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

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.

Combined Modality Therapy↗

High prevalence of syphilis-HIV co-infection at four hospitals of the city of Buenos Aires, Argentina.

A cross-sectional anonymous study of 261 STD (sexually transmitted diseases) outpatients and 288 outpatients from other hospital departments was conducted at four major city hospitals in Buenos Aires. High prevalence of human immunodeficiency virus (HIV) (14.5%) and syphilis (30.2%) was noted. Fifty-two persons were diagnosed with both HIV and syphilis. Of the 87 HIV cases observed, 52 (59.7%) were co-infected with syphilis. Stratified analysis by gender showed that the prevalence of HIV, syphilis and HIV/syphilis co-infection was significantly (p < 0.001) higher in men than women (HIV: 20.1% vs. 4.6%; syphilis: 39.3% vs. 17.4%; co-infection: 13.6% vs. 1.7%). Integrated HIV/STD intervention programs and more effective surveillance are required in Argentina.

Adolescent↗

Regional and temporal trends in the surveillance of syphilis, United States, 1986-1990.

During the latter half of the 1980s, an epidemic of syphilis occurred throughout the United States. A comparison of regional rates of primary and secondary syphilis in 1990 indicated that the rates were highest in the South, followed by the Northeast, the West, and the Midwest. Primary and secondary syphilis rates from 1986 through 1990 exhibited different regional patterns. Rates of primary and secondary syphilis in the West peaked in 1987 and declined from 1987 to 1990. Rates increased in the Northeast and the South from 1986 to 1990, but the increase reached a plateau in the Northeast in 1990. Rates did not begin to increase in the Midwest until 1988. More detailed analyses of the syphilis epidemics in specific communities in each region are needed to better understand the regional patterns. A comparison of these findings across regions could be helpful in evaluating which sexually transmitted disease intervention and control programs are most effective during epidemic periods.

Female↗

Syphilis during 1900-1910: similarities to present-day AIDS.

At the beginning of the 20th century, despite 20 years of intensive bacteriologic research, the cause of syphilis was unknown; no diagnostic test and no treatment had been found. Syphilis was one of the leading causes of morbidity and mortality, and those who had the disease were burdened with a social stigma. It was considered a disease of "bad blood." But success was soon to follow. In only 10 years, from 1900 to 1910, the Treponema pallidum was discovered as the cause of syphilis. Animal models were developed for research. The Wassermann test was "invented" for serologic diagnosis, and Paul Ehrlich proved that salvarsan, or 606, was effective for the treatment of syphilis. This success was preceded by 300 failures with related arsenical compounds. The scientific, medical, social, ethical, and economic issues of that day have recurred again with the AIDS epidemic. This earlier drama, therefore, is reflected in the current decade, but the success of Ehrlich, Wassermann, and others in the fight against syphilis is an optimistic omen that researchers will be equally successful in the fight against acquired immune deficiency syndrome (AIDS).

History, 20th Century↗

[Epidemiologic status of syphilis and gonorrhea in the area of Belgrade].

The authors present the epidemiological situation of venereal diseases (syphilis and gonorrhea) on the territory of Belgrade over the past twenty years with a detailed analysis of the past ten-year period. Constant decrease in morbidity rate was recorded in both diseases. The study showed that both diseases, expressed a high degree of parallelism in the dynamics of their appearance. Gonorrhoea was more frequent, with the rate of 1:4-41 in favour of gonorrhoea; the rate depended on the age. The incidence of gonorrhoea was 3.5 times higher in males than in females. However syphilis incidence was 2.5 times higher. The wafey endangered age groups for both diseases were 20-29 and 15-19 years for gonorrhoea, and 30-39 years for syphilis. In people working in catering services, tourism, public traffic, craftwork, as well as students and unemployed persons the highest frequency of these two diseases was observed. There was no seasonal difference in the incidence of syphilis, while gonorrhoea was frequent in the Summer months. There were differences in incidence (recent cases) and prevalence (number of recorded cases) of syphilis. Of the total number of annually recorded cases 30-60 per cent were recent cases. Repeated cases (especially of gonorrhoea) were frequent. The epidemiological research showed that approximately 37 per cent of primary source of infection were never recorded due to the lack of evidence and careless sexual contacts especially in the adolescent population.

Adolescent↗

Evaluation for endotoxemia in patients receiving penicillin therapy for secondary syphilis.

