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PubMed1981

Treatment of syphilis.

THE RESULTS OF THE TREATMENT OF EARLY SYPHILIS WITH PENICILLIN HAVE BEEN EXCELLENT: patients are rendered non-infectious within hours, sero-reversal to tests with lipid antigens occurs within months and insignificant numbers of patients with cardiovascular or neurosyphilis are found among those who have received adequate treatment. On the other hand, seropositivity to tests with treponemal antigens may persist, sometimes indefinitely, and reinfections are, today, by no means uncommon. The physician also has a responsibility to persuade the patient with early infectious syphilis to induce the person who was the source of the infection and subsequent sexual partners to undergo examination and treatment.In late syphilis, no treatment can repair structural damage that has already occurred, e.g., severed neurons in the nervous system or loss of elastic tissue in the aortic wall, and clinical progression may occur in spite of treatment. Nevertheless, penicillin provides the basis of therapy.Early congenital syphilis, like the acquired infection, responds well to penicillin. However, because benzathine penicillin penetrates poorly into the cerebrospinal fluid much higher doses of procaine penicillin are now recommended, or alternatively the use of crystalline penicillin G.A recent WHO Scientific Group on Treponemal Infections has made new recommendations concerning the treatment of syphilis and these will be considered by the next WHO Expert Committee on Venereal Diseases, Treponematoses and Neisseria infections. Some of these recommendations are outlined in this article.

Adult↗

PubMed1982

[Specificity and sensitivity of immunological diagnosis of congenital neonatal syphilis by the 19S(IgM)-FTA-ABS test (author's transl)].

Reports on the significance in the demonstration of IgM class antibodies in congenital syphilis are contradictory. The reason for discrepant observations are of technical or biological source. In order to explain the several uncertainties, serum samples from 1031 newborns and infants of syphilitic mothers were investigated quantitatively with the IgM-FTA-ABS, the 19S (IgM)-FTA-ABS and cardiolipin CF test. If serum specimens of the mothers were available they were investigated in the same tests for treponema-specific 19S(IgM) class and antilipoidal antibodies. In the evaluation of the results, the history of infection and treatment of the mothers as well as clinical observations in the infants were considered. In 26 children a congenital acquired syphilis was strongly indicated by demonstration of treponema-specific 19S(IgM) class antibodies by the 19S(IgM)-FTA-ABS-Test and tae good agreement with the history of untreated mothers. In another 1005 infants a congenital infection by T. pallidum could be excluded by the non-reactive 19S(IgM)-FTA-ABS as well as clinical observations. Furthermore, immunological findings of three children who had acquired syphilis after birth are demonstrated before and after specific treatment. It could be shown that the 19S(IgM)-FTA-ABS is much more infaillable than the IgM-FTA-ABS as far as technical and biological uncertainties are concerned. Considering all possible errors and the results of re-investigations of IgM non-reactive infants of syphilitic mothers (up to one year after birth) it is demonstrated that congenital syphilis can be differentiated from passively transmitted 7S(IgG) class antibodies (of the mother) or 19S(IgM) class anti-antibodies (of the child) with a significance of about 99%. It is finally concluded that serological diagnosis of congenital syphilis should be started in the pregnant women. By making the diagnosis in pregnancy followed by adequate treatment, irreversible damages as well as so-called serological scars can be avoided in the children.

Antibodies, Bacterial↗

PubMed1994

[Acquired syphilis and HIV infection].

The currently observed increased prevalence of syphilis in subjects with human immunodeficiency virus (HIV) infection could be an expression of an increase in sex-related risks or could result from facilitated viral transmission via ulcerations of the genital organs. In addition, viral-immunological interactions related to HIV infection could affect the natural history of syphilis suggesting that the clinical pictures of the past may be making a comeback due to modified response to syphilis infection. These observations would suggest revising a certain number of the classical diagnostic and therapeutic criteria for syphilis in HIV positive patients. The consequence of these interactions on response to treatment may be the key to the increased number of unsuccessful treatments observed recently and to the increased frequency of early neurological and ocular manifestations of syphilis. Clinicians should revise their therapeutic schemes which have become unadapted to the new situation caused by HIV infection.

France↗

PubMed1994

[The Extencillin treatment of patients with early forms of syphilis].

