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PubMed2026

[Syphilis and human treponemes: a long evolutionary history revealed by paleogenomics].

Recent discoveries in paleogenomics have revolutionized our understanding of syphilis and other human treponematoses. Far from being a pathogen that suddenly appeared in Europe in the late Middle Ages, we now know that Treponema pallidum has been circulated among human populations for millennia. Ancient genomes recovered from pre-Columbian contexts in the Americas show that major treponemal lineages had already diversified well before the modern era, often in the absence of recognizable skeletal lesions. Genomic analyses further indicate that treponemal diversity is not the result of extensive genetic acquisition, but rather of small-scale modulation of a highly conserved genome, notably via antigenic variation involving the tpr gene family. Combined with data on endemic treponematoses, congenital syphilis, and historical pathology collections, these findings support a model in which syphilis, yaws, and bejel represent context-dependent expressions of an ancient treponemal continuum, with implications for diagnosis, epidemiology, and vaccine design.

Humans↗
PubMed2003

Activated and mature CD83-positive dendritic cells and interferon-gamma-positive cells in skin eruptions of secondary syphilis.

Dendritic cells are considered to be the most potent antigen-presenting cells, and CD83 is expressed at a high level in immunocompetent, activated and mature dendritic cells. Various pathogens can activate and modulate the function of dendritic cells. The presence of activated and mature dendritic cells in skin lesions of secondary syphilis has never been reported. In the present study, an immunohistochemical technique was used to determine the exact tissue distributions of CD83+ dendritic cells and interferon-gamma+ cells in skin lesions of patients with secondary syphilis. Immunohistochemical staining was performed by using formalin-fixed, paraffin-embedded sections. A small but significant subpopulation of CD83+ dendritic cells was found in the dermis. CD83+ dendritic cells were in close contact with lymphocytes. High-intensity staining of CD83 antigens was detected not only on the surface but also in the cytoplasm of dendritic cells. Infiltrating mononuclear cells were stained positively for CD4 or CD8, with CD8+ cells always being in the majority. A small number of interferon-gamma+ cells resembling mononuclear lymphoid cells were detected in all samples. These results provide in vivo support for the hypothesis that dendritic cells are activated by Treponema pallidum and that thus activated and mature CD83+ dendritic cells may play a role in the Th1 response in secondary syphilis.

Antigens, CD↗
PubMed1998

An evaluation of the Behring Diagnostics Enzygnost Syphilis enzyme immunoassay.

The Enzygnost Syphilis (Behring Diagnostics, Marburg, Germany) was evaluated (i) using sera already characterised using the rapid plasma reagin test and the Treponema pallidum hemagglutination test (TPHA); (ii) prospectively; (iii) using sera which are recognised as causing "problems" with enzyme immunoassays. The Enzygnost Syphilis was found to have a reproducibility of 98.6% and a sensitivity of 99.5% using sera known to be TPHA-reactive. When tested prospectively, the false reactive rate was 3.2%. These results show that the assay performs sufficiently satisfactorily for its introduction as a screening assay for evidence of syphilis infection in our population.

False Positive Reactions↗
PubMed2000

Unusual presentation of congenital syphilis.

Congenital syphilis (CS) usually presents in the neonatal period and may involve any organ system. The signs are diverse and a high index of suspicion must be maintained to make the diagnosis. Early congenital syphilis can present at any time before 2 years of age, but a review of the literature over the last 30 years indicates that it usually presents in the neonatal period and seldom later than 3-4 months of life. We report an 8-month-old boy who presented an unusual combination of signs of congenital syphilis, which led to delay in establishing the diagnosis. This case emphasises the importance of maintaining a high index of suspicion for CS throughout early childhood.

Biopsy↗
PubMedDate not supplied

A large ulcer and cutaneous small-vessel vasculitis associated with syphilis infection.

Cutaneous vasculitis (CV) is a condition with cutaneous manifestations and possible systemic involvement. The causative factors or associated diseases are usually drugs, infection, collagen vascular disease, or malignancy. Syphilis as a cause of cutaneous vasculitis is rare. We report the case of a large cutaneous ulcer and small-vessel vasculitis associated with syphilis infection. We suggest that in apparently idiopathic CV or a chronic ulcer refractory to treatment, screening should be performed to detect any underlying infection such as syphilis. It is important to have a rapid and accurate diagnosis because the lesions are very contagious, but may be rapidly and completely cured by early administration of antibiotic treatment.

Aged↗
PubMedDate not supplied

Cost-effectiveness of antenatal screening for syphilis.

Routine obstetric screening for all prenatal checkups is an important issue. A study was conducted to ascertain the effectiveness of an antenatal screening program for syphilis. Charts of pregnant women for a 9-year period from 1982 to 1990 at the American University of Beirut were reviewed. Demographic data and the results of screening for syphilis were collected. In a total of 23,145 patients screened (with a biological false-positive rate of 0.3%), serological evidence of Treponema pallidum infection occurred in 0.27% of patients. The outcome in infants was satisfactory in all cases where appropriate antibiotic therapy was instituted antenatally. Thus antenatal screening for syphilis in our setting is a cost-effective program.

Adult↗
PubMed2001

Molecular subtyping of Treponema pallidum in an Arizona County with increasing syphilis morbidity: use of specimens from ulcers and blood.

A molecular-based subtyping system for Treponema pallidum was used during an investigation of increasing syphilis in Maricopa County, Arizona. Genital ulcer or whole blood specimens from patients with syphilis were assayed by a polymerase chain reaction (PCR) amplification of a T. pallidum DNA polymerase I gene. Positive specimens were typed on the basis of PCR amplification of 2 variable genes. In all, 41 (93%) of 44 of ulcer specimens and 4 (27%) of 15 blood specimens yielded typeable T. pallidum DNA. Twenty-four (53%) of 45 specimens were subtype 14f; other subtypes identified included 4f, 4i, 5f, 12a, 12f, 14a, 14d, 14e, and 14i. Only 2 specimens were from epidemiologically linked patients. This investigation demonstrates that multiple subtypes of T. pallidum can be found in an area with high syphilis morbidity, although 1 subtype (14f) was predominant. Four typeable specimens were from blood, a newly identified specimen source for subtyping.

Arizona↗
PubMed2002

Treatment of syphilis 2001: nonpregnant adults.

After a precipitous increase in the incidence of infectious syphilis in the United States during the late 1980s and early 1990s, the rate of new cases has declined so dramatically that a program initiated by the Centers for Disease Control and Prevention (CDC) to achieve elimination appears to stand a good chance of succeeding. In the fall of 2000, the CDC convened an advisory group to examine the recent medical literature regarding syphilis treatment. Published literature in peer-reviewed journals and abstracts from relevant scientific meetings that have appeared since the last STD Treatment Guidelines meeting in 1997 were reviewed. Where applicable, unpublished data from studies in progress were also discussed. Expert opinion was sought. Through all these efforts, it appears that the azalide azithromycin and the third-generation cephalosporin ceftriaxone should find more definitive roles in the treatment of syphilis. None will eclipse the continued primacy of penicillin for this purpose.

Adult↗
PubMed2005

Shakespeare's chancre: did the bard have syphilis?

Shakespeare's obsessive interest in syphilis, his clinically exact knowledge of its manifestations, the final poems of the sonnets, and contemporary gossip all suggest that he was infected with "the infinite malady." The psychological impact of venereal disease may explain the misogyny and revulsion from sex so prominent in the writings of Shakespeare's tragic period. This article examines the possibility that Shakespeare received successful treatment for syphilis and advances the following new hypothesis: Shakespeare's late-life decrease in artistic production, tremor, social withdrawal, and alopecia were due to mercury poisoning from syphilis treatment. He may also have had anasarca due to mercury-related membranous nephropathy. This medical misadventure may have prematurely ended the career of the greatest writer in the English language.

Drama↗
PubMed2003

Syphilis and HIV prevalence among commercial sex workers in Central Java, Indonesia: risk-taking behavior and attitudes that may potentiate a wider epidemic.

A cross-sectional study was conducted on 200 commercial sex workers (CSWs) from two brothel communities in Central Java, Indonesia, to determine the seroprevalence of syphilis and HIV and characterize associated knowledge, beliefs, and risk-taking behaviors. A questionnaire was administered and blood drawn for HIV and syphilis serologies. Focus groups with a total of 20 women were also conducted at both communities to supplement survey data. The mean CSW age was 27.3 years; mean number of clients seen per day was 2.27. The prevalence of syphilis and HIV were 7.5% and 0.5%, respectively. Thirty percent said they and their partners never used condoms during sex, and only 3.0% said they always used condoms. The most common client groups were truck drivers and sailors. While Central Java appears to remain in a pre-epidemic state, there is enormous potential for a significant increase in HIV and STD transmission.

Adolescent↗
PubMed1998

Malignant syphilis: a review.

Syphilis is a disorder that may mimic many other diseases. Its incidence has risen and fallen over the centuries. A particularly malignant and virulent form, lues maligna, has recently been more frequently observed in the HIV-infected population. Raising the awareness of the occurrence of and the clinical and laboratory criteria of syphilis in general and lues maligna in particular in the HIV-infected population is becoming more urgent. Early treatment can result in a good outcome and stem the spread of the disease; as with other forms of syphilis, penicillin is the drug of choice.

HIV Infections↗
PubMed2005

Secondary syphilis presenting with acute severe hepatic involvement in a patient with undiagnosed HIV disease.

A case report of acute, massive, prolonged hepatitis related to secondary syphilis in a patient with undiagnosed HIV infection is described together with possible pathogenetic mechanisms. This is a rare occurrence in resource-rich countries in the era of antibiotics. The impaired immune response and the dysregulation of the cytokine network may have played a role in mediating this severe expression of HIV-associated secondary syphilis. An apparently unexplained acute hepatitis should deserve accurate screening for sexually transmitted diseases, including syphilis and HIV infection.

Adult↗
PubMedDate not supplied

Syphilis serology in human immunodeficiency virus-infected patients with symptomatic neurosyphilis: case report and review.

The clinical and serologic diagnosis of syphilis in the human immunodeficiency virus-infected patient may be difficult to make. We have recently seen a case of symptomatic neurosyphilis in such a patient presenting with positive serum and CSF syphilis serology. On the basis of this case and similar cases reported in the literature, we conclude that most, if not all, human immunodeficiency virus-infected patients with symptomatic neurosyphilis will have an elevated serum and CSF syphilis serology. However, experience with additional cases will be necessary in order to validate this conclusion.

Adult↗
PubMedDate not supplied

Syphilis, historical and actual: cultural geography of a disease.

Nineteenth-century Russian physicians identified two forms of syphilis, venereal and endemic, which they associated with the difference between city and country life. Modern medical authorities have generally rejected Victorian ideas of nonvenereal contagion, but students of preindustrial societies have found evidence that endemic syphilis does in fact occur. Because it was hard to distinguish one form from the other, however, prerevolutionary Russian doctors allowed their cultural preconceptions to guide them where evidence was weak. Their view of syphilis thus provides the historian with a remarkable guide to attitudes toward class, gender, and social change. Modern neglect of the nonvenereal variant demonstrates not merely the progress of scientific knowledge but also the cultural restriction on our own view of the world.

Civilization↗
PubMed1994

Historical and contemporary correlates of syphilis and cancer.

BACKGROUND: This study examined the relationship between antecedent syphilis infection and cancer incidence in an attempt to identify specific cancer patterns. METHODS: The study cohort consisted of 16,420 people diagnosed with syphilis between 1972 and 1987 and who were residents of New York State, exclusive of New York City, at time of diagnosis. Incident cancers among cohort members were identified through linkage with files maintained by the New York State Cancer Registry. RESULTS: A total of 350 cancer cases were diagnosed among cohort members. For males and females combined, incidence was significantly elevated for cancers of the oral cavity standardized incidence ratio (SIR = 169, 95% confidence interval [CI]: 109-249), and specifically for cancer of the tongue (SIR = 251, 95% CI: 108-494). Significantly elevated incidence was observed among males for Kaposi's sarcoma (SIR = 2000, 95% CI: 1290-2950). CONCLUSION: While no conclusions may be reached concerning causality, the data do argue for increased cancer surveillance among people with syphilis. Moreover, findings are discussed in light of historical considerations.

Adolescent↗
PubMed1988

Characterization of the components in circulating immune complexes from infants with congenital syphilis.

Immunoglobulin class-specific Clq-solid-phase assays were used to detect circulating immune complexes in the sera of infants with congenital syphilis. Elevated levels of IgM complexes were present in the sera of all infants with overt disease and in two of 14 asymptomatic infants considered to be "at risk." The sera of infants born to normal, serofast, and biologic false-positive mothers did not contain immune complexes. Immunoblotting techniques revealed that complexes isolated from the sera of the infected infants contained endogenous host antigens, as well as a limited number of treponemal polypeptides. Consistent with earlier findings examining purified immune complexes from adults with secondary syphilis and from infected animals, an 83-kilodalton Treponema pallidum antigen was present in all of the isolated complexes from infants with congenital syphilis. Our findings emphasize the fact that current serological and clinical measures of infection are inadequate and that certain "at risk" infants should be treated despite normal cerebrospinal findings and the absence of clinical manifestations.

Antigen-Antibody Complex↗
PubMed1987

Epidemiology of an outbreak of infectious syphilis in Manitoba.

An outbreak of 82 cases of infectious syphilis (primary, secondary, and early latent) which occurred in 1984 in the province of Manitoba was analyzed by age, sex, geographic distribution, and stage of disease. In the preceding four years, from 1980-1983, there were 19, 24, 13, and 32 cases, respectively, of infectious syphilis, of which 89% involved males. Compared with 1983, the overall crude incidence rate in 1984 increased by 259%, from 2.9 to 7.5/100,000 population, with a peak incidence in the 25- to 29-year age group of 25.8/100,000 population. This increase was predominantly due to a striking increase in incidence in females which rose 6.3-fold, from 0.4 to 2.5/100,000 females, compared with a 2.3-fold increase in males. This increase was accompanied by a decline in the male-to-female ratio, from 15.0 to 4.9. Of the 68 males, 45 named women as their sexual contacts. Females were 2.4 times more likely to present with early latent disease, whereas males were 7.0 times more likely to present with primary disease (p less than 0.01). There was clustering in suburban locations with regard to clinical presentation (60% primary disease) and overall incidence (46% of all cases). These data suggest the occurrence of a major change in the epidemiology of syphilis in the province of Manitoba, with a shift from homosexual to heterosexual transmission.

Adolescent↗
PubMed1993

Maternal risk factors for congenital syphilis: a case-control study.

This study estimated the strength of association between maternal cocaine use and congenital syphilis after adjustment for other factors, especially the use of prenatal care. The authors reviewed medical chart and laboratory data for 75 liveborn infants treated for congenital syphilis at Harlem Hospital Center (New York City) in 1987, 150 matched control infants, and their mothers. Cocaine use was determined from universal maternal medical histories and infant toxicology screenings, and the sensitivity of each method of ascertainment was evaluated. With the use of either maternal history or positive infant urine toxicology as evidence of cocaine use, 66.2% (49/74) of case infants versus 16.1% (24/149) of control infants were judged to have been exposed to cocaine in utero (odds ratio (OR) = 9.1, 95% confidence interval (Cl) 4.7-29.2). However, in multiple logistic regression, lack of prenatal care was the single variable with the highest adjusted odds ratio (adjusted OR = 11.0, 95% Cl 1.3-93.1); maternal cocaine use had the second-highest adjusted odds ratio (adjusted OR = 4.9, 95% Cl 1.8-13.0). Thus, despite the emergence of maternal cocaine use as a new risk factor, underutilization of prenatal care remains the strongest predictor of congenital syphilis.

Adult↗