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PubMed1990

Epidemiology of primary and secondary syphilis in the United States, 1981 through 1989.

Between 1981 and 1989, the incidence of primary and secondary syphilis in the United States increased 34%, from 13.7 to 18.4 cases per 100,000 persons, the highest since 1949. The populations affected most by syphilis also changed substantially. From a peak of 10.0 cases per 100,000 persons in 1982, the incidence among white men had decreased 69% by 1989 (3.2 cases per 100,000 persons). From 1982 to 1985, the incidence also decreased among black men (30%, 101.9 to 71.5 cases per 100,000) and black women (22%, 45.8 to 35.8 cases per 100,000). However, in 1986 this trend reversed, and the incidence among blacks more than doubled from 1985 to 1989 (52.6 to 121.8 cases per 100,000 persons). Racial differences in syphilis incidence increased (black-to-white incidence rate ratio in 1981 was 14.5 and in 1989 was 47.8), as did regional differences. Trends in syphilis incidence indicate changes in sexual behavior that may determine future sexual transmission of human immunodeficiency virus. Targeting resources at populations most affected by this recent epidemic is an urgent public health priority.

Adolescent↗
PubMed1985

AIDS-induced decline of the incidence of syphilis in Denmark.

The incidence rate of acquired syphilis per 100 000 total population in Denmark increased by 70% from 6.8 in 1978 to 11.6 in 1982. In 1984 this incidence had decreased by 61.2% to 4.5. The fluctuation of the number of acquired syphilis predominated in the male population with an increase of 71.8% during the five year period 1978-1982 and a decrease of 63.2% during the years 1983 and 1984. In 1978, the incidence of acquired syphilis in males was 11.3 per 100 000 total population increasing to 19.5 in 1982, decreasing to 7.2 in 1984. The decreasing number of acquired syphilis cases during the past two years are correlated to a lower number of sexual contacts among homosexual men because of fear of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88.

Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively.

Alaska↗
PubMed1989

Rapid Plasma Reagin test (RPR) compared to Venereal Diseases Research Laboratory test (VDRL) for the diagnosis of syphilis in pregnancy.

Obstetric departments which provide service for a large number of patients from different parts of the country and socioeconomic backgrounds like the Obstetric Department of Chulalongkorn hospital, need to develop rapid laboratory tests which can cope with the volume of work and yet provide sound laboratory data for management decisions. We, therefore, undertook a study of the suitable Rapid Plasma Reagin (RPR) test as a diagnostic tool for syphilis in 9,347 pregnant women who attended antenatal clinics at this institute from August 1984 to May 1985. The RPR test was used in addition to the routine serological tests for syphilis namely the VDRL, TPHA and/or FTA-ABS. Analysis of results confirmed that the RPR test fulfilled all laboratory results for clinical requirements. The results from RPR and VDRL were not significantly different. Their sensitivities were 90.86 and 89.95 per cent, their specificities were 99.57 and 99.68 per cent, their positive predictive values were 82.11 and 85.92 per cent, their negative predictive values were 99.8 and 99.78 per cent, and their accuracy was 99.39 and 99.47 per cent respectively. In our study it was found that the RPR test could provide a laboratory diagnosis in 60-90 minutes; in the same morning period when 15-20 prenatal patients were seen for the first time. The above results suggest that the RPR test is a rapid and reliable tool which is particularly suitable for syphilis screening in a busy antenatal clinic. The test enabled all 197 patients with syphilis in pregnancy to be treated promptly and without any loss of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Errors↗
PubMed1988

Secondary syphilis. A clinicopathological study.

Syphilis is still a common disease in many countries. The clinical features of secondary syphilis are well documented, and the histopathological features of secondary syphilis have been reviewed in a few studies. The present study documents the histopathology of secondary syphilis based on 68 skin biopsies from 38 patients. Based on the findings of this study, and a review of the literature, diagnostic guidelines are suggested and the differential diagnoses are discussed.

Adipose Tissue↗
PubMed1987

Gonorrhea and syphilis in incarcerated urban adolescents: prevalence and physical signs.

