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Li M, Zhang X, Huang K, Qiu H, Zhang J, Kang Y, Wang C. Presence of Chlamydia trachomatis and Mycoplasma spp., but not Neisseria gonorrhoeae and Treponema pallidum, in women undergoing an infertility evaluation: high prevalence of tetracycline resistance gene tet(M). AMB Express 2017; 7:206. [PMID: 29150724 PMCID: PMC5691826 DOI: 10.1186/s13568-017-0510-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/11/2017] [Indexed: 01/07/2023] Open
Abstract
Chlamydia trachomatis, Mycoplasma spp., Neisseria gonorrhoeae and Treponema pallidum are sexually transmitted pathogens that threaten reproductive health worldwide. In this study, vaginal swabs obtained from women (n = 133) that attended an infertility clinic in China were tested with qPCRs for C. trachomatis, Mycoplasma spp., N. gonorrhoeae, T. pallidum and tetracycline resistance genes. While none of vaginal swabs were positive for N. gonorrhoeae and T. pallidum, 18.8% (25/133) of the swabs were positive for Chlamydia spp. and 17.3% of the swabs (23/133) were positive for Mycoplasma species. All swabs tested were positive for tetracycline resistance gene tet(M) which is the most effective antibiotic for bacterial sexually transmitted infections. The qPCRs determined that the gene copy number per swab for tet(M) was 7.6 times as high as that of C. trachomatis 23S rRNA, and 14.7 times of Mycoplasma spp. 16S rRNA. In China, most hospitals do not detect C. trachomatis and Mycoplasma spp. in women with sexually transmitted infections and fertility problems. This study strongly suggests that C. trachomatis and Mycoplasma spp. should be routinely tested in women with sexually transmitted infections and infertility in China, and that antimicrobial resistance of these organisms should be monitored. Further studies are warranted to determine the prevalences in different regions and associated risk factors.
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Zhu J, Jiang Y, Shi Y, Zheng B, Xu Z, Jia W. Clinical manifestations and treatment outcomes of syphilitic uveitis in HIV-negative patients in China: A retrospective case study. Medicine (Baltimore) 2017; 96:e8376. [PMID: 29069031 PMCID: PMC5671864 DOI: 10.1097/md.0000000000008376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Syphilitic chorioretinitis should be included in differential diagnosis of any form of ocular inflammation. A significantly higher proportion of human immunodeficiency virus (HIV)-positive patients with ocular syphilis as compared to HIV-negative cases have been reported in published studies. However, the clinical signs and symptoms are more insidious in HIV-negative patients who are easily misdiagnosed. We report a series of cases of ocular syphilis and describe the clinical manifestations and treatment outcomes of syphilitic chorioretinitis in HIV-negative patients in China.This was a retrospective case series study. The clinical records of patients with syphilis chorioretinitis were reviewed. Demographic information and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. All patients received the standard treatment. Ophthalmology examination and laboratory evaluation were repeated every 3 months. All changes were recorded. The treatment was considered successful if the patients had no inflammation in both eyes and rapid plasma reagin titer was negative after therapy.The study examined 41 eyes of 28 HIV-negative patients. The main complaints were blurry vision, floaters, and visual field defect. Twenty-seven eyes presented with panuveitis, and all had posterior involvement, including uveitis, vasculitis, chorioretinitis, and optic neuritis. The most common manifestations were uveitis and retinal vasculitis. Disc hyperfluorescence and persistent dark spots were the most common findings on FFA and ICGA. The ill-defined inner segment/outer segment junction was the most frequent manifestation on SD-OCT. Patients were diagnosed with syphilitic uveitis based on positive serological tests. Best-corrected visual acuity (BCVA) was improved in 34 eyes after treatment. Eleven patients were misdiagnosed before serological tests were performed. The delay in treatment led to long-standing cystoid macular edema and optic neuropathy, which were associated with poor BCVA (P = .037).The common manifestations of syphilitic chorioretinitis were uveitis, retinal vasculitis, and optic neuritis. Further diagnosis should be prompted by FFA, ICGA, and SD-OCT when ocular manifestation is suspected. The standard treatment for neurosyphilis was effective. If patients are presumed to be in low-risk groups such as HIV-negative, delays in diagnosis, and therapy may be likely. It is necessary to reiterate the importance of including syphilis uveitis as a differential diagnosis for any form of ocular inflammations, especially posterior uveitis and optic neuropathy.
