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PubMed1999

[Gonorrhea and syphilis from Russia to Norway].

In the 1990s, Russia has experienced a rapidly increasing incidence of syphilis and gonorrhoea. There are concerns of a spread of the epidemics to neighbouring Norway. From 1993 to 1998, 1,335 cases of gonorrhoea and 62 cases of syphilis were reported to the Norwegian notification system for infectious diseases. We studied cases with a Russian patient or source partner and cases acquired in Russia. 28 (2.1%) of gonorrhoea cases and 12 (19%) of syphilis cases had links to Russia. There was no time trend over the period. Ten gonorrhoea and three syphilis cases were from Finnmark, a sparsely populated county neighbouring Russia. Most patients were males over 30 years of age. So far, the gonorrhoea and syphilis epidemics in Russia have had minor impact in Norway. Thorough surveillance is still needed.

Adult↗

PubMed1999

Cost-effective syphilis screening in military recruit applicants.

A cost-effectiveness analysis of syphilis screening was performed. Strategies included no screening, universal testing at military entrance processing stations, universal testing at basic training centers, and contracting centralized screening. Probabilities derived from data retained on recruit applicants from 1989 through 1991 (N = 1,588,143) and from the published literature were used. Cost estimates were derived from costs incurred by the military and costs projected from implementing new strategies. Sensitivity analyses were performed. Modifying the existing contract for human immunodeficiency virus screening to include syphilis screening would maximize the effectiveness of screening at a cost to the Department of Defense of $9.52 per additional year of service received. The no-screening option was significantly more cost-saving than the current method of testing. Syphilis is rare and treatable, and individuals with syphilis will be identified by other means in many cases. Syphilis screening of recruit applicants at the military entrance processing stations should cease, saving the military $2,541,000 per year.

Algorithms↗

PubMed1999

[Increase of early syphilis in Rotterdam (1995-1997): more (addicted) prostitutes and their clients].

OBJECTIVE: To detect risk groups in an increase of early (infectious) syphilis. DESIGN: Retrospective study of patient records. METHOD: Data from visitors with an early syphilis were collected from their respective medical records in the outpatient clinic for sexually transmitted diseases (STD) of the Academic Hospital Rotterdam-Dijkzigt, the Netherlands, over the years 1993-1997. In particular, data on risk behaviour and risk groups were collected. To obtain an indication of the (possible) causes of the increase in the number of visitors with early syphilis, (shifts in) characteristics of this population over the years were compared. RESULTS: 195 patients with early syphilis had visited the outpatient clinic, 130 males and 65 females, mean ages ranging from 30.9 (1993) to 38.1 years (1997). Most infected persons (68%) came to the outpatient clinic because of symptoms. The number of women who came to the outpatient clinic through partner notification increased considerably, from an average of 5% in 1993-1995 to 36% in 1996. Over the years a relative increase of (drug addicted) prostitutes and their clients was observed (1993-1995: 39%; 1996: 56%). CONCLUSION: The cause of the increase, or failure to decrease, of the number of syphilis-infected visitors in the STD outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt should probably be sought among (drug addicted) prostitutes and their visitors.

Adult↗

PubMedDate not supplied

Routine antenatal syphilis screening--a case against.

To highlight the deficiencies associated with the routine antenatal syphilis screening as it is done now in the University College Hospital, Ibadan, and determine the cost effectiveness or otherwise of syphilis screening using as parameters the specificity of the method of screening as well as the gravity of the disease. The results of VDRL tests performed on pregnant women attending the antenatal clinic of the University College Hospital, Ibadan, in a 10-year period, January 1988 to December 1997 were analysed for seropositivity as well as congenital syphilis. The case notes of 110 sero-reactive patients were retrieved and analysed for pregnancy outcome. The prevalence rate of seropositive patients was 1.1%. Only 3 of the seropositive had repeated tests and were treated empirically with high doses of penicillin. There was no case of congenital syphilis. This study has shown that the syphilis screening as it is done now is not cost-effective. If VDRL test is to be continued, efforts must be made to reintroduce TPHA-test, which is more specific-specificity; it wastes a lot of time and money of the patients. Hence it is not cost effective. If VDRL test is to be continued efforts must be made to reintroduce TPHA-test, which is more specific.

