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PubMed2002

[Ocular syphilis].

BACKGROUND: Syphilis has distinctly increased in the last decades. It is necessary to know the different eye changes in syphilis. PATIENTS: In four patients, between 34 and 71 years of age, typical as well as unusual syphilitic eye changes were found. In three patients diagnosis was made due to the inflammatory eye changes. RESULTS: An iritis was found in two patients (62 and 34 years old). In addition, the 62-year-old patient showed the unusual fundus picture of both vasculitis and neuroretinitis, with macular exudates and swelling of the optic disk. A venous occlusion, a rare sign in syphilis, was diagnosed in a 55-year-old patient. A 71-year-old patient revealed the characteristic finding of a placoid chorioretinitis. All four patients showed a swelling of the optic disk. CONCLUSION: Syphilis should be suspected even in older patients with an uncertain origin of uveitis, optic nerve disease, pupillary changes, or eye motility disturbances giving rise to carry out serologic tests in patients with the suspected diagnosis.

Adult↗

PubMed1993

[Syphilis screening in pregnancy].

A review of the effectiveness of antenatal screening for syphilis in the 3 year period 1989 to 1991 was made at the Department of Obstetrics, University of Zurich. In a total of 5640 pregnancies, 30 had a reactive TPHA-result. Using FTA-ABS-test and IgM-tests, 2 were false positive and 27 were considered as seropositive without signs of infection. Only one patient had a serology consistent with a latent syphilis. In Switzerland, every year approx. 9 newborns with positive serology for syphilis are found. Most of them, however, are not infected and the result only reflects the serostatus of the mother. Because of these poor results we doubt the usefulness of an antenatal screening programme for syphilis.

Adult↗

PubMed1992

Serological tests in cerebrospinal fluid for congenital syphilis in central Africa.

Serological tests were performed in the cerebrospinal fluid (CSF) of 13 children with active congenital syphilis (presence of specific IgM FTA-ABS antibodies) and of seven seropositive children with no active syphilis (FTA-ABS IgM-negative) born to syphilitic treated mothers in Libreville, Gabon. Antibodies against treponema were measured by the Venereal Disease Research Laboratory test (VDRL), the Treponema pallidum haemagglutination assay (TPHA) and the fluorescent treponema antibody absorption tests (FTA-ABS IgG and IgM). Of the 13 children with active syphilis, seven had a positive FTA-ABS IgG in the CSF. The result of this test was not correlated with the severity of clinical features, CSF protein levels or number of CSF white blood cells. The CSF-TPHA test was positive in four out of 12 children, and the CSF-VDRL test was negative in all the children with active congenital syphilis. One of the seven newborns with mother-transmitted antibodies had a positive FTA-ABS and TPHA in the CSF. These data show that the VDRL is not sensitive enough to diagnose congenital neurosyphilis, and that FTA-ABS or, at least, TPHA are convenient, sometimes with false-positive results, when a sophisticated method of detecting specific IgM in CSF is not available.

Fluorescent Treponemal Antibody-Absorption Test↗

PubMed1988

Congenital syphilis in The Netherlands: cause and parental characteristics.

During 1982-5 the 19S (IgM) fluorescent treponemal antibody absorption (19S (IgM) FTA-ABS) test gave positive results in 19 children. The parental histories were analysed. As five of the children were adopted, 14 pregnancies were evaluated. Mothers of foreign origin and extramarital pregnancies were found to be over-represented. Of 13 women who attended for pregnancy checkup, three were not serologically screened for syphilis. In four the infection had developed late in the course of pregnancy. In at least four treatment had not been given or had been inadequate or too late. At least two had positive 19S (IgM) FTA-ABS test results that did not indicate congenital syphilis. The possibility of false positive 19S (IgM) FTA-ABS test results is pointed out. As the male sexual partners of four of the 14 mothers had presented elsewhere with early syphilis at the time of their partner's pregnancy, adequate contact tracing appears to be important to prevent congenital syphilis in future.

Adolescent↗

PubMed2001

Clinical and epidemiological features of syphilis in pregnant women: the course and outcome of pregnancy.