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Affiliation(s)
- Jiang Zhu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yuan Jiang
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yewen Shi
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bo Zheng
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Zhiguo Xu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Wei Jia
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
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Zong Z, Yang W, Sun X, Mao J, Shu X, Hearst N. Migration Experiences and Reported Sexual Behavior Among Young, Unmarried Female Migrants in Changzhou, China. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:516-524. [PMID: 28899871 PMCID: PMC5620347 DOI: 10.9745/ghsp-d-17-00068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/20/2017] [Indexed: 11/28/2022]
Abstract
30% reported being sexually experienced, but only 38% reported using contraception at first sex and 58% consistently over the past year, leading to many unintended pregnancies and abortions. These findings document an unmet need for reproductive health education and services for young, unmarried female migrants in urban China. Background: China has a large migrant population, including many young unmarried women. Little is known about their sexual behavior, contraceptive use, and risk of unintended pregnancy. Methods: 475 unmarried female migrants aged 15–24, working in 1 of 6 factories in 2 districts of Changzhou city, completed an anonymous self-administered questionnaire in May 2012 on demographic characteristics, work and living situation, and health. We examined demographic and migration experience predictors of sexual and contraceptive behavior using bivariate and multivariate regressions. Results: 30.1% of the respondents were sexually experienced, with the average age at first sex of 19 years (standard deviation=3). 37.8% reported using contraception at first sex, 58.0% reported using consistent contraception during the past year, and 28.0% reported having at least 1 unintended pregnancy with all unintended pregnancies resulting in abortion. Those who had had at least 1 abortion reported having on average 1.6 abortions [SD=1] in total. Migrating with a boyfriend and changing jobs fewer times were associated with being sexually experienced. Younger age, less education, and changing jobs more times were associated with inconsistent contraceptive use. Conclusion: These findings demonstrate there is an unmet need for reproductive health education and services where these women work as well as in their hometown communities. This education must begin early to reach young women before they migrate.
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Affiliation(s)
- Zhanhong Zong
- Institute of Public Administration, Hohai University, Nanjing, China.,School of Economics, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Wenjian Yang
- Institute of Public Administration, Hohai University, Nanjing, China
| | - Xiaoming Sun
- School of Economics, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jingshu Mao
- School of Economics, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Xingyu Shu
- School of Economics, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Norman Hearst
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA.
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Liao KJ, Zhang SK, Liu M, Wang QM, Liu J, Shen HP, Zhang YP. Seroepidemiology of Syphilis Infection among 2 Million Reproductive-age Women in Rural China: A Population-based, Cross-sectional Study. Chin Med J (Engl) 2017; 130:2198-2204. [PMID: 28875956 PMCID: PMC5598332 DOI: 10.4103/0366-6999.213975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND: Quantifying syphilis prevalence is important for planning interventions and advocating for resources on syphilis. However, data on large sample studies regarding the prevalence of syphilis among reproductive-age women in rural China were not available for analysis. The aim of the study was to determine the prevalence, epidemiological characteristics, and related factors of syphilis infection among reproductive-age women in rural China. METHODS: Data were obtained from a nationwide, population-based, cross-sectional study under the National Free Preconception Health Examination Project which covered all the 31 provinces in Mainland China. Women intending to get pregnant within the next 6 months were enrolled between January 1, 2010, and December 31, 2012. Sociodemographic, gynecological and obstetric characteristics, and other relevant