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PubMed2006

Prevalence of sexually transmitted infections among adolescents in Kampala, Uganda, and theoretical models for improving syndromic management.

PURPOSE: To estimate the prevalence of treatable sexually transmitted infections (STI) in adolescents visiting a youth health clinic. To evaluate the algorithm for management of the abnormal vaginal discharge (AVD) syndrome recommended in Uganda's national guidelines and compare it with other theoretical flowchart models. METHODS: Sexually experienced adolescents who were visiting an urban youth health clinic in Kampala, Uganda were examined and interviewed (with their consent) about their socio-demographic background, sexual risk factors, and genital symptoms. Samples taken for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and Trichomonas vaginalis (TV) were analyzed by polymerase chain reaction (PCR). Rapid plasma reagin (RPR) was used with confirming treponema pallidum hem agglutination (TPHA) for syphilis diagnosis. One hundred ninety-nine females and 107 males were examined. Performance of the national algorithm was compared with different theoretical algorithms. RESULTS: Prevalence of CT, NG, TV and syphilis was 4.5%, 9.0%, 8.0%, and 4.0%, respectively, for girls and 4.7%, 5.7%, 0%, and 2.8%, respectively, for boys. We found that 20.6% of the females and 13.2% of the males had at least one STI. The national AVD flow chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. All the models had PPV of less than 20% and sensitivity less than 85%. The best performing algorithm using risk and protective factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3%, respectively (p = .012). CONCLUSIONS: An algorithm for management of STI using behavioral and demographic factors in this population demonstrated enhanced sensitivity, specificity, and PPV.

Adolescent↗
PubMed2007

Two subgingival plaque-sampling strategies used with RNA probes.

BACKGROUND: The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies. METHODS: In 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test. RESULTS: For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P < or =0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately. CONCLUSIONS: Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td.

Aggregatibacter actinomycetemcomitans↗
PubMed2006

Otosyphilis mimics immune disorders of the inner ear.

Syphilis is a well established cause of hearing loss. Sensorineural hearing loss may develop in the congenital or acquired form. The clinical course of the early acquired and late congenital forms are similar: sudden or rapidly progressive bilateral sensorineural hearing loss with mild vestibular symptoms. Cochleovestibular involvement in early acquired syphilis has been related to a basilar meningitis with lymphocytic infiltration of the labyrinth and VIIIth nerve. However, neurosyphilis and inner ear syphilis are not the same disease. Prompt diagnosis and treatment with corticosteroids and penicillin are mandatory to reduce the immune response and fibrosis of the labyrinth and the endolymphatic sac. Unfortunately, early acquired syphilis is frequently overlooked in the differential diagnosis of other forms of sensorineural hearing loss, particularly autoimmune inner ear disease. Given the increasing number of luetic infection cases, especially in immunocompromised patients, this condition should be considered in any sexually active patients affected by sudden hearing loss. Cases of inner ear syphilis are presented. Immunopathology of luetic inner ear infection is discussed and compared with immune disorders of the inner ear.

Adolescent↗
PubMed1993

The use of a rapid enzymatic assay in the field for the detection of infections associated with adult periodontitis.

There are few objective assays for studies of the epidemiology of periodontal diseases. The PerioScan is an assay capable of detecting three periodontal pathogens, namely T. denticola, P. gingivalis, and B. forsythus, which have been associated with adult periodontitis. The PerioScan was tested in a sample of 301 Brazilians. Clinical indices--bleeding, probing depth, gingival index, and periodontal index--were recorded from four sites in each subject. Subgingival plaque samples were collected from those sites and placed on the PerioScan card. Color results were scored in the field after 15 minutes. The plaque samples were screened with polyclonal antibodies for the three species by an ELISA system. The PerioScan, when compared with the ELISA system, yields a sensitivity of 91 percent, specificity of 89 percent, and an accuracy of 90 percent. When the PerioScan was compared to clinical indices, there was a high sensitivity (at least 93%) and a low specificity (no less than 47%), with an accuracy of at least 61 percent.

Adolescent↗
PubMed1982

Tiamulin feed premix in the prevention and control of swine dysentery under farm conditions in the UK.