During a 1-year period from July 1983 to June 1984, 285 adolescent girls and 2,236 adolescent boys, ranging in age from 9 to 18 years (89% were 14 to 16 years of age), were screened for gonorrhea and syphilis on entry into a detention facility in New York City. The prevalence rate for gonorrhea was 3% for boys and 18.3% for girls, and the prevalence rate for syphilis was 0.63% for boys and 2.5% for girls. The rates of gonorrhea without penile or cervical discharge on physical examination were 2.1% for boys and 10.9% for girls. This high prevalence of syphilis and gonorrhea and the high frequency of disease without physical signs of illness indicate the desirability of screening high-risk adolescents for these and other sexually transmitted diseases. Our data support the need for programs in detention facilities and, we believe, schools, to encourage use of barrier contraceptives to control gonorrhea, syphilis, Chlamydia, human papillomavirus, human immunodeficiency virus, and unwanted pregnancy.

Adolescent↗
PubMed1978

[Syphilis serology: "ELISA", a third generation test].

The characteristics and the working modalities of ELISA (Enzyme Linked Immunosorbent Assay) are outlined at the onset. Subsequently, the Authors refer the data relevant to the use of ELISA in the syphilis serodiagnosis, by describing the operative phases for the working out of the test with the enzyme peroxidase, and reporting the results of the clinical investigation performed on primary and secondary syphilis in progress, on treated primary and secondary syphilis (examinations performed 1 to 10 years after the end of therapy), on healthy blood donors, and on samples of false biological positivities. On the basis of the analysis of the results, the Authors feel that ELISA for its characteristics of sensitivity, easiness in carrying out, rapidity and reproducibility, might find a rational indication in the modern serodiagnosis of the syphilis.

Blood Donors↗
PubMedDate not supplied

[Immunoelectrophoretic study of serum from patients with untreated recently adquired syphilis].

An immunoelectrophoretic study of serum from patients with non-treated recently acquired syphilis (RAS) is made for the first time in our country. Increases in IgM and IgG fractions were detected; the increase of the former exceeded to the latter in patients with cutaneous symptomatic recently acquired syphilis (CSRAS) in comparison with those having mucous cutaneous symptomatic recently acquired syphilis (MCSRAS). IgG were increased in 100% of patients with this latter disease, although both fractions were increased in patients with latent recently acquired syphilis (LRAS).

Adolescent↗
PubMed1986

[Specific antibody activity as a marker of pathogen-stimulated immune response in the central nervous system. Exemplified by syphilis and zoster diseases].

Under normal conditions the portion of any antigen specific IgG of total IgG is identical in serum and CSF. This thesis was investigated in 51 patients who were found to have seropositive syphilis without CNS involvement. For this purpose a special index (ITpA-index) was used, based on the ratio of specific IgG per total IgG of CSF to specific IgG per total IgG of serum. This index has a value of 1 (0.5-2), if there is no antibody synthesis in the CNS, as confirmed on the 51 seropositive control patients. In patients with syphilitic CNS involvement the index rose above 2 (3-430), due to local antibody synthesis in the CNS. When there is an ITpA-index below 2.0 in patients with seropositive syphilis who show any CNS symptoms whatsoever, it can be presumed that the actual CNS disease is not a consequence of the former syphilitic infection, but is caused by a condition other than syphilis. In 6 patients with reactive syphilis tests, moderate CSF pleocytosis and increased CSF total IgG, the ITpA-index was below 0.5. Among these 6 patients the inflammatory CNS process was non-syphilitic. The principle of the ITpA-index is applicable to other bacterial or viral CNS diseases insofar as a local humoral immune response takes place. This could be demonstrated in cases of herpes zoster.

Antibodies↗
PubMed1985

Diagnosis of liver involvement in early syphilis. A critical review.

