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PubMedDate not supplied

[Liver involvement in syphilis].

The authors report two cases of syphilitic hepatitis. In the first case, acute hepatitis occurred during the secondary stage of syphilis. The diagnosis was made without waiting for the hepatitis to respond to penicillin treatment, on the basis of the following signs: icterus involving inflammatory syndrome, moderate cytolysis, clear retention, eruption of papular syphilids and a strongly positive test for syphilis. The second case involved a female patient who had been treated 15 years earlier for bone syphilis with ulcerous gummas. The signs were sclerotic, gummatous, hepatic lesions revealed by a syndrome of calcified hepatic lesions. The serologic test for syphilis was negative in this patient. Laparotomy and biopsy were necessary before a firm diagnosis could be made. The authors examine literature data concerning this pathology.

Adult↗
PubMed1985

[Classification of the developmental periods of syphilis].

With the acquisition of specialized laboratory techniques, as the determination of serum immune complexes and the auditory evoked potentials, which bring new knowledge, the study of syphilis must be reviewed, in particular the classification of the evolution periods. The authors consider latent syphilis and neuro-syphilis. Based on these facts the new ways of treatment as well as the evolution control must be revised. These test should always be performed in order to determine exactly the syphilis period of the patient.

Antigen-Antibody Complex↗
PubMed1985

[Early congenital syphilis: apropos of 5 cases].

Congenital syphilis has in large part disappeared in countries where antiveneral legislations and preventive measures are well developed. In France, although there is no declaration of congenital syphilis between 1971 and 1983 in the official statistics of the Paris region, congenital syphilis is nevertheless mentioned as sporadic cases. The authors report here five cases of precocious congenital syphilis collected from august 1981 to december 1982 by a department of antiveneral consultations in the Paris region.

Doxycycline↗
PubMed1983

[Recent progress in syphilis serology].

Serological investigations for the diagnosis of syphilis have been performed in a special subunit at the Department of Dermatology to Lainz Hospital, Vienna, since 70 years. At present 80,000 to 100,000 sera are tested annually. The classical test systems VDRL, TPHA, AMHA-TP and FTA-ABS demonstrate, in particular, the presence of IgG antibodies and are, thus, suitable for the diagnosis of the disease, but do not permit conclusions on the activity of the disease and the actual need for antisyphilitic treatment. The newly developed IgM diagnosis of syphilis with the IgM-SPHA- and the 19S-IgM-FTA-ABS test solve these problems and can be performed even under routine conditions using the methods of solid phase haemadsorption and computerized high pressure liquid chromatography. In addition, the serological diagnosis of neurosyphilis has been worked out by the determination of the TPHA-index and the detection of antitreponemal IgM-antibodies in the cerebrospinal fluid. The relative frequency of latent syphilis infections has increased over the past years and serodiagnosis of syphilis, thus, become more and more important. The availability of five independent test systems has enabled the elaboration of a test profile which keeps the margin of error to below 0.1%. A further method, the ELISA technique is at present under investigation and renders promising results by the use of recently developed reagents.

Cerebrospinal Fluid↗
PubMed1984

[CSF diagnosis in syphilis].

Treponemal antibodies in CSF are often to be found by FTA-ABS and TPHA, also in cases without syphilis cerebrospinalis. The checking of the CSF barrier allows--together with the TPHA-index--the diagnostic of the syphilis cerebrospinalis. Antibodies against treponema pallidum have been proved in 15 patients at different stages of syphilis until 30 years after treatment, but the titres were low. Only in one case we have found an active syphilis cerebrospinalis by the help of the TPHA- and IgG-index.

Adult↗
PubMed1981

[Present aspects of syphilis: 2. Serology, therapy].

