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PubMed1999

Resolving the common clinical dilemmas of syphilis.

The diagnosis and treatment of syphilis can present difficult dilemmas. Serologic tests can be negative if they are performed at the stage when lesions are present, and the VDRL test can be negative in patients with late syphilis. Cerebrospinal fluid examination is not required in patients with primary or secondary disease and no neurologic signs or symptoms, but it may be warranted in patients with late latent syphilis or in whom the duration of infection is unknown. Patients with penicillin allergy can be treated with alternative regimens if they have primary or secondary syphilis. Penicillin is the only effective drug for neurosyphilis; oral desensitization should be accomplished before treatment of penicillin-allergic patients. Other dilemmas may be encountered in the treatment of patients who have concurrent human immunodeficiency virus infection.

Diagnosis, Differential↗

PubMed1954

A decade of reorientation in the treatment of venereal syphilis.

As experience with penicillin in the treatment of venereal syphilis has grown over the last decade, this drug, used without adjuvants, has become increasingly widely accepted as being effective, convenient, non-toxic, and relatively inexpensive. Metal chemotherapy required the use of repeated subcurative doses over a long period of time and was essentially suppressive in character; penicillin can be given in the form of repository preparations which ensure a treponemacidal blood-level of long duration. These can be given in large single doses or in repeated smaller doses; the therapeutic results will not vary whichever of these procedures is used.In the first part of this paper, the authors discuss the effect of penicillin and the time factor, the choice of penicillin preparation, the mode of administration, and the reaction to infection with Treponema pallidum. In the second part, they consider the present status of penicillin therapy in venereal syphilis, dealing with the principles of follow-up and control; with the treatment of early, latent, late, and congenital syphilis; and with the treatment of incubating syphilis and contacts.

Humans↗

PubMed1956

Endemic syphilis in the Bakwena Reserve of the Bechuanaland protectorate: a report on mass examination and treatment.

A form of endemic syphilis exists in the Bakwena Reserve of the Bechuanaland Protectorate known by the local name of "dichuchwa". It is similar to bejel, njovera and the endemic syphilis reported elsewhere in the world. The Government of the Protectorate, with the assistance of WHO and UNICEF, began in November 1953 a mass campaign in the Reserve to control this disease and, at the same time, to study its epidemiological, clinical, social and therapeutic aspects. The seropositivity rate in the Reserve was found to be 37%.Dichuchwa is a childhood and family disease, usually spread non-venereally. The early lesions are similar to secondary lesions of sporadic venereal syphilis, and are often followed by tertiary lesions affecting mainly the skin, nasopharynx and long bones. Primary lesions are rare but may occur under certain epidemiological conditions if the inoculum is sufficiently large; thus a mother may develop primary sores on the nipples through suckling an infected infant. Lesions of the cardiovascular and central nervous systems and congenital syphilis are also rare. Superinfection of an already infected and allergic host is probably the chief reason for the frequency of the tertiary lesions.Treatment of the disease with penicillin is very effective, and the authors believe that mass treatment of cases and contacts combined with an improvement in the standards of hygiene could eradicate the disease.

Botswana↗

PubMed1959

Facts and fallacies about gonorrhea and syphilis.

The limitations and special usefulness of clinical and laboratory diagnostic techniques in the diagnosis of gonorrhea are poorly understood and utilized by the average practitioner today. Most physicians and clinics, lulled by complacency or lack of ancillary aid in the area of diagnosis, proceed by measures based in many instances upon past fallacy rather than upon the facts recently developed by research in this disease. The same circumstances apply concerning treatment and management of this disease, particularly in females. All physicians are potentially capable of giving excellent treatment for syphilis today. The problem is to properly diagnose the disease, manage the patient and deal with the source. Looming large in the area of diagnosis is the interpretation of serologic tests for syphilis. No serologic test diagnoses syphilis, but rather gives information as to the immunologic status of the the patient in relation to reagin and treponemal antibodies. None of the antibodies measured in these tests are absolutely specific for syphilis alone. There is no substitute for a well-informed physician, who knows his patient, to relate and interpret even the best of treponemal serologic tests.

Female↗

PubMed2004

[Syphilis and pregnancy].

