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PubMed2002

Syphilis. Diagnosis and management in general practice.

BACKGROUND: Although largely regarded as an uncommon condition, recent outbreaks of syphilis in Western nations combined with the increasing popularity of travel are likely to result in increases in rates in Australia. OBJECTIVES: To discuss the common modes of presentation and interpretation of syphilis tests, and the treatment of syphilis at various stages. DISCUSSION: Accurate interpretation of syphilis test results is essential for staging of disease and appropriate treatment. With these skills many cases of syphilis can be effectively managed in a general practice setting.

Australia↗
PubMedDate not supplied

Field efficiency of syphilis screening in antenatal care: lessons from Gutu District in Zimbabwe.

OBJECTIVES: To determine coverage for antenatal syphilis screening in a rural area and evaluate the accuracy of on-site Rapid Plasma Reagin (RPR) tests performed by nurse-midwives. DESIGN: Descriptive cross sectional. SETTING: Rural Health Centres (n = 23) in the Gutu District of Zimbabwe. SUBJECTS: Women booking for antenatal care in the district were used to determine coverage of screening. Results from women who had an RPR test performed during a nine week period were used in assessing the accuracy of tests performed by nurse-midwives. INTERVENTION: On-site antenatal screening for syphilis using an RPR kit with immediate results and treatment for women who tested positive. MAIN OUTCOME MEASURES: Prevalence of syphilis (positive RPR) at booking and the level of agreement between three observers (RHC nurse-midwife, medical practitioner under field conditions and medical laboratory technologist). RESULTS: Eighty five percent of women were screened for syphilis at the first antenatal visit and 11% had a positive RPR. Almost all (97.3%) women with a positive RPR test result were treated. The accuracy of tests performed by RHC staff was poor with a sensitivity of 40% (95% CI 21.8 to 61.1) when compared to those done by the medical practitioner and 8.7% (95% CI 1.5 to 29.5) when compared to those done in a laboratory. The predictive value of a positive test was 22.7% and that of a negative test was 94.9%. CONCLUSION: The coverage of screening for syphilis in pregnant women in Gutu District was good but the results were unreliable. There is need for nurse-midwives, who perform the majority of RPR tests in the RHC, to receive adequate training to ensure competence in testing and to strengthen quality control procedures.

Antibodies, Bacterial↗
PubMed2004

Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa.

Preventing congenital syphilis is not technically difficult, however operational difficulties limit the effectiveness of programmes in many settings. This paper reports on programmes in Bolivia, Kenya, and South Africa. All three countries have established antenatal syphilis control programmes. Early antenatal syphilis screening and management of positive cases were difficult to implement since most women presented for their first antenatal clinic visit after 6 months of pregnancy. Most women had rapid plasma reagin (RPR) testing; results were available on the same day in some clinics but took up to 4 weeks in others. No clinic had a system for tracking RPR-reactive women who did not return for their results. There were no guidelines for providers in Kenya and Bolivia. In all countries, supplies, drugs, notification cards, and other consumables were often unavailable. Health-care providers were unmotivated in Kenya and reported an excessive client load. In South Africa and Kenya some clients reported at their exit interview that they had never heard of syphilis nor had they been informed why blood was collected. Several prevention strategies could be implemented at the clinic level. These include encouraging women to attend for antenatal care before the fourth month of pregnancy, providing point-of-care testing so that results are available immediately and women who test positive can be treated, implementing presumptive treatment of sexual partners of women who test positive, adding a second test later in pregnancy so that incident cases can be managed, and improving the quality of syphilis care during pregnancy, delivery, and the neonatal period.

Bolivia↗
PubMed2004

[Direct detection of Treponema pallidum in diagnosis of syphilis].