The actual aspect of syphilis in the Federal Republic of Germany is determined by epidemiology, treponemal specific serodiagnosis and modern therapy. Compared with the frequency after the last war, syphilis diminished to a level of 5-10 per cent at present. In particular, connatal, tertiary and neuro-syphilis have decreased absolutely and relatively. In serodiagnostics of lues venerea the first tests to be used are the indirect hemagglutination-test TPHA and the quantitative lipoidal test VDRL. In case of reactive results in one of these methods, the FTA-ABS-test and furthermore the TPI-test are applied for verification. The treponemal specific IgM-diagnosis (IgM-FTA-ABS, IgM-19 S-FTA) permits a statement on the acuteness of the syphilitic process and control of the course after treatment. In current chemotherapy of syphilis penicillin ranges in the first place followed by tetracyclines and erythromycin.

Erythromycin↗
PubMed1980

Routine Serologic Testing for Syphilis in a Community Medical Practice.

A retrospective review of 8,100 serologic tests for syphilis ordered during a 42-month period yielded positive rapid plasma reagin test results in 127 patients (1.6 percent) and a positive fluorescent treponemal antibody absorption reaction in 91 patients (1.1 percent). Of the 36 cases of biologic false-positive reactions, most were in prenatal patients. Forty-six cases of syphilis were previously undiagnosed but antibiotic therapy was given in only 26 of the patients. Some 24 percent of syphilitic patients were not treated because the positive serologic findings were overlooked. Cerebrospinal fluid determinations were analyzed and cost-effectiveness of finding a single case of previously undiagnosed syphilis was calculated. We found that routine serologic tests and cerebrospinal fluid studies for syphilis in asymptomatic patients had low rates of positivity in our community hospital and outpatient practice.

Costs and Cost Analysis↗
PubMed1994

Fetal death from syphilis: an epidemiologic evaluation in Ribeirão Preto, Brazil.

An epidemiologic study was done of five Ribeirão Preto women whose pregnancies ended in fetal death from syphilis at the University Hospital of the Ribeirão Preto Medical School, São Paulo, in 1991. The study sought to establish the epidemiologic profiles of these women, determine the prenatal care they had received, assess the risk factors involved, and propose strategies for controlling syphilis during pregnancy within the region. Data were collected through home interviews with the study subjects. Obstetric (maternal and fetal) information obtained from these interviews was subsequently verified by consulting the women's medical records. In all, some 25 problems with a bearing on the fetal deaths were found, these being ascribable in roughly equal measure to health system shortcomings and the study subjects' knowledge and behavior. Notable among the health system problems were delayed receipt of serologic findings, failure to comply with recommended routines, late medical diagnosis, and ineffective monitoring of cure. Principal patient-related problems included ignorance of syphilis and unawareness of the importance of prenatal care. In view of the fact that fetal death from syphilis continues to occur in the affected region, it is recommended that maternal and child health authorities seek to establish or reestablish prenatal care of the requisite quality by instituting clear-cut guidelines for serologic screening, implementation of epidemiologic surveillance, and effective action by medical and paramedical teams.

Adult↗
PubMed1994

Diagnosis of congenital syphilis in adults presenting with interstitial keratitis.

In the antibiotic era the ophthalmologist has become less familiar with the diagnosis of congenital syphilis. The recognition of this disease is crucial, as neurosyphilis or cardiovascular syphilis will develop in a substantial number of patients with latent congenital syphilis without the appropriate treatment. We describe eight patients aged 60 years or more who presented with refractive problems in whom congenital syphilis was subsequently diagnosed for the first time. One patient was found to have neurosyphilis and the highest VDRL result ever recorded by the London Public Health Laboratory. Seven patients required extensive antibiotic therapy, and three subsequently underwent successful ocular surgery. These cases illustrate the importance of recognizing this treatable disease.

Aged↗
PubMed1993

[Reactivity of serologic tests for the detection of syphilis in patients infected with the human immunodeficiency virus].

