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PubMed1994

Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya.

OBJECTIVE: To identify the risk factors for gonorrhoea, syphilis, and trichomonas infections among low risk women in Nairobi, Kenya. METHOD: In a cross-sectional study, 4,404 women attending two peri-urban family planning clinics between 1989 and 1991 were interviewed using a structured questionnaire and examined for signs of sexually transmitted disease (STD) infection. Cervical cultures for gonorrhoea, PAP smear (including microscopy for trichomonas), RPR and HIV testing were done. RESULTS: Positive cervical cultures for gonorrhoea were found in 3.2% of women, positive syphilis serology in 1.9%, and positive trichomonas microscopy in 5.2%. Genital ulcers were found in 1.9% of women. Although unmarried status and reporting more than one sex partner in the previous year were both significantly associated with each disease in the crude analysis, these associations were attenuated after controlling for each other and for other risk factors. The population attributable risks (PARs) for these factors were low (7-16%) owing to the high proportion of cases who were married and monogamous. The majority of women with microbiological evidence of infection had normal pelvic examinations. Clinical diagnostic algorithms for STDs in this population had a low sensitivity and positive predictive value. Nevertheless, a strong association between HIV seropositivity and STDs was observed. CONCLUSION: The low population attributable risks found in this study suggest that behaviour change messages directed to women, particularly if they are married have a low potential for preventing STDs. The poor performance of clinical diagnostic algorithms illustrates the desirability of testing these algorithms in a variety of populations and reinforces the need for low-cost methods of microbiologic diagnosis if populations with relatively low prevalences of these infections are to be included in programmes to diagnose and treat STDs.

Adolescent↗
PubMed1995

The prozone phenomenon in secondary syphilis.

We describe a 37-year-old woman with secondary syphilis, in whom the prozone phenomenon (false-negative test in undiluted specimens) occurred. The patient had been maintained on cyclosporine and prednisolone after renal transplantation. B-cell dysfunction induced by continuous immunosuppression may lead to higher non-treponemal serological titers. Non-treponemal testing should be repeated using serum dilutions to prevent missing the diagnosis of syphilis.

Adult↗
PubMed1989

[Sero-epidemiology of congenital syphilis in Kinshasa, Zaire].

Between March 1 and May 31, 1988, 314 mother-baby couples have been tested for syphilis at confinement in two large hospitals of Kinshasa (Hôpital Mama Yemo and Clinique de Ngaliema). The study used in first instance the Veneral Disease Research Laboratory (VDRL) test. When positive, the results were verified quantitatively with the Treponema Pallidum Hemagglutination (TPHA) reaction. The prevalence levels obtained were low: 0.9% in the newborns and 1.6% in the mothers. In spite of the relative rarity of the disease, clinical examination of all newborns should remain a permanent concern for the clinician, especially for the pediatrician, in order to make sure that the diagnosis be made as soon as possible and treatment started without undue delay. The authors insist on the necessity to adopt, in Kinshasa, measures for veneral disease control aiming at reducing the prevalence of congenital syphilis.

Democratic Republic of the Congo↗
PubMed1987

[Economic aspects of serologic syphilis tests in routine screening in Viennese hospital facilities].

971, 786 patients in Viennese municipal hospitals were routinely screened by serological testing for syphilis between January 1980 and December 1984, leading to the detection of 28,090 cases of untreated latent infection. The annual incidence varied between 7463 and 4623 cases. Roughly one third of patients with untreated syphilis develop severe late manifestations: 10.4% show cardiovascular involvement, 6.5% get neurosyphilis and 15.8% have a gumma. The mortality rate is 85% in cardiovascular disease and 64% in neurosyphilis, whilst irreversible incapacity is the fate of the remaining 15% and 36% of these patients, respectively. Calculations on the basis of the current costs for treatment of the acute diseased and for nursing of incapacitated patients reveal that routine screening of all in- and out-patients of the Viennese municipal hospitals is completely justified from the medical and the economic point of view and should, therefore, be reinforced.

Austria↗
PubMedDate not supplied

Treatment of syphilis: a short critical review.