Outpatient treatment of syphilis was given to 250 patients. All of them received extencilline (benzathine penicillin G) in intramuscular injections. One injection of the drug (2400000 U) was administered for primary seronegative syphilis (15 cases) and for prevention (65 subjects). Two injections with 7-day interval were carried out in the dose 2400000 U for primary seropositive (58 cases), secondary early (14 cases) and recurrent syphilis (36 cases). Patients with secondary recurrent syphilis whose body mass exceeded 85 kg (55 cases) and subjects with latent disease (72 cases) received 3 injections in 7-day intervals. Extencilline proved a potent antisyphilis tool able to rapidly eliminate clinical symptoms of the disease and to promote making serological reactions negative. Extencilline activity is superior to that of bicillin and water-soluble penicillin. Treponema pallidum escape from syphilid surface within 7 treatment hours, on the average. Extencilline is worthy of being used among most effective drugs in outpatient treatment of early syphilis.

Adolescent↗

PubMed1993

Comparison of maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis: relationship with maternal treatment.

The incidence of congenital syphilis has increased rapidly over the past few years. Most infected mothers and their newborns are asymptomatic at birth and diagnosis depends on serologic testing during pregnancy and at delivery. This study was initiated to compare maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis and to assess the role of maternal treatment (administration of penicillin to the mother at least 1 month before delivery) on the serologic results at the time of delivery. The serologic results from all live deliveries complicated by a positive maternal and/or neonatal test for syphilis during a 12-month period were compared using chi 2 analysis and multiple comparisons for proportions. Of 3306 livebirths, 73 (2.2%) were complicated by a positive maternal or neonatal serology. At delivery, the serologic test was positive in 68 (94%) of 72 maternal sera, 30 (50%) of 60 cord sera, and 43 (63%) of 68 neonatal sera. In the absence of maternal treatment, 95% of the maternal sera, 66% of the cord blood samples, and 86% of the neonatal sera were positive. If the mother had been treated, 94% of maternal sera, 36% of cord sera, and 39% of neonatal sera were positive. Cord blood and neonatal sera appear to be inferior to maternal sera for detecting prenatal exposure to syphilis. Cord serology is also inferior to neonatal serology at 2 to 3 days of age. The most effective way to identify newborns at risk for congenital syphilis is to obtain a maternal serologic diagnosis during pregnancy and to test maternal and neonatal sera at delivery.

Age Factors↗

PubMed1998

Epidemic of congenital syphilis--Baltimore, 1996-1997.

In 1996 and 1997, Baltimore, Maryland, had the highest rate for primary and secondary syphilis among U.S. cities. From 1993 to 1996, the rate for congenital syphilis (CS) in Baltimore increased from 62 to 282 per 100,000 live-born infants. To assess the magnitude of the syphilis epidemic in pregnant women and to identify ways to improve CS prevention, the Baltimore City Health Department (BCHD), the Maryland Department of Health and Mental Hygiene (DHMH), and CDC analyzed CS surveillance data for and reviewed medical records of pregnant women with syphilis. This report summarizes the results of this investigation, which indicated that 90% of cases could have been prevented by adequate prenatal care and more timely syphilis screening and treatment

Baltimore↗

PubMed1987

[Clinical aspects, diagnosis and therapy of syphilis in pregnancy and in newborn infants].

A clinically manifest primary or secondary syphilis that develops during pregnancy has become an extremely rare occurrence. What is more frequently found in pregnant women, however, is a reactive syphilis serology where there is otherwise an absence of clinical symptoms or where, at least, there are untypical symptoms. What has to be decided in these cases is whether one is dealing with latent seropositive syphilis that can be transmitted to the child and thus needs to be treated, or with a serum scar resulting from an infection which occurred some time before. As a rule, this decision can be reached serologically by demonstrating Treponema-specific IgM antibodies by means of the 19S-IgM-FTA-ABS test or some similar methods. In the case of specific IgM detection, immediate treatment of the mother, and thus of the child, is important. Daily intramuscular injections of 1 million I.U. penicillin over a total of 21 days are recommended. Only in proved cases of penicillin allergy should one resort to erythromycin; although it must be said that there is no guarantee that this will produce a therapeutically sufficient fetal blood level. In rare cases such as these, the child must therefore be retreated with penicillin after birth. Today, the clinical signs of premature or retarded congenital syphilis are hardly ever seen in their classic form. Symptoms are frequently uncharacteristic - especially in the case of premature births - and can only be distinguished from other congenital infections with difficulty.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythromycin↗

PubMed1976

The erythrocyte sedimentation rate in syphilis.

