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PubMed1991

Syphilis serology in blood donors: a possible surrogate marker for human immunodeficiency virus risk.

We report a preliminary study on whether syphilis serology might be reactive in some blood donors at risk for human immunodeficiency virus (HIV) infection. We retrospectively analyzed voluntary blood donations with reactive Treponema pallidum antibody (TPA) tests according to the type of donation, the presence of other safety markers, confidential unit exclusion, syphilis diagnosis, and HIV risk factors. Over 2 years (1987-1988), 1 in 8,900 regular homologous donations (n = 258,610) was TPA positive as compared with 1 in 2,200 directed donations (n = 6,685) and 1 in 300 autologous donations (n = 8,870; p less than 0.05 for both). The rate in directed donations was not significantly higher than in first-time regular donors (1 in 4,800; n = 57,000). TPA-positive donations had higher rates of antibody to hepatitis B core antigen and confidential unit exclusion than TPA-negative donations. Ten TPA-positive homologous or directed donors had latent or previously treated syphilis (1 in 26,500 such donations), and 2 of these had HIV risk factors. None of the autologous donors were determined to have active syphilis. Syphilis serology in blood donors bears further scrutiny as a possible surrogate marker for HIV risk.

Biomarkers↗
PubMed1994

Evaluation of neurosyphilis in human immunodeficiency virus-infected individuals.

The diagnosis of neurosyphilis in patients infected with the human immunodeficiency virus (HIV) remains problematic. We examined the use of the Treponema pallidum hemagglutination (TPHA) index and quantitative tests of CSF by means of microhemagglutination-T. pallidum for diagnosis of neurosyphilis in 58 HIV-infected persons with latent syphilis who had not recently received therapy for syphilis. Five patients (9%) had reactive CSF VDRL tests and thus had proven neurosyphilis. For 13 patients (22%), CSF findings were normal and revealed no evidence of neurosyphilis. For 40 patients (69%), abnormal CSF findings were characteristic of neurosyphilis, but their CSF VDRL tests were nonreactive. Twenty-five of the 40 patients with possible neurosyphilis had pleocytosis and elevated CSF levels of protein and/or IgG. Five (12.5%) of these 40 patients had positive TPHA indices that indicated intrathecal antitreponemal antibody production, a finding that provided greater support for the diagnosis of active neurosyphilis. With use of the TPHA index, patients with CSF abnormalities can be better classified in regard to their need for therapy for neurosyphilis.

Adult↗
PubMed1984

Sexually transmitted diseases in children.

Venereal infections acquired from the mother are responsible for significant morbidity and mortality in the newborn. Prepubertal children may be exposed to these diseases through sexual abuse. The clinical pictures often differ from those of adult syndromes. All cases require epidemiologic investigation, precise etiologic identification and full courses of treatment. The list of bacterial, "bacteria-like," fungal, viral, protozoan and parasitic infections is extensive. Pathogens of chief interest are the gonococcus, condyloma acuminatum virus, Treponema pallidum, Trichomonas, herpes simplex virus and Chlamydia trachomatis.

Adolescent↗
PubMed1987

Enteropathogenicity of Treponema hyodysenteriae in young chicks.

Observation by scanning electron microscopy served to demonstrate that Treponema hyodysenteriae colonized the cecal mucosa of young chicks on day 3 after inoculation and produced lesions from 9 days after inoculation. Severe and clearly visible lesions were present on the cecal mucosa of all chicks necropsied 18, 21, and 24 days after inoculation. Severe lesions such as roughness of mucosal surface and disappearance of the mucosal foldings were observed at low magnification. The lesions were characterized by a destruction of superficial epithelial cells and dilation of crypt orifices. The dilated orifices of crypts were clearly observed, and the number of the crypts increased as compared with that of the crypts on the cecal surface in non-infected chicks. At high magnification, mucosal epithelial cells were found to be desquamated and the surface of the lamina propria mucosae had appeared. Numerous treponemas became visible on the surface of damaged epithelial cells and on the surface of the lamina propria mucosae.