Consequences of syphilis for mother, pregnancy, fetus and child are considerable, but preventable. Serological screening must be offered at the first prenatal visit, using both a treponemal (eg. TPHA) and a non treponemal (eg. VDRL or RPR) test. When the results are compatible with any type of active syphilis, treatment is required. The treatment of choice is penicillin: benzathine penicillin G, 2.4 million units intramuscular, repeated one week later, and most authors recommend a third dose if a late latent syphilis is suspected, or in case of coinfection with HIV. Women with a proven penicillin allergy can be desensitized. Alternative therapies, such as macrolids, are less well evaluated. Follow-up during and after therapy must not be neglected. In case of Jarisch-Herxheimer reaction, the mother should be managed on an inpatient basis, and the fetus carefully monitored. The VDRL should be repeated (usually every trimester), and therapy be renewed if there is not a significant decrease in titer. The fetus should be followed by serial ultrasound examinations. Finally, the child must be followed up clinically and biologically, and treated in case of congenital syphilis. The residual risk of adverse outcome is increased in case of reinfection, lack of maternal therapy or incomplete treatment, or when diagnosis and therapy are performed late in pregnancy.

Adult↗

PubMed2006

[Results of study of the diagnostic efficiency of the new linear enzyme immunoassay test system "INNO-Lia Syphilis Score"].

A comparative study of 224 serum samples certified in different serological tests for syphilis has established the high diagnostic effectiveness of the new linear enzyme immunoassay test system (immune blotting assay "Improved INNO-Lia Syphilis ("IMMO-Lia Syphilis Score")) (Immunogenetics, Gent, Belgium). The assay showed a 100% sensitivity and 98% specificity; the reproducibility of positive and negative results was 100%. It is proposed to use the test system in the laboratories engaged in the expert diagnosis of syphilis as an additional or alternative Treponema pallidum immobilization test and immunofluorescence test supporting the assay of serum or plasma samples for this infection, which has yielded positive results on screening.

Antibodies, Bacterial↗

PubMed2006

[The value of prophylactic serological tests for syphilis in the region of Białystok in years 1994-2004 (before and after the introducing the health care system reform in Poland)].

The prophylactic serological tests for syphilis (psts), belong to the principal methods of controling the spread of the disease. The aim of the study was to to analyze the epidemiological efficacy of psts performed in Bialystok region before and after the health care system reform. The results of psts performed in 1994-1998 (N = 752.787) and in 1999-2004 (N = 407.366) were analyzed. The average annual number of psts declined from 150.557 to 68.687 in two periods analyzed, respectively. The lowest number of tests performed (51.654) was noticed in 2004. Sixty-one of 117 (52.14%) and 30 of 52 (57.97%) syphilis cases have been detected owing to psts in two periods analyzed, respectively. The efficacy index of psts was highest in convicts or prisoners and in pregnant women in both periods (172,1 and 134,6 and 67,9 and 50,7, respectively). The significant decline in efficacy index was noticed for tests performed as periodic prophylactic examinations of employees and prior to employment. The results indicate that psts remain one of the most efficient methods of diagnosis and prevention of syphilis despite the decline in the number of the tests and the formal renouncement of the screening among convicts and prisoners since 2003. Low syphilis incidence rate in Poland can be, in part, own to diminished number of performed tests. There is a need for the parallel studies in other regions of Poland.

Female↗

PubMed1991

Syphilis and HIV infection.

The management of an HIV-infected patient with syphilis is an evolving and difficult area of clinical medicine. Many such patients initially present with dermatologic problems, and the practicing dermatologist must be alert to the variety of presentations syphilis may take in these patients. The role of biopsy with immunofluorescent or Warthin-Starry silver staining is often crucial in correctly diagnosing confusing cases. The treatment of early syphilis in HIV-infected patients may need to be more intensive than has previously been recommended, because the immunosuppression induced by HIV can accelerate the pace of the infection and increase the risk of progression to neurosyphilis. After treatment, careful and frequent follow-up is essential so that the often irreversible consequences of late syphilis can be avoided.

HIV Infections↗

PubMed1991

[Syphilis and blood transfusion].