Three field trials were carried out to evaluate the efficacy of tiamulin hydrogen fumarate at levels of 20 and 30 ppm in the feed for the prevention and control of swine dysentery. Tiamulin at 30 ppm was shown to be highly effective in preventing the clinical signs of dysentery. Treponema hyodysenteriae was not isolated from these pigs. Tiamulin at 20 ppm was effective in two out of three trials. The trials were performed on pigs either on or from farms with swine dysentery problems which had proven resistant to medication with other products.

Animal Feed↗
PubMedDate not supplied

[Importance of looking for specific IgM in serological investigations for syphilis].

Syphilis is still a quite common infection often lacking clinical symptoms and sometimes ignored. Serological tests have peculiar importance in order to settle the diagnosis and therapy. Traditional tests as VDRL and TPHA cannot clearly define the clinical pattern because these tests remain positive for a long period of time. Moreover they can prove the recovery of the patients only if they continue to give low titres. The immunofluorescence test FTA ABS, that raised interest at its outset, has low sensitivity against IgM specific antibodies and defines serological state of patients only in 50% of the cases. The reading of this test remains subjective. The authors intend to verify the importance to detect the IgM specific antibodies to assume medical and legal decisions in unknown subjects, without clinical knowledge. 20,000 sera of normal subjects and of risk group have been assayed. Specific IgM are absent in 60 clinically recovered subjects with VDRL and TPHA still positive, specific IgM are present in 15 cases of Syphilis under treatment and also in 15 subjects with unknown Syphilis. The results show that: 1) IgM specific antibodies for Syphilis are not detectable in patients under a long term antibiotic treatment while the traditional serological tests (VDRL, TPHA) are positive; 2) they are present in patients under treatment with still active infection; 3) they are also present in patients with ignored infection, never treated. In conclusion the Authors consider important to include in the panel of Syphilis testing new assays for the detection of specific IgM antibodies. This is particularly important in subjects under treatment and also in unknown subjects.

Anti-Bacterial Agents↗
PubMed1993

Experiences with a vaccine being developed for the control of swine dysentery.

A prototype vaccine that is being developed for the control of swine dysentery (SD) was tested in two groups of experimental pigs. Vaccination induced high circulating antibody titres against the aetiological agent, Serpulina (Treponema) hyodysenteriae. Pigs in the first trial were vaccinated twice before being challenged orally with the bacteria. Five of 6 unvaccinated animals developed dysentery within a fortnight of challenge, but only 1 of 6 vaccinated pigs showed signs of disease at this time. Unexpectedly, 1 mo after challenge, the surviving unvaccinated pig and 2 remaining healthy vaccinated animals succumbed to the disease. The reason for the development of this late-onset form of dysentery was not clear. In the second trial, 8 pigs were vaccinated 3 times. Only 2 of these animals (25%) developed severe dysentery after being mixed with infected pigs, whereas 7 of 8 (88%) unvaccinated control pigs in the same pen became diseased. The late-onset form of dysentery was not observed. The prototype vaccine for SD provided a useful level of protection, and could be used in programs to control the disease in Australia.

Animals↗
PubMedDate not supplied

Retinal vasculitis due to secondary syphilis.

BACKGROUND: Retinal vasculitis is one of the manifestations of ocular syphilis. CASE: A 29-year-old man was referred to our hospital with the complaint of sudden visual loss in the left eye lasting more than three weeks. OBSERVATIONS: Ophthalmoscopic examination showed retinal hemorrhages, edema, and sheathing of large retinal arteries and veins. Fluorescein angiography revealed extensive occlusion of the affected retinal arteries, veins, and capillaries. Little evidence of uveitis or vitritis was observed. The fluorescent treponemal antibody-absorption test was positive, and the Treponema pallidum hemagglutination titer was 1:10,240. The treatment with penicillin was effective, leading to resolution of the retinal hemorrhages and edema, although occlusion of the retinal vessels persisted. CONCLUSIONS: Vascular occlusion occurred simultaneously in large retinal arteries, arterioles, and capillaries as well as in segments of retinal veins, resulting in irreversible changes in the vascular walls.

Adult↗
PubMed1988

Serologic diagnosis of Lyme disease.

