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PubMedDate not supplied

A review and update on adult syphilis, with particular reference to its treatment.

Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia coli, allowing study of treponemal proteins. The importance of cell mediated immunity in syphilis has been demonstrated in animal models. A diagnosis of syphilis is usually confirmed by dark-field microscopy or serological tests. Seroconversion may be delayed in HIV infected individuals. A positive reaginic test in cerebrospinal fluid (CSF) has a high specificity but low sensitivity in the diagnosis of neurosyphilis. Indeed, virulent treponemes can be identified in CSF samples which have negative reaginic tests, normal cell counts and protein levels. In the CSF, the FTA-Abs test has a high sensitivity but low specificity for neurosyphilis. Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain barrier poorly. Treatment with intramuscular benzathine penicillin 2.4 million units stat, or 600,000 units procaine penicillin daily does not produce treponemicidal levels within the CSF. However, the incidence of neurosyphilis is low in immunocompetent patients treated with such regimens during early syphilis. Acceptable alternatives in penicillin-allergic patients include ceftriaxone and doxycycline. Erythromycin is not recommended as it has produced unacceptably high rates of treatment failure. Recently, a strain of macrolide-resistant Treponema pallidum was isolated from a patient with secondary syphilis. For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12-24 million units daily. Early syphilis can be treated adequately over 10 days, but 21 to 28 days is appropriate for late syphilis. In HIV-infected patients syphilis may present atypically with initially negative serological tests. Treatment of early syphilis in HIV-positive patients has been associated with the early development of neurosyphilis. It is advisable to treat all patients co-infected with HIV with an antibiotic regimen that achieves adequate levels within the CSF.

Adult↗
PubMed1993

[Prevalence of hepatitis C virus and human immunodeficiency virus infection among Japanese female prostitutes].

To investigate the incidence of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection in Japanese sexual workers, 191 out of 194 female prostitutes working in a certain district of the Tokyo metropolitan area were tested for anti-HCV, anti-hepatitis B virus (HBV), anti-HIV and anti-Treponema pallidum (TP). They were also interviewed with regard to their past history of blood transfusion, vaccination against HBV, liver diseases and repeated skin piercing treatments such as tattooing, acupuncture and intravenous drug use. Sera from 300 female blood donors (aged 20 s-40 s), of the same district, collected during the same year, were assessed for comparison. Incidence of seropositives for anti-HCV and anti-TP were found to be significantly high in the prostitute group (11.0% and 16.2%, respectively) compared to the control (0% for both). Anti-HBV seropositives were 14.1% in the prostitute group and 12.7% in the control group without significant difference and none of our subjects were found to be anti-HIV positive. Among HCV infected only 5 experienced repeated skin-piercing treatment and none underwent blood transfusion. From these results it is concluded that HCV has a potential for being transmitted by heterosexual contact, although the exact risk for infection needs to be determined by further investigation.

Adult↗
PubMed1983

Further evidence for hyaluronidase activity of Treponema pallidum.

The presence of hyaluronidase in preparations of Treponema pallidum was previously shown using acidified bovine serum albumin reactions and Ouchterlony immunodiffusion. To expand on these preliminary findings more sensitive techniques of viscometry, additional immunologic reactions, and altered capillary permeability were used to characterize treponemal-associated hyaluronidase. The pathogens T. pallidum and T. pertenue degraded hyaluronic acid, whereas the nonpathogens T. denticola and T. vincentii did not. As syphilitic infection progressed, hyaluronidase activity decreased; organisms harvested from 14-day testicular infections degraded hyaluronic acid less rapidly than organisms from 4-day infections. Uninfected rabbit testicular extract also exhibited significant enzyme activity. The neutralizing activity of immune sera was decreased by prior adsorption with bovine hyaluronidase, suggesting that some of the neutralizing factors are associated with this enzyme. Radioimmunoassay was used to quantitate antibodies to hyaluronidase in immune sera. Antihyaluronidase sera were isolated from rabbits immunized with bovine hyaluronidase. Treponema pallidum, as well as uninfected rabbit testicular extract, cross-reacted with these antisera. Immunofluorescence indicated that the hyaluronidase was uniformly distributed along the treponemal surface. As a final indicator of hyaluronidase activity, alterations in capillary permeability were detected 1 h after intradermal injection of T. pallidum.

