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PubMed1987

Pityriasis rosea and the need for a serologic test for syphilis.

A rapid plasma reagin (RPR) test was performed in fifty patients with a clinical diagnosis of pityriasis rosea to determine the frequency of syphilis as the underlying cause of the eruption. In none of the fifty patients was syphilis the cause. Experience in diagnosing skin diseases, frequency of syphilis in the community served, and the characteristics of the individual eruption are important factors in the decision to perform an RPR test.

Adolescent↗

PubMed1985

[Positive serological tests for syphilis in black primary school children in Bloemfontein: a pilot study].

Sera from 1575 black primary school children in Bloemfontein were subjected to serological screening tests for syphilis. Forty-six (2,92%) were found to be seropositive on screening; 32 (2,03%) of these were confirmed as true-positive reactions and 10 (0,64%) manifested only biological false-positive reactions. Four sera were insufficient for confirmatory tests. From published reports covering a period of over 60 years, it is evident that syphilis is widespread in South Africa, especially in black communities. There is no evidence of a decline in the prevalence of the disease but rather of an increase, including endemic syphilis affecting children. A nationwide survey is recommended to determine the magnitude of the problem and the need for a sustained treatment campaign.

Adolescent↗

PubMed1979

Epidemiology of infectious syphilis at a tertiary hospital.

In 19 of 20 patients in whom the correct diagnosis of primary or secondary syphilis was not obvious initially, a positive routine admission VDRL test result was the first indication of the correct diagnosis. A retrospective study during a one-month period to correlate hospital admissions by clinical service with required routine admission serologic tests for syphilis disclosed an overall compliance rate of only 37.1% (range, 94.6% to 8.0%). Of the 38 patients who did have a positive admission VDRL test result, 55.3% were falsely positive. The false-positive rate was slightly higher for weakly reactive titers than it was for higher titers. The routine serologic testing program uncovered 129 and 116 new cases of syphilis during 1976 and 1977, respectively. The decision to continue the routine admission VDRL screening program was made because the consequences of an incorrect diagnosis could be very great for an individual patient.

Adolescent↗

PubMed1970

A graphic guide for clinical management of latent syphilis.

A graphic luetic record form is used as a guide to physicians in diagnosis and management of latent syphilis. The form provides a uniform method of recording laboratory and clinical findings as well as treatment. It facilitates checking progress and forwarding of information necessary to assure continuity in treatment of patients with latent syphilis who are transferred to other medical facilities. It is designed primarily as a guide to the clinician who does not specialize in the treatment of syphilis.

Female↗

PubMed1981

Syphilis and other sexually transmitted diseases.

As early syphilis becomes more uncommon in the community, it will present frequently to the tertiary hospital as a diagnostic problem. Twenty patients with classic signs and symptoms of primary and secondary syphilis in whom the correct diagnosis was initially missed are presented. The importance of a routine admission Venereal Disease Research Laboratory test (VDRL) in making the correct diagnosis is emphasized. The laboratory techniques for diagnosing syphilis and recommended treatment schedules are presented. Clinical manifestations of herpes progenitalis, problems with pregnancy and association with cervical carcinoma are also presented. Enteric diseases (hepatitis, shigellosis, giardiasis and amebiasis) as sexually transmitted diseases in homosexual men are summarized.

Adolescent↗

PubMed1984

Secondary and tertiary syphilis presenting as sarcoidal reactions of the skin.

Secondary and tertiary skin lesions of syphilis are infrequently biopsied and studied histologically. Examination of biopsy specimens from two patients, one with secondary and one with tertiary syphilis, revealed sarcoidal reactions, which caused confusion in the patients' diagnoses. The response to penicillin therapy in each patient was dramatic and contrary to the response anticipated in sarcoidosis. The histologic changes of secondary and tertiary syphilis are discussed.

Adult↗

PubMed1982

[Syphilis, infection and serology].

The in- and out patient departments of Dermatology report in Switzerland every year between 300 to 400 newly diagnosed cases of syphilis--mostly primary syphilis--to the federal public health service. The serological tests decisive for such a diagnosis have been fundamentally changed in the last few years. Among the classical tests only the cardiolipin complement binding test (Card-CFT) and the VDRL test remain still valuable. They are suitable for controlling the course of disease after treatment. Nowadays two tests are essential for the diagnosis, i.e. the TPHA and the FTA-ABS. They are highly specific for syphilis and become already positive between the 2nd and the 3rd week after inoculation. On the other hand these tests are of no value for the follow-up after therapy. A positive FTA-ABS-19S-IgM test indicates the necessity of treatment. Practical examples may illustrate the interpretation of different reactions.

Adult↗

PubMed1982

Sexually transmitted diseases. Primary syphilis.

Syphilis is an infectious spirochetal disease caused by Treponema pallidum. The disease is transmitted from person to person during sexual intercourse, congenitally by an infected pregnant woman to the fetus in utero, or very rarely, non-sexually. In its natural course, syphilis is characterized by an acute infectious primary and secondary stage, followed by a subclinical course of latency which may persist for years, or may progress in a minority of patients to a noninfectious late symptomatic stage where active involvement of the central nervous system, the cardiovascular system or localized gummatous destructive lesions may occur. This article reviews the clinical features and management of primary syphilis.

