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PubMed2002

A case study of antenatal syphilis screening in South Africa: successes and challenges.

BACKGROUND: To evaluate the process of providing routine syphilis screening to antenatal care (ANC) clients at primary healthcare clinics in KwaZulu-Natal Province, South Africa. GOAL: To document the program performance and make recommendations for improving the current program and informing proposals for on-site testing. STUDY DESIGN: Nine health facilities were recruited for the study. The methodology used for this case study included: Key informant interviews, inventory, focus group discussions with clients, client flow analysis, exit interviews with clients and observations of consultations. RESULTS: All 51 women attending their first ANC visit had a blood sample taken for a syphilis rapid plasma reagin (RPR) test. Unreliable transport resulted in an average 4 weeks turnaround time to get RPR test results back to clinics. Due to late presentation in the pregnancy for their first ANC visit, 15% would have been unable to complete their treatment before delivery if they had been found positive. Health providers gave minimal information and/or counseling on syphilis, neither did they stress the importance of treatment of positive clients and their partners. There was no strategy to track positive clients who had not been treated or their partners. Providers were unclear on whether partners should be tested before treatment. CONCLUSION: Although testing was readily available, most of the constraints were centered round logistics of ensuring treatment of women and their partners. These issues must be addressed by sexually transmitted infection managers and policymakers.

Adolescent↗
PubMed1995

A case of secondary syphilis with mucous patches on the hard palate.

A rare case of secondary syphilis showing mucous patches on the hard palate is reported. A 31-year-old male had two erosive patches which were slightly raised on his hard palate. A linear lesion was also present on the inside of his right alveolar process. Many red-brown macules on his abdomen and bilateral inguinal lymphadenopathy accompanied these symptoms. The serological tests for syphilis were positive: VDRL test 1:512, TPHA test 1:20,480, and IgM-FTA-ABS test 1:40. Immunohistochemical staining with rabbit monoclonal antibody to Treponema pallidum by the biotin-streptoavidin system detected treponemal organisms in the paraffin-embedded specimen from his mucous patch. A diagnosis of secondary syphilis was made, and he was given amoxicillin (AMPC) at 750 mg per day for 4 weeks. His eruptions, including the mucous patch, healed in a week.

Adult↗
PubMed1985

Early congenital syphilis still occurs.

Seven cases of early congenital syphilis have been recorded in the past 10 years in the Mersey Regional Health Authority. Antenatal serology was initially negative in five mothers, who were either incubating or acquired the infection later, and treatment had probably failed in two women given erythromycin for syphilis during pregnancy. Serology should be repeated later in pregnancy in those at high risk. Social factors that define this group include women who book for antenatal care late in pregnancy, have a past history of sexually transmitted disease, and have multiple consorts. Clinical signs in the infant such as failure to thrive, hepatosplenomegaly, symmetrical rash, rhinitis, and osteochondritis should alert the clinician to the possibility of congenital syphilis. Adequate management of mother and baby requires close liaison between the genitourinary physician, microbiologist, obstetrician, and paediatrician. Penicillin remains the treatment of choice.

Adult↗
PubMed1981

Auditory brain-stem responses in syphilis.

Analysis of auditory brain-stem electrical responses (BSER) provides an effective means of detecting lesions in the auditory pathways. In the present study the wave patterns were analysed in 11 patients with secondary or latent syphilis with no clinical symptoms referrable to the central nervous system and in two patients with congenital syphilis and general paralysis. Decreased amplitudes and prolonged latencies occurred frequently in patients with secondary and with advanced syphilis. This technique is a notable diagnostic advance in detecting syphilitic damage of the brain stem.

Adult↗
PubMed1976

Adverse reactions in syphilis therapy.

Reactions related to treatment of syphilis may be due to treponemal infection, therapy, or to the interaction of these. In this review I discuss the Jarisch-Herxheimer (J-H) reaction and the therapeutic paradox. Antibiotic side effects are not unique among patients treated for syphilis; therefore, readers are referred elsewhere for reviews of major antibiotic side effects. J-H reactions are acute, transient episodes with manifestations occurring both systemically and at local sites of treponemal concentration. These reactions are related to the rapid destruction of treponemes by various therapeutic agents. In this review, I suggest that J-H reactions may be significant only in syphilitic paresis, pregnancy complicated by syphilis, and when local inflammation can cause serious functional compromise, as with second or eighth cranial nerve involvement. Many workers use prednisone in conjunction with penicillin in some or all of these situations. However, the efficacy of corticosteroids has not been evaluated for such problems in clinical trials. Therefore, the use of prednisone can be supported only in very selected situations and for short duration (ie, 2 days). Therapeutic paradox, which is clinical worsening despite cure of infection, is said to result from scar formation after rapid treponemal destruction by therapeutic agents. The therapeutic paradox does not appear of great significance. Futhermore, no methods to prevent such reactions are generally advocated.