Animals↗
PubMed1996

Gender differences in sexual practices and sexually transmitted infections among adults in Lima, Peru.

OBJECTIVES: This study examined the prevalences of antibodies to Treponema pallidum, Chlamydia trachomatis, and herpes simplex virus type 2 in a sample of Peruvian adults. METHODS: Among adults seeking health certification in Lima, Peru, 600 were randomly selected to undergo interviews and serologic testing. RESULTS: Men's reported mean lifetime number of partners (10.6) far exceeded women's (1.1), yet antibody to sexually transmitted infection pathogens among sexually experienced participants was 2.8 times more prevalent among women than among men. Among men, female sex workers accounted for 37% of recent partners, and only sex with female sex workers while using condoms less than half of the time was independently associated with antibody (odds ratio = 3.6, 95% confidence interval = 1.5, 8.8). among women, number of partners was associated with any sexually transmitted infection antibody, while intercourse before 18 years of age was associated with C trachomatis antibody. At every level of perceived risk, sexually transmitted infection antibody was more frequent among women. CONCLUSIONS: Men having unprotected sex with female sex workers had the greatest risk of acquiring infections and (by inference) of transmitting them to women.

Adult↗
PubMed1992

Acute syphilitic meningitis in a man with seropositivity for human immunodeficiency virus infection and normal numbers of CD4 T lymphocytes.

Coinfection with the human immunodeficiency virus (HIV) and Treponema pallidum may predispose to accelerated neurosyphilis. The mechanism underlying this interaction is undefined, but usually presumed to result from HIV-induced suppression of cell-mediated immunity as reflected in the CD4 T-lymphocyte count. We report a patient infected with HIV who developed aggressive neurosyphilis despite a CD4 count of 1000/mm3. The CD4 cells constituted 17% of his total lymphocytes. Our case suggests that while severe neurosyphilis can occur in HIV-infected persons with normal absolute CD4 counts, the percentage of CD4 cells may be a better indicator of the risk of neurosyphilis. These observations are relevant to designing treatment strategies for patients coinfected with HIV and T pallidum based on measures of their immunocompetence.

CD4-Positive T-Lymphocytes↗
PubMed1997

Sexually transmitted diseases and risk of HIV infection in men attending a sexually transmitted diseases clinic in Dakar, Senegal.

This cross-sectional study was carried out among male outpatients with symptoms of STDs at the STD reference centre at the Institute of Social Hygiene (IHS), Dakar, Senegal, from March 1989 through May 1991. This study was used to determine the prevalence of STDs and HIV among male patients attending an STD clinic and to identify their socio-demographic characteristics and risk factors. A total of 975 patients were enrolled in the study. The most common syndromes were urethritis (76%) and genital ulcers (22%). Considering single infections, the major STD agents were Neisseria gonorrheae (N.gonorrheae, 30%), Chlamydia trachomatis (C.trachomatis, 15%), Treponema pallidum (T.pallidum, 12%), and Haemophilus ducreyi (H.ducreyi, 7%). HIV prevalence was 2.6 percent (25/975). After multivariate analysis, the risk factors associated with HIV infection were a history of sex with prostitutes (odds ratio [OR] = 8.6, 95% confidence interval [CI] = 2.0-37.8), unprotected sexual contact (OR = 5.6, 95% CI = 1.2-25.0), a history of urethritis (OR = 3.4, 95% CI = 1.3-8.9), current STDs due to H.ducreyi or T.pallidum (OR = 6.1, 95% CI = 2-18.8), and mixed STD infection (OR = 5.3, 95% CI = 1.3-21.8). HIV prevalence was quite low in this population compared to similar studies of STD patients from other sub-Saharan African countries. Neisseria gonorrheae and Chlamydia trachomatis were the leading causes of STDs. A history of risky sexual behaviour, previous STDs, current genital ulcers, and mixed STD infections were associated with HIV infection. Further studies are necessary to determine changes in the relationship of STDs and HIV infection in this population.