Clinical and epidemiological features of syphilis and the course and outcome of pregnancy were studied in 155 pregnant women infected with syphilis; 95 (61%) women were unemployed, 47% were unmarried. Syphilis proceeded without clinical manifestations in 121 cases (78%). Discordant results of complement fixation (Wassermann) test, precipitation test, Treponema pallidum immobilization test, and fluorescent antibody test were observed in 22 (14%) of the women. Pregnancy pathology was observed in 75 cases (48.8%) and more often appeared as anemia in 49 (31.5%), stillborn in 46 (29.8%) and toxicosis in 44 (28.4%). Fetal ultrasonic stigmas of infection were evident in 23 cases (49%). There was distension of the brain ventricle system and hepatomegaly each in 1 case (2%), transvascular infiltration of liver in 2 cases (4%), dilation of intestinal loops, gastromegaly, ventriculomegaly and petrifaction in lungs each in 1 case; ultrasonic changes in vessels of organs: of the liver in 4 cases (8%), intestines and stomach in 16 cases (32%), lungs in 4 cases (8%), kidneys in 10 cases (21%) and of the ventricular system in 9 cases (19%). Fetus development retardation was revealed in 3 cases (6%), fetal hypoxia in 1 (2%), hypohydrosis in 2 (4%) and hydropsy in 1 case (2%). The pregnancy pathology in women with syphilis was considered not pathognomonic.

Adolescent↗

PubMed1979

The effect of treatment on the Treponema Pallidum Haemagglutination test in early syphilis.

The response of the Treponema Pallidum Haemagglutination Assay (TPHA) to treatment was studied in 61 cases of early infectious syphilis. In none of the 55 cases of early syphilis in which the pre-treatment TPHA was positive did the TPHA test become consistently negative after treatment. In primary and early latent syphilis it was not possible to demonstrate any significant changes, but in some cases of secondary syphilis a significant and rapid fall in TPHA titre occurred with treatment. It is suggested that the post-treatment TPHA titre need not necessarily reflect the stage at which the disease was arrested.

Hemagglutination Tests↗

PubMed1975

The laboratory diagnosis of syphilis. New concepts.

Although new tests for syphilis, as well as new applications of standard tests, continue to appear, the usefulness of several of these procedures has not been determined. When the Fluorescent Treponemal Antibody-Absorption (FTA-ABS) test is used to screen for syphilis, the proportion of positive results that are true positives decreases. The value of modified FTA tests in the diagnosis of neurosyphilis and congenital syphilis remains unproved. Although not studied as extensively as the standard tests, several newer methods--the direct fluorescent antibody test for Treponema pallidum (DFATP), the Rapid Plasma Reagin (RPR) card test, and the microhemagglutination test for T. pallidum (MHA-TP)--may have certain advantages. To be of optimal diagnostic value, tests for syphilis must be selected according to the clinical situation.

Cerebrospinal Fluid↗

PubMed2002

Congenital syphilis following negative antenatal screening.

We report a case of severe early congenital syphilis in the infant of a mother who acquired syphilis in mid pregnancy. The mother had received full antenatal care including serological screening for syphilis. Congenital syphilis is re-emerging in a number of industrialised countries and this report demonstrates that some of the most serious cases cannot be prevented by routine antenatal screening.

Contact Tracing↗

PubMed2003

Congenital syphilis in the 21st century.

The rate of congenital syphilis is declining in the United States, but congenital syphilis is still a significant public health problem. Maternal serum screening is the mainstay of diagnosis. Maternal treatment will prevent most, but not all, cases of congenital syphilis. Access to prenatal care is critical to further reduce the rate of congenital syphilis.

Female↗

PubMed1991

[Diverse aspects of congenital syphilis].

Together with the new rise of recent syphilis in the adult woman, congenital syphilis reappears sporadically in our countries, where prophylactic measures (prenatal serology) are sometimes defeated. It remains much more frequent in developing countries. One should know how to interpret a positive serology in a newborn, as it may only reflect passive transplacental transfer of maternal antibodies. One should on the other hand think of syphilis again when the clinical signs are more or less suggestive, the typical picture not being, by far, the most frequent. In spite of the efficacy of Penicillin G: 50,000 U/kg/day during 10 days, neonatal death rate for congenital syphilis is in the neighbourhood of 10%. Our major effort should therefore be aimed at prevention.

Female↗

PubMed1979

Diagnostic evaluation of syphilis during pregnancy.

Obstetric patients with serologic evidence of syphilis should have cerebrospinal fluid (CSF) analysis to determine the presence of tertiary disease. In the present study, 19% of untreated and asymptomatic patients with serologic evidence of syphilis were found to have tertiary syphilis following examination of CSF. Despite maternal therapy, 11% of the infants born to mothers with syphilis had reactive serum and CSF involvement as documented by the presence of a fluorescent treponemal antibody absorption (FTA-ABS)-specific IgM.