To determine if endotoxin liberation occurs after antibiotic administration to patients with syphilis, serial plasma samples were obtained from 15 patients receiving intramuscular penicillin G benzathine for secondary syphilis. The endotoxin content of these plasma samples was determined using a Limulus lysate assay (detection limit, 0.025 ng of reference Escherichia coli endotoxin per milliliter of patient plasma). Although secondary syphilis is the stage of syphilis having the greatest burden of spirochetes and the highest incidence of Jarisch-Herxheimer reactions, no endotoxin was detected in plasma either before or after antibiotic therapy. Despite the absence of detectable endotoxemia, five patients experienced mild Jarisch-Herxheimer-like reactions. These results suggest that endotoxin is not an important factor in either secondary syphilis or the reactions associated with antibiotic therapy of this disease.

Adult↗

Serological diagnosis of syphilis in pregnancy. Experiences at King Edward VIII Hospital, Durban.

Three different serological screening tests for syphilis were performed at the 'booking' visit of 500 antenatal patients at the King Edward VIII Hospital, Durban. The prevalence of active syphilis was 7,4%. The rapid plasma reagent test not only had a high biological false-positive rate at 11,8%, but also failed to detect 18,9% of the 37 patients diagnosed as having syphilis by means of the IgM-specific fluorescent treponemal antibody absorption (FTA-ABS) test. The Treponema pallidum haemagglutination (TPHA) test had a similarly high biological false-positive rate of 15,8%, but did not miss any of the 37 cases of active syphilis. The TPHA test is therefore advocated for screening patients for syphilis.

Adolescent↗

Seroprevalence of human immunodeficiency virus infection and its association with syphilis seropositivity among antenatal clinic attenders at Debretabor Rural Hospital, Ethiopia.

Sera collected for syphilis screening from pregnant women attending antenatal clinic at Debretabor rural hospital, north west Ethiopia were tested for HIV infection with the objective of assessing HIV prevalence and the relationship between syphilis and human immunodeficiency virus (HIV) seropositivity. A total of 270 pregnant women who visited antenatal clinics from June to September, 1994 were included in the study. Socio-demographic characteristics of the women were retrieved from antenatal care cards. Sera were screened for syphilis and HIV infection by VDRL and ELISA tests respectively. Twenty nine pregnant women (10.7%) were found to be HIV positive. Those living in other villages and rural towns appeared to have a low risk (odds ratio 0.3, 95% confidence interval 0.1-0.8) of acquiring HIV infection when compared to those living in Debretabor town. Women who were seropositive for syphilis were twice as likely to be positive for HIV. Prevention of HIV transmission to women and infants is a priority health and social concern. Prevention and early recognition and treatment of syphilis and other sexually transmitted diseases (STDs) will be important factors in the prevention and control of HIV transmission.

Adolescent↗

Syphilis in San Diego County 1983-1992: crack cocaine, prostitution, and the limitations of partner notification.

BACKGROUND AND OBJECTIVES: Recent epidemics of syphilis have been associated with crack cocaine use and anonymous sex for drugs, suggesting a potential limitation of sex partner notification as a disease control strategy. To assess these factors in an inner city epidemic of syphilis in San Diego County, California, we performed a descriptive epidemiologic analysis. STUDY DESIGN: Descriptive epidemiologic data were obtained from case investigation reports of primary and secondary syphilis. RESULTS: In the middle and late phases of the epidemic (1990-1992), the incidence of syphilis in the inner city area was more than six times that in remainder of the county. Illegal drug use was reported by 30% of patients. Drug use, especially crack cocaine, was related to prostitution. The estimated total number of sex partners per patient ratio was 4.2, whereas the named sex partners per patient ratio was only 1.5. Twenty-two percent of patients did not report any named partners. Overall, only 26% of the estimated total number of sex partners received treatment. CONCLUSIONS: Expanding partner notification to include more high-risk persons identified through social networks and increasing screening among high-risk populations may improve control of inner city drug/prostitution-related syphilis epidemics.

California↗

Ocular syphilis and neurosyphilis in a patient with human immunodeficiency virus infection.

A patient who presented with severely decreased bilateral vision was found to have syphilis and neurosyphilis that responded well to a 14-day course of penicillin and prednisone. The patient tested positive for HIV, which can alter the natural course of syphilis, often making the diagnosis and treatment difficult. Conventional therapy for syphilis may not be effective in patients with HIV. Any patient with syphilis who is in a high-risk group should be tested for HIV; conversely, any patient with HIV should be tested for syphilis if signs or suspicions exist.

Adult↗

Congenital syphilis: a reminder about the return of an old scourge.

Congenital syphilis had almost become a forgotten disease with the advent of maternal prenatal serology and penicillin therapy for infected mothers. From the 1950s into the mid-1980s, cases of congenital syphilis steadily declined to only 688 cases in the United States in 1988; however, the number of cases increased to 2,841 by 1990. The heralding event occurred between 1981 and 1989 with a 34% increase nationally in the incidence of primary and secondary syphilis. A peak in the number of cases of congenital syphilis was attained in 1992 in the country at large, but in 1993 in the State of Missouri, there were almost three times as many cases as were reported in 1992. Physicians, particularly those who practice in the metropolitan areas of the state, should be alert to the clinical profile of prospective mothers who may have primary or secondary syphilis.

Adult↗

Absence of lower extremity ossification centers in term infants with congenital syphilis.

Radiologic evaluation is valuable for confirmation of congenital syphilis. Bony abnormalities are thought to be secondary to active disease or a growth response of bone to systemic illness. Anteroposterior lower extremity radiographs of 85 euthyroid term infants (> or = 38 weeks' gestation; mean weight, 3244 gm; range, 1940-4380 gm) with presumptive congenital syphilis were evaluated for the presence of the distal femoral and proximal tibial secondary ossification centers and other bony abnormalities. Both proximal tibial and distal femoral ossification centers were absent in only 9 of 85 infants with syphilis; the proximal tibial center was absent in 26 of 85 (total 30.6%; 95% confidence limits 0.2 to 0.4). This observation is significant at the p < 0.01 level by chi-square analysis with use of historical controls. Periosteal new bone formation was seen in 2 of 85 infants. Metaphyseal lucent bands were present in 21 of 85 infants, 8 of whom also had absent lower extremity ossification centers. For comparison we reviewed lower extremity radiographs from 12 term infants without congenital syphilis. Ossification centers were absent in one growth-retarded infant, and metaphyseal lucent bands were found in one infant. Although standard texts report nearly universal ossification of the distal femoral epiphysis at term, we observed delayed skeletal maturation in 30.1% of term infants with congenital syphilis. We speculate that this delay may be reflective of systemic infection.

Chi-Square Distribution↗

[Prevalence of syphilis and gonorrhea in a family practice in Curaçao,1987-1991].

OBJECTIVE: To determine the prevalence of syphilis and gonorrhoea in a general practice from 1987 to 1991. DESIGN: Contact registration. SETTING: Sentro Mediko Kas Chikitu in Curaçao. METHOD: The numbers of patients having a syphilis or gonorrhoea infection were recorded. Using the chi 2-test prevalence was related to age and (or) sex. RESULTS: Syphilis infections (n = 96) were not age-related (chi 2 = 2.21; df = 4; p = 0.70) and occurred significantly more often among men (chi 2 = 19.70; p < 0.001); 6 out of 31 infected women contracted a syphilis infection during pregnancy; 9% of the men and 3% of the women between the ages of 15 and 64 contracted syphilis during this period. Between the ages of 15 and 24 there were significantly more and between the ages of 45 and 64 significantly fewer gonorrhoea infections (chi 2 = 21.99; df = 4; p < 0.001). Gonorrhoea infections (n = 75) were significantly more frequent among men (chi 2 = 61.3; p < 0.001); 37% of the men had had a previous infection. Of the cultured N. gonorrhoea 27% proved to be beta-lactamase-positive. Of the male population between 15 and 64 years 6% contracted gonorrhoea, of the female population 0.4%.

Adolescent↗

Gastric syphilis. Primary diagnosis by gastric biopsy: report of four cases.

Gastric involvement in secondary or tertiary syphilis is rarely recognized clinically, and its diagnosis by examination of endoscopic biopsy specimens has been reported infrequently. We report four cases of gastric syphilis with the primary diagnosis made by gastric biopsy. The patients, all male, ranged in age from 38 to 78 years and presented with gastric complaints, the most common being upper gastrointestinal tract bleeding (three of four). Gastroscopy showed either erosive gastritis or gastric ulcers with heaped, nodular edges. The clinical diagnoses ranged from benign ulcer disease to infiltrating carcinoma and lymphoma. Gastric biopsy specimens in all cases showed a severe gastritis with dense plasmacytic infiltration, associated with varying numbers of polymorphonuclear leukocytes and lymphocytes, variable degrees of glandular destruction and reactive atypia, and a vasculitis without proliferative changes. Modified Steiner silver impregnation stain revealed numerous spirochetes in all four cases and associated Helicobacter pylori infection in one case. Serologic studies for syphilis were positive in all four cases (rapid plasma reagin test, fluorescent treponemal antibody absorption test). None of the patients were seroreactive for antibodies to human immunodeficiency virus. These recent cases of gastric syphilis emphasize the importance of remaining alert to the protean clinical manifestations of syphilis and aware of the histopathologic patterns of this disease.