The diagnosis of liver involvement in early syphilis has always posed problems because of its rarity and the difficulty of excluding coincidental liver disease caused by a multitude of pathogens. Case reports deal predominantly with jaundiced homosexual men in whom syphilis is discovered later, and the prospective studies of patients with early syphilis disclose only mild biochemical abnormalities in liver function test results. There is no single characteristic feature attributable to early syphilitic hepatitis. Even liver histologic findings are variable. At least in those patients who have jaundice, there is a likelihood of coincidental viral hepatitis. Therefore, the evidence to implicate Treponema pallidum as a liver pathogen in early syphilis is not convincing.

Hepatitis↗
PubMedDate not supplied

[Syphilis. An up-to-date physio-biological view of the main topics. III -- The problem of immunity (author's transl)].

The problem of immunity in Syphilis is a very complex problem which is tightly bound to healing. But for lack of being able to grow T. pallidum and as we are without any absolute criterion of bacteriological sterilization, the only method we have to be able to consider this study is to have recourse to experimentation upon animals. Two theories had been proposed to give an explanation about this phenomenon occurring during a late treated syphilis: on one side, for Kolle, Evers and Neisser, immunity in syphilis would be due to a premunition given by the only persistence in the organism of T.p. having still kept all their virulence. On the other hand, as far as Chesney and Kemp are concerned it would be a true immunity, obtained before the application of any therapeutic treatment, but which is not due to persistence of T.p. in tissues. However, recent works have proved, and this has been confirmed by several searchers, that a penicillin therapy, even at a high dose, given six months after the infection outset, is no longer able of destroying all T.p. Immunity in syphilis would then be due to a modification of tissular receptivity kept by the persistence of T.p. vegetating in the organism in a commensal state. As far as the nature of this immunity is concerned, all the present research would lead to prove that this refractory state would not be due to tumoral properties, but more likely to tissular properties and probably to cell mediated phenomena. Similar research carried out in man has created an opportunity to demonstrate these facts similar to those observed in experimentations upon animals. They particularly prove that a persistent serology over a long period is not due to a "cicatrice sérologique" (Serological marker) but to the keeping of T.p. in a quiescent state. However, it is a more or less relative immunity which is concerned, depending upon a very large number of factors that are far from being elucidated.

Animals↗
PubMed1984

Clinical manifestations of otological syphilis.

One patient with early otological syphilis and five patients with late otological syphilis are described including audiological and serological findings. In patients with late syphilis poorer than expected speech discrimination scores relative to the pure tone audiograms were noted. Profound hypo-activity of vestibular responses to caloric stimulation was present in the cases of late otological syphilis. Routine non-treponemal serological tests were not sensitive enough to establish the diagnosis. It is recommended that more sensitive treponemal serological tests such as the FTA-ABS should be employed.

Adult↗
PubMed1978

A child with the nephrotic syndrome associated with endemic syphilis.

A 21-month old infant with endemic syphilis who presented with nephrotic syndrome is described. Clinically, the features correlated well with those of renal disease associated with secondary syphilis. The onset of renal disease in association with syphilis after early infancy may be a valuable aid in drawing attention to the possibility of endemic syphilis. Morphologically the features were those of an immune complex-mediated glomerulonephritis. We regard the presence of a large number of immature-looking glomeruli as a retrogressive phenomenon.

Humans↗
PubMedDate not supplied

Control of epidemic early syphilis: the results of an intervention campaign using social networks.

BACKGROUND: During an epidemic of early syphilis, social networks were used for an intervention campaign. GOAL OF THIS STUDY: To characterize the epidemic and describe the yield of new cases from index-case interviews. METHODS: Analyses of morbidity data collected by the Montgomery County, Alabama, sexually transmitted disease program determined the course of the epidemic and characterized the new case yields from social networks identified via index-case interviews (partner notification investigations) and interviews with sex partners and their associates (cluster investigations). Results and costs were compared to a noncampaign period. RESULTS: The number of reported syphilis cases nearly doubled from 1990 to 1991 (201 to 348 per 100,000 residents). During the 21-week campaign, 373 case-patients had partner notification/cluster investigations; 113 (11%) of 984 sex partners and 41 (3%) of 1,146 high-risk associates (persons identified during cluster investigations) had syphilis. No subgroup of case-patients for which the partner notification/cluster investigation yielded more infected persons than other subgroups was identified. The cost per case detected was more than twice that during a noncampaign period ($1,627 vs. $771). CONCLUSION: Partner notification investigations yielded more infected persons than cluster investigations. Further evaluation is needed to determine the role of intense partner notification/cluster investigators' efforts in the control of epidemic syphilis.

