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PubMed1990

Ocular syphilis.

The ability of syphilis to mimic different ocular disorders can lead to misdiagnosis and delay in appropriate antimicrobial therapy. The authors describe their experience over the past 5 years with the ocular manifestations of syphilis in 25 patients who comprised 2.45% of 1020 new patients. Uveitis was the most common ocular manifestation seen. All patients had positive results from FTA-ABS tests, whereas only 68% had reactive serum VDRLs. Two of five patients tested for human immunodeficiency virus (HIV) antibody were reactive. The authors recommend routine FTA-ABS and VDRL screening in patients with uveitis or unexplained ocular inflammation. They also recommend testing for HIV antibody in luetics and aggressive treatment with high-dose aqueous penicillin for syphilis.

Adult↗
PubMed2000

Syphilis testing.

The organism that causes syphilis, Treponema pallidum, is impossible to culture in the clinical laboratory. Direct visualization of the pathogen is one laboratory technique used in the diagnosis of syphilis. Currently, serologic testing is the most widely used laboratory technique in diagnosing syphilis and monitoring its course after treatment. Serologic tests are divided into two categories, the nontreponemal and treponemal antibody tests. Newer techniques such as enzyme immunoassays have shown excellent results.

Emergency Medicine↗
PubMed2002

Prevalence of circulating Treponema pallidum DNA and RNA in blood donors with confirmed-positive syphilis tests.

BACKGROUND: Although there have been no well-documented cases of transfusion-transmitted syphilis in more than 30 years, serologic tests for syphilis (STS) continues to be required for donated blood. Previously, the methods for detecting viable spirochetes were dependent on the use of the rabbit infectivity test. DNA PCR and RNA RT-PCR were applied to assess the presence of Treponema pallidum DNA or RNA in blood donors with confirmed-positive results in STS. STUDY DESIGN AND METHODS: This case series describes T. pallidum DNA and RNA testing of platelet concentrates prepared from blood donors with reactive results in an automated treponemal screening test and positive test results in the fluorescent treponomal antibody absorption test. The first DNA test was specific for the T. palladium polA gene. The second DNA test was a multiplex PCR using a T. pallidum 47-kDa gene target. The RT-PCR for RNA used T. pallidum 16S rRNA as a template for production of a cDNA target. RESULTS: One hundred sixty-nine samples (including rapid plasma reagin [RPR]+ and RPR-) tested for T. pallidum DNA and/or RNA were negative. CONCLUSIONS: A lack of demonstrable T. pallidum DNA or RNA suggests that blood donors with confirmed-positive results in STS are unlikely to have circulating T. pallidum in their blood and that that their blood is unlikely to be infectious for syphilis.

Adult↗
PubMed2001

[Secondary ocular syphilis with chorioretinitis of the posterior pole - a case report].

BACKGROUND: Diagnosis of syphilis is often very difficult due to the absence of typical organ manifestation. In addition syphilis has the ability to imitate any ocular inflammation. This may result in misdiagnosis and delay of appropriate antimicrobial therapy. Up to now the first choice therapy is penicillin. CASE REPORT: We report about an otherwise healthy, 40 year-old-woman, who was referred to the Department of Ophthalmology, University of Tuebingen, due to an unclear loss of visual acuity (OD 0.1 and OS 0.4). The fundus examination disclosed focal chorioretinitis on the posterior pole, which was verified in fluorescein angiography. Secondary syphilis was diagnosed due to positive serological testing. Medical treatment consisted in Penicillin (i.m.) for 2 weeks and additional oral corticosteroids, which were tapered down slowly. After 3 months visual acuity had improved to 0.9 in the right and to 1.0 in the left eye. The former chorioretinitis regions showed only hyperpigmentation. CONCLUSIONS: Laboratory syphilitic testing should be performed in every uveitis.

Adult↗
PubMed2001

[Optic nerve involvement in syphilis in 4 patients].

BACKGROUND: Due to increasing numbers of cases syphilis again becomes more important in ophthalmology. Syphilitic ocular manifestations do not show any typical characteristics and therefore are often not diagnosed although a correct and early diagnosis with adequate therapy is very important for the visual outcome. PATIENTS: We report on four patients with luetic ocular fundus manifestations, who were referred to our clinic with unspecific ocular complaints. Funduscopic examination revealed in all patients a papilledema, which was bilateral in three patients and unilateral in one patient. Additional findings were a non-granulomatous uveitis anterior and a chorioretinitis in both eyes of a 61-year-old HIV positive patient with retinal scars from a bilateral acute retinal necrosis syndrome (ARN), a mild non granulomatous iridocyclitis in a 53-year-old patient and a bilateral chorioretinitis and a cystoid macular edema in a 37-year-old patient. A 54-year-old patient showed a vein branch occlusion. Serological analysis demonstrated active syphilis in all cases and an EBV-infection in two patients. After penicillin therapy the ocular findings resolved. CONCLUSION: In all cases of inflammatory fundus manifestations syphilis should be taken into consideration and serological lues tests should be performed routinely.