Cost-Benefit Analysis↗

PubMedDate not supplied

Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality.

A prospective study of all cases of congenitally acquired syphilis diagnosed at Goroka Base Hospital was conducted between January 1998 and December 1999. 67 affected neonates and children were seen, of whom 19 died during the first admission and 3 died during the period of follow-up. Congenital syphilis caused 5.5% of 994 neonatal admissions, but 22% of all neonatal deaths. The major risk factor for death in affected babies was low birthweight. A birthweight of less than 2 kg had an odds ratio for death of 30.0 (95% confidence interval 6.90-131.1). During the time of the study 5385 women attended antenatal care at Goroka Base Hospital, of whom 382 had both positive VDRL and TPHA tests. The incidence of syphilis in women attending antenatal care was 7.1%. Syphilis is a major cause of neonatal mortality and morbidity and a major cause of morbidity among women of childbearing age in the Eastern Highlands Province. Current antenatal screening is inadequate, covering less than 30% of pregnant women. New ways to extend syphilis screening and treatment to all affected pregnant women are urgently required and must be formally assessed.

Birth Weight↗

PubMedDate not supplied

Anti-beta2 glycoprotein I and anticardiolipin antibodies in leptospirosis, syphilis and Kala-azar.

OBJECTIVE: Reports have shown that anticardiolipin (aCL) antibodies present in patients with autoimmune diseases are dependent on the cofactor,beta2 glycoprotein I (beta2 GPI), as opposed to aCL antibodies seen in infectious diseases such as syphilis, HIV hepatitis C, etc. The assay for anti-beta2GPI antibodies has been reported to be more specific for antiphospholipid syndrome (APS). However, the prevalence of these antibodies in diseases such as leishmaniasis and leptospirosis remains unknown. The aim of the present study was determine the prevalence of antibodies to cardiolipin and to beta2GPI in patients with different infectious diseases, including leptospirosis, syphilis and leishmaniasis. METHODS: Samples from patients with Kala-azar (visceral leishmaniasis), syphilis or leptospirosis were tested for IgG and IgM anticardiolipin and IgG anti-beta2GPI antibodies by ELISA. RESULTS: In patients with Kala-azar the prevalence of IgG aCL, IgM aCL and anti-beta2GPI was 6% (2/30), 3% (1/30) and 53% (16/30), respectively. In syphilis the prevalence was 18% (14/74), 13% (10/74) and 10% (8/70), respectively. In leptospirosis the frequency of these antibodies was 23% (9/39), 10% (4/39) and 17% (6/34), respectively. There was no statistical correlation between aCL and anti-beta2GPI antibodies in these diseases. DISCUSSION: This study clearly shows a significant prevalence of anti-beta2GPI antibodies in leptospirosis and leishmaniasis and syphilis. This indicates that the assay for antibeta2GPI antibodies should be thoroughly validated before it is introduced as a definitive tool for the diagnosis of APS, testing a larger number of sera from patients with a wider range of clinical conditions.

Adolescent↗

PubMed1954

Long-term studies of results of penicillin therapy in early syphilis.

In 1945, the US Public Health Service and co-operating treatment centres began a study of the results of penicillin therapy in a group of syphilis patients selected for intensive post-treatment observation. One objective was to test the hypothesis that patients lapsing from follow-up have the same experience as those remaining under observation, and evidence is presented which indicates that this is the case. The major objective was to evaluate the long-term results of penicillin in early syphilis. At the sixth year following penicillin treatment, satisfactory results were recorded for 98%-99% of the patients with primary and secondary syphilis (including those re-treated). There is no evidence that the cure of syphilis is enhanced by the addition of arsenic and bismuth. Seronegativity rates at the sixth post-treatment year were 81.0% for patients given combined penicillin-arsenic-bismuth therapy, and 80.7% for those treated with penicillin alone, while re-treatment rates were 17.4% and 16.3%, respectively. When cases treated with "adequate" dosage of arsenic and bismuth are analysed by the same statistical method as that employed in evaluating penicillin, the superiority of penicillin is clearly evident. A minimum of 4,800,000 units of penicillin is recommended for the treatment of early infectious syphilis.