Adult↗
PubMed2004

Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial.

CONTEXT: Sexually transmitted infections (STIs) are common in female sex workers (FSWs) and may enhance susceptibility to infection with human immunodeficiency virus type 1 (HIV-1). OBJECTIVE: To examine regular antibiotic prophylaxis in FSWs as a strategy for reducing the incidence of bacterial STIs and HIV-1. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted between 1998-2002 among FSWs in an urban slum area of Nairobi, Kenya. Of 890 FSWs screened, 466 who were seronegative for HIV-1 infection were enrolled and randomly assigned to receive azithromycin (n = 230) or placebo (n = 236). Groups were well matched at baseline for sexual risk taking and STI rates. INTERVENTION: Monthly oral administration of 1 g of azithromycin or identical placebo, as directly observed therapy. All participants were provided with free condoms, risk-reduction counseling, and STI case management. MAIN OUTCOME MEASURES: The primary study end point was incidence of HIV-1 infection. Secondary end points were the incidence of STIs due to Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, and Haemophilus ducreyi, as well as bacterial vaginosis. Analysis of herpes simplex virus type 2 (HSV-2) infection was performed post hoc. RESULTS: Seventy-three percent of participants (n = 341) were followed up for 2 or more years or until they reached an administrative trial end point. Incidence of HIV-1 did not differ between treatment and placebo groups (4% [19 cases per 473 person-years of follow-up] vs 3.2% [16 cases per 495 person-years of follow-up] rate ratio [RR], 1.2; 95% CI, 0.6-2.5). Incident HIV-1 infection was associated with preceding infection with N gonorrhoeae (rate ratio [RR], 4.9; 95% CI, 1.7-14.3) or C trachomatis (RR, 3.0; 95% CI, 1.1-8.9). There was a reduced incidence in the treatment group of infection with N gonorrhoeae (RR, 0.46; 95% CI, 0.31-0.68), C trachomatis (RR, 0.38; 95% CI, 0.26-0.57), and T vaginalis (RR, 0.56; 95% CI, 0.40-0.78). The seroprevalence of HSV-2 infection at enrollment was 72.7%, and HSV-2 infection at baseline was independently associated with HIV-1 acquisition (RR, 6.3; 95% CI, 1.5-27.1). CONCLUSIONS: Despite an association between bacterial STIs and acquisition of HIV-1 infection, the addition of monthly azithromycin prophylaxis to established HIV-1 risk reduction strategies substantially reduced the incidence of STIs but did not reduce the incidence of HIV-1. Prevalent HSV-2 infection may have been an important cofactor in acquisition of HIV-1.

Adult↗
PubMed1992

Susceptibility of Treponema pallidum and other selected spirochaetes to zidovudine.

The antiviral nucleoside derivative zidovudine (3'-azido-3'-deoxythymidine) previously has been shown to be an effective antibacterial agent in animals infected with Escherichia coli or Salmonella typhimurium. Since HIV infection can alter the course of human syphilis with serious consequences, it was of interest to determine if the noncultivable spirochaetal agent of syphilis, Treponema pallidum, is susceptible to this compound. The progression of experimental rabbit syphilis over a three week period was unchanged in animals receiving either 50 or 150 mg/kg oral zidovudine daily. In addition, a number of cultivable pathogenic and nonpathogenic spirochaetes were tested for susceptibility to zidovudine in vitro. At a concentration of 100 mg/L, zidovudine had no detectable effect on spirochaete growth, morphology, or motility. Thus it appears that spirochaetes are generally not susceptible to this compound, and that long-term zidovudine therapy will not be of benefit in preventing or controlling syphilis or other spirochaetoses in HIV-infected humans receiving this drug.