Adult↗
PubMed1991

[Tertiary syphilis with liver gummata].

Sonography revealed multiple echo-poor lesions in the liver of a 51-year-old man with nonspecific symptoms (fatigue, drop in performance, pressure sensation in the upper abdomen), increased blood sedimentation rate (68/110 mm) and evidence of cholestasis (gamma-GT 126 U/l, alkaline phosphatase 444 U/l, leucine-aminopeptidase 64 U/l). Under the diagnosis of liver metastases the primary tumour was looked for. These investigations and a fine-needle biopsy having proved unsuccessful, laparoscopy was performed. The biopsies so obtained showed whitish yellow, tight elastic structures indicating gummas of the liver in tertiary syphilis. Treponema-specific IgM antibodies in serum characterized active syphilis requiring treatment. Administration of antibiotics (penicillin 1 mega U daily i.m.; because of allergy replaced after four days by erythromycin 2 g daily for six weeks) resulted in complete normalization of all biochemical findings and, some time later, regression of the gummas. The patient has now been symptom-free for three years. This case illustrates the need even to-day of including syphilis in the differential diagnosis of unclear space-occupying lesions of the liver.

Biopsy↗
PubMed2005

Simultaneous bilateral exudative retinal detachment and peripheral necrotizing retinitis as presenting manifestations of concurrent HIV and syphilis infection.

PURPOSE: To describe an unusual case of simultaneous bilateral exudative retinal detachment and peripheral necrotizing retinitis as presenting manifestations of concurrent HIV and syphilis infection. CASE REPORT: A previously healthy 35-year-old Caucasian male was first seen for bilateral sudden visual loss. Ophthalmoscopy showed bilateral exudative retinal detachment involving the posterior pole and a placoid-like area of peripheral necrotizing retinitis in his left eye. Physical examination revealed anal condylomata and aphthous oral lesions. Laboratory investigations confirmed the diagnosis of concurrent HIV and syphilis infection. Ocular lesions resolved in response to anti-syphilitic medication administered for three weeks. DISCUSSION: This case demonstrates the importance of considering syphilis as a cause of atypical retinitis in the HIV-positive population.

Adult↗
PubMed2004

Internet-based site-specific interventions for syphilis prevention among gay and bisexual men.

Recent increases in syphilis in gay men in urban areas in the US and Europe have been associated with men meeting new sex partners on the Internet in chat-rooms and at websites that facilitate partner meeting. In response to the syphilis epidemic in San Francisco, the San Francisco Department of Public Health partnered with a community-based organization, Internet Sexuality Information Services, Inc., to develop, implement and evaluate a broad range of innovative Internet-based prevention interventions including the creation of a website, individual online outreach, banner advertisements, chats, an educational site, message boards, warnings and an online syphilis testing program. This paper documents the varied success of these interventions with process measures and calls for greater emphasis on impact measures in the evaluation of these types of intervention.

Advertising↗
PubMed1996

Prominent osseous and unusual dermatologic manifestations of early syphilis in two patients with discordant serological statuses for human immunodeficiency virus infection.

Numerous case reports of atypical and/or severe forms of syphilis in individuals coinfected with human immunodeficiency virus (HIV) have led many authorities to conclude that HIV exacerbates early syphilitic infection. Herein we report prominent osseous and unusual dermatologic manifestations of early syphilis in two individuals whose serostatuses for HIV infection were discordant. Our cases emphasize the need for caution before conclusions are drawn from anecdotal data about the interactions between HIV infection and syphilis.

Adult↗
PubMed1986

Role of circulating immune complexes in human secondary syphilis.

Studies in animal models and in the glomerulonephritis of human secondary syphilis and results from in vitro assays have suggested a role for circulating immune complexes (CICs) in human secondary syphilis. Nine adult subjects with early secondary syphilis were studied. All patients tested had CICs on C1q-binding or Raji cell assays. Proteins previously described as Treponema pallidum-specific antigens were detected by radioimmunoblot techniques in CICs from all five subjects tested. Biopsy of early cutaneous lesions revealed immunoreactants (IgG, C3, and/or C1q) in three of nine subjects and treponemal antigen in six of eight subjects tested. Histamine was injected intradermally as a trap for CICs, and biopsy of these injection sites revealed immunoreactants in four of nine subjects and treponemal antigen in five of eight subjects tested. A neutrophilic vascular reaction consistent with CIC-mediated vessel damage was seen in three of nine lesions and six of nine histamine injection sites. Normal controls did not show these changes.