Antidiarrheals↗

PubMed1992

Congenital syphilis presenting as desquamative dermatitis.

During the last 5 years the incidence of congenital syphilis has increased several-fold and reached epidemic proportions. This increase is directly related to a similar increase in cases of primary and secondary syphilis in women and has been linked to the use of "crack" cocaine. Factors responsible for the increase in reported cases of congenital syphilis include poor prenatal care, implementation of new surveillance case definition, failure to perform serological tests, treatment failures with benzathine penicillin, and maternal reinfection. Clinical manifestation of congenital syphilis are multisystemic but are often absent at birth. We report a case of congenital syphilis missed at birth and later characterized by prominent desquamative dermatitis affecting most of the skin surface.

Dermatitis, Exfoliative↗

PubMed2003

[Osteitis in secondary syphilis].

BACKGROUND: The aim of this study is to report two patients with osteitis in secondary syphilis. The increase in the number of cases of syphilis, linked to the changes in sexual behavior and to the increase of immigrants from areas of high prevalence of STD, as well as its relationship with HIV infection, makes important to clinicians become aware of unusual presentation of secondary syphilis. PATIENTS: We report two patients diagnosed of secondary syphilis, one of them with HIV infection. Both showed dermatological lesions in palms and soles, malaise and fever. Bone scintigraphy showed significant uptake in parietal and frontal bones in both patients. Clinical response was quickly achieved after penicillin treatment. CONCLUSIONS: In patients with secondary syphilis and osteoarticular symptoms luetic osteitis must be included in differential diagnosis. Bone scintigraphy should be the first diagnostic tool because it possibilities to perform a total body scan which allows localizing asymptomatic lesions. Moreover bone scan shows a high sensitivity.

Adult↗

PubMed1992

Controlling a syphilis epidemic.

In 1986 the rate of infectious syphilis (primary and secondary) in Los Angeles County began to rise from previously stable levels of about 23.5 per 100,000 to peak at 55.6 per 100,000 in 1987. The incidence of congenital syphilis increased from 205 cases in 1987 to 575 cases in 1989. The county's Sexually Transmitted Disease Program instituted a disease-specific plan to address the epidemic. Factors considered in designing the program included the high morbidity and mortality associated with congenital infection, the existence of latent infection, self-limiting symptoms, and the availability of an inexpensive screening test and curative treatment. Policy changes implemented comprised expanded screening, expanded surveillance, increased contact tracing, and the initiation of condom promotion programs. To evaluate the relative effectiveness of Los Angeles County's syphilis control efforts, the epidemic curve for infectious syphilis was compared with trends in other urban areas. Although the rate of infectious syphilis climbed a year earlier in Los Angeles than in other cities, it returned to baseline levels when other cities' rates remained at epidemic levels.

Health Education↗

PubMed2004

Azithromycin treatment failures in syphilis infections--San Francisco, California, 2002-2003.

The San Francisco Department of Public Health (SFDPH) is investigating several clinical failures in syphilis patients treated with the macrolide antibiotic azithromycin. This report describes the use of azithromycin for syphilis treatment, recent treatment failures in San Francisco, and CDC recommendations for syphilis treatment. Clinicians should exercise caution in using azithromycin for treating incubating syphilis or syphilis infection until the risk and mechanism of failure are better understood.

Adult↗

PubMed2004

[Syphilis, new epidemiologic features].

The epidemiologic survey by the InVS from data from voluntary sites shows an increase of the cases of syphilis from 2000 to 2002 in France. Most of patients with early syphilis are men having sex with men and more than half of cases is HIV infected patients. Resurgence of syphilis reflects the relapse of high-risk sexual practices and the most sexual practice evocated is unprotected oral sex. The same situation has been reported in countries from the west of Europe. In east of Europe, the epidemiology is a little bit different with an increase of cases since the early 90's mostly in sex workers and in relation to the rapid increase in the number of injecting drug users. In United States, although increases in syphilis rates among men who have sex with men have been documented since 1997, the majority of cases have been reported in the South affecting disproportionately blacks, reflecting low access to medical care but also racial segregation in sexual activity. The resurgence of syphilis while it is limited highlights the need for more health promotion initiatives especially in the most affected population.