information were obtained through face-to-face interviews. Treponema pallidum particle agglutination assay test was used to detect positive samples of syphilis. Univariate and multivariate logistic regressions were performed to assess the associations between syphilis seropositivity and related factors. RESULTS: The overall seroprevalence of syphilis (SPS) among the 2,044,126 women who received syphilis screening test during 2010-2012 was 0.37% (95% confidence interval [CI]: 0.36-0.37%). The SPS appeared 0.24% (95% CI: 0.23-0.26%) and 0.66% (95% CI: 0.59-0.72%) in women at 21-24 and 40-44 years of age, respectively, showing an increase of SPS, parallel with age, and the difference was significant. SPS was significantly higher in ethnic minorities than that in Han nationality (0.58% vs. 0.35%, respectively, odds ratio [OR] = 1.41, 95% CI: 1.30-1.53) and higher in workers than that in farmers (0.45% vs. 0.36%, respectively, OR = 1.27, 95% CI: 1.14-1.41). Women with primary school or below level had a higher SPS as compared to those with college or above educational level (0.61% vs. 0.32%, respectively, OR = 2.49, 95% CI: 2.14-2.89), and the increase reversely correlated with the levels of education. Women whose spouses were syphilis seropositive had significant greater risk (OR = 48.26, 95% CI: 44.38-52.48) as compared those whose spouses were seronegative. Women who reported having had a history of sexually transmitted infections were more likely to be tested positive for serological syphilis (OR = 27.17, 95% CI: 20.44-36.11) as compared to those without. CONCLUSIONS: High SPS is seen among reproductive-age women in rural China that calls for targeted interventions on syphilis prevention and control in this target population, with emphasis on those who are 35 years of age and above, less educated, being minor ethnicity, workers, and living in the western regions of China.
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Affiliation(s)
- Kai-Ju Liao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Shi-Kun Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing 100044, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Qiao-Mei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing 100044, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Hai-Ping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing 100044, China
| | - Yi-Ping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing 100044, China
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Zhang W, Du Z, Huang S, Chen L, Tang W, Zheng H, Yang B, Hao Y. The association between human perceived heat and early-stage syphilis and its variance: Results from a case-report system. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 593-594:773-778. [PMID: 28364611 PMCID: PMC5748342 DOI: 10.1016/j.scitotenv.2017.03.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND The relationship between temperature and syphilis is poorly understood despite clues and suggestions from previous studies. We examined the association between human perceived temperature (humidex) and the relative risk of early-stage syphilis in the most affected area of China, as well as its variance across social-economic status and age groups. METHODS Information regarding early-stage (primary and secondary) syphilis cases reported to the China Case Report System between 2005-2013 from Guangdong province was analyzed in this study. Weather data were obtained from the National Meteorological Information Center. Distributed lag nonlinear models were applied to assess the relationship between humidex and the relative risk of early-stage syphilis. Results were further stratified by social-economic status and age groups. RESULTS The relative risks of early-stage syphilis mainly increased with increased humidex, and were elevated when the humidex was around 30 or greater than 38. The humidex-RR association for the 15-40 age group was similar to the scenario pooled across the age groups, particularly in the Pearl-River Delta Region. The relative risk of syphilis in the elderly for the non-Pearl-River Delta Region did not show a clear change with humidex, whereas that in the Pearl-River Delta Region substantially increased, particularly when humidex was above 25. CONCLUSIONS Human perceived temperature was positively related to the relative risk of early-stage syphilis. People in the Pearl-River Delta Region tended to be more sensitive, with relative risk elevated at potential comfortable times or under excessively hot conditions. The vulnerability of the elderly in the Pearl-River Delta Region is concerning.