Administration, Cutaneous↗
PubMed1998

Antenatal HIV prevalence in Yaounde, Cameroon.

From June 1994 to July 1996, 4100 pregnant women living in Yaounde, Cameroon, were tested for human immunodeficiency virus type 1 (HIV-1) and syphilis. The HIV seroprevalence was 4.2% (95% confidence interval (CI): 3.6%-4.8%), and that of antibodies to Treponema pallidum was 17.4% (95% CI: 16.3%-18.6%) (HIV infection was twice as common in women with positive syphilis serology) (7.2% vs 3.6%). Over the study period, the antenatal seroprevalence of syphilis remained stable, while there was an increase in the HIV seroprevalence rate. There was an increase in HIV seropositivity in women uninfected with syphilis between 1994/1995 and 1995/1996 from 2.9% to 4.3%. By the end of the study, HIV infection was no commoner in women with negative compared with positive syphilis serology. It is therefore postulated that HIV infection in Yaounde has entered the general, sexually active female population. We suggest that management of pregnant women in Cameroon should include routine screening for both HIV infection and other sexually transmitted diseases (STDs).

Cameroon↗
PubMed1998

Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking.

OBJECTIVES: To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis. METHODS: Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chlamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis. RESULTS: Among 767 women, 206 (26.9%) had at least one STD. The prevalence of gonorrhoea was 2.7%; chlamydial infection 12.2%; gonococcal and/or chlamydial cervical infection 14.1%; trichomoniasis 11.5%; syphilis seroreactivity 5.9%. The clinical algorithm was 3.7% sensitive and 96.7% specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5% sensitive and 60.6% specific using LED and 57.7% sensitive and 46.2% specific using the risk inclusive algorithm employed in Jamaican STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5% sensitive and 53.3% specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0% to 33.4% to detect cervical infection and/or trichomoniasis in these women. CONCLUSION: STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men.

Adult↗
PubMed1992

[Identification of bacteria using DNA probes].

Since the microbial specificity of periodontal diseases is well established, having a valid microbial diagnostic test is essential for a correct and a coherent treatment planning. DNA probe will be used to identify and quantify the oral pathogens, most commonly associated with periodontitis. This test utilizes innovative DNA probe technology to identify unique segments of DNA in each of the following bacteria: Bacteroides gingivalis, Bacteroides intermedius, Actinobacillus actinomycetemcomitans, Wollinella recta, Fusobacterium nucleatum and the spirochete, Treponema denticola.

Bacteria↗
PubMed1985

[Activity of thiamphenicol in the early stage of syphilis].

Possible activity of thiamphenicol on Treponema pallidum during single-dose treatment of gonococcal infection with 10 tablets of 0.250 mg each was investigated using a new, more accurate method. We found that, under the conditions of our study, thiamphenicol fails to kill T. pallidum, exhibiting only incomplete activity. Thus, thiamphenicol taken during incubation of syphilis may delay or inhibit the emergence of primary manifestations but fails to achieve bacteriologic sterilization of T. pallidum acquired concomitantly with gonococcus. Clinical and serologic evidence of syphilis should therefore be looked for routinely three and six months after treatment.

Animals↗
PubMed1997

[Neurosyphilis with multiple gummas and AIDS. Report of a case].

The incidence of neurosyphilis has been increasing since AIDS has appeared but acute gummatous necrotizing progression is so far exceptional. We report a second case of "quaternary neurosyphilis" in a 29-year-old patient without serologic nor CT scan evidence of treponema. Diagnosing neurosyphilis is particularly difficult in HIV-1 infected patients, specially in spirochetes-poor injuries.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Treponema amylovorum sp. nov., a saccharolytic spirochete of medium size isolated from an advanced human periodontal lesion.