Animals↗
PubMed1993

Prevalence of syphilis infection in Mozambican women with second trimester miscarriage and women attending antenatal care in second trimester.

OBJECTIVES: To elucidate whether recent syphilis infection is significantly more prevalent among women with mid-trimester miscarriage than among antenatal care attenders in midtrimester pregnancy. DESIGN: Two categories of pregnant women were compared regarding serological signs of syphilis. Rapid Plasma Reagin (RPR) analyses were done in Mozambique and Veneral Disease Research Laboratory (VDRL) tests in Sweden. In case of RPR and/or VDRL positivity, Treponema pallidum haemagglutination (TPHA) and Captia Syphilis-M were performed. SETTING: A suburban antenatal care clinic and the emergency ward at the Department of Obstetrics and Gynecology at the Central Hospital in Maputo, Mozambique, were studied June-August 1991. SUBJECTS: Randomly selected women seeking antenatal care in midtrimester pregnancy (N = 202) were compared with 114 women consecutively entering with clinical signs of midtrimester miscarriage. RESULTS: Among antenatal care attenders, 37/202 (18.3%), and among women with midtrimester miscarriage, 37/114 (32.5%), had syphilis confirmed with the Treponema pallidum haemagglutination test (p < 0.01). Significant titres of IgM antibodies tended to be more prevalent among women with miscarriage (7.0%) than among women attending antenatal care (4.5%), though the difference only approached statistical significance. CONCLUSION: The findings suggest a potential association between syphilis seropositivity and midtrimester miscarriage. Present findings justify more extensive studies to establish whether or not recent syphilis infection is a risk factor for midtrimester miscarriage.

Abortion, Spontaneous↗
PubMed1997

Low prevalences of HIV infection and sexually transmitted disease among female commercial sex workers in Mexico City.

OBJECTIVES: This study tried to determine human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevalences among female commercial sex workers in Mexico City. METHODS: A sampling frame was constructed that included bars, massage parlors, and street corners. RESULTS: Prevalences for Treponema pallidum, herpes simplex virus type 2, HIV, Neisseria gonorrhoeae, and Chlamydia trachomatis were 6.4%, 65%, 0.6%, 3.7%, and 11.1%, respectively. A significant association was found between higher STD frequencies and working at street sites. CONCLUSIONS: Most STD frequencies were lower in comparison with rates found for female sex workers in other countries. However, preventive programs against STD/ HIV are needed in this population.

Female↗
PubMed1993

Latex agglutination test for detecting antibodies to Treponema pallidum.

We have developed an automated latex agglutination test for Treponema pallidum (TPLA) for measurement of the concentration of treponemal antibodies in syphilitic sera. The assay needs neither a complicated pretreatment of the sera nor special techniques. Intra- and interassay precision studies showed high reproducibility. Potentially interfering substances, such as bilirubin, hemoglobin, triglycerides, and rheumatoid factor, did not affect the results. The results obtained with the TPLA test showed a strong correlation with those from conventional methods. This test for antibodies to T. pallidum may be useful for the mass screening of syphilitic infections.

Antibodies, Bacterial↗
PubMed1995

Brief communication: a case of congenital syphilis during the colonial period in Mexico City.

Congenital syphilis has been diagnosed very seldom in ancient populations. The case that we examined comes from San Jeronimo's Church (17th and 18th centuries AD; Mexico City). Coffin 43 contained an incomplete skeleton of an approximately 2-year-old infant. The pathological lesions of this skeleton include bilateral osteochondritis, diaphyseal osteomyelitis, and osteitis and/or periostitis on the long bones. The radiographic appearance depicts symmetrical osteomyelitic foci, particularly at the proximal extremity of both tibiae (Wimberger's sign). The skull exhibits hydrocephaly and periosteal changes on the vault, and the unerupted upper incisors evince dental hypoplasia and other pathological alterations reminiscent of Hutchinson's incisors. All these features strongly suggest a case of early congenital syphilis.