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Affiliation(s)
- Wangjian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
| | - Shujie Huang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Lei Chen
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Weiming Tang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China; University of North Carolina at Chapel Hill, NC 27599, USA
| | - Heping Zheng
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Bin Yang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
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Tao C, Hao X, Xu W, Zhang J, Pan S, Tao Z, Li X, Chen J, Zhang B, Qiu Y, Wu Y, Ou Q, Huang X, Wang L. Evaluation of the Elecsys syphilis immunoassay for routine screening of serum samples in China. Sci Rep 2017; 7:9559. [PMID: 28842664 PMCID: PMC5572731 DOI: 10.1038/s41598-017-10103-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
We compared the performance of the Roche Diagnostics Elecsys immunoassay for the detection of Treponema pallidum specific antibodies in patient serum samples with that of the Abbott Laboratories Architect chemiluminescent microparticle immunoassay and the InTec and KHB enzyme-linked immunosorbent assays, which are commonly used in China. We tested 13,767 serum samples collected from 13 independent laboratories throughout China, which included samples from 999 previously confirmed syphilis cases and 158 'borderline' samples previously identified using the Architect, InTec, and KHB tests. The Mikrogen Syphilis Immunoblot was used to confirm positive test results. The consistency between the four different assays was 100%. The sensitivity of Elecsys immunoassay was 100% versus 98.26% for Architect, 99.11% for InTec; and 98.56% for KHB. The specificity of the Elecsys immunoassay was 99.81% versus 99.74% for Architect; 99.93% versus 99.80% for InTec; and 99.85% versus 99.77% for KHB. For borderline samples, the Elecsys immunoassay yielded no false-negative results and fewer false-positive results, compared to the other tests. Considering the ease-of-use, automation, high speed, and high throughput capacity of the Elecsys assay, the higher sensitivity and specificity indicate it is superior for routine screening of serum samples for syphilis diagnosis.
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Affiliation(s)
- Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, China
| | - Xiaoke Hao
- Department of Clinical Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Wei Xu
- Department of of Clinical Laboratory, The First Hospital of Jilin University, No. 71 Xinmin street, Changchun, 130021, China
| | - Jie Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, No. 49 North Huayuan Road, Beijing, 100191, China
| | - Shiyang Pan
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Zhihua Tao
- Department of Clinical Laboratory, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Xiaofei Li
- Department of Clinical Laboratory, The Third People's Hospital of Kunming, No. 391 Wujing Road, Kunming, 650011, China
| | - Junmei Chen
- Department of Clinical Laboratory Center, Beijing Youan Hospital, Capital Medical University, No. 8 Youan Menwai Xitoutiao, Beijing, 100069, China
| | - Bingchang Zhang
- Department of Clinical Laboratory, Shandong Province Hospital, No. 324 JingWu WeiQi Road, Jinan, 250021, China
| | - Yurong Qiu
- Department of Clinical Laboratory, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Yanan Wu
- Department of Clinical Laboratory, Fujian Provincial Hospital, Provincial Clinical College, Fujian Medical University, No. 134 DongJie, Fuzhou, 350001, China
| | - Qishui Ou
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, 350005, China
| | - Xianzhang Huang
- Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China
| | - Lanlan Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, China.
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Li F, Wang T, Wang L. Secondary syphilis primarily presenting with multiple nodules on the scalp: Case report and published work review. J Dermatol 2017; 44:1401-1403. [PMID: 28714113 DOI: 10.1111/1346-8138.13965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023]
Abstract
Syphilis, a sexually transmitted disease caused by Treponema pallidum, manifests with a broad spectrum of clinical presentations that usually involves skin. Nodular secondary syphilis occurs rarely, and mostly manifests as disseminated papulonodules or plaques over the trunk and limbs. We report an extremely rare case of nodular secondary syphilis that primarily presented with multiple nodules on the scalp, resembling Rosai-Dorfman disease or cutaneous malignant metastasis. Immunohistochemistry confirmed T. pallidum spirochetes microscopically.