Available methods for direct diagnosis of syphilis are summarized with emphasis being on those promising for routine use. Direct detection of the causative agent T. pallidum is limited since the agent is not able to synthesize enzyme cofactors, fatty acids and nucleotides de novo, is completely dependent on its host and thus culture on synthetic media is not feasible. Direct diagnosis of syphilis is based on rabbit infectivity testing (RIT), dark field or fluorescent microscopy and recently also on molecular biological methods used with increasing frequency in routine practice. Suitability and usability of different methods for direct detection of T. pallidum at different stages of syphilis are explained. Except for molecular biological methods, most of detection techniques can only be used at the primary and secondary stages or in early congenital syphilis. Major PCR methods for diagnosis of syphilis are presented. Not all of them are suitable for use in routine practice owing to differences in their sensitivity and design. The polA PCR method appears to be the most promising in this regard.

Animals↗
PubMed2004

Congenital syphilis in a Nairobi maternity hospital.

OBJECTIVE: To assess adverse pregnancy outcome associated with maternal syphilis and congenital syphilis rate based on FTA-ABS-19s-IgM. DESIGN: Descriptive cross-sectional study. SETTING: Pumwani Maternity Hospital (PMH), the largest maternity unit in Nairobi, Kenya. SUBJECTS: Rapid Plasma Reagin reactive women and their live born infants. MAIN OUTCOME MEASURES: Syphilis serology in pregnant women, FTA-ABS-19s-IgM in cord blood and pregnancy outcome. RESULTS: Three hundred and seventy seven out of 12,414 women (3%) were RPR+. 4.0% of RPR+ and 1.4% of RPR- women delivered a stillbirth (OR 3.0, p<0.001). 19% of RPR+ and 10% of RPR- had low birth weight deliveries (OR 2.1, p<0.001). Mothers untreated for syphilis during pregnancy had significantly more preterm births (18.5% vs 9.2%, OR 2.3, p=0.026), and more stillbirths (5.4% vs 1.0%, OR 6.3, p=0.044). Of the 200 randomly selected cord bloods of RPR+ women, 142 (72%) were TPHA+. Nine (6.3%) of the 142 TPHA+ cords were FTA-ABS-19s-IgM+. CONCLUSIONS: Stillbirth and low birth weight rates were high in RPR+ untreated pregnant women and treatment significantly improved pregnancy outcome. Based on very stringent laboratory criteria (FTA-ABS-19s-IgM), 6.3% of live born infants with TPHA+ cord blood were considered syphilis infected.

Cross-Sectional Studies↗
PubMed2006

[Differential diagnosis of specific gastric lesions in early syphilis patients with helicobacter infection].

AIM: To evaluate differential-diagnostic significance of different clinical signs, endoscopic and serological studies in making diagnosis of early gastric syphilis (EGS) in patients with helicobacter infection. MATERIAL AND METHODS: Thirty patients were hospitalized with diagnosis of gastric and/or duodenal ulcer. Helicobacter pylori was identified morphologically or with a rapid urease test. Syphilis was rejected when microprecipitation reaction was negative and confirmed with Wassermann reaction. The patients received standard treatment including a course of eradication therapy. RESULTS: Endoscopic examination discovered single and multiple ulcers in 25 and 5 patients, respectively, located in the stomach and duodenum. A rapid test for syphilis produced negative and positive results in 28 and 2 patients, respectively. Twenty two patients tolerated eradication therapy well. Positive results were achieved in 19 (84.6%) patients. Six patients had side effects (pruritus, urticaria, dyspepsia) on eradication treatment day 2-3. Jarisch-Herxheimer reaction (elevated body temperature 38-38.6 degrees C) and roseola eruption were observed in 2 (6.7%) patients with positive serological reactions for syphilis on the first day of eradication therapy. CONCLUSION: Diagnostic criteria of EGS are the following: serologically confirmed manifest or latent syphilis, poor effect of standard antiulcer treatment, rapid elimination of the disease symptoms in antisyphilis therapy and positive changes in pathological alterations in gastric mucosa.

Adult↗
PubMed1992

HIV-1 seroprevalence in pregnant women testing positive on serologic screening for syphilis.