Adult↗

False-positive reaction between syphilis and hepatitis C infection.

There are limited data about false-positive reactions against hepatitis C virus (HCV) in syphilitic patients and false-positive reactions against syphilis in the patients with HCV infection. The aim of this study was to demonstrate the false-positivity of syphilis in patients with HCV infection, the false-positivity of anti-HCV in patients with syphilis and the validity of the serological tests in such patients. Fifty patients with positive anti-HCV, 21 patients with positive VDRL and 50 healthy subjects were studied. Syphilis serology was determined by the Venereal Disease Research Laboratory (VDRL) test and microhemagglutination for T. pallidum (MHA-TP) test. Hepatitis C serology was determined by a second generation ELISA (Ortho Diagnostics) test for HCV antibody, and anti-HCV positive patients were tested for HCV RNA by polymerase chain reaction (PCR). All assays were performed on all subjects. Not only the false-positive VDRL reaction in the patients with HCV infection but also false-positive anti-HCV tests in syphilitic patients have been observed. Four patients with syphilis had positive anti-HCV and negative HCV-RNA, whereas 10% (5 of 50) of patients with hepatitis C infection had positive VDRL and these patients were negative for MHA-TP test. The rates of false-positivity of VDRL and anti-HCV were higher than within the control group (p < 0.05). According to these data, positive anti-HCV in syphilitic patients and positive VDRL in chronic hepatitis C may be false-positive results with regard to the reaginic tests. Therefore, therapeutic measures should not be initiated without confirmation with a treponemal test or PCR. VDRL and HCV-ELISA tests may be interacted with IgM or IgG antibodies. This relationship should be investigated in further studies.

Adult↗

Early syphilis in an active duty military population and the surrounding civilian community, 1985-1993.

Syphilis among active duty soldiers at Fort Bragg, North Carolina, and the nonmilitary population of Cumberland County was examined during a 9-year period encompassing the most recent nationwide syphilis epidemic. A total of 762 cases of primary and secondary syphilis were recorded between 1985 and 1993, 27% of which occurred in soldiers. The epidemic struck both military and civilian populations simultaneously; epidemic curves in the two populations were parallel, peaking in 1990-1991, with highest annual incidences of 122.6/ 100,000 (military) and 48.0/100,000 (civilian). Individual risk factor data were not available for analysis, but a relationship was observed between primary and secondary syphilis diagnoses in both populations and cocaine arrests in Cumberland County. Our findings provide epidemiological support for a high degree of interplay between the military and the surrounding civilian communities that has significant implications for control of sexually transmitted diseases. Enhanced collaboration between military and civilian public health authorities is essential to the control of syphilis and other sexually transmitted diseases.

Adult↗

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

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.

Adult↗

Problems in the current case definitions of congenital syphilis.

During the course of a population-based epidemiologic study of congenital syphilis, we found discrepancies and problems of validity in the case definitions of congenital syphilis of the Centers for Disease Control and Prevention and other experts. We analyzed these problems and determined their impact on case classification in our study. The most important problem that we found was the case definitions' lack of a valid scientific basis for the classification of symptom-free infants born to mothers who have been treated for syphilis but have uncertain infection status (286 infants in our study). The classification of these infants is based on diagnostic tests whose sensitivity and specificity are unknown. In our study, we found that results of some tests were rarely positive and that values for others were similar to those in uninfected infants. We believe that symptom-free infants of treated mothers of uncertain infection status should be classified as cases, pending the development of better diagnostic tests for congenital syphilis. The economic impact of treating these infants can be lessened by obtaining fewer diagnostic tests and by use of one injection of penicillin rather than a 10- to 14-day course, an approach suggested by a literature review. Use of infants' diagnostic tests to classify any other group of symptom-free infants does not seem appropriate, even though this is often recommended.

Centers for Disease Control and Prevention, U.S.↗