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Affiliation(s)
- Fan Li
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Wang
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Wang
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
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Chen L, His JH, Wu X, Shen Z, Lu H, Chen H, Huang H, Zhang H, Ruan Y, Shao Y, Tang Z. Disparities in HIV and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China. BMC Infect Dis 2017; 17:269. [PMID: 28403825 PMCID: PMC5389008 DOI: 10.1186/s12879-017-2367-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background Heterosexual intercourse accounted for 93% of reported HIV cases in Guangxi, and Guangxi had 10% of China’s total number of reported HIV cases. Older men are particularly vulnerable to STIs, for example, 46% of Guangxi’s HIV cases were men over 50 years of age. As this is an under-studied population in China, effective prevention and control policies have yet to be developed. Thus, the aim of this study was to use a large-scale cross-sectional survey to understand the demographic and behavior factors associated with HIV and syphilis infections among older male clients of female sex workers (FSWs) in a high epidemic area of rural Guangxi, China. Methods A large-scale cross-sectional survey was conducted in 2012 among older male clients of FSWs in low-cost commercial sex venues. Questionnaire interviews were administered to collect sociodemographic and sexual behavior information. Blood samples were collected for HIV and syphilis infection tests. Results Of the 3485 participants, 2509 (72.0%) clients had a steady sex partner and 976 (28.0%) clients had no steady sex partner. The overall prevalence of HIV and syphilis infection were 3.0% and 3.2%, respectively. Compared to those with a steady sex partner, clients with no steady partner had higher odds of HIV infection (AOR: 1.90, 95% CI: 1.27–2.86), syphilis infection (AOR: 1.53, 95% CI: 1.02–2.30), and having factors associated with HIV or syphilis infection, including non-commercial casual sex encounters in last month (AOR: 3.29, 95% CI: 2.42–4.46), >10 years of commercial sex history (AOR: 1.31, 95% CI: 1.12–1.53), >2 incidents of commercial sex in last month (AOR: 1.53, 95% CI: 1.19–1.96), and aphrodisiac use in last month (AOR: 1.40, 95% CI: 1.16–1.70). Clients with no steady partner had lower odds of having heterosexual intercourse (AOR: 0.66, 95% CI: 0.56–0.79), awareness and knowledge of HIV/AIDS (AOR: 0.75, 95% CI: 0.64–0.88), and having had HIV tests (AOR: 0.65, 95% CI: 0.44–0.98). Conclusion Older male clients of low-cost commercial sex venues in rural southwestern China are at high risk for HIV and syphilis infection, especially those with no steady sex partner. Improved interventions are urgently needed for this neglected risk population.
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Affiliation(s)
- Li Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Jenny H His
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Xinghua Wu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Huaxiang Lu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Huanhuan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Hui Huang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China
| | - Heng Zhang
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Zhenzhu Tang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, No.18 Jinzhou Road, Nanning, Guangxi, China.
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Tang W, Huang S, Chen L, Yang L, Tucker JD, Zheng H, Yang B. Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study. Sci Rep 2017; 7:45339. [PMID: 28338084 PMCID: PMC5364404 DOI: 10.1038/srep45339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/22/2017] [Indexed: 11/09/2022] Open
Abstract
Due to challenges in diagnosis and the need for complex laboratory tests, misdiagnosis of neurosyphilis and tertiary syphilis is common in China. We validated the diagnosis and examined the treatment of late neurosyphilis and tertiary syphilis in Guangdong Province, China. A cross-sectional study was conducted to collect data from late neurosyphilis and tertiary syphilis cases reported between 2009 and 2014 in Guangdong, China. Descriptive analysis, bivariate analyses and multiple logistic regressions were performed to determine the structural factors associated with correct diagnosis and standard treatment of late neurosyphilis and tertiary syphilis. Among the 3805 respondents (3805/3936, 96.7%), 1,837 (48.3%) met the misdiagnosed criteria. The misdiagnosis rate decreased over the study period (54.2% in 2009 and 41.8% in 2014). Only 27.1% and 24.9% of the correctly diagnosed late neurosyphilis and tertiary syphilis cases received standard treatment, respectively. Multiple logistic regression revealed that departments of dermatology or STDs [aOR = 3.24, 95% CI: 2.66-3.95], county or township level hospitals [aOR = 2.89, 95% CI: 2.14-3.89], and hospitals situated outside of Pearl River Delta area [aOR = 1.70, 95% CI: 1.46-1.97] had higher likelihood in misdiagnosis of neurosyphilis, compared to the reference groups. Targeted trainings for physicians and expanded syphilis screening services are urgently needed.