Adolescent↗
PubMed1994

Prevalence of vaginitis, syphilis and HIV infection in women in the Orange Free State.

OBJECTIVE: To determine the prevalence of vaginitis, syphilis and HIV infection in women in the Orange Free State. METHOD: By cluster sampling, 120 rural (farm) and 120 urban (local authority) clusters, each containing 4 women, were selected. Women aged 18-49 years who were included in the study had a cervical smear taken for cytological evaluation and blood specimens drawn for syphilis and HIV testing; they were questioned on their knowledge of AIDS. RESULTS: Trichomonas vaginalis vaginitis was present in 27.4% of the rural women and 29.6% of the urban women, Gardnerella vaginalis in 7.2% and 8.4% and Candida spp. in 2.6% and 6.7% respectively. Syphilis serology was positive in 12% of rural and 16% of urban women. HIV was present in 0.4% of rural and 1.5% of urban women. Ninety per cent of urban women and 74% of rural women knew AIDS was a sexually transmitted disease. CONCLUSIONS: The prevalences of trichomonas vaginitis and syphilis were unusually high, while HIV positivity was similar to that in other reports in South Africa.

Adolescent↗
PubMed1994

[Cutaneomucous tertiary syphilis].

On the basis of two new cases of cutaneous mucosal tertiary syphilis and a personal series of 30 cases observed at the University Hospital of Rabat and Casablanca from 1963 to 1980, we reviewed the clinical presentations of this disease. Late stage syphilis has not disappeared and appears to be increasing over the last decade. Lesions of the nervous system are increasingly reported in atypical often unrecognized forms. Cutaneous mucosal tertiary syphilis is very rare and little known and can take on the form of skin lesions suggesting tuberculosis, deep mycosis, sarcoidosis, leprosy or leishmaniasis. Based on our experience, we recall the variety of clinical presentations including superficial nodules and deep gommas leading to atrophic and rarely hypertrophic scars. The diagnosis relies essentially on the serology results which are always positive at a significant level. The pathology examination adds no essential information. Rapid response to treatment is one of the important criteria of the diagnosis of syphilis.

Adolescent↗
PubMed1994

Syphilis in Missouri: a continuing problem.

Syphilis has re-emerged as a significant public health problem in the United States and Missouri. Reported cases of primary and secondary (P&S) syphilis and congenital syphilis in Missouri have been increasing since the late 1980s, and a major outbreak of these diseases continues in the St. Louis area. The nature of syphilis combined with certain characteristics of those populations at highest risk of infection can make prevention and control difficult. Achieving success requires the cooperative efforts of practicing physicians and public health professionals.

Adolescent↗
PubMed1993

Syphilis in pregnancy: a medical audit in a rural district.

A medical audit was performed in Umzingwane District, Zimbabwe, to assess the quality of antenatal care in 1991 regarding detection and management of syphilis. Two thousand one hundred and sixty one women booked for antenatal care, 1433 (66 pc) received a RPR test result, 197 (14 pc) tests were positive. In 32 (16 pc) of the 197 RPR positive women the outcome of the pregnancy could not be established. Of 165 women 111 (67 pc) received adequate treatment for syphilis. A perinatal mortality rate (PNMR) of 173/1,000 was associated with inadequately or not treated RPR positive mothers and a PNMR of 21/1,000 with RPR negative and untested mothers (odd's ratio = 9.9; 95 pc confidence interval 3.8-24.9, p < 0.001). It is estimated that only 42 pc of all pregnant women and 24 pc of the couples with syphilis in 1991 were treated adequately. Recommendations are made to improve the quality of surveillance of syphilis in pregnancy in a rural district.

Algorithms↗