Indirect fluorescent antibody tests and enzyme-linked immunosorbent assays are being used as laboratory aids for the diagnosis of Lyme disease and related disorders. Depending on the needs, polyvalent or class-specific reagents can be used to detect total immunoglobulins (Ig) or IgM and IgG antibodies. The sensitivities of these assays are relatively low when serum samples are obtained from patients within 3 weeks after onset of erythema migrans and are tested by either the IFA method or ELISA. During neuritis or arthritis, IgG antibody levels are usually elevated, and serologic verification is more easily achieved. Cross-reactivity occurs when sera from patients with Lyme disease, relapsing fever, or treponemal infections are screened against heterologous antigens, but these diseases can usually be separated clinically or by further seroanalyses. Although IFA tests and ELISA are both suitable for confirming Lyme disease, the objective results and the ability to perform many more analyses make ELISA the preferred method.

Antibodies, Bacterial↗
PubMed2001

[Etiologic approach in infertile couples in Mahajanga].

In Madagascar, as in other places in the world, infertility is associated with social stigmatism and an underlaying long-term risk for separation of the couple. A 12 months prospective study was carried out in 1999 in the Department of Gynecology, Obstetrics and Reproductive Health at the University Hospital in Mahajanga in order to collect data related to possible causes of infertility. For the women, serologic tests for Treponema pallidum (syphilis) and Chlamydia trachomatis were performed. And, in addition to sonography and hysterosalpingography, cervico-vaginal smears were obtained as part of the pelvic examination. A semen sample was obtained from each male partner. Of the 37 couples enrolled in the study 35 were classified as primary infertile (n = 9) or secondary infertile (n = 28). The mean age of the women and the men was 30.7 years (ranged 20 to 41 years) and 34.3 years (ranged 24 to 46 years), respectively. Various potential causes of infertility among the women were observed, such as hormonal disturbance (76%), tubal occlusion (76%), genital infection (70%). The figures indicate that there seems to coexist the possibility of multiply causes of infertility. Of 37 semen samples 24 (65%) were found with abnormalities, predominantly of oligospermia type. In 21 couples a possibly cause of infertility was observed in both partners.

Adult↗
PubMed2000

Role of bacterial proteinases in matrix destruction and modulation of host responses.

Recently accumulated large bodies of evidence have strongly implicated proteolytic enzymes released by subgingival plaque bacteria in the pathogenicity of periodontal disease. With regard to proteolytic power, however, the contribution from different microbial species considered as periodontal pathogens is not equal. Two of these bacteria, P. gingivalis and T. denticola, have developed an elaborate proteolytic systems composed of several surface-located or secreted enzymes, which apparently serve a role to provide bacteria with nutrients in the form of small peptides and amino acids. Of these two species, proteinases of P. gingivalis are the most intensively studied, and during the last decade an impressive array of information has been accumulated with respect to the biochemical characterization of purified proteinases and structure of the genes encoding them, the regulation of expression and the effects of these enzymes on host systems. In addition, studies on proteinase-deficient isogenic mutants has shed light on both their housekeeping functions and potential role(s) in the pathogenicity of periodontitis. Among several proteinases produced by P. gingivalis, the cysteine proteinases, referred to as gingipains, are clearly in the spotlight. They are the subject of several recent reviews and generally considered as the major virulence factors of this periodontal pathogen (59, 105, 139, 182, 183, 186, 281, 284, 286, 289). Gingipains seem to be key players in subverting host defense systems with, significantly, the complement and neutrophils being the main target. In addition, through uncontrolled activation of kallikrein/kinin pathway and coagulation cascade they contribute to local generation of bradykinin and thrombin, two synergistically working pro-inflammatory reagents with a strongly, although indirectly, stimulatory effect on bone resorption. Furthermore, the ability to interact with the cytokine networking systems has the potential to dysregulate the local inflammatory reaction. Finally, gingipains have a strong effect on mechanisms controlling host matrix metalloproteinase activity at the level of gene expression and zymogen activation (Fig. 10). Collectively, at the periodontal lesion site, the non-restrained action of gingipains, supported by other proteinases locally produced by subgingival plaque bacteria, would dysregulate most mechanisms controlling inflammatory reaction. Although successful in limiting infection to the periodontium, the ultimate effect of uncontrolled inflammatory processes would be the destruction of periodontal connective tissue, certainly the hallmark of periodontitis.

Adhesins, Bacterial↗
PubMed2002

Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care.