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Affiliation(s)
- Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Shujie Huang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Lei Chen
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Ligang Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
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Peng RR, Wu J, Zhao W, Qi T, Shi M, Guan Z, Lu H, Long F, Gao Z, Zhang S, Zhou P. Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter? PLoS Negl Trop Dis 2017; 11:e0005456. [PMID: 28288165 PMCID: PMC5363990 DOI: 10.1371/journal.pntd.0005456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/23/2017] [Accepted: 03/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai. METHODOLOGY/PRINCIPAL FINDINGS Between 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38-4.13%) and 0.35% (95% CI: 0.06-1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia. CONCLUSIONS/SIGNIFICANCE Benzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Tengfei Qi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Haikong Lu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Fuquan Long
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zixiao Gao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Sufang Zhang
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
- * E-mail:
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Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, Babu GR, Jia Y, Huan X, Xu G, Yang H, Fu G, Li L. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS 2017; 28:170-178. [PMID: 26992411 PMCID: PMC5026914 DOI: 10.1177/0956462416638224] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
The recent upsurge of syphilis infections among men who have sex with men (MSM) is one of the major challenges facing China. However, the overall burden is still not clear. This study aims to summarize the incidence of syphilis among MSM in China by using meta-analysis. We comprehensively searched PubMed-MEDLINE, China National Knowledge Infrastructure and Chinese Wanfang databases. Articles published between December 2009 and March 2015 that met the inclusion criteria were considerably involved in this meta-analysis. Two reviewers performed a quality assessment of the studies and extracted data for estimating the overall syphilis incidence. STATA 12.0 was used to summarize the overall incidence of syphilis. In all, 14 studies from 13 papers were included in this study. Follow-up duration of these studies ranged from six to 36 months, while drop-out rates ranged from 11.9% to 83.6%. The individual incidence rates of the included studies varied from 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) to 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), with a pooled incidence of 9.6/100 person-years (95% CI, 7.0-12.2/100 person-years). The subgroup meta-analysis revealed that incidence estimates were 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), 12.1/100 person-years (95% CI, 7.0-17.2/100 person-years), 11.2/100 person-years (95% CI, 0.7-23.1/100 person-years), 8.9/100 person-years (95% CI, 6.5-11.2/100 person-years), 5.7/100 person-years (95% CI, 3.4-8.0/100 person-years) and 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) in Northeast, North, Southwest, East, South and Northwest China, respectively. Syphilis incidence among Chinese MSM is high, and this may increase the spread of other sexually transmitted infections, including human immunodeficiency virus. It is essential to integrate syphilis control programs with HIV control programs. This can be achieved by establishing public health response systems to monitor and control the epidemic of syphilis and HIV together in China.
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Affiliation(s)
- Guohong Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ya Cao
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Yuan Yao
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ming Li
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Jianjun Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Giridhara R Babu
- Public Health Foundation of India, IIPH-H, Bangalore Campus, Bangalore, India
| | - Yue Jia
- School of Life Science, Xiamen University, Xiamen, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Genxing Xu
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Haitao Yang
- Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lei Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. Minocycline, a representative tetracycline derivative, has the greatest antimicrobial activity among all tetracyclines. There are few reports about treating syphilis with minocycline because there is a lack of efficacy data from controlled trials. We compared the rates of serological cure in patients with early syphilis who were treated with minocycline or benzathine penicillin G (BPG).During the study period, a total of 40 syphilis patients received the BPG treatment, which was a single intramuscular dose of 2.4 million units of BPG, and 156 patients were treated with minocycline; 77 patients were placed in the 2-week, standard minocycline therapy group and received 100 mg of minocycline orally, twice daily for 14 days, and 79 patients were placed in the 4-week, lengthened minocycline therapy group and received 100 mg of minocycline orally, twice daily for 28 days. The outcome of interest was the rate of serological cure in these patients.At the end of the 2-year follow-up, the serological cure rate of the 4-week, lengthened minocycline therapy group (87.34%) was higher than that of both the 2-week, standard minocycline therapy group (72.73%) and the BPG treatment group (77.50%). In addition, the curative effect of the 4-week, lengthened minocycline therapy was significantly greater than that of the 2-week, standard minocycline therapy in patients who were aged >40 years; exhibited an initial rapid plasma reagin titer ≥1: 32; or exhibited secondary syphilis (P = 0.000, 0.008, 0.000; <0.05).Minocycline appears to be an effective agent for treating early syphilis, especially when applied as a 4-week, lengthened therapy.