Antigen-Antibody Complex↗
PubMed1993

Evaluation of molecular methodologies and rabbit infectivity testing for the diagnosis of congenital syphilis and neonatal central nervous system invasion by Treponema pallidum.

IgM immunoblotting and polymerase chain reaction (PCR) were evaluated for use in diagnosing congenital syphilis, and the prevalence of central nervous system (CNS) invasion by Treponema pallidum during congenital infection was examined. The results of rabbit infectivity testing (RIT) on serum and cerebrospinal fluid (CSF) of 19 infants born to mothers with untreated early syphilis were compared with results of PCR and IgM immunoblotting. Seven infants had clinical evidence of congenital syphilis supported by positive serum IgM immunoblot (7/7), PCR (6/7), and RIT (3/3). Six symptomatic infants (86%) had T. pallidum isolated from CSF by RIT; 5 of 6 RIT-positive CSF samples were positive by PCR, and 2 also were reactive by IgM immunoblot. In 12 asymptomatic infants, 5 (42%) had a reactive serum IgM immunoblot and in 4 of these IgM reactivity was the only evidence of congenital infection. CNS invasion by T. pallidum was uncommon among asymptomatic infants; only 1 (8%) was positive by CSF RIT. The excellent agreement between RIT and PCR further substantiates the use of PCR as a surrogate for RIT. Our data indicate that the diagnosis of asymptomatically infected neonates will require a comprehensive approach using assays for both specific neonatal IgM and T. pallidum DNA in serum and CSF.

Adolescent↗
PubMed1994

Association of hepatitis C virus infection with false-positive tests for syphilis.

The prevalence of false-positive reactions for syphilis (reactive rapid plasma reagin [RPR] test and nonreactive fluorescent treponemal antibody absorption [FTA-ABS] test) among patients at sexually transmitted disease (STD) clinics was assessed to evaluate the association between false-positive RPR reactions and hepatitis C virus (HCV) infections. Among 2672 patients, 400 (15.0%) had antibodies to HCV (anti-HCV) and 254 (9.5%) had a reactive RPR test. Of the 254 reactive RPR tests, 231 (90.1%) were also positive by FTA-ABS, leaving 23 false-positive RPR reactions. After excluding the 231 patients with positive FTA-ABS tests, false-positive RPR tests were found in 9 (2.7%) of 330 anti-HCV-positive patients compared with 14 (0.6%) of 2154 anti-HCV-negative participants (relative risk, 4.5; 95% confidence interval, 1.9-10.9; P = .0017). These data demonstrate that HCV infection is associated with false-positive RPR test results. However, because of the high prevalence of syphilis among STD patients, the RPR test remains a strong indicator of syphilis in this setting.

Adolescent↗
PubMedDate not supplied

Erythromycin failure in the treatment of syphilis in a pregnant woman.

A pregnant woman with a history of allergy to penicillin was diagnosed as having primary syphilis. Two successive courses of erythromycin therapy failed to cure the infection. Penicillin desensitization and therapy were initiated and were successful. The newborn was diagnosed as having probable congenital syphilis. This case emphasizes the need for close follow-up of pregnant women after erythromycin treatment for early syphilis.

Adult↗
PubMedDate not supplied

IgG and IgM antibody reactivity to antigens of Treponema pallidum after treatment of syphilis.

The persistence or loss of IgG and IgM antibody specificities for individual polypeptides of Treponema pallidum after therapy for syphilis was examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and by the Western blot technique. Both IgG and IgM antibodies to as many as 12 treponemal antigens, including a major 47-kdalton molecule, were evident in plasma from patients with untreated primary syphilis. IgM reactivity declined rapidly and uniformly after therapy, whereas IgG persisted despite some diminution in intensity of staining. Faint-to-moderate IgM and strong IgG antibody reactivities to at least 22 treponemal antigens (12-85 kdaltons) were identified in plasma from patients with untreated secondary and early latent syphilis. Again, IgG antibody declined slightly in staining intensity after treatment but continued to show reactivity against all molecules detected initially. IgM antibody reactivity declined more rapidly and was lost entirely against some determinants, including the 14- and 12-kdalton molecules. Immunofluorescence titers of IgG and IgM antibodies to T. pallidum in sera from these patients generally correlated with results of Western blot analysis. Antibody to the 12-, 14-, and 47-kdalton molecules of T. pallidum may have potential diagnostic applications.