Women seeking care in Madagascar for genital discharge (n = 1,066) were evaluated for syphilis seroreactivity; bacterial vaginosis (BV) and trichomoniasis. Chlamydial infection was assessed by ligase chain reaction (LCR) and by direct immunofluorescence (IF); gonorrhoea by direct microscopy, culture and LCR. Leucocytes were determined in endocervical smears and in urine using leucocyte esterase dipstick (LED). Gonococcal isolates were tested for minimal inhibitory concentrations. BV was found in 56%, trichomoniasis in 25%, and syphilis in 6% of the women. LCR detected gonorrhoea in 13% and chlamydial infection in 11% of the women. Detection of Gram(-) intracellular diplococci in endocervical smears, and gonococcal culture were respectively 23% and 57% sensitive and 98% and 100% specific compared to LCR. Chlamydia antigen detection by IF was 75% sensitive and 77% specific compared to LCR. Leucocytes in endocervical smears and LED testing lacked precision to detect gonococcal and chlamydial infections. Of 67 gonococcal strains evaluated, 19% were fully susceptible to penicillin, 33% to tetracycline; all were susceptible to ciprofloxacin, ceftriaxone, and spectinomycin. Patients who present with genital discharge in Madagascar should be treated syndromically for gonococcal and chlamydial infections and screened for syphilis. Gonorrhoea should be treated with ciprofloxacin.

Animals↗
PubMed1993

Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users.

OBJECTIVE: To describe the effects of human immunodeficiency virus (HIV) infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. DESIGN: Cohort study of intravenous drug users. SETTING: Medical clinic in a hospital-based methadone maintenance treatment program in New York City. PATIENTS: Fifty patients with syphilis, of whom 31 were HIV seropositive and 19 HIV seronegative. MEASUREMENTS: Serologic tests for syphilis and clinical manifestations. RESULTS: Stage of syphilis at presentation was not associated with HIV serologic status. No unusual or fulminant manifestations of early syphilis or neurosyphilis were noted among HIV-seropositive cases. Maximum nontreponemal titers were higher among HIV-seropositive (median, 1:128) than among HIV-seronegative (median, 1:32) patients with syphilis (P = 0.05); this difference was present only among patients with first-episode syphilis. All 26 evaluable, HIV-seropositive patients treated for syphilis responded appropriately, including 13 patients given standard or less-than-standard doses of penicillin. Seven of 43 patients (16%) showed reversion to negative treponemal antibody assay results after treatment for syphilis; this finding was not associated with HIV infection, CD4 count, or stage of syphilis. Low nontreponemal titer was weakly associated with treponemal test reversion. CONCLUSIONS: Infection with HIV did not alter the stage at presentation, clinical course, serologic manifestations, or response to treatment of syphilis in this cohort of intravenous drug users.

Adult↗
PubMedDate not supplied

[Headaches, otalgia and peripheral facial palsy as a form of presentation of neurosyphilis].

INTRODUCTION: Decrease in incidence of neurosyphilis over the last few decades implies that clinicians consider less frequently this diagnosis. On the other hand, some reports suggest an increase in atypical forms of this disease that represent an additional reason for missing this diagnosis. CLINICAL CASE: We report on a 16 year-old immunocompetent black female from Guinea-Bissau presented with headaches, ear pain, hearing loss and peripheral facial paralysis. A cranial CT scan showed a hypodense area in the left cortico-subcortical zone and a contrast enhancement on the left pontocerebellar angle and internal auditory meatus. On the third day of admission a diagnosis of meningitis was made, with high titles of VDRL and TPHA in CSF and serum, leading to a diagnosis of neurosyphilis. The epidemiological aspects of this case suggest either a late congenital syphilis or an infection as a result of a blood transfusion administered seven years earlier in Guinea-Bissau. CONCLUSION: This rare form of presentation of neurosyphilis emphasizes the importance of considering systematically this diagnosis, even in the context of atypical presentations.

Adolescent↗
PubMed1988

Central nervous system involvement in early and late syphilis: the problem of asymptomatic neurosyphilis.