A highly motile, medium-size, saccharolytic spirochete was isolated from an advanced human periodontal lesion in medium OMIZ-Pat supplemented with 1% human serum. The growth of this organism is dependent on either glucose, maltose, starch, or glycogen. The cells contain six endoflagella, three per pole, which overlap in the central region of the cell body. On the basis of its cell morphology and enzyme activities, as well as its sodium dodecyl sulfate-polyacrylamide gel electrophoresis protein and antigen profiles, this organism is clearly distinct from all previously cultured spirochetes. The presence of a novel species is supported by the 16S rRNA sequence of this organism, which places it in phylotype 19 of Choi et al. (B. K. Choi, B. J. Paster, F. E. Dewhirst, and U. B. Göbel, Infect. Immun. 62:1889-1895, 1994). The only isolate, strain HA2P, is designated the type strain of a novel species, for which we propose the name Treponema amylovorum.

Bacterial Proteins↗
PubMed1989

Efficacy of cefmetazole in the treatment of active syphilis in the rabbit model.

Cefmetazole, a cephamycin-type antibiotic, was shown to be as effective as standard benzathine penicillin for therapy of active syphilis in the rabbit model. Four groups of six adult male rabbits were inoculated intradermally with 10(6) Treponema pallidum per site, producing primary syphilitic lesions. One week following infection, groups of rabbits were treated with benzathine penicillin (200,000 U intramuscularly weekly for 2 weeks) or cefmetazole (20 or 40 mg/kg per day intramuscularly in four divided doses for 15 days); one group was untreated. Daily dark-field microscopic examination of lesion aspirates demonstrated that the mean times to dark-field negativity were the same for benzathine penicillin- and two cefmetazole-treated groups (1.0. 1.0, and 1.17 days, respectively), while all untreated animals remained dark-field positive for greater than 15 days. Mean maximum lesion diameters in cefmetazole-treated animals (8.7 +/- 1.3 and 8.1 +/- 1.3 mm) were equivalent to those in penicillin-treated animals (8.6 +/- 1.6 mm) and were smaller than observed in untreated animals (12.4 +/- 2.2 mm; P less than 0.01); fewer lesions ulcerated in penicillin- or cefmetazole-treated rabbits than in untreated rabbits (P less than 0.001). Persistent infection was documented in lymph nodes of untreated rabbits; no evidence of latent infection was found in penicillin- or cefmetazole-treated animals.

Animals↗
PubMed1992

Experimental congenital syphilis: guinea pig model.

Neonates born to female guinea pigs of either a highly susceptible (C4D) or a resistant (Albany) strain, infected prior to or during pregnancy with a single dose of Treponema pallidum, showed in their sera from the first day of life immunoglobulin M (IgM) antibodies to T. pallidum, circulating immune complexes consisting of IgM antibodies and treponemal antigens, and IgM rheumatoid factor. Although the animals were asymptomatic for a 6-month observation period, several lines of evidence indicated that they were infected in utero. Molecular analysis of whole sera, purified serum IgM fraction, or dissociated immune complexes demonstrated IgM reactivity against one (47 kDa) or more of several T. pallidum peptides (15, 17, 37, 42, 45, and 87 kDa) recognized as integral membrane components. Sequential analysis of the neonates' sera by immunoblot and enzyme-linked immunosorbent assay, using alcohol-treated T. pallidum, T. phagedenis biotype Reiter, and T. vincentii, demonstrated early IgM antibodies followed 3 to 4 months later by IgG2- and IgG1-specific antibodies to T. pallidum. Moreover, an infectivity test done in five rabbits with pooled tissue extracts prepared from liveborn or stillborn animals evoked a seroconversion in two rabbits (reactive Venereal Disease Research Laboratory and fluorescent treponemal antibody tests), suggesting the presence of T. pallidum in the organs. Sera from neonates born to either T. phagedenis biotype Reiter-injected mothers or three normal pregnant females were all serologically negative. The model offers new possibilities for exploration of factors responsible for asymptomatic infection often observed in human congenital syphilis.

Animals↗