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PubMed1981

[Limitations of passive treponema haemagglutination test (TPHA) in the detection of early syphilis (author's transl)].

The sera from 80 patients with clinical signs of primary syphilis were subjected to fluorescent treponemal antibody absorption test (FTA-abs), TPHA test and cardiolipin reactions (Kline, VDRL, Kolmer). The superiority of the FTA-abs test in screening for early primary syphilis was confirmed, but the TPHA test was less sensitive: the sera of 14 patients were reactive in the FTA-abs test and cardiolipins reactions but not in the TPHA test. The TPHA test alone cannot be relied upon to detect early syphilis; when the FTA-abs test is not performed, it must always be combined with one of the cardiolipin reactions.

Cardiolipins↗
PubMed1981

Syphilis and gonorrhea; epidemiology update.

The epidemiologic patterns of venereal diseases (VD) in Greece were studied using data from the National Statistical Service, the University Hospital for VD and the special clinic for VD of the Ministry of Health, where prostitutes and homosexuals are examined. The main findings are as follows. Between 1962 and 1976 the frequency of both syphilis and gonorrhea declined among men as well as among women but the decline was more evident among women and among the older age groups (20+). Among men, the highest incidence is the age group 20-29 years, whereas among women the peak incidence is a little earlier. The rates for both syphilis and gonorrhea are higher in men than in women, higher in the greater Athens area than in the rest of Greece, and higher in single persons than in married one. There was a marked seasonal variation of VD with peak incidence at late summer. The decline of VD was also evident among prostitutes and male homosexuals with the exception of syphilis among uncontrolled prostitutes (increase) and male homosexuals (slight decrease).

Adolescent↗
PubMed1980

Treatment of primary and secondary syphilis. Serological response.

One hundred thirty-eight patients with primary syphillis and 161 patients with secondary syphilis were treated with penicillin G benzathine, 2.4 million units given intramuscularly weekly for two weeks, for a total of 4.8 million units. All 138 patients with primary syphilis had a rapid resolution of their lesions, and all became seronegative within one year. Similarly, the 161 patients with secondary syphilis were cured clinically, and all achieved seronegativity within 24 months.

Administration, Oral↗
PubMed1995

Skeletal lesions in early congenital syphilis (a review of 86 cases).

Early congenital syphilis is still common in Morocco, where it causes a large number of stillbirths and neonatal deaths. Over the last 16 years, we managed 86 cases of congenital syphilis in infants aged one day to four months. Multiple organs were affected in half the patients. Skeletal lesions were found in 65% of patients, Wimberger's sign in nearly 20% (17/86), and pseudoparalysis in 23%. The significance of the skeletal lesions often seen in congenital syphilis in Morocco is emphasized.

Bone and Bones↗
PubMed1995

Comparison of the effects of anticardiolipin antibodies from patients with the antiphospholipid syndrome and with syphilis on platelet activation and aggregation.

Anticardiolipin antibodies (aCL) are induced both in the Antiphospholipid Syndrome (APS) and syphilis, but thrombosis, thrombocytopenia, and pregnancy loss occur only in the APS. Differences in specificity and function of aCL antibodies might explain clinical differences between APS and syphilis. This study compared the effects on platelet activation and aggregation of affinity purified IgG anticardiolipin antibodies from 6 patients with the APS (IgG-APS) and 5 patients with syphilis (IgG-syph). Platelet aggregation was studied by aggregometry and platelet activation by flow cytometry. In the presence of low concentrations of thrombin, ADP, or collagen, all 6 IgG-APS samples induced platelet aggregation and activation, but none of the IgG-syph samples had this effect. In the absence of platelet agonists, only 3 of 6 IgG-APS caused platelet aggregation and none caused platelet activation; IgG-syph had no effect. The IgG-APS samples but not IgG-syph bound phosphatidylserine by ELISA. We conclude that polyclonal antibodies specific for phosphatidylserine may induce platelet activation and aggregation in the presence of low concentrations of platelet agonists.