Epidemic increases in active syphilis have been reported in the geographic areas hit hard by acquired immunodeficiency syndrome. Although both epidemics have been associated with illicit substance abuse, the extent to which recent increases in syphilis are linked to the human immunodeficiency virus (HIV-1) epidemic is uncertain. In order to define the frequency of syphilis and HIV-1 coinfection in the pregnant patients seen at City Hospital Center at Elmhurst, we saved syphilis-positive serologic specimens from obstetrical patients for anonymous HIV-1 antibody testing. Of 120 women who tested positive for syphilis, 7/120 (5.8%) had antibodies to HIV-1; of the 44 women with VDRL titers greater than or equal to 1:16 (suggestive of a recent infection), 1/44 (2.3%) had antibodies to HIV-1.

Female↗
PubMed1991

Alternative case-finding methods in a crack-related syphilis epidemic--Philadelphia.

Use of crack cocaine and exchange of drugs for sex have been identified as substantial contributors to the syphilis epidemic in Philadelphia and other locations in the United States. In Philadelphia, from 1985 through 1989, the number of reported cases of early syphilis (primary, secondary, and early latent stages) increased 551%, from 696 to 4528 cases per year. Among 2473 persons with early syphilis interviewed by the Philadelphia Department of Public Health (PDPH) from January through July 1990, 48% reported they or a sex partner used crack cocaine, and 31% reported exchanging drugs or money for sex (not all of those interviewed answered both questions). Traditional approaches to the control of syphilis that emphasize partner notification have not been effective in halting this epidemic. The partner notification approach requires public health workers to identify sex partners of a person with a sexually transmissible disease (e.g., syphilis) and then to contact these sex partners to provide examination and curative or preventive treatment. However, because persons who are involved in the exchange of drugs and/or money for sex often cannot or will not provide sufficient information about sex partners to enable public health authorities to locate those partners (2,4,5), alternative case-finding methods are needed. This report describes efforts by the PDPH to identify persons infected with Treponema pallidum by using serologic screening at locations where crack cocaine is used.

Cluster Analysis↗
PubMed1991

Long-bone radiographic abnormalities as a sign of active congenital syphilis in asymptomatic newborns.

Metaphyseal abnormalities are present in greater than 90% of infants with symptomatic congenital syphilis. The incidence of these lesions in asymptomatic newborns in the present epidemic is not known. To determine the incidence of bone lesions at birth in asymptomatic congenital syphilis, long-bone films were obtained for all babies born during a 9-month period with a positive perinatal serology. Of 2544 newborns, 61 had a positive maternal serology and 40 also had a positive cord serology. Two symptomatic babies had abnormal radiographs and 12 of 59 asymptomatic newborns had metaphyseal changes consistent with congenital syphilis. It is concluded that long-bone radiographs are abnormal in approximately 20% of asymptomatic newborns with positive perinatal treponemal serology. With the increasing incidence of congenital syphilis, radiologic studies should be included in the assessment of all newborns with a positive serology. Indeed, those patients with any sign of active disease should be carefully followed because even treated infants remain at some risk for developing the late sequelae of congenital syphilis.

Bone Diseases↗
PubMed1990

Testing for syphilis--rational use and interpretation.

Syphilis is a disease caused by a spiral organism, Treponema pallidum. Microscopy is useful in diagnosing syphilis in its primary stage while the serological tests are used for diagnosing primary secondary or latent stages of syphilis. The non specific serological tests are the non treponemal tests such as the Venereal Disease Laboratory Test (VDRL) and the Rapid Plasma Reagin Test (RPR). Both these tests are used as a screening test. The specific tests are the treponemal tests. The two common treponemal tests are fluorescent treponemal antibody absorption test (FTA/ABS) and the Microhaemagglutination assay for Treponema pallidum (MHA-TP). These two tests can be used to confirm the diagnosis of syphilis. The usefulness of laboratory tests in the diagnosis of syphilis depends on the selection of the appropriate standard tests.