Four decades of treatment of syphilis with penicillin confirm the absolute superiority of this drug in all stages of the disease. Various long-acting repository preparations (particularly benzathine penicillin G) are used in treatment of early and late syphilis, and even for prophylactic treatment, with satisfactory results. Treatment schedules and follow-up criteria for examination and indications for retreatment vary little among various authors and countries. Adverse reactions to penicillin, in particular the allergic reactions, make alternative treatment with other antibiotics (tetracyclines, erythromycin, etc) sometimes necessary.

Anti-Bacterial Agents↗
PubMed1992

Spinal cord syphilis associated with human immunodeficiency virus infection: a treatable myelopathy.

A 33-year-old woman, seropositive for human immunodeficiency virus type 1 (HIV-1), presented with progressive weakness and numbness of the lower extremities, gait difficulties, and urinary frequency. Physical examination revealed bilateral lower extremity weakness, a left-sided Babinski reflex, and a thoracic sensory level to pinprick at T8. Serum rapid plasma reagin was 1:64, and fluorescent treponemal antibody-absorption (FTA-ABS) was 4+. Examination of the cerebrospinal fluid showed a mononuclear pleocytosis and reactive FTA-ABS. The myelopathy responded promptly to high-dose intravenous aqueous penicillin. Syphilis needs to be considered in the differential diagnosis of any patient who develops a myelopathy in association with HIV-1 infection. Because of the diverse nature in which syphilis may affect the spinal cord, treatment with intravenous aqueous penicillin, 12 to 24 million units daily, for a minimum of 10 days, should be considered in any HIV-1-seropositive patient with a progressive, unexplained myelopathy and positive serologic studies for syphilis.

Adult↗
PubMed2000

Neelaredoxin, an iron-binding protein from the syphilis spirochete, Treponema pallidum, is a superoxide reductase.

Treponema pallidum, the causative agent of venereal syphilis, is a microaerophilic obligate pathogen of humans. As it disseminates hematogenously and invades a wide range of tissues, T. pallidum presumably must tolerate substantial oxidative stress. Analysis of the T. pallidum genome indicates that the syphilis spirochete lacks most of the iron-binding proteins present in many other bacterial pathogens, including the oxidative defense enzymes superoxide dismutase, catalase, and peroxidase, but does possess an orthologue (TP0823) for neelaredoxin, an enzyme of hyperthermophilic and sulfate-reducing anaerobes shown to possess superoxide reductase activity. To analyze the potential role of neelaredoxin in treponemal oxidative defense, we examined the biochemical, spectroscopic, and antioxidant properties of recombinant T. pallidum neelaredoxin. Neelaredoxin was shown to be expressed in T. pallidum by reverse transcriptase-polymerase chain reaction and Western blot analysis. Recombinant neelaredoxin is a 26-kDa alpha(2) homodimer containing, on average, 0.7 iron atoms/subunit. Mössbauer and EPR analysis of the purified protein indicates that the iron atom exists as a mononuclear center in a mixture of high spin ferrous and ferric oxidation states. The fully oxidized form, obtained by the addition of K(3)(Fe(CN)(6)), exhibits an optical spectrum with absorbances at 280, 320, and 656 nm; the last feature is responsible for the protein's blue color, which disappears upon ascorbate reduction. The fully oxidized protein has a A(280)/A(656) ratio of 10.3. Enzymatic studies revealed that T. pallidum neelaredoxin is able to catalyze a redox equilibrium between superoxide and hydrogen peroxide, a result consistent with it being a superoxide reductase. This finding, the first description of a T. pallidum iron-binding protein, indicates that the syphilis spirochete copes with oxidative stress via a primitive mechanism, which, thus far, has not been described in pathogenic bacteria.

Amino Acid Sequence↗
PubMed1996

Primary and secondary syphilis lesions contain mRNA for Th1 cytokines.

Phagocytosis of Treponema pallidum by cytokine-activated macrophages aids bacterial clearance and lesion resolution in early syphilis. To investigate the cytokine profiles of cells infiltrating primary and secondary syphilis lesions, reverse transcription and polymerase chain reaction (RT-PCR) were used to detect cytokine mRNA in 13 lesion biopsies. Both primary and secondary lesions contained mRNA encoding interleukin (IL)-2, interferon-gamma (IFN-gamma), IL-12p40, and IL-10. In contrast to a lesion from a patient with recurrent herpes simplex virus type 2, no message for IL-4 could be detected in any of the syphilis lesions, and 10 of 13 had no mRNA for IL-5 or IL-13. These findings are consistent with a Th1-predominant local cellular response activating macrophages and support the hypothesis that IFN-gamma-activated macrophages are primary effectors in treponeme clearance.