Chancre↗

PubMed1995

Early congenital syphilis--a continuing problem in Malaysia.

Between February 1990 and May 1993, 13 cases of early congenital syphilis (ECS) were managed in the Paediatrics Unit, University Hospital, Kuala Lumpur. Twelve mothers were unbooked with 10 inborn babies. Only one mother had antenatal booking at this hospital but she defaulted antenatal follow-up. Several risk factors associated with ECS were identified: inadequate or no prenatal care (5/13), failure to repeat a serological test for syphilis in the third trimester when it was tested negative at first booking (5/13), sexual promiscuity, substance abuse and a past history of contracting sexually transmitted disease. All 10 mothers who had their serological test repeated at delivery were found to have a positive VDRL and TPHA. Adequate antenatal care early referral of infected, expectant mothers for treatment, and a repeat serological test for syphilis could have prevented these cases of ECS.

Adult↗

PubMed1994

Infectious syphilis.

Optimistic predictions about the extinction of syphilis have proven to be premature. During the beginning of the decade, the reported numbers of infectious syphilis cases were the highest in 40 years. Despite numerous publications about syphilis, the disease continues to challenge clinicians with its protean cutaneous and systemic manifestations. Co-infection with the human immunodeficiency virus does not appear to significantly influence the stage at presentation, clinical course or serologic positivity in most patients, but coinfected patients may be at risk of developing neurosyphilis and late complications even after administration of adequate treatment.

Female↗

PubMed1993

Surveillance for geographic and secular trends in congenital syphilis--United States, 1983-1991.

PROBLEM/CONDITION: CDC monitors trends in the occurrence of congenital syphilis (CS) in the United States by using surveillance data sent from state and local health departments. Comparisons of data from this surveillance system with data from the Division of Sexually Transmitted Diseases/HIV Prevention and the Birth Defects Monitoring Program (BDMP) can be used to assess the potential effects of changes in case finding and reporting practices on these trends. REPORTING PERIOD COVERED: This report covers CS surveillance in the United States for the years 1983-1991. DESCRIPTION OF SYSTEM: Cases of CS among infants < 1 year of age and primary and secondary (P&S) syphilis among women are reported quarterly to CDC. The BDMP is a CDC national surveillance system that samples hospital discharge data on U.S. births. RESULTS: During the period 1983-1991, 12,151 CS cases were reported. Before 1988, regional CS incidence increased 35%-131% annually. Larger increases occurred in the Northeast (578%) in 1989 and in the South (178%), Midwest (244%), and West (777%) in 1990. Within regions, these larger increases were temporally related to increases in P&S syphilis in women and changes to a more sensitive CS case definition. INTERPRETATION: CS incidence has increased since 1983 in all regions of the United States. Increases since 1988 reflect both changes in surveillance reporting practices--the surveillance case definition for CS was changed in 1988 and further revised in 1989--and a true increase in incidence. ACTIONS TAKEN: These data indicate where CS prevention efforts need to be targeted. To facilitate reporting of CS cases, CDC has developed a) a shorter form for reporting cases of CS after 1991 and b) a software package for use by state and local health departments to enter and analyze CS data.

Adult↗

PubMed1996

Evaluation of cerebrospinal fluid in Southeast Asian refugees with reactive serologic tests for syphilis.

To determine the prevalence of cerebrospinal fluid abnormalities in Southeast Asian refugees with reactive serologic tests for syphilis, we evaluated 65 patients, 36 prospectively and 29 retrospectively, in a primary care clinic. Information was collected on history of treponemal infections, neurologic symptoms and signs, and total protein concentration, leukocyte count, and the VDRL test in the cerebrospinal fluid. Neurologic symptoms were reported by all patients for whom data were available. Abnormal neurologic signs were found or noted in medical records in 15 (42%) prospectively evaluated patients and 9 (64%) of 14 retrospectively evaluated patients for whom data were available. No patient had evidence of congenital or non-neurologic sequelae such as cutaneous or cardiovascular manifestations of syphilis. No patient had a positive cerebrospinal fluid VDRL test, 1 had more than 5 x 10(6) leukocytes per liter (5 leukocytes per mm3), and 6 (9%) had elevated total protein levels in the cerebrospinal fluid. Previous therapy for syphilis was not associated with lower serum VDRL reactions, neurologic symptoms and signs, or cerebrospinal fluid findings. In the absence of other indications, routine examination of the cerebrospinal fluid in seropositive Southeast Asian refugees who have nonspecific neurologic symptoms has a low yield, perhaps because of the high prevalence of yaws in this population, and may not be warranted.

Adolescent↗

PubMed1996

Seroprevalence of syphilis by TPHA test.