BACKGROUND: The coexistence of syphilis and infection by the human immunodeficiency virus (HIV) appears to modify the natural history of both diseases. The aim of this study was to know the prevalence of syphilis in a population of patients with HIV infection, the possible association with certain risk practices and the validity of the reaginic test in such patients. METHODS: Three hundred sixty-seven patients with HIV infection who went for the first time to a monographic clinic of a university hospital were studied. Syphilis serology was carried out: rapid plasma reaginic (RPR) and hemagglutination (MHA-TP) tests. RESULTS: Out of all the patients 26 (7.1%) had positive MHA-TP. The proportion of homosexuals was greater among those who had a positive treponemic test (69%) than among those who were negative (6.4%; odds ratio [OR] = 32.6; confidence interval 95%: 16.2-65.4). The positivity of MHA-TP was more frequent among those presenting criteria of the acquired immunodeficiency syndrome (AIDS) at the diagnosis (18% versus 5.6%; OR = 3.6 [1,5-8,9]). Seventy-four false positive reactions were observed with the RPR (20%) corresponding almost exclusively (96%) to intravenous drug users who presented false positivity in 25% of the cases. CONCLUSIONS: The prevalence of syphilis detected by treponemic serology among subjects with infection by the human immunodeficiency virus is related with homosexuality as the principal practice of risk. One quarter of the intravenous drug users with infection by the human immunodeficiency virus presented false positive results to the reaginic test thus leading to the recommendation that therapeutic measures should not be initiated without confirmation with a treponemic test.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The Julius Rosenwald Fund syphilis seroprevalence studies.

In 1929 the Julius Rosenwald Fund, in conjunction with the Public Health Service (PHS), sponsored a syphilis seroprevalence study in the South characterized as a humanitarian effort to benefit the health of rural African Americans. The study reported extraordinarily high rates of positive Wassermann tests, even among children. Despite the unreliability and nonspecificity of this test, modern authors continue to indict these subjects as syphilitic. However, there was no consistent relationship between syphilis and a positive Wassermann test. Additional treponemal pathogens that potentially caused false-positive tests could explain the results. After public outcry to the Tuskegee Syphilis Experiment, the Rosenwald study acquired new significance. It was used as evidence to bolster the argument that Tuskegee was a consequence of humanitarian motives that became captive to misguided methods of researchers at the Venereal Disease Division of the PHS. Humanitarianism implies the acknowledgement of a right invested in the recipient; health is an end in itself. However, African Americans were necessary as a source of cheap labor for competition in the world cotton markets and as a restraint on the market value of white labor in manufacturing. The administrative structure of the PHS, not zealous individuals, adopted utilitarianism as its paradigm for human research. Syphilis seroprevalence was a calculated use of public health as a means to economic development.

Black or African American↗
PubMed1997

Late cutaneous syphilis.

Late cutaneous syphilis has become a rarity as a result of effective treatment of early and latent syphilis with antibiotics. Superficial nodular lesions of late cutaneous syphilis should be differentiated from conditions including sarcoidosis, leprosy, lupus vulgaris, and granuloma annulare. We report the case of a 50-year-old woman with superficial nodular lesions of late cutaneous syphilis.

Diagnosis, Differential↗
PubMed1998

On-site screening for syphilis at an antenatal clinic.

OBJECTIVE: To determine the validity, predictive value and accuracy of the rapid plasma reagin card test performed on site to diagnose active syphilis in pregnant women so that immediate treatment can be offered to prevent congenital syphilis. DESIGN: Open, descriptive study. SETTING: Antenatal clinic, Mamelodi Hospital, Pretoria. PATIENTS: Four hundred and seventy-four pregnant women attending the antenatal clinic for the first time were entered into the study. METHODS: A rapid plasma reagin test was performed on site with no specialised equipment and the results were compared with those of the reference laboratory. RESULTS: In the event of rapid plasma reagin titres of 1:8 and higher, indicative of active syphilis, the on-site rapid plasma reagin test had a sensitivity of 90.5%. The test had a sensitivity of 100% if the rapid plasma reagin titres were 1:16 and higher. CONCLUSION: The on-site rapid plasma reagin test identified all women with rapid plasma reagin titres higher than 1:8. This implies that all women whose fetuses were in danger of acquiring congenital syphilis were identified at the clinic and could be treated immediately.

Female↗
PubMed1998

[Maternal and congenital syphilis].

Testing for syphilis during pregnancy reveals a positive serologic status in 0.02% of cases. However, a 66% rate of stillbirths is noted in women who are infected and who have not benefited from any treatment. Routine screening is at present performed during the early stages of pregnancy but a second serologic test during the third trimester is useful in the diagnosis of a late infection especially in drug users or HIV (human immunodeficiency virus) positive patients. Congenital syphilis is diagnosed in utero when a positive maternal serologic status is associated with ultrasound images showing fetal abnormalities; these include hepatosplenomegaly, hyperechogenic bowel, signs of bowel obstruction or fetal hydrops. Maternal syphilis is treated by delayed action penicillin and is indicated even for patients allergic to the antibiotic which in this particular case is delivered after desensitization. First line therapy by intravenous penicillin is indicated when confronted with the following high risk factors of congenital syphilis: an elevated titre of VDRL (venereal disease research laboratory) at the time of diagnosis or delivery, unknown date of the precise onset of the infection, the appearance of a rash or of a chancre during pregnancy, ultrasound fetal abnormalities or late therapy during the third trimester. Treatment of the new-born child will depend on the results of clinical, serologic and X-ray evaluation. Long term follow-up for at least a year is mandatory.

Aftercare↗
PubMed1994

Testing for syphilis.

Syphilis remains an important public health problem of growing proportions despite effective means of prevention and therapy. Clinical staging is difficult. The diagnosis is complicated by the lack of an easy culture method. History, clinical findings, and the detection of spirochetes in tissue serve as the basis for diagnosis. Simple nontreponemal tests are available for screening, and more difficult treponemal tests are used for confirmation. False-positive test results are more common with the reaginic tests but are also seen with the specific antitreponemal tests. The diagnosis of central nervous system syphilis is imprecise and is of particular importance in HIV-positive individuals. HIV infection has complicated the diagnosis of syphilis with serologic testing, although the current tests are generally adequate. Follow-up testing after treatment is used to confirm a therapeutic response. New diagnostic tests, including monoclonal antibody staining and the polymerase chain reaction, may ultimately assist in the diagnosis of this ancient disease that still has major health implications in the modern world.

Antibodies, Monoclonal↗
PubMed1978

Reversible sudden deafness in early acquired syphilis.

Although congenital syphilis is a well established cause of hearing loss, early acquired syphilis is frequently overlooked in the differential diagnosis of sensorineural deafness. This is due, in part, to a decrease in the incidence of syphilis and to the advent of penicillin in previous years which reduced this complication to a clinical rarity. However, with the increase in new cases of syphilis in the past decade, early acquired syphilitic deafness is being seen with increasing frequency. Along with it is the syndrome of early syphilitic meningitis with sudden sensorineural deafness. This potentially reversible condition should be considered in sexually active patients in whom sudden deafness develops. Early diagnosis and treatment are essential for maximum recovery of hearing.

Adult↗
PubMed1993

Gastric syphilis mimicking linitis plastica.

The decreased incidence of gastric syphilis has made its clinical presentation less widely appreciated. A 61-year-old man suffering from epigastric pain, nausea, and vomiting had an initial diagnosis of gastric carcinoma; the pathologic diagnosis was equivocal. Eventually, gastric syphilis was diagnosed. In the context of the case described below, positive serologic findings in a relatively young adult should raise the suspicion of gastric syphilis. Carcinoma must be ruled out, lest the patient lose valuable time while being treated for syphilis.

Biopsy↗
PubMed1984

Congenital syphilis. Why is it still occurring?

A total of 159 cases of early congenital syphilis were reported in the United States during 1982, with Texas reporting 50 cases. We reviewed these Texas cases to identify the most important characteristics on which to focus control efforts. Thirty-eight mothers were 25 years of age or younger; 33 were unmarried. All were from minority groups. No congenital syphilis occurred in whites. Blacks were twice as likely as Hispanics to have an infected infant. Foreign-born Hispanic women were three times more likely to be delivered of an infected child than Hispanics born in the United States. Attendance at prenatal care facilities significantly affected the risk of being delivered of an infected child in both black and Hispanic women; 31 women received no prenatal care. Based on these findings, congenital syphilis in Texas can be reduced primarily through improving prenatal care for high-risk populations and by refining casefinding efforts to control infectious syphilis in the community.

Female↗