Base Sequence↗
PubMed1996

Increase of syphilis in Finland related to the Russian epidemic.

In the early 1990s only 30 to 40 new serologically confirmed cases of syphilis were reported annually in Finland. Typical syphilis patients were heterosexual men who acquired the infection abroad. Since 1993, the incidence of syphilis has increased. In 19

Journal Article↗
PubMed2006

Seroprevalence of HIV, HBV and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan.

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention (Int J STD AIDS 1990;10:300-4).

Journal Article↗
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↗
PubMed1992

The variety of clinical and histopathologic presentations of glomerulonephritis associated with latent syphilis.

Glomerulonephritis is a well established but rather uncommon complication of latent secondary syphilis. We present three cases of glomerulopathies associated with luetic infection, observed and managed in our institutions in the past three years. They illustrate a variety of clinicopathologic presentations of this nephropathy, from acute nephrotic syndrome through membranous glomerulopathy up to rapidly progressive glomerulonephritis. Regardless of the clinical course and histologic type, they were all characterized by strongly positive results of serologic tests for syphilis. Our observations suggest the necessity of eliminating luetic infection in aetiologic considerations of each newly diagnosed case of nephrotic syndrome.

Adult↗
PubMed1990

Influence of human immunodeficiency virus infection on treponemal serology, in patients who have been treated for syphilis.

Sera from 20 homosexual men who were infected with the human immunodeficiency virus (HIV) and had been treated previously for syphilis, were examined for cardiolipin and treponemal antibodies by the Venereal Diseases Research Laboratory (VDRL) test, and the Treponema pallidum haemagglutination assay (TPHA) and fluorescent treponemal antibody absorbed test. In only one case was probable reactivation of syphilis, as judged by rising titres in the VDRL test, noted.

Adult↗
PubMed1975

A reappraisal of the value of the IgM fluorescent treponemal antibody absorption test in the diagnosis of congenital syphilis.

To re-evaluate the usefulness of the IgM fluorescent treponemal antibody absorption test in the diagnosis of congenital syphilis, three groups of infants were investigated. Group 1 infants showed that the test was always negative in normal neonates born to seronegative mothers. From Group 2 infants we determined the standardization of the test using commercially prepared conjugate to allow the maximum exclusion of false positive and negative results. Studies on Group 3 neonates confirmed that the standardized test was extremely successful in determining whether or not an asymptomatic infant was infected with Treponema pallidum. Finally it was shown that the standardization of the test varies with different commercially prepared conjugates. From the investigation it was concluded that the IgM FTA test, if suitably standardized, was a highly successful method for diagnosing congenital syphilis, especially in asymptomatic neonates.

Black or African American↗
PubMed1987

Is serological evidence of infection with syphilis a contraindication to kidney donation? Case report and review of the literature.

We report successful transplantation of kidneys from a cadaveric donor with serological evidence of syphilis and no transmission of the disease. Existing guidelines prohibiting the use of serologically positive donors and experience with other forms of iatrogenic transmission of syphilis are reviewed. Specific guidelines for the use of serologically positive donors are proposed.

Adult↗
PubMed1978

Syphilis and pelvic inflammatory disease.

Since screening every patient in the emergency department for venereal disease is impractical, we hypothesized that patients with the clinical diagnosis of pelvic inflammatory disease (PID) might be at higher risk and a group that should be screened. Seventy women with a clinical diagnosis of PID treated in our adult emergency department from July to November 1976 were screened for syphilis using three separate serologic tests: Venereal Disease Research Laboratory, fluorescent treponemal antibody absorption, and treponema pallidum hemagglutination. The incidence of positive serologies in our study group was significantly higher (11.4%) than that of 100 controls (4%). All patients with a clinical diagnosis of PID should be screened for syphilis using both FTA-Abs and TPHA tests, as well as a VDRL.

Adult↗