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Zhao Y, Wong CKH, Miu HYH, Yuen WWY, Chin WY, Luo T, Wong WCW. Translation and Validation of a Condom Self-Efficacy Scale (CSES) Chinese Version. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:499-510. [PMID: 27925485 DOI: 10.1521/aeap.2016.28.6.499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The English version of the Condom Self-Efficacy Scale (CSES) was translated, back-translated, and tested among a representative sample of the Hong Kong general population. It then underwent reconsolidation, confirmation, and validation following standard procedures. Construct validity was performed by exploratory factor analysis and item-scale correlation. Independent t-test and effect size were used to identify the score differences between consistent and non-consistent condom users. The factor loading scores of 14 items ranged between 0.749 and 0.884. Cronbach's alpha for the traditional Chinese version of CSES (CSES-TC) was 0.96 for the overall scale. The CSES-TC was highly correlated with self-reported condom use among the 265 participants who indicated they had been sexually active in the past 12 months. The CSES-TC demonstrated satisfactory psychometric properties in terms of validity, reliability, and sensitivity. This scale can be used as an instrument to measure condom use efficacy for condom promotion and intervention purposes.
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Affiliation(s)
- Yanping Zhao
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Heidi Yin Hai Miu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Winnie Wing Yan Yuen
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Tongyong Luo
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
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Tian X, Jiang J, Wang J, Zhang S. Improved Fecundity in Northern China: A Secular Trend from 1980 to 2003. PLoS One 2016; 11:e0165097. [PMID: 27788188 PMCID: PMC5082934 DOI: 10.1371/journal.pone.0165097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/02/2016] [Indexed: 11/21/2022] Open
Abstract
Objective This study aimed to assess the trend of human fecundity over time in China. Methods This retrospective study was conducted in Tongliao, China. Couples who were married during the time period between January 1, 1981 and December 31, 2003 were considered eligible for this study. A total of 27,413 individuals provided valid information via house-to-house interviews. The 12-month cumulative pregnancy rate (CPR) and annual percentage change were used as the outcome measurements. Results There was a significant increase in the CPR over the five successive time groups. A break point in 1988 divided the entire study period into two distinct segments: 1981–1988, during which the CPR increased from 72.2% to 84.2%, and 1988–2003, during which the CPR increased from 84.2% to 87.2%. Conclusions The findings were unlikely to be the result of biases, and could not be explained by increased medical treatment for infertility and changes in the prevalence of sexually transmitted diseases. Dramatic societal and behavioral changes due to the unique family planning policy and economic reform policies in China might have been the plausible reason for the results.
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Affiliation(s)
- Xiaobing Tian
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jingmei Jiang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences, School of Basic Medicine of Peking Union Medical College, Beijing, China
| | - Jiedong Wang
- National Research Institute for Population and Family Planning, Beijing, China
| | - Shucheng Zhang
- National Research Institute for Population and Family Planning, Beijing, China
- * E-mail:
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Yang S, Jiao D, Liu C, Lv M, Li S, Chen Z, Deng Y, Zhao Y, Li J. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections among blood donors at Shiyan, Central China. BMC Infect Dis 2016; 16:531. [PMID: 27716251 PMCID: PMC5045580 DOI: 10.1186/s12879-016-1845-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 09/17/2016] [Indexed: 12/26/2022] Open
Abstract
Background Ordinary screening of transfusion-transmissible infections (TTIs) among blood donors is essential for blood transfusion. Although there is several TTIs studies focus on human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections in China, it is no data to illustrate any firm conclusion from Shiyan City, Central China. It aims to verify the seