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PubMed2005

An oral fluid test for syphilis.

We have developed a time-resolved fluorescence immunoassay to detect antibodies to Treponema pallidum recombinant antigens in oral fluid specimens. Using an 'Oracol' swab, oral fluid was collected from 34 subjects with a serological diagnosis of syphilis and 97 seronegative controls. Using a cut-off of three standard deviations over control mean, the sensitivity and specificity of the assay in all subjects with positive syphilis serology was 76.5% and 97.9%, respectively. In those with early syphilis, the sensitivity and specificity of the assay was 100% and 97.9%. In a non-outbreak situation, screening clinic attendees for syphilis using oral fluid specimens is potentially useful when collection of blood is not practicable. In addition, it may have much to offer in outreach projects and epidemiological investigations.

Adult↗
PubMed2005

The impact of syphilis mass treatment one year later: self-reported behaviour change among participants.

In 2000, syphilis mass treatment using oral azithromycin was delivered to at-risk British Columbians during a sex trade-related outbreak. The initiative included education, counselling and referral. This cross-sectional, observational study examines knowledge, attitudes and self-reported behaviour after one year among mass treatment participants compared with eligible non-participants. Participants self-reported positive changes: reduction in sexual partners overall (P=0.001) and for sex workers (P<0.01), decrease in unprotected oral sex (P=0.03), knowledge of asymptomatic syphilis (P=0.02), positive attitudes to mass treatment (P=0.02) and to the street nurses (P=0.01). Increased awareness was associated with increased condom use for vaginal sex overall (P=0.02) and for sex workers (P=0.03) and increased condom use for oral sex (P=0.05). There was no difference in syphilis incidence. Syphilis outbreak interventions that include education, support and referral can result in long-term positive behaviour changes.

Adolescent↗
PubMed1997

Infection with HIV, syphilis and hepatitis B in Ethiopia: a survey in blood donors.

Sera of all male donors appearing at the blood bank of a regional hospital in Northwest Ethiopia in 1994 (n = 1022) and 1995 (n = 1164), were screened for the presence of human immunodeficiency virus (HIV-1) and treponemal antibodies. Additionally, screening for hepatitis B surface antigen (HBsAg) was carried out on 549 consecutive sera. In 1995, the crude seroprevalence of HIV-1 infection and syphilis was 16.7% and 12.8%. Seroprevalence of HBsAg was 14.4%. HIV and syphilis seroprevalence was highest in soldiers (30.6% and 20.9%) and daily workers (18.8% and 13.5%), and lowest in farmers (8% and 6.7%). However, farmers had the highest rate of HBsAg (18.8%). HIV-positive donors had an increased risk for being positive for syphilis antibodies (OR = 3.69, 95% CI = 2.69-4.96), but not for HBsAg (OR = 0.79, 95% CI = 0.36-1.67). The data indicate that (i) the HIV epidemic has not yet reached a plateau phase in Ethiopia, and (ii) the transmission and epidemiology of HBsAg in Ethiopia is different from that of HIV and syphilis.

Adult↗
PubMed2001

Evaluation of the passive particle agglutination test in the serodiagnosis and follow-up of syphilis.

We performed the present study to determine the rate of concordance of the fluorescent treponemal antibody absorption test (FTA-ABS) and of the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) with the passive particle agglutination test (TP.PA) in patients with early syphilis and to observe the reactivity of the rapid plasma reagin (RPR), MHA-TP, and the TP.PA tests for 1 year after therapy. The study included 449 people who were given therapy if they had syphilis and followed up for 1 year. The rate of concordance of the TP.PA with the MHA-TP was 98.4%, and it was 98.9% with the FTA-ABS. During follow-up, a significant decrease of antibodies was found in 56%, 26%, and 70% of the patients when using the RPR, the MHA-TP, and the TP.PA, respectively. The TP.PA seems to be an adequate routine assay for the diagnosis of syphilis, being as sensitive as the FTA-ABS test in primary syphilis and as useful as the RPR test in monitoring therapy.

Agglutination Tests↗
PubMed2002

Survival with hypopituitarism from congenital syphilis.

Congenital syphilis continues to occur despite the advances in testing of pregnant women in many countries and the availability of penicillin since 1943. This is a report of a child with multiple systemic manifestations of congenital syphilis. This is one of the few cases of survival with pituitary involvement from congenital syphilis and the first noted case in which diabetes insipidus developed. Institution of routine testing in all countries might have prevented the severe manifestations of syphilis seen in this child.

Disease-Free Survival↗
PubMed2002

Mortality associated with congenital syphilis in the United States, 1992-1998.

OBJECTIVE: To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality. METHODS: We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992-1998. RESULTS: From 1992-1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.4%. Untreated, inadequately treated, or undocumented treatment of syphilis during pregnancy accounted for 87.4% of reported cases. Among CS cases, there was an inverse relationship between the number of prenatal care visits (0, 1-4, 5-9, >/=10) and risk of fatal outcome. Among deaths, 52% of deliveries occurred by 30 weeks' gestation. Among live born infants with CS, death occurred more often in infants for whom no radiograph or cerebrospinal fluid evaluation was reported. Although both cases and deaths from CS declined from 1992-1998, there was no significant change in the case fatality ratio. CONCLUSION: Mortality associated with CS continues to be an important public health problem that will resurge if adult syphilis rates increase. Because a large proportion of deaths occur at low gestational age, earlier diagnosis and treatment of maternal syphilis may substantially reduce the case fatality ratio.

Adult↗
PubMedDate not supplied

Analysis of Treponema pallidum recombinant antigens for diagnosis of syphilis by western blotting technique.

Three GST fusion recombinant antigen of Treponema pallidum, described as GST-rTp47, GST-rTp17 and GST-rTp15 were analyzed by Western blotting techniques. We have tested 53 serum samples: 25 from patients at different clinical stages of syphilis, all of them presenting anti-treponemal antibody, 25 from healthy blood donors and three from patients with sexually transmitted disease (STD) other than syphilis. Almost all samples from patients with syphilis presented a strong reactivity with GST-rTp17 antigen. Some samples were non-reactive or showed a weak reaction with GST-rTp47 and/or GST-rTp15, and apparently there was no correlation with the stage of disease. There was no seropositivity among blood donors. No sample reacted with purified GST. We concluded that due to their specificity these recombinant antigens can be used as GST fusion protein for development of syphilis diagnostic assays.

Antigens, Bacterial↗
PubMed2003

Atypical presentation of syphilis in an HTLV-I infected patient.

We report the case of a 44 year-old female, who presented a long-lasting, clinically atypical, secondary syphilis ("malignant syphilis") in the right foot, which started six months before medical evaluation. The patient had a serological diagnosis of HTLV-I infection and syphilis two years before the onset of the skin lesions, following a blood donation. As she believed she was allergic to penicillin, she initially received sulfamethoxazole + trimethoprim, without any improvement of the clinical picture. After failure of this first treatment regimen, she was given penicillin, which promoted complete healing of the lesion. We found evidence that infection by HTLV-I is capable of modifying the clinical course of secondary syphilis.

Adult↗
PubMed2005

Premature loss of primary teeth associated with congenital syphilis: a case report.

Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported.

Alveolar Bone Loss↗
PubMed1990

Risk factors for syphilis: cocaine use and prostitution.

In Philadelphia, a large increase in syphilis among minority group heterosexuals began in 1986 and preceded similar increases elsewhere in the United States. To determine reasons for this increase, we conducted a case-control study in the metropolitan sexually transmitted diseases clinic during 1987 and 1988. Cocaine use (odds ratio [OR] 3.1; 95% confidence interval [95% CI] = 1.5, 6.5 among men; OR 5.8; 95% CI = 1.5, 33 among women) and exchange of drugs for sex (OR 3.5; 95% CI = 1.4, 8.7 among men) were risk factors for syphilis. Although cocaine users reported more sexual partners and more frequently reported sex with prostitutes, cocaine use remained a risk factor after adjustment for these behaviors. These data suggest that sexual behavior or another factor, such as availability or utilization of health care, among cocaine users leads to increased risk of syphilis in this population. Increases in cocaine use may be partly responsible for recent increases in syphilis incidence in the United States.

Adult↗
PubMed2006

Neurosyphilis is unlikely in patients with late latent syphilis and a negative blood VDRL-test.

Patients with latent syphilis or syphilis of unknown duration should be evaluated for tertiary disease and neurosyphilis. The aim of this retrospective study was to determine relevant serological parameters for the identification of those individuals with syphilis who are most likely to have neurosyphilis and who therefore require lumbar puncture. After excluding repeated estimates and patients whose blood syphilis serology had either been negative or not been determined within 3 months of lumbar puncture, 265 out of 710 cerebrospinal fluids from 1988 to 2004 were analysed. In each of those patients the earliest available pairs of serum and cerebrospinal fluid samples were evaluated. The diagnosis of neurosyphilis was based on criteria according to established guidelines. Forty-three of 265 patients (16.2%; 5 women, 38 men; mean age 47+/-16 years) had neurosyphilis. Seven of 72 (9.7%) of those testing HIV-positive, fulfilled the criteria of neurosyphilis. Not a single patient with neurosyphilis tested Venereal Disease Research Laboratory test (VDRL)-negative in peripheral blood, an effect which was highly significant (p < 0.01, chi2-test). The median blood-VDRL titre was significantly higher in patients with neurosyphilis than in those without (1:32 vs. 1:0; p < 0.01, t-test, two-sided). Hence, neurosyphilis is very unlikely in patients with a negative blood-VDRL. Therefore, lumbar puncture is not recommended in these patients.

Adult↗
PubMed1994

Immunosuppression in patients with syphilis and problems of human immunodeficiency virus infection.

An investigation of the induced suppression and cytotoxicity of T lymphocytes, carried out in 57 patients with different forms of syphilis, has made it possible to find some reasons for the depression of cell-mediated immunity (CMI) in patients with early syphilis. The analysis of the immunoreaction of patients with different forms of syphilis clarifies the influence of the human immunodeficiency virus (HIV) on the dynamics and formation of syphilis manifestations.

Adult↗
PubMed1993

Congenital syphilis: clinical manifestations in premature infants.

During the 4-year period February 1989 to January 1993, 13 premature babies aged 1-21 days and with congenital syphilis were admitted to the National Cheng Kung University Hospital. Of the 13 premature infants, 8 (62%) had unusual desquamation over palms and soles. Bone changes with periosteal reaction and/or metaphyseal dystrophy were observed in 11 cases (85%). Three mothers were diagnosed as being infected during pregnancy; 2 were treated with penicillin. The clinical features of congenital syphilis in premature neonates are somewhat different from those previously reported. Bone changes, hepatosplenomegaly, respiratory distress, skin lesions, especially over the soles and palms, cerebrospinal fluid abnormalities, and jaundice were the major manifestations in our series. In premature infants with these symptoms and signs, congenital syphilis should be considered as one of the differential diagnoses. Once the diagnosis of congenital syphilis is made, adequate penicillin therapy should be given.

Female↗
PubMed1987

Syphilis in 1986.

Symptoms of syphilis have evolved over the ages. In the 16th century, they were essentially cutaneomucous ones. While the intensity of the symptoms decreased localization of the infection in the various organs--mainly those of the cardiovascular and nervous system--gradually appeared. Over a period of years following the introduction of penicillin therapy, the cutaneous and visceral stages became less common. Reminder of the chief serological reactions and of some aspects of the experimental syphilis in the rabbit, similar to certain forms of human syphilis--a strong but late penicillin therapy has been proven ineffective in humans as well as in animals. It is to be regretted that numerous methods of using penicillin (all over the world), had been, from the beginning--except in a few cases--of a purely empirical nature. The authors emphasize--with proof to support their opinion--the failure of antibiotic therapy, which can explain the recent reappearance of hepatic and nervous localizations that had disappeared for 30 years. Despite views to the contrary the authors conclude that penicillin has in no way resolved all the problems raised by the treatment of syphilis.

Animals↗
PubMed2006

Gastric syphilis mimicking adenocarcinoma: a case report.

Syphilis is an unexpected diagnosis in the stomach, and the reduced incidence of syphilis has made its clinical presentation less widely appreciated. We report a 43-yr-old man suffering from epigastric tenderness with an initial diagnosis of gastric carcinoma; gastric syphilis was confirmed by demonstrating spirochetes in a gastric biopsy specimen by silver impregnation. Excessive lymphoplasmacytic infiltration with diffuse thickening of gastric rugae should raise suspicion of gastric syphilis, which should be considered in the differential diagnosis of diffuse erosive gastritis and infiltrative lesions of the stomach.

Adenocarcinoma↗
PubMed2004

[Nodular secondary syphilis in a HIV patient mimicking cutaneous lymphoma].

We report the case of a 61-year old man who, already for a month, had infiltrated plaques on the chest, back, neck and face as well as axilar lymphadenopathy, bearing a striking resemblance to lymphoma. During his stay in the hospital he had fever, sore throat, macules on the palms and soles and a depapilated plaque on the tongue and alopecia. A test for syphilis confirmed the diagnosis. The HIV serology was also positive. The nodular secondary syphilis is an unusual form that was first documented more than 20 years ago. Since then, only a few cases have been reported in which the first diagnosis included lymphoreticular malignancy. This form of secondary syphilis was found in the HIV-infected as well as non-infected patients. We discuss the atypical clinical course, the inappropriate serological reactions and the therapy in HIV infected patients with secondary syphilis.

Diagnosis, Differential↗
PubMed1983

Syphilis case-finding in an Australian men's sauna club.

A survey of 623 volunteers from a popular sauna club for homosexual men in Melbourne was carried out over a 12-month period. Blood samples were taken for serological tests for syphilis from each subject; in 114 (18.3%) of these, the test results were positive. Thirty-four subjects with positive test results (5.4%) had no previous history of syphilis. Follow-up was possible in 22 of these (64.7%), which resulted in 17 new cases of syphilis being detected and treated (a case incidence of 2.7%). Blood testing at sauna clubs patronized by homosexuals is a productive and cost-effective way of detecting asymptomatic syphilis in individuals at high risk of infection.

Adolescent↗
PubMed1993

Fetal syphilis: correlation of sonographic findings and rabbit infectivity testing of amniotic fluid.

Fetal syphilis is the presumed diagnosis when the sonographic findings of fetal hydrops are found in the presence of maternal syphilis. In the absence of fetal hydrops, the diagnosis of fetal infection is difficult. We hypothesized that intra-amniotic infection would be accompanied by anatomic placental and fetal abnormalities that could be detected by ultrasonography. Rabbit infectivity testing (RIT), intratesticular inoculation of rabbits with amniotic fluid, can be used to confirm intra-amniotic infection with Treponema pallidum. Twenty-one gravidas with untreated early (primary, secondary, and early latent) syphilis underwent sonography and amniocentesis for RIT at 24 weeks of gestation or later. Antenatal sonographic findings were compared to their amniotic fluid RIT results. Hepatomegaly was significantly (P < 0.01) associated with amniotic fluid infection detected by RIT. Antenatal detection of hepatomegaly, which is probably the initial sonographic manifestation of hydrops fetalis, may ultimately identify the fetus affected with congenital syphilis.

Amniotic Fluid↗