Adult↗

PubMed2004

Syphilis clusters in Walsall: case profiles and public health implications.

Between the beginning of December 2002 and the end of March 2003, eight cases of infectious syphilis were diagnosed in Walsall. Two unrelated clusters were identified. The first consisted of three cases, two heterosexual patients and a baby with congenital syphilis. The infant had no congenital stigmata of syphilis, which is consistent with recent infection. The second cluster consisted of five cases in men who have sex with men (MSM) who attended a local sauna that attracts men from the Midlands and north west England. One infection was detected in an outreach screening initiative of 60 MSM. Both clusters illustrate the problems of case ascertainment and the need for continued vigilance to the potential of syphilis infection in high risk groups. Vigorous public health efforts are required to promote safer sex and awareness to infection with syphilis and human immunodeficiency virus, reinforced by targeted case finding in clinic and community settings.

Cluster Analysis↗

PubMed2004

The epidemiology of infectious syphilis in the Republic of Ireland.

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.

Adolescent↗

PubMed1992

Resurgence of congenital syphilis.

As a result of the alarming increase in primary and secondary syphilis in the United States, congenital syphilis has resurged in many areas, including Detroit. Several maternal risk factors have been identified as contributing to the increase in congenital syphilis, the most important of which are poor prenatal care and the trading of sex for illicit drugs, specially "crack" cocaine. Contact tracing programs are currently ineffective. To prevent the continuing increase in congenital syphilis, a comprehensive prenatal care program starting in early pregnancy is essential. STS should be determined during pregnancy and may be required more than once in high-risk mothers. Results of STS must be verified before infants are discharged from nurseries. Obstetricians, neonatologists, pediatricians, and general practitioners should be more aware of the problem of congenital syphilis and the need for early intervention and treatment.

Humans↗

PubMed1992

An unusual presentation of secondary syphilis in a patient with human immunodeficiency virus infection. A case report and review of the literature.

BACKGROUND: Syphilis has been reported to assume unusual clinical appearances and to exhibit unusual courses in patients infected with the human immunodeficiency virus (HIV) type 1. We recently observed a distinct manifestation of syphilis in an HIV-infected patient with features not previously described. OBSERVATIONS: A 38-year-old HIV-seropositive homosexual man presented with fever, chills, malaise, and a cutaneous eruption consisting of indurated, shiny, erythematous plaques that were confluent on the face and scalp leading to alopecia and extreme tautness of the skin. Initial clinical diagnoses included lymphoreticular malignancy and infection. Although cultures yielded Staphylococcus aureus, a skin biopsy specimen was diagnostic of syphilis. CONCLUSIONS: This case demonstrates an unusual clinical manifestation of syphilis in a patient with HIV infection and emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of virtually any inflammatory cutaneous disorder in HIV-seropositive individuals.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Province of residence and active syphilis infection among Zambian men and women: new evidence from population-based data.

This study examined the risk factors for active syphilis infection in a subset of nationally-representative population-based survey of Zambian men and women. Syphilis prevalence was 6.5% for women = 2107) and 7.4% for men (N = 1745). In the multivariate model, province was a strong risk factor for active syphilis infection, with Copperbelt, Eastern, Luapula, Lusaka, North-Western and Western Provinces presenting significantly higher risk for women, and Copperbelt, Eastern and Lusaka Provinces presenting significantly higher risk for men compared to the Northern Province. In addition to province, age, education, age at first intercourse, marital status, history of genital sore or discharge, and having ever paid for sex were independent predictors of syphilis infection. Given the ongoing HIV-1 epidemic in Zambia, more aggressive diagnosis and treatment of active syphilis infections, particularly in high-risk provinces, are important strategies to reduce reproductive morbidity and curb HIV-1 transmission.

Adolescent↗

PubMed2006

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

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.

Catholicism↗