A total of 1074 sera obtained from clinically suspected cases of Syphilis and various risk groups were screened for antitreponemal antibodies by Treponema pallidum Haemagglutination (TPHA) test and cardiolipin antibodies by the Venereal Disease Research Laboratory (VDRL) tests. The TPHA test was positive in 291 (27.09) per cent. The TPHA was positive in 53.31 per cent (161 out of 302) patients of primary syphilis, 54.17 per cent (26 out of 48) of secondary, 32.76 per cent (19 out of 58) of tertiary syphilis, 17.12 per cent (19 out of 111) of other Sexually Transmitted Disease (STD) patients, 25.32 per cent (60 out of 237) pregnant women and 1.89 per cent (6 out of 318) healthy individuals. TPHA was found to be superior to VDRL test in all the study groups. Almost a total agreement was seen between the TPHA test and VDRL test with a titre of 1 in 16 & above; while in as many as 32.39 per cent sera with VDRL titre of 1 in 8 TPHA was negative indicating that the VDRL titres above 1 in 8 should be considered as true reactives to minimize the biological false positive reactions.

Diagnostic Errors↗

PubMed1987

[Value of the 19S IgM FTA ABS test in the diagnosis and therapy of syphilis. Personal experiences and remarks on the method].

Sera from patients with syphilis in various stages (525 sera specimens from untreated and 496 from treated patients) were tested, as were 17 sera specimens from infants with suspected neonatal syphilis. The tests employed for the detection of treponemal and reaginic antibodies were IgG-FTA-ABS, IgM-FTA-ABS, 19S-IgM-FTA-ABS, TPHA, VDRL and the complement fixation test. The purpose of this study was to see whether in all cases the demonstration of antitreponemal antibodies of the IgM class is a reliable criterion for treatment of seropositive patients. This was shown to be valid in nearly all cases where specific IgM was demonstrated by the 19S-IgM-FTA-ABS test. Possible biological or technical factors leading to erroneous results of this test are discussed.

Fluorescent Antibody Technique↗

PubMed1986

Acute syphilitic meningitis. Its occurrence after clinical and serologic cure of secondary syphilis with penicillin G.

Acute syphilitic meningitis developed in a 36-year-old man three months after apparently successful treatment of secondary syphilis with doses of penicillin G benzathine recommended by the current Centers for Disease Control guidelines. He was then treated with high-dose intravenous penicillin G sodium, with resolution of symptoms and cerebrospinal fluid abnormalities. Although other instances of neurosyphilis following adequate therapy for early syphilis have been reported, in most cases reinfection cannot be convincingly excluded. We believe this patient represents a particularly well-documented example of progression to neurosyphilis, despite recommended therapy with penicillin. A review of recently reported cases suggests that progression of syphilis, despite "appropriate" therapy, is not an isolated event.

Acute Disease↗

PubMed1984

Low molecular weight-IgM antibody in syphilis detected by Treponema pallidum immune adherence (TPIA) test.

Sera obtained from patients with syphilis were subjected to gel filtration chromatography to estimate antibody activity in the fractions by means of Treponema palludum immune adherence (TPIA) test. Antibody activity was found in IgM and IgG fractions and in the intermediate fraction between them. The TPIA activity of the intermediate fraction was depleted by an immunosorbent coupled with anti-mu chain antibody but not by that coupled with anti-alpha chain antibody. After separation by gel filtration and affinity chromatography, the fraction with the TPIA activity showed a positive precipitation reaction against anti-mu chain antiserum but a negative reaction with anti-alpha chain or anti-gamma chain antiserum. The antibody activity in this fraction was thus confirmed to be mainly due to low molecular weight-IgM antibody. In untreated patients with primary and secondary syphilis, the TPIA activity was demonstrated with high frequency in the low molecular weight-IgM fraction and it decreased gradually after treatment, although lowered activity persisted over a long period of time. Late syphilis cases did not show any appreciable change in TPIA activity in this fraction even after treatment.

Antibodies, Bacterial↗

PubMedDate not supplied

Semiautomated reminder system for improving syphilis management.

This project utilized an automated record system, COSTAR, to assess and improve the quality of care in managing syphilis in a health maintenance organization. A scoring tool was developed to assess care. There were four experimental periods, each lasting one year. The periods were Baseline (no intervention), Education (publication of guidelines and an educational session), Reminder (deficiencies in care brought to the attention of providers in time to permit correction), and Post-reminder (no intervention). Scores for overall management of syphilis rose from 70.4 to 90.5% during the Reminder period and did not deteriorate significantly in the Post-reminder period. Scores in the Education period were not significantly higher than baseline. The cost of the system was $195 per year. An inexpensive reminder system was effective in bringing about a significant improvement in quality of care for syphilis, and the effect persisted for at least a year after the system was discontinued.

Database Management Systems↗

PubMed2006

[Did Heinrich Heine have syphilis?].

Though Heinrich Heine died 150 years ago, the underlying illness responsible for his lengthy suffering has never been fully clarified. The diagnosis most frequently put forward is that of syphilis. However, when the available source material and its interpretation in the context of the contemporary nosology of syphilis is considered, this diagnosis is called into question. The fact that the German Jew Heinrich Heine was diagnosed with syphilis can at best be explained by the cliché of the "Jewish venereal disease." The ultimate cause of Heine's death, however, can be best explained by his longstanding and well-documented opium abuse.

Famous Persons↗