The erythrocyte sedimentation rate was studied in 520 men and 202 women with syphilis. It was raised in 66-6 per cent. of sero-negative primary cases, 80 per cent. of sero-positive cases, 100 per cent. of secondary cases, 80 per cent. of early latent cases, and 73-9 per cent. of late latent cases. It was also raised in sixteen out of seventeen cases of neurosyphilis and in all eleven cases of cardiovascular syphilis. It was concluded that the ESR had little place in the management of syphilis in general, but could be helpful in the post-treatment follow-up of late syphilis.

Blood Sedimentation↗

PubMed1989

[The atypical course of syphilis in HIV infection].

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%).

Acquired Immunodeficiency Syndrome↗

PubMed1987

[Latent and manifest acquired syphilis--clinical aspects, diagnosis and therapy].

The annual reported incidence of new syphilis infections in the FRG is decreasing; cases with atypical or oligosymptomatic forms of syphilis, however, show a relative increase. In contrast to the primary or secondary stage, the late stages of syphilis are very rare. Of great diagnostic importance is the serological examination which today can be limited to the VDRL and TPHA tests for screening and the FTA-ABS test for confirmation. In cases with an atypical clinical picture or history, the necessity for treatment can be verified with the 19S-IgM-FTA-ABS test and demonstration of treponemal IgM antibodies. Penicillin is still the drug of choice for the treatment of syphilis. In patients who are allergic to penicillin, the administration of erythromycin, tetracycline and, recently, of cephalosporins can be considered.

Anti-Bacterial Agents↗

PubMed2004

Congenital syphilis resurgent.

Syphilis is resurgent in many parts of the world. Even in those countries where rates have fallen focal outbreaks still occur. Congenital syphilis is an inevitable consequence of undetected and untreated syphilis in a pregnant woman. Universal screening in pregnancy, even if the positive yield from the test is low, remains the keystone to congenital syphilis prevention. Programmatic attention to testing, treating, education, and contact tracing in pregnancy and subsequent late trimester retesting of high-risk women will lower congenital infection rates. Any slip in this meticulous process inevitably leads to resurgence of congenital syphilis.

Female↗

PubMed1995

Chest radiographs of neonates with respiratory failure caused by congenital syphilis.

Congenital syphilis still occurs in newborn babies and the prevalence has increased in recent years, especially in developing countries. This has led to an increase in the number of babies with congenital syphilis requiring intensive care for respiratory failure. The early recognition of this disease could lead to the institution of timely and appropriate treatment. In this study the radiological picture of syphilitic pneumonitis is described in 20 neonates admitted to our neonatal intensive care unit requiring ventilation for respiratory failure. The radiological picture of the babies with syphilis was compared to 20 babies with other causes of respiratory distress. The radiological picture in 17 babies demonstrated a coarse nodular pattern in addition to band-like opacities radiating from the hilar regions. The nodular opacities became confluent on follow-up radiographs. In 13 cases, the proximal humeri showed changes typical of congenital syphilis. Two of the three babies with syphilis who did not have the typical chest radiological picture had bony involvement visible on the chest radiograph. Both the sensitivity and specificity of radiographic diagnosis were 75% with a positive and negative predictive value of 75%. The diagnosis of congenital syphilitic pneumonitis can therefore be suspected on chest radiographs and should be included in the differential diagnosis of any baby who presents with an interstitial pattern on chest radiography.

Case-Control Studies↗

PubMed2005

[Increase in syphilis and STD coinfections in HIV-infected individuals in Dresden].

BACKGROUND: In the past few years, increased diagnoses of syphilis and other sexually transmitted diseases (STD) have been reported in the cities of the United States and Europe, including Germany. The majority of cases identified were men who have sex with men (MSM). PATIENTS AND METHODS: A retrospective chart review of 144 HIV-infected patients from Dresden enrolled between 2000 and October 2003 was analyzed for the prevalence of syphilis and other STDs and compared with previous data of 104 patients collected between 1993 and 1999. RESULTS: The seroprevalence of syphilis increased from 13.5% to 17.5%, mainly due to a marked increase of active early syphilis from 0% to 7% of patients, all of whom were MSM. 63% of the patients had clinical or serological signs of other STDs. CONCLUSION: These data confirm previous reports on the increase of syphilis among MSM. The frequent occurrence of other STDs in HIV-infected patients outlines the need for special STD screening offers and adequate counseling.

Adult↗

PubMed2005

[Syphilis treatment. German and international guidelines--a comparison].

