presence of IgE class antibodies with cardiolipinic and treponemal specificity in syphilis. Quantitative evaluation by IgE prist radio-immuno-assay.

    PubMed

    Ionescu, A D; Ivănescu, M

    1992-01-01

    60 serum samples (reactive in VDRL, ELISA-Reiter, FTA-Abs tests) from 25-45 years old male patients with untreated latent syphilis (EL) (30 cases) and persistent positive treated syphilis (ET+) (30 cases) were tested for IgE by IgE-PRIST. On 30 sera from 25-45 years old male healthy persons, normal mean value for serum IgE was established: 159.63 +/- 124.09 U/ml. Cardiolipin and group treponemal IgE fractions were indirectly calculated by the difference between the specific activity induced by sera as such and that induced by sera absorbed with cardiolipin and group treponemal sorbents. In EL, total IgE level was 197 +/- 107 U/ml; cardiolipin IgE -24.9 +/- 8.3 U/ml and group treponemal IgE 35.8 +/- 6.6 U/ml. In ET, total IgE value was 152.6 +/- 122.5 U/ml, cardiolipin IgE -11 +/- 10.5 and group treponemal IgE -26.6 +/- 14.2 U/ml. Summing up the two specificities, the total specific IgE represent about 1/3 from total IgE in EL and 1/5 in ET+. Taking into account the short half-life (2-3 days) of IgE presence of a significant proportion of specific IgE in those two stages proves, by their continuous synthesis paralleling antigenic stimulation, the presence in various tissular zones of viable treponemas as sources of antigens. PMID:1457821

  20. Prevalence and risk factors of HIV and syphilis, and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing, China

    PubMed Central

    Ma, Wenzhe; Wu, Gohui; Zheng, Hui; Zhang, Wenjuan; Peng, Zhihang; Yu, Rongbin; Wang, Ning

    2016-01-01

    Abstract High HIV prevalence and incidence burdens have been reported in men who have sex with men (MSM) in Chongqing, China. We aimed to estimate the prevalence of HIV and other sexually transmitted infections (STIs), to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM, and to analyze the possible causes of deviation between behavior and knowledge to make better strategies. We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling (RDS) method in Chongqing, China. Through the collection of questionnaire-based data and biological testing results from all objects, we launched a cross-sectional survey. STATA/SE was used for data analysis by frequency, ANOVA, rank sum test and logistic regression models. MSM with syphilis (OR=4.16, 95%CI: 2.35-7.33, P<0.0001) were more likely to be HIV infected. Being a company employee (OR=3.64, 95%CI: 1.22-10.08, P<0.0001) and having bought male for sex (OR=3.52, 95%CI: 1.10-11.32, P < 0.034) were associated with a higher probability of syphilis. MSM with younger age, higher education and greater monthly income had a higher mean knowledge score. MSM who had HIV testing had a higher mean knowledge score than those who never had. Students, venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations, venues for finding sex partners and sexual orientation. There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.