Adult↗

PubMed1985

Syphilis--an appraisal of the Groote Schuur Hospital antenatal screening programme.

Syphilis is a major public health problem in pregnant women. Since congenital syphilis is preventable, an adequate screening programme is an essential facet of antenatal care. At Groote Schuur Hospital, Cape Town, the Venereal Disease Research Laboratory and Treponema, pallidum haemagglutination tests are employed for antenatal screening. A survey of the current literature on serological testing for syphilis does not reveal clear guidelines for an optimal antenatal screening programme. The high prevalence of syphilis in pregnant women is confirmed by this study, which shows the current programme to be very effective in excluding women without disease.

Evaluation Studies as Topic↗

PubMed1983

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

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.

Humans↗

PubMed1995

Postneonatal screening for congenital syphilis.

The incidence of congenital syphilis has recently reached epidemic proportions. With the resurgence of this important clinical entity, currently recommended screening procedures may be inadequate. We describe three cases that highlight the limitations of these screening procedures. All these infants had associated maternal risk factors for congenital syphilis, such as poor prenatal care and illicit drug use. All the infants and mothers were seronegative for syphilis at the time of birth but the infants became seropositive at 2 months of age. These cases support the need to reexamine current screening policies. In addition to prenatal and at-delivery screenings for congenital syphilis, it may be appropriate to screen infants born to high-risk mothers at 4 to 8 weeks of age.

District of Columbia↗

PubMed1996

[Early syphilis].

Given the transmission of Treponema pallidum during human sexual contact, syphilis now occurs in France only in sexually high-risk, disadvantaged populations. The English-language terminology of "early syphilis" has progressively replaced that of "primary" and "secondary" in French usage. Induration of the chancre and the papular nature of secondary skin rashes remain the best criteria for clinical diagnosis. Serological tests associate test specific for treponematoses (Treponema pallidum haemagglutination assay, TPHA) and a nonspecific screening test (Venereal diseases research laboratory, VDRL) to confirm clinically suspected disease. Routine use of long-acting penicillin (benzathine penicillin) is consistently effective. The continuing risk of active syphilis in a pregnant woman and the possibility of severe syphilis in HIV patients require vigilance.

Disease Outbreaks↗

PubMed1976

An analysis of 340 cases of syphilis diagnosed in the laboratory in six months in 1973.

Between July and December, 1973, 340 new cases of syphilis previously unknown to the laboratory were diagnosed on the results of serological tests. The male-female ratio was 2-5 : 1. Homosexually acquired infections accounted for 34-3% of cases of syphilis in males. The cases were grouped into primary, secondary, latent and late stages of syphilis according to history, clinical signs and serological test results. Cases in each stage were subdivided into age groups. Primary and secondary syphilis (that is, the early infectious stages) occurred in 56 males and 23 females under 29 years of age. In 41 of the males (73-2%) this infection was homosexually acquired. The figures from this analysis show similar trends to those available in the United Kingdom.

Adolescent↗

PubMed1995

[Scientific facts and their public: the history of the diagnosis of syphilis].

In the 1910's and 1920', thanks to the conjunction of scientific views concerning the specificity of anti-bacterial antibodies, of lay ideas about the existence of anti-bacterial antibodies and of the perceived importance of developing a syphilis test for public health officials, the community of serologists collectively transformed a relatively inefficient diagnostic test described by Wassermann in 1906 into an "incontestable scientific fact". This "scientific fact" established the equivalence: Wassermann positive individual=person infected with the germ Treponema pallidum, the etiological agent of syphilis. It modified the boundaries of the nosologic entity "syphilis", medical practices, professional attitudes, lay perceptions of syphilis, and health policies. In the 1950's, however, discrepancies between Wassermann test data and epidemiological data and, on the other hand, the development of specific anti-treponemal tests, destabilized the previously stabilized "scientific fact". A high percentage of Wassermann positive individuals were redefined as "biological false positifs", that is persons who suffered from chronic affections able to induce positive results of the Wassermann test. The equivalence Wassermann positive person=individual infected by Treponema pallidum was replaced by the equation: Wassermann positive person=individual infected by Treponema pallidum or biological false positive. The new perception of the Wassermann test again changed scientific views, professional practices and lay beliefs. The history of the Wassermann reaction illustrates the complicated interaction between "scientific facts" and "social facts", and the mutual shaping of both.

Diagnostic Tests, Routine↗

PubMed2005

[Syphilis and HIV infection. Characteristic features of diagnosis, clinical assessment, and treatment].

The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.

AIDS Serodiagnosis↗