Guidelines are an important instrument for improving the quality of medical care. In 2001, the German STD Society (DSTDG) published guidelines for syphilis diagnostics and treatment. For two reasons, these guidelines had to be reviewed urgently: Firstly, there is an obvious "renaissance" of syphilis among men having sex with men, which is complicated by a frequent comorbidity with HIV infection. Secondly, the standard drug for syphilis treatment in Germany, clemizole penicillin, has no longer been available since July 2003. In this article, the new German guidelines for syphilis treatment 2004, published by the DSTDG, are compared with other syphilis guidelines, which are valid for the European countries, i.e., the CDC, UK, Russian, and European guidelines 2002.

AIDS-Related Opportunistic Infections↗

PubMed1999

Response to standard syphilis treatment in patients infected with the human immunodeficiency virus.

In a study designed to evaluate the efficacy of penicillin in HIV-infected patients with syphilis and to determine the clinical and laboratory responses after treatment, 13 patients with HIV infection and syphilis were assessed at enrollment and at the last follow-up examination (median time of 21 months). The Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum hemaglutination test, and leukocyte counts in cerebrospinal fluid were evaluated both at enrollment and at the last follow-up visit, and the polymerase chain reaction for Treponema pallidum DNA and the rabbit infectivity test were performed on cerebrospinal fluid samples at the last follow-up visit. Primary syphilis was confirmed in four patients, latent syphilis in five, and neurosyphilis in four. After penicillin treatment, all patients were asymptomatic. The serum rapid plasma reagin test became negative in five patients, and titers declined in eight. The VDRL test, Treponema pallidum DNA, and the rabbit infectivity test were negative in all 13 patients. Except for one patient whose serological titer was slow to decline, all patients had good clinical and serological responses to penicillin. In certain settings, factors other than penicillin treatment failure should be considered in HIV-infected patients with suspected relapse of syphilis.

Adult↗

PubMedDate not supplied

Ocular syphilis.

There has been a steady increase in the number of cases of syphilis in the United States since the middle 1980s, with a dramatic rise in incidence among heterosexual men and women and of congenital syphilis. There also have been changes in geographic distribution of cases and an association with cocaine use. The ophthalmologic manifestations of syphilis are broad. There is anecdotal evidence that the natural history of syphilitic infection is altered by coinfection with human immunodeficiency virus. The potential of coinfection with HIV makes the clinical evaluation, treatment, and assessment of therapeutic outcome of syphilitic infection more confounding and controversial. This article provides a review of the changing demographics and ophthalmic manifestations of syphilis, the current status of laboratory testing techniques, and management approaches to various types of ocular syphilis.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Nonvenereal treponematoses: yaws, endemic syphilis, and pinta.

The nonvenereal treponematoses--yaws, endemic syphilis, and pinta--constitute a major health concern for many third world countries. These diseases are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Nonvenereal treponematoses differ significantly in their modes of transmission, epidemiology, and clinical presentation from venereal syphilis. Like venereal syphilis, they have a chronic relapsing course and have prominent cutaneous manifestations. Recently, several cases of imported yaws and endemic syphilis have been described in Europe. With the escalating U.S. military presence in many remote areas of the world and ever-increasing world-wide travel, the diagnosis of the nonvenereal treponematoses must be considered in appropriate clinical and historical situations.

Adolescent↗

PubMed1992

Is syphilis an incurable disease?

Structures which morphologically resemble treponemes have been found in material from patients suffering from latent or late latent syphilis, many of whom have received treatment in the past. These structures were also found in the blood or spinal fluid (SF) of asymptomatic patients with both positive and negative serological tests for syphilis. They have been found in the eye in the presence of active disease as well as in cases without inflammation ('quiet eye'). In latent syphilis, the presence of treponemes after penicillin treatment raises the question of whether the patient is completely cured of syphilis after treatment. Experimental evidence indicates that continued specific antibody production following penicillin treatment depends on the persistence of the specific antigen in the body. This raised three questions: a) Are these stimuli living treponemes? b) Are they still virulent? c) Is syphilis completely curable following penicillin treatment? Our hypothesis is that slowly dividing treponemes are not killed by penicillin. The persistence of living treponemes somewhere in the body may be the proof of this hypothesis. Cases of relapsing neurosyphilis after penicillin treatment have recently been described. We return to the old dilemma: is it a scar-tissue injury or a reactivation of the disease? Since neurosyphilis is asymptomatic, the patient is usually examined because of seroconversion. Only repeated serological analyses and clinical observations of treated cases with immediate penicillin administration can prevent relapse and damage to the central nervous system (CNS) or to other parts of the body.

Animals↗