Along 17 years (1973-1989), syphilis screening has been performed on 146,355 blood units in the author's blood bank. A total number of 143 positive results (confirmed by MHA-TP) was registered, which means an incidence of 0.097%. Of the total number of blood units, 31,529 came from professional donors, 51 of them (0.16%) being positive, while of the 114,826 blood units from voluntary donors 92 were positive (0.08%). With respect to voluntary donations, the highest incidence of positive reactions was found between 1980 and 1982, but this period registered also the highest number of blood units studied. Along this 17 year period 8 patients have received blood products with positive syphilis test. They were transfused on urgent request with fresh blood or platelet concentrates, the transfusion being performed before knowing the results of the screening for syphilis. No special measures were taken in 2 such cases, who died shortly after the transfusion on account of their disease. Two other were treated with penicillin at the time of transfusion. The remaining four patients received preventive penicillin. Even taking into account that positive screening tests are uncommon amongst blood donors, and that only under special circumstances the patients receiving contaminated blood may develop the illness, it seems advisable for every blood bank to perform the screening for syphilis on every blood donation.

Blood Banks↗

PubMed1991

[Use of mildronate in therapy of seroresistant syphilis (serologic and immunologic comparisons].

Clinico-serological and immunological examinations were applied to 84 patients suffering from seroresistant syphilis with positive serological reactions within 1.5 to 10 years after termination of the treatment by various methods. The initial diagnosis of recently inflicted secondary syphilis was recorded in 8.9 per cent of the patients. 43.3 and 47.8 per cent of the patients had secondary relapsing syphilis and early occult syphilis, respectively. The percentage of lymphocytes CD3+, CD4+, CD8+ and HLA DR+ was determined in peripheric blood with the monoclonal antibodies OKT-3+, OKT-4+, OKT-8+ and FITC-labeled antimouse Ig. The quantity of IgA, IgG and IgM was determined by radial immunodiffusion. The immunoregulatory index (IRI, the ratio of T-helper/inductor cells and T-suppressor cells/cytotoxics) was calculated. The use of mildronate, a drug developed at the Institute of Organic Chemistry of the Academy of Sciences of the Latvian SSR (Riga), led to normalization of the impaired immunological indices and complete negativation of the serological reactions in the group of the patients with disorders in the immunity status (CD8+ - 33 per cent and IRI - 1.3), p less than 0.01.

Adult↗

PubMed1991

[HIV infection and syphilis. Case description and literature review].

Recent case reports emphasize that HIV infection may influence the clinical picture, course and therapy of concurrent syphilis. The case of a 32-year-old patient with coinfection by T. pallidum and HIV is presented. Clinical presentation, diagnostic procedures and therapy are discussed in the light of the current literature. False negative serologic tests for syphilis in HIV-patients raise the question of the sensitivity of these tests in HIV infection. Efficacy of therapy for neurosyphilis and the value of CSF (cerebrospinal fluid) examination in early syphilis are of increased importance in HIV infection. Current guidelines for diagnosis and therapy of syphilis in HIV patients are outlined.

AIDS Serodiagnosis↗

PubMed1990

[The dynamic serological reactions after treating patients with early forms of syphilis by the single-course shortened reserve method].

A total of 156 patients with early syphilis were treated with tetracyclin and oletetrin. The drugs were administered 4 times daily (every 6 hrs) in a dose of 0.5 g (daily dose 2.0 g). Patients with primary seropositive syphilis were treated for 20 days, the dose per course being 40 g, those with secondary fresh syphilis for 25 days, dose per course 50 g, those with secondary recurring syphilis for 40 days, dose per course 80 g. The treatment was well tolerated by all the patients. Early negative results of specific serologic tests after treatment confirm the efficacy of the suggested method.

Adolescent↗

PubMed1989

[Immunologic aspects of the pathogenesis of latent and seroresistant forms of syphilis].

Studies of the cellular and humoral immunity in patients with latent and seroresistant syphilis have revealed decreased content of T-lymphocytes and elevated levels of B- and antigen-reactive lymphocytes. Reduced T-cell level is due to a decrease of the T-suppressor subpopulation. Unlike latent syphilis, seroresistant form is associated with a complete disappearance of the theophylline-sensitive subpopulation, whereas T-lymphocytes are represented mainly by the theophylline-resistant (helper) subpopulation. Effective therapy of patients with seroresistant syphilis has normalized the counts of T- and B-antigen-reactive lymphocytes, and theophylline-sensitive cells appear in the blood. These data give grounds to prescribe immunostimulating therapy to patients with seroresistant syphilis.

Adult↗

PubMed1989

Neurosyphilis and ocular syphilis in patients with concurrent human immunodeficiency virus infection.