Patients with syphilitic infections are at risk of development of symptomatic neurosyphilis. Adequate treatment with 2.4-7.2 x 10(6) units benzyl penicillin-G intramuscularly within 1 year after infection will rule out this risk. However, more than 1 year after infection this treatment is not fully reliable. In asymptomatic CNS involvement (asymptomatic neurosyphilis) only intravenous penicillin treatment is considered to be adequate in the prevention of neurosyphilis. In this study we redefined criteria for this condition by comparing serum and cerebrospinal fluid (CSF) samples of symptomatic neurosyphilitic patients with those of latent syphilitic patients without CNS involvement. Diagnostic criteria of the World Health Organization and of Centers of Disease Control for asymptomatic neurosyphilis (positive CSF Venereal Disease Research Laboratory (VDRL) test, combined with raised CSF cell count and/or protein content) were studied and compared with some newer parameters such as signs of intrathecal treponemal antibody production (Treponema pallidum haemagglutination assay and intrathecal Treponema pallidum assay index), immunoglobulin G (IgG) and M (IgM) index. The results of this study in 203 syphilitic patients revealed that either a positive CSF-VDRL or combination of a raised IgG and/or IgM index with an elevated CSF cell count both are useful criteria for "ruling-in" asymptomatic neurosyphilis.

Humans↗
PubMed2003

Enzymatic degradation of collagen-guided tissue regeneration membranes by periodontal bacteria.

Bacterial infection in the vicinity of guided tissue regeneration barrier membranes was shown to have a negative effect on the clinical outcomes of this increasingly used technique. Several oral and specifically periodontal bacteria were shown to adhere to such membranes in vivo and in vitro with a higher affinity to membranes constructed from collagen. The present study examined the role of periodontal bacteria and their enzymes in the degradation of commercially used collagen membranes. Degradation of two collagen membranes [Biomend (Calcitek, Colla-Tec Inc., Plainsboro, NJ) and Bio-Gide (Geistlich Biomaterials, Wolhousen, Switzerland)] labeled by fluorescein isothiocyanate was examined by measuring soluble fluorescence. Porphyromonas gingivalis, Treponema denticola and Actinobacillus actinomycetemcomitans and their enzymes were evaluated. Collagenase from Clostridium hystolyticum was used as a positive control. While whole cells of P. gingivalis were able to degrade both types of membranes, T. denticola could degrade Bio-Gide membranes only and A. actinomycetemcomitans whole cells could degrade none of the membranes. Fractionation of P. gingivalis cells revealed that cell membrane associated proteases were responsible for the degradation of the two collagen membranes. In T. denticola, the purified major phenylalanine protease was found to be responsible for the degradation of Bio-Gide membranes. These results suggest that proteolytic bacterial enzymes may take part in the degradation of collagen barrier membranes used for guided tissue regeneration.

Aggregatibacter actinomycetemcomitans↗
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

[Maternal and congenital syphilis in two Mexican hospitals: evaluation of a rapid diagnostic test].

OBJECTIVE: To estimate the prevalence of maternal and neonatal syphilis, to assess the usefulness of a rapid treponemic diagnostic test, and to evaluate the frequency of screening for syphilis during prenatal care in Mexican women. MATERIAL AND METHODS: This was a cross-sectional study that included 1,322 women interviewed in two hospitals (Hospital General in Cuernavaca, Morelos, and Hospital de la Mujer in Mexico City). Women answered a questionnaire on reproductive background, exposure to sexually transmitted infections and prenatal care. In order to diagnose syphilis, a rapid Determine TP test and a latex-VDRL test were used among all participating women. Positive cases were confirmed using FTA-ABS test. RESULTS: Prevalence of serologically active syphilis was 0.3% (4/1322). Using as comparison standard a combination of VDRL and FTA-ABS tests, the Determine TP test had a sensitivity and specificity of 100%. Two newborns with positive FTA-ABS IgM, one negative with FTA-ABS IgM and one first-trimester abortion were found from seropositive women. Prenatal serum screening for syphilis was conducted in only 6.9% of women included in the study. CONCLUSIONS: Although the prevalence of maternal syphilis is relatively low, results show that if the situation found in the hospitals studied is shared by other hospitals in Mexico, a systematic screening for maternal syphilis would help to diagnose more cases of this infection than the number reported in official figures. Screening of syphilis in pregnant women using rapid tests may help in the prevention of congenital syphilis.

Antibodies, Bacterial↗