Bone Diseases↗
PubMedDate not supplied

Potential for development of antibiotic resistance in pathogenic treponemes.

Penicillin has been widely used for many years for the treatment of yaws and other human treponematoses without the emergence of penicillin-resistant treponemal strains. However, experience with various bacterial pathogens serves to emphasize that resistance to penicillin and other antibiotics can suddenly appear after decades of exquisite sensitivity. The finding of plasmid DNA in at least one strain of Treponema pallidum, the reporting of several instances in which antibiotic treatment of syphilis has failed, and the demonstration that a recent clinical isolate of T. pallidum is resistant to erythromycin indicate that the pathogenic treponemes do have the potential to develop antibiotic resistance. Although it is impossible to predict when antibiotic resistance might become a significant problem in dealing with infections caused by these organisms, the vigorous pursuit of alternatives to antibiotic therapy for the control of human treponematoses seems prudent.

Anti-Bacterial Agents↗
PubMed1997

Sexually-transmitted disease (STD) markers in multitransfused children in relation to human immunodeficiency virus type-1 (HIV-1) infection: impact of STD markers in blood donors.

Association of serological markers for various sexually transmitted diseases (STDs) with Human Immunodeficiency Virus type 1 (HIV-1) infection among heterosexually promiscuous blood donors is well recognized. However, possibility of similar association among children receiving transfusion from these donors has not been adequately explored. Study on the association of some STD markers with HIV-1 infection in multitransfused (MT) children showed that both HIV-1 positive and HIV-1 negative groups of children had significantly higher prevalence of hepatitis B virus (HBV) markers, i.e. HBsAg (23 and 30 per cent), anti-HBs (46 and 57 per cent), anti-HBc (18 and 23 per cent), antibodies to cytomegalovirus of IgM class (36 and 37 per cent) and IgG class (72.7 and 70 per cent), IgG antibodies to Herpes Simplex Virus type-2 (23 and 23 per cent) compared to control group. However, seropositivity for HIV-1 infection could not be attributed as a risk factor for any of these markers in the group of MT children. On the contrary, significant association of anti HBc, anti HCV, CMV IgG and antitreponemal antibody with HIV-1 infection could be recorded in the group of blood donors. It appeared that due to low prevalence of HIV-1 infection among blood donors in India, both HIV-1 positive and HIV-1 negative groups of MT children received transfusion from HIV negative donors predominantly resulting in a comparable prevalence of STD markers in both the groups of MT children due to cumulative effect of transfusion from HIV-1 negative donors.

Biomarkers↗
PubMed2005

Analytical epidemiology of periodontitis.

AIMS: To review the literature related to the analytical epidemiology of periodontitis generated over the past decade. This review does not deal with descriptive epidemiologic studies of the prevalence, extent and severity of periodontitis with respect to global geography, but focuses exclusively on analytical epidemiology issues, including the challenges posed by the use of different case definitions across studies, current theories and models of disease progression, and risk factors associated with the onset and progression of periodontitis. METHODS: Relevant publications in the English language were identified after Medline and PubMed database searches. FINDINGS AND CONCLUSIONS: There is a conspicuous lack of uniformity in the definition of periodontitis used in epidemiologic studies, and findings from different research groups are not readily interpretable. There is a lack of studies that specifically address the distinction between factors responsible for the onset of periodontitis versus those affecting its progression. Colonization by specific bacteria at high levels, smoking, and poorly controlled diabetes have been established as risk factors for periodontitis, while a number of putative factors, including specific gene polymorphisms, have been identified in association studies. There is a clear need for longitudinal prospective studies that address hypotheses emerging from the cross-sectional data and include established risk factors as covariates along with new exposures of interest. Intervention studies, fulfilling the "targeting" step of the risk assessment process, are particularly warranted. Obvious candidates in this context are studies of the efficacy of elimination of specific bacterial species and of smoking cessation interventions as an alternative to the traditional broad anti-plaque approach in the prevention and control of periodontitis. Ideally, such studies should have a randomized-controlled trial design.

Aggregatibacter actinomycetemcomitans↗
PubMed1977

Nitroblue tetrazolium test in experimental syphilis.

The reduction of nitroblue tetrazolium (NBT) by phagocytic leucocytes in peripheral blood has been examined in rabbits injected intratesticularly with Treponema pallidum, T. pallidum-free supernatant of orchitic testes, or normal rabbit testes supernatant. A significant (P less than 0.01) increase in NBT reduction was observed only in the infected animals.

Animals↗
PubMed1998

Many faces of lupus anticoagulants.

Lupus anticoagulants (LA) are immunoglobulins which inhibit one or more of the in-vitro phospholipid (PL) dependent tests of coagulation. Virtually any physician may encounter LA-positive patients. Such patients present with a variety of diagnostic challenges including arterial and venous thromboembolic events, recurrent fetal loss, TIAs, livedo reticularis, etc. LA and anticardiolipin antibodies (ACA) are the most common cause of acquired thrombophilia. Consequently, it is imperative for clinicians and laboratorians to work together in establishing the diagnosis of LA/ACA. The laboratory diagnosis of LA requires careful adherence to the SSC Subcommittee on Lupus Anticoagulants/Phospholipid-dependent Antibodies guidelines. Four sequential steps are required, including: screening tests, mixing studies (to establish the presence of an inhibitor), confirmatory tests based on increased or altered PL concentrations, and ruling out other coagulopathies (for example, factor VIII inhibitor).

Adult↗
PubMed2001

[Simultaneous meningitis caused by Candida and tuberculosis as manifestation of AIDS].

Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequently implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.

AIDS-Related Opportunistic Infections↗
PubMed2006

Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in taiwan.

OBJECTIVES: This study aimed to investigate the prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and predictors of risky sexual behaviors among men visiting gay bathhouses. STUDY DESIGN: A cross-sectional study was conducted at 8 gay bathhouses in Taiwan. Bathhouse attendees were invited to complete a questionnaire and to be screened for HIV/STIs. RESULTS: Of 451 men recruited for the study, 339 (75%) completed the questionnaire and were screened for HIV/STIs. The study indicated that seroprevalence rates of anti-HIV-1 antibody, specific Treponema pallidum antibodies detected by hemagglutination assay, surface antigen of hepatitis B virus, IgG antibodies for hepatitis A virus, antibody for hepatitis C virus, and indirect hemagglutination antibody for Entamoeba histolytica (serum titer > or =1:128) were 8%, 18%, 16%, 38%, 3%, and 6%, respectively. Prevalence rates for chlamydial and gonococcal infections reflected by nucleic acid amplification tests in urine samples were 7% and 4%, respectively. Irregular use of condoms during oral sex, condom inaccessibility at bathhouses, unprotected sex at public venues, no prior HIV test, and 5 or more visits to bathhouses every month were independently associated with unprotected anal intercourse. CONCLUSION: Men attending gay bathhouses report engaging in unsafe sex practices and are at substantial risk of acquisition of HIV/STIs. These findings highlight the need for more comprehensive prevention efforts at gay bathhouses.

Adult↗
PubMed1977

[Technical advances in demonstration of treponema-specific 19S-IgM antibodies in patients with latent or late-latent syphilis (author's transl)].

In patients with latent or late-latent syphilis as well as neurosyphilis the demonstration of treponema-specific 19S-IgM antibodies is not regularly possible. In this publication it is shown that high IgG antibodies are the reason for a competitive IgM inhibition in the indirect immunofluorescence tests. It is demonstrated that in the above mentioned states of the infection the IgM-FTA-19S test seemed to be the method of choice to realize the existence of 19S-IgM antibodies. In sera with competitive inhibited IgM it is possible to calculate the IgM antibody activity with the aid of the socalled F factor.

Antibodies, Bacterial↗