Anti-Bacterial Agents↗
PubMed2003

Nodular secondary syphilis.

Secondary syphilis can have protean clinical manifestations and may present with unusual lesions, which may go unrecognized. We report a case of secondary syphilis with nodular lesions. A 22 year old male presented with nodular and annular skin lesions over the face, back and limbs and condylomata lata lesion at the penoscrotal junction associated with generalized lymphadenopathy, fever and malaise. Prior to onset of these lesions the patient also had history of a painless genital sore, which healed within two weeks. The serology revealed a reactive VDRL(1:64) and positive TPHA. The HIV serology was non-reactive. The patient responded to a single dose of benzathine penicillin, 2.4 million units, given intramuscularly. This case highlights that secondary syphilis may present with nodular lesions and should be suspected in the appropriate clinical setting.

Adult↗
PubMedDate not supplied

[Secondary syphilis with ocular involvement in a 77-year-old man].

A 77 year old man complained of vision loss and presented psoriasiform skin manifestations. A bilateral panuveitis was observed and after extensive investigation including vitrectomy the patient was diagnosed with secondary syphilis with ocular involvement. Syphilis has shown an increasing incidence in Sweden especially within the group of men who have sex with men. This case report reminds us of the diversity of symptoms which syphilis may present and the importance of PCR to demonstrate Treponema pallidum.

Aged↗
PubMedDate not supplied

[Clinical picture of early syphilis in patients with HIV infection in the light of literature data].

A literature survey is presented concerning the clinical pattern of early syphilis in subjects infected with HIV. The course of syphilis infection in HIV-positive subjects differs often from the usual one, the clinical picture may be that of the so called malignant syphilis with early development of syphilitic lesions in the central nervous system and involvement of the visual system; Serological reactions differ also, they may give negative results or may appear with delay, sometimes high titres of these reactions are found.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[The combination of syphilis and HIV infection].

Seven cases of a combined course of syphilis ad HIV infection are described. All the patients are men, homo- and bisexuals. No apparent clinical features of syphilis in these patients were detectable. Recommendations on the strategy of syphilis treatment in patients with HIV infection are given.

AIDS Serodiagnosis↗
PubMed1989

Early and congenital syphilis.

The incidence of infectious syphilis is increasing in the United States, particularly among women. Not surprisingly, congenital syphilis rates have also risen. These have led to a rekindling of interest in the manifestations and treatment of primary, secondary, and latent syphilis. Coinfection with human immunodeficiency virus may alter clinical presentations and response to therapy.

Humans↗
PubMed1989

[A specific stimulation test of the peripheral blood lymphocytes in the diagnosis of syphilis].

The authors analyze the results of laboratory studies on the diagnosis of syphilis with the use of this test. T. pallidum has been used as an antigen. The study has involved 234 patients with active and latent forms of syphilis, as well as donors and subjects with nonspecific positive serologic reactions. The test has yielded negative results in 27 (12%) patients; of these, in only 1 of the 170 patients with active syphilis.

Evaluation Studies as Topic↗
PubMed1988

Prevention of congenital syphilis.

Syphilis, though rare, is a serious disease particularly in pregnancy, as undetected it will have severe adverse effects on the growing fetus. An alarming increase in the incidence of primary and secondary syphilis in some countries must prompt efforts to control congenital syphilis by screening and treatment of targeted high-risk groups of women.

Erythromycin↗
PubMed1993

Re-screening for syphilis at the time of delivery in areas of high prevalence.

Two hundred women who were screened for syphilis at their initial antenatal visit were rescreened at the time of delivery. Umbilical cord blood specimens as well as maternal sera were tested. Twenty-two (11%) women were rapid plasma reagin (RPR)-positive at booking, while a total of 23 (12%) were RPR-positive at the time of delivery, including an additional 5 (3%) who seroconverted. Four women who were RPR-positive at initial testing had become negative by the time of delivery following treatment. Of all neonates born to seropositive women, only 1 demonstrated clinical evidence of congenital syphilis. In view of the high seroconversion rate, we recommend screening for syphilis at the initial antenatal visit and rescreening at the time of delivery in areas such as ours.