Animals↗
PubMedDate not supplied

A population-based serosurveillance of syphilis in Costa Rica.

As part of a case-control study to investigate the high incidence of cervical cancer in Costa Rican women, the seroprevalence of the treponematoses, in particular, syphilis was determined. In each age group, women with a history of two or more sex partners were two to four times more likely to be seroreactive in tests for syphilis than women with zero or one sex partner. The highest percentage of reactive results in the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) was seen in samples from women aged 50-59 who had had two or more lifetime partners (23.8%). Three observations from our study support reactivity due to syphilis rather than yaws or pinta: (1) a similar percent of reactive rapid plasma reagin (RPR) card test results among MHA-TP reactors in the two age groups of women who were surveyed (42 vs. 49%) was observed; (2) women who were seroreactive in the MHA-TP had multiple risk factors for STD [low socioeconomic status (9.4%), urban residence (22.8%), first intercourse under 16 years of age (14.1%), and multiple sex partners (26.3%)], and (3) only sexually experienced women had reactive results in the MHA-TP test.

Adult↗
PubMedDate not supplied

False-negative syphilis screening due to change in temperature.

BACKGROUND AND OBJECTIVES: Inaccurate test results for syphilis may cause an individual to experience serious effects. GOAL OF THE STUDY: Investigate potential sources of error and test limitations causing false-negative reactions. STUDY DESIGN: In 5 months, two laboratories screened 2,232 patients for syphilis by the Rapid Plasma Reagin (RPR) test. RESULTS: The hospital laboratory reported 5.3% (64/1,210) of patients' test as reactive on initial screening, and the research laboratory found 6.4% (78/1,210) reactive. Fourteen reactive patients were incorrectly reported negative by the hospital laboratory, as confirmed by both laboratories. A refrigerated centrifuge in the hospital laboratory possibly caused sera to be cooled before testing, producing false-negative results. When its temperature was adjusted from 4 degrees C to 27 degrees C, an additional 1,022 samples tested were consistent between the two laboratories. CONCLUSION: Cold temperature produces false-negative reactions for syphilis screenings in patients' samples with titers < 1:4 dilution. Patients' samples with titers > or = 1:16 dilution were not affected. According to this study, incorrect temperatures for test sera can alter testing outcomes. Therefore, test manufacturer's directions must be strictly followed.

Bias↗
PubMed2000

Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail.

BACKGROUND: High rates of syphilis are found in inmates of county jails. Treatment of this infected transient population necessitated the development of a rapid protocol. GOAL: To evaluate a rapid screening and treatment protocol for syphilis in a county jail. STUDY DESIGN: Over a 2-year period 18,442 inmates were screened for syphilis with a nontreponemal test and record search for treatment history. Confirmatory test results were reviewed following treatment. Cost was defined as deflated marginal outlays. Benefit was calculated as the discounted expected cost of treatment of congenital, late, and neurosyphilis. RESULTS: The sensitivity, specificity, and positive predictive value of the protocol were 99.6%, 80.8%, and 79.3%, respectively. Of 257 confirmed cases, 183 were offered treatment in jail. The percentage of short-term inmates treated increased following implementation. The cost-benefit ratio was 9.14:1. CONCLUSIONS: The protocol was highly effective in patient identification and treatment delivery, and cost-effective as well.

Cost-Benefit Analysis↗
PubMed1984

Neglect of syphilis in hospitalized patients.

Of 9,375 inpatients consecutively discharged from a major university hospital during a six-month period, 2,912 (31%) had a serologic test for syphilis (STS) before or during hospitalization. Seventy-five patients (2.6%) had reactive serology, and further testing confirmed the diagnosis of syphilis in at least 56 patients (75%). Forty-seven (84%) of the 56 patients were aged 40 or more, and 32 (57%) were women; seven (12.5%) had a spinal tap. A history of venereal disease was recorded for only 20 patients (36%), and 16 had a positive history of venereal disease or exposure. Forty-three percent of patients with reactive serology, including those with a biologic false-positive reaction, had proper management, including treatment when indicated. Only 16 (28%) of the 56 patients with syphilis had evidence of adequate therapy either before, during, or after hospitalization. We conclude that STS is frequently omitted in the evaluation of hospitalized persons, and that even with evidence of positive serology, the diagnosis, proper interpretation, and therapy are often ignored.

Adult↗