False Positive Reactions↗
PubMed1990

[The use of immunoenzyme analysis for recording specific IgM antibodies in syphilis patients].

Specific IgM antibodies were assayed in blood sera of 230 patients with various forms of syphilis and of 561 controls. Enzyme immunoassay (EIA) sensitivity has made up 95.8 percent for primary syphilis, 93.8 percent for secondary new, 78.3 percent for secondary recurrent, 35.4 percent for early latent, 37.5 percent for late latent, and 80 percent for unknown syphilis. False-positive reactions were recorded in 5.5 percent of cases and were as a rule seen in the sera from patients with diffuse diseases of connective tissue. IgM EIA has proved highly effective in testing the sera from patients with primary seronegative syphilis and from subjects who had sexual intercourse with patients suffering from contagious forms of syphilis.

Antibodies, Bacterial↗
PubMedDate not supplied

[Importance of looking for specific IgM in serological investigations for syphilis].

Syphilis is still a quite common infection often lacking clinical symptoms and sometimes ignored. Serological tests have peculiar importance in order to settle the diagnosis and therapy. Traditional tests as VDRL and TPHA cannot clearly define the clinical pattern because these tests remain positive for a long period of time. Moreover they can prove the recovery of the patients only if they continue to give low titres. The immunofluorescence test FTA ABS, that raised interest at its outset, has low sensitivity against IgM specific antibodies and defines serological state of patients only in 50% of the cases. The reading of this test remains subjective. The authors intend to verify the importance to detect the IgM specific antibodies to assume medical and legal decisions in unknown subjects, without clinical knowledge. 20,000 sera of normal subjects and of risk group have been assayed. Specific IgM are absent in 60 clinically recovered subjects with VDRL and TPHA still positive, specific IgM are present in 15 cases of Syphilis under treatment and also in 15 subjects with unknown Syphilis. The results show that: 1) IgM specific antibodies for Syphilis are not detectable in patients under a long term antibiotic treatment while the traditional serological tests (VDRL, TPHA) are positive; 2) they are present in patients under treatment with still active infection; 3) they are also present in patients with ignored infection, never treated. In conclusion the Authors consider important to include in the panel of Syphilis testing new assays for the detection of specific IgM antibodies. This is particularly important in subjects under treatment and also in unknown subjects.

Anti-Bacterial Agents↗
PubMed1986

[Is systematic syphilis serology still useful in a department of internal medicine? A one-year prospective study using a diagnostic and therapeutic decision algorithm].

During one year syphilis serology was systematically studied, using the TPHA and VDRL tests, in each of the 1,279 patients hospitalized in an Internal Medicine department. In all cases diagnosis and treatment were analyzed by means of a decision algorithm. Only 37 patients were found to have one or both serological tests positive. No evolutive syphilis was observed, and none of these positive tests was contributive to the diagnosis of another disease. Only 14 patients received a specific antibiotic treatment on the grounds that their positive test confirmed a late asymptomatic syphilis. We conclude that systematic syphilis serological tests are not useful in an Internal Medicine department, except in some patients epidemiologically at high risk of syphilis.

Algorithms↗
PubMed1988

Congenital syphilis has not disappeared.

Thirty-three cases of congenital syphilis that were seen at The Children's Hospital, Camperdown, over a 34-year period were reviewed. Twenty-nine cases were examples of early congenital syphilis, as the patients developed clinical features in the first two years of life, and the other four cases were examples of late congenital syphilis, with the clinical features developing between two years and nine months of age and 10 years of age. Twenty-five patients were symptomatic at the time of admission to hospital. The most common clinical feature on the patient's presentation to hospital was a maculopapular or vesiculobullous skin eruption which occurred in 13 of the infants. Hepatic and splenic enlargement were present in 12 cases, and nine children had the "snuffles". Five of the children died. Patient follow-up occurred in fewer than 40% of cases and three of the children who were followed-up suffer from developmental delay. Congenital syphilis can occur in all social groups but is most common in infants who are premature or are small for gestational age and are born to young, unmarried mothers of low socioeconomic status. The treatment of congenital syphilis is simple and effective although the patients may need to be linked with community-health facilities to assist in their compliance with follow-up appointments.