Epidemiologic studies have demonstrated a strong association between human immunodeficiency virus (HIV) and syphilitic infection. Recent reports have suggested that concurrent HIV and luetic infection may lead to an accelerated and more fulminant course of syphilis. Specifically, neurosyphilis is encountered much earlier in such patients. We report two cases in which both neurosyphilis and ocular syphilis were present in HIV sero-positive patients. A review of the literature reveals that 11 of 13 (85%) HIV-infected patients with ophthalmic syphilis also had neurosyphilis. In patients who present with signs of ocular inflammation and pose a diagnostic dilemma, syphilis and possible concurrent HIV infection merit strong consideration. We wish to emphasize that patients should be evaluated for the presence of neurosyphilis if co-infection exists. Ophthalmologists should be aware that neuro-ophthalmic lues may prove to be the presenting feature of infection with HIV.

Adult↗

PubMed1987

Ocular syphilis 1986. Prevalence of FTA-ABS reactivity and cerebrospinal fluid findings.

Serum FTA-ABS tests were obtained for 247 consecutive patients undergoing ambulatory oculoplastic surgery over a 5-month period. The incidence of FTA-ABS reactivity was 52.8%. Cerebrospinal fluid (CSF) from 50 patients with ocular signs of late syphilis and reactive serum FTA-ABS tests was examined. Only 12 (24%) of these patients had reactive serum VDRLs. Thirty patients (60%) had a lymphocytic pleocytosis, elevated protein, or both, in their CSF. No patients had reactive CSF VDRLs. It was concluded that FTA-ABS reactivity is common, serum VDRL tests are inadequate for diagnosing ocular syphilis, and a significant percentage of patients with ocular syphilis have abnormal CSF. More aggressive diagnosis and treatment of ocular syphilis is suggested.

Aged↗

PubMed1977

Spinal syphilis: the problem of fluorescent treponemal antibody in the cerebrospinal fluid.

Spinal manifestations of syphilis are now uncommon. Three adults with presumptive nontabetic spinal syphilis are presented. This paper should serve as a reminder to physicians that cases of late syphilis continue to occur and may be manifested as obscure spinal syndromes and be misdiagnosed unless the possibility of syphilis is constantly kept in mind. Some of the clinical dilemmas associated with the reactivity of fluorescent treponemal antibody in the cerebrospinal fluid are discussed,

Absorption↗

PubMed1978

[Immunity in syphilis].

Following a brief review of the characteristics of the causative organism of syphilis, its maintenance in laboratory animals and its relationship to the treponemes of the tropical treponematoses, consideration is given to the immune reactions and the development of antibodies to the treponeme of syphilis. The individual tests used in the diagnosis of syphilis, especially the complement fixation reactions and the flocculation tests, as well as the reactions employing specific antigens, such as the Treponemal Immobilisation Test (TPI), the Reiter Protein Complement Fixation Test (RPCFT), the Fluorescent Treponemal Antibody Test (FTA-ABS) and the Treponema Pallidum Haemagglutination Assay (TPHA), are discussed in detail. An evaluation of the results of the tests and the possible sources of errors are considered. The problem of the persistence of treponemes after clinically successful treatment is analysed and existing literature reviewed. The paper ends with a discussion of existing knowledge on protective immunity against infection with Treponema pallidum and a reminder of the need for further research into the immunology of syphilis.

Antibodies, Bacterial↗

PubMed1987

[Syphilis in pregnant women in Libreville (Gabon)].

We are reporting here the data of two surveys carried out in Libreville between 1982 and 1985. The first one was done with 153 women at the maternity hospital of le centre hospitalier de Libreville, the other one involved 623 women at antenatal visit. In this last group, the rate of women being seropositive is in inverse ratio to the social status, with women from high income strata having a percentage of 1,5 to 3,4% and women from lower income strata starting at 21% up to 26% of seropositivity. Promiscuity and lack of information among youngster could explain the relatively high percentage of seropositivity among female pupils and students (10.6%). We suggest to consider this group as a risk group for syphilis and to focus all necessary information toward this group and the lower income women strata of the population. Getting back to 153 women at the maternity hospital, 31 of them (20.3%) were seropositive and the ground of their admission to the hospital was: 27 delivery of death in utero, 1 case of abortion at 3 months of pregnancy, 2 cases of miscarriage at the 5 month and one case of hypotrophic fetal development, because the mother was treated for syphilis during pregnancy. The risk of congenital syphilis is low when the mother has been treated during pregnancy, so, the high number of congenital syphilis, 12/47 pregnancies followed up to delivery are an indication of an inadequacy or a total lack of treatment during those pregnancies.

Female↗