Female↗
PubMed1993

Congenital syphilis: when the medium fails to transmit the message.

OBJECTIVE: To report two cases of congenital syphilis, a disease which should have been prevented. CLINICAL FEATURES: Two infants, both from the country, presented to Princess Margaret Hospital for Children. Case 1, a boy of five months, had unexplained fractures of radius and clavicle, suggesting non-accidental injury, a belief which lasted until skeletal survey showed widespread bone disease. Exact diagnosis became clear after serological studies. Case 2, an Aboriginal baby of six weeks, came with more classic symptoms and signs--rhinorrhea, rash with desquamation, irritability, anaemia, and lack of movement in an upper limb; the serological diagnosis already made. INTERVENTION AND OUTCOME: Both infants (and their mothers) were treated with appropriate antibiotics and the symptoms resolved. CONCLUSIONS: The first case was a challenge to the system for handling suspected child abuse; the second will be a challenge to the follow-up system in a remote area of Western Australia. The delay in diagnosis occurred because the results of the serological tests for syphilis were not appreciated and acted upon. The reports have become complex, consisting of acronyms and numbers which do not convey meaning to clinicians who receive them. Each report should translate the terms and endeavour to interpret the results, to aid prevention of congenital syphilis in the antenatal period or to give early diagnosis and accurate, efficient treatment of the affected infant.

Australia↗
PubMed2000

The Diagnosis and Management of Syphilis in the HIV-Infected Patient.

In the 1980s, the number of cases of syphilis in the United States increased concurrently with the onset of the HIV epidemic. Within a short time, clinicians began to note unusual presentations of syphilis and inappropriate responses to standard therapy for syphilis in dually infected patients. Whether these cases collectively represented a new aspect of the natural history of syphilis remains to be elucidated. In recent years, only a few prospective studies have addressed this issue, and the results of these studies have been inconclusive.

Journal Article↗
PubMed2000

Syphilis in women.

Infection with the spirochete Treponema pallidum causes syphilis. Transmission of syphilis occurs through sexual contact with persons who have infectious mucocutaneous lesions. Before the advent of penicillin, this infection was responsible for a large portion of the debilitated patients residing in mental institutions. Later during this century, the disease became somewhat uncommon, only to see a resurgence during the early part of this decade. Syphilis progresses through stages defined as primary, secondary, latent, and tertiary. Diagnosis of this infection is by clinical examination, dark-field microscopy, and serology. Penicillin is the treatment of choice for all stages of syphilis. Doxycycline and tetracycline are acceptable alternatives in some penicillin-allergic patients. If patients are pregnant or have central nervous system involvement, alternative regimens should not be used because of lack of efficacy and/or fetal toxicity. Therefore, these patients must be desensitized and treated with penicillin. No effective vaccine for this infection is currently available.

Journal Article↗
PubMed2005

Early syphilis presenting as a painful polyradiculopathy in an HIV positive individual.

Neurosyphilis and neurological complications from syphilis may be commoner in HIV disease. With outbreaks of early syphilis in HIV positive individuals being observed over recent years, rare neurological manifestations of secondary syphilis will be observed more commonly. We describe a case of an HIV positive individual whose first presenting feature of early syphilis was a polyradiculopathy.

HIV Infections↗
PubMedDate not supplied

[Congenital syphilis: incidence among newborns]

OBJECTIVE: To determine the incidence of congenital syphilis among newborns at the maternity of a public hospital. METHODS: The study was conducted at the maternity of Fundação Santa Casa de Misericórdia do Pará, from May to September 1996; 361 mothers were interviewed, and physical examination was performed in their newborns. Serum samples from both, mothers and neonates, were tested using three methods: VDRL, FTA - Abs, ELISA IgM. The diagnosis of congenital syphilis was established according to the criteria defined by Ministério da Saúde in 1993. RESULTS: The rate of congenital syphilis was of 9.1% (33); in 14 cases, there were one or more signs of the disease: prematurity, hepatomegaly, stillbirth, splenomegaly, perinatal death, abdominal distention, nasal stuffiness, jaundice, newborn small for gestational age. The majority of the infected mothers belonged to the age group of 20-35 years (81.8%); 60.6% were married; 63.6% received prenatal care; 48.5% reported previous spontaneous abortion, and 12.1% previous stillbirth. The rate of bisexuality among fathers was of 9.1%. CONCLUSION: The syphilis control measures and the prenatal care, have not been sufficient to prevent the high rate of the disease.

Journal Article↗