Child↗
PubMed1978

[Passive haemagglutination test in serodiagnosis of syphilis. Survey of a one-year trial in a venereal diseases prophylactic center (author's transl)].

We report here a one-year study of the reliability of the Treponema pallidum Haemagglutination Test (TPHA) in the serological diagnosis of syphilis. By comparing TPHA data with the diagnosis based on a set of grouped criteria, we were able to determine TPHA accuracy. All studies were conducted at the Antivenereal Prophylactic Center, in Nice, France, on 1,775 sera. The grouped data consisted of:--Serological Test for Syphilis (STS) using cardiolipin antigen,--medical and epidemiological records;--two specific reactions; namely the Fluorescent Antibody Test (FTA) and the Treponema Immobilisation Test (TIT). Reliability is excellent in 98.58 p. 100: the TPHA either proves syphilis or eliminates this diagnosis. The TPHA was particularly useful in investigating "problem sera" for which there existed conflicts in the grouped data. The applicability of TPHA is limited, however, in that it has low sensitivity during early primary syphilis, and it cannot be used to monitor antibodies during treatment. Nevertheless, TPHA, based on a standard specific antigen, is assured of a high place among the tools of serological diagnosis of syphilis because of its high accuracy and sensitivity, its objective and easily read results, and the simplicity of its technique.

False Negative Reactions↗
PubMed1984

A cost-benefit analysis of California's mandatory premarital screening program for syphilis.

As do most states, California requires premarital serologic tests for syphilis. The Venereal Disease Research Laboratory (VDRL) test and a fluorescent treponemal antibody-absorbed (FTA-ABS) are often used in series for this purpose. In 1979 in California, there were approximately 300,000 persons tested premaritally, but only 35 were found to have asymptomatic infectious syphilis (incidence=0.012%). Including all the direct costs of this screening program, the yearly costs of premarital screening is $8.5 million or almost $240,000 per case found. If one takes into account the sensitivities and specificities of the tests, one still has 6 false-negative and 90 false-positive tests using the 1979 figures. The benefits of the program are the number of cases of congenital syphilis that are prevented. Using a worse-case method, no more than 1.5% of the cases of syphilis detected would result in a case of congenital syphilis. The estimated benefits would result in a savings of approximately $161,000. The economic costs of the premarital screening program far outweigh the benefits.

California↗
PubMed1982

Syphilis in patients with Hansen's disease.

Between 1975 and 1979, 630 patients with leprosy of Hansen's disease (HD) were examined clinically and screened for syphilis using both the rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) tests. Seropositive syphilis was found more frequently than in the general population; 10% were true positive reactors with a reactive RPR, a reactive FTA-ABS, and historical, clinical, and/or postmortem evidence of syphilis. Only 8% exhibited false positive tests for reagin with a negative FTA-ABS and neither historical nor clinical evidence of treponemal infection. Among those with FTA-ABS test reactivity, highly positive FTA-ABS immunofluorescence (+3, +4) was highly predictive for syphilis (94.7%). Seropositive HD patients with both RPR and FTA-ABS reactivity should be seriously evaluated for syphilis and, if not yet treated, they should be treated.

Erythema Nodosum↗
PubMed1983

Standards for treatment of primary and secondary syphilis.

A total of 4.8 million u of benzathine penicillin G was used to treat 500 patients with their first attack of primary syphilis and 522 with secondary syphilis. All patients with primary syphilis became seronegative within one year, and those with secondary syphilis within two years. The physician now has an objective norm in evaluating the effect of treatment in patients with their first attack of primary or secondary syphilis.

Adult↗