Adenosine Diphosphate↗
PubMed1995

[Aneurysm of the descending thoracic aorta in tertiary syphilis].

A 53-year-old female presented with septicaemia caused by left ureteric obstruction due to ureterolithiasis. Further diagnostic work-up for left mediastinal widening revealed an asymptomatic aneurysm of the descending aorta. Serologic tests for syphilis were highly positive (TPHA 1:10240, 19s-IgM-FTA-Abs 1:20, Cardiolipin KBR 1:72 IU/ml). After a three weeks course of Penicillin G, 19s-IgM-FTA-Abs was negative. A successful tube resection of the aneurysm was performed. The diagnosis of luetic aneurysm of the descending aorta was confirmed histologically. Although rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysm in middle-aged patients lacking classical risk factors for atherosclerosis. The immune pathogenesis of cardiovascular syphilis still remains subject of controversy.

Aorta, Thoracic↗
PubMedDate not supplied

Gastric syphilis: case report and review of the literature.

A 35-year-old Japanese woman consulted our clinic with a one-month history of epigastric pain. Although a superficial depressed type of early gastric carcinoma was highly suspected from the results of upper gastrointestinal barium studies and gastroscopy, there was no evidence of malignancy in the biopsy specimen. Gastric syphilis was then considered based on skin lesions and serological studies. Diagnostic antisyphilitic therapy improved the symptoms and gastric lesion promptly. A review of the recent reports indicated that most cases of early phase gastric syphilis seem to present morphologically either as a narrowing lesion or shallow ulcero-nodular lesion at the pyloric antrum. Therefore, whenever such findings are recognized either radiologically or gastroscopically and no malignant cells are found in biopsy specimens, gastric syphilis and diagnostic antisyphilitic therapy should be considered.

Adult↗
PubMed1994

[Azithromycin in the treatment of syphilis].

The results of the use of azithromycin (sumamed) in the treatment of 100 patients with fresh syphilis were analyzed. The antibiotic was used in accordance with two treatment schemes: 500 mg daily for 10 days and 500 mg every two days. The total course dose was 5 g in both the cases. The results of the treatment with azithromycin were compared with those of the treatment with erythromycin (30 g) and penicillin (300,000 U every 3 hours for 16-28 days depending on the disease stage). The results were estimated by the rate of the elimination of Treponema pallidum and syphilids as well as by the time course of the seroreactions. The analysis provided a conclusion that the therapeutic efficacy of sumamed in the treatment of patients with fresh manifest syphilis was high: by comparison with penicillin and erythromycin it more rapidly eliminated the clinical signs of syphilis and in the majority of the cases induced negativation of the cutaneous serological reactions within the first 4 months of the treatment.

Adolescent↗
PubMed1994

Gastric syphilis: a disease with multiple manifestations.

The resurgence of syphilis in the United States is effecting all areas of medical care. We describe a young female presenting with symptoms of peptic ulcer disease who failed to respond to H2-receptor antagonist therapy. After further evaluation, she was diagnosed with gastric syphilis and responded well to penicillin. Because gastric syphilis has no pathognomonic clinical findings, the clinician needs to be aware of this disease entity so as to make the correct diagnosis and institute the appropriate antibiotic therapy.

Adult↗
PubMed1994

Congenital syphilis.

Congenital syphilis offers many parallels with perinatal HIV infection. Both affect multiple organs including the central nervous system, may be asymptomatic for months to years, and pose diagnostic dilemmas, especially from a laboratory perspective. Syphilis is a co-infection in some cases of HIV. Public policy issues raised by the AIDS epidemic, including stigmatization, discrimination, and denial of access to health care, have their antecedents in syphilis.

Anti-Bacterial Agents↗
PubMed1993

Congenital syphilis as a notifiable disease.

A review of the notification of congenital syphilis at Johannesburg Hospital from 1 May 1991 to 30 April 1992 was conducted to evaluate the effect of the recently introduced notification programme. A total of 209 Wassermann reaction (WR)-positive mothers were delivered during this time; 12 pregnancies (5.7%) resulted in stillbirths and 8 (3.8%) in incomplete abortions, and there were 2 (0.96%) early neonatal deaths. Only 45 (21.5%) of this group of WR-positive mothers had received antenatal care, and of these 9 (20%) had had adequately documented treatment. There were thus 200 potentially notifiable cases of congenital syphilis according to the Centers for Disease Control classification, of which 24 (12.0%) were actually notified. The goals of the notification programme, namely to increase awareness of congenital syphilis among health care providers and to evaluate the extent of the problem accurately, are clearly not being met.

Health Personnel↗
PubMedDate not supplied

Syphilis in HIV-infected persons.

Since syphilis and HIV infection are associated with each other at a higher rate than expected by chance, all HIV-infected persons and persons with syphilis should be tested for syphilis and vice versa. Because the immunological dysfunction of HIV-infected patients can interfere in clearing of T. pallidum, concomitant infection with T. pallidum requires that maximal doses of appropriate antibiotics be given (Table 2). Although falling nontreponemal titers, especially in early HIV stages, is evidence of adequate treatment, some appropriately treated HIV-infected persons will maintain a high persistent titer. If reinfection is ruled out, they require only one or two retreatments. Because some HIV-infected persons will inappropriately decrease their titer level, only adequate treatment (Table 2) gives the clinician confidence that the patient is cured.

Anti-Bacterial Agents↗
PubMed1993

[Gastric ulcers: a rare manifestation of secondary syphilis].

Gastric lesions in the progression of syphilis are very rare and they have several forms of presentation resembling lesions of different nature. We describe a case of secondary syphilis in an heterosexual patient, with persistent gastric ulcers and hepatic affection, in which the evolution and the observations with laparotomy suggested neoplasia. In the gastric biopsy, an infiltration of plasmatic and neutrophil cells was observed and in the hepatic biopsy, necrotic nodules and granulomas. The spirochaeta-specific tinction, although not indispensable, confirms the diagnosis of gastric syphilis. The previous presence of a syphilitic chancre and typical cutaneous lesions are of great help in suspecting a luetic process.

Humans↗
PubMed1993

[Current aspects in the diagnosis of syphilis].

In order to present the diagnostic possibilities of treponemal infections, syphilis can be chosen as an example. The direct detection of the pathogen is limited mainly to the early stages of the disease. The diagnostic significance of the PCR as a possible alternative method cannot yet be estimated. The concept for the serodiagnosis of syphilis which includes the TPHA assay as a screening test, the FTA-ABS as the confirmatory test, and the detection of T. pallidum specific IgM antibodies and lipoidal antibodies for the estimation of the disease activity has proven to be very successful. Whether the enzyme immunoassays can replace or supplement the conventional methods has yet to be evaluated critically. There is no possibility for a general statement on the symptomatology of syphilis and the pattern of serological reactions in HIV-infected persons, since the immune system function of each individual is of great importance.

HIV Infections↗
PubMed1993

Selective screening to augment syphilis case-finding--Dallas, 1991.

Increased use of crack cocaine and the exchange of sex for drugs have been major contributors to the increased occurrence of syphilis in U.S. urban, minority populations (1-3). Because many persons who use drugs do not voluntarily seek health care (1,4), and because their sex partners are often difficult to locate (5), a substantial number of persons may have undiagnosed syphilis infections, thereby contributing to continuing transmission. Because of the continuing increase in the number of persons in Dallas County (1990 population: 1.8 million), Texas, in whom early syphilis* had been diagnosed, and who had reported having had sex partners at crack motels and crack houses (i.e., places where crack cocaine was sold), in February 1991, the Dallas Countywide Health Department (DCHD) developed a sexually transmitted disease (STD) screening program aimed specifically at those sites. This report describes Dallas County's selective screening program and summarizes results of the program from March 1 through December 31, 1991.

Crack Cocaine↗
PubMed1995

Socioeconomic status and risk of HIV-1, syphilis and hepatitis B infection among sex workers in São Paulo State, Brazil. Instituto Adolfo Lutz Study Group.

OBJECTIVES: To determine how HIV risk behavior and the prevalences of sexually transmitted diseases vary according to socioeconomic status and city among sex workers in São Paulo State, Brazil. SUBJECTS AND METHODS: A cross-sectional study of 600 female sex workers (100 of a higher socioeconomic status and 100 of a lower socioeconomic status in each city) was conducted in the cities of São Paulo, Campinas and Santos. HIV risk behavior was assessed by questionnaire; serological tests were administered to assess prior exposure to HIV-1, syphilis and hepatitis B. RESULTS: Only statistically significant (P < 0.05) findings are reported here. Compared to those with a higher socioeconomic status, sex workers with a lower socioeconomic status worked longer hours each day (9.6 versus 7.9), had more clients per day (5.4 versus 2.6) and had fewer episodes of intercourse per client per encounter (1.1 versus 1.4). Levels of condom use for vaginal, anal and oral sex were significantly higher in Santos than in São Paulo or Campinas. Twenty-three per cent of the women said they feared violence if they insisted that their clients wear condoms; 74% voiced similar fears regarding their non-client sexual partners. Overall, 11% of sex workers were positive for exposure to HIV-1, 45% for syphilis and 39% for hepatitis B. Those with a lower socioeconomic status were more likely than those with a higher socioeconomic status to be infected with HIV-1 (17 versus 4%), syphilis (66 versus 24%) and hepatitis B (52 versus 26%), but there were no differences in prevalence rates by city. CONCLUSIONS: These data demonstrate substantial heterogeneity in HIV risk behavior and the prevalence of HIV-1 and other sexually transmitted diseases among sex workers in São Paulo State, many of which were related to differences in socioeconomic status. Interventions to prevent HIV transmission among sex workers must be tailored to the local environment and, in particular, to the socioeconomic status of these workers.

Adolescent↗
PubMed1977

[Syphilis therapy--results of an inquiry].

In order to get some more information about the kind of treatment of syphilis in the F.R.G. a study among the 1578 practising dermatologists (without members of hospital staff) by means of questionaires was made. 1164 (79%) answered the inquiry. The study shows that nearly 50% of the answering dermatologists treat syphilis by several series of penicillin applications. On the other side, only one third of the respective dermatologists performs treatment by one series, giving penicillin from 15 to 21 Mega units. The study shows that the kind of therapy is rather age-dependend insofar as the older dermatologists prefer the multiple therapy series scheme, whereas the younger dermatologists are inclined to use the single series scheme. Furthermore geographical differences could be shown, e.g. most of the Bavarian dermatologists use the single series scheme. The kind of penicillin, way of application and the time intervals were rather uniform related to regions and schemes of therapy. Tetracycline and Erythromycin are used in case of penicillin allergy. In the opinion of less than 50% of dermatologists additional redications are necessary, whereby the younger ones prefere corticosteroides, the older ones potassium iodide. The benefits of uniformly performed therapy of syphilis by the single series scheme are discussed.

Adrenal Cortex Hormones↗
PubMed1996

Condyloma latum of the toe webs: an unusual manifestation of secondary syphilis. A report of two cases.

The incidence of primary and secondary syphilis in the United States peaked in 1990, exceeding the number of reported cases since 1948. Uncommon manifestations of secondary syphilis seen more frequently in the preantibiotic era may be less well recognized today. One such manifestation is the condyloma latum, or split papule of the toe web. Two patients with condyloma of the toe web are presented and the previous literature is reviewed. Condyloma latum is a common manifestation of secondary syphilis; however, condyloma latum of the toe webs is unusual. Failure to recognize toe web condyloma latum may delay diagnosis and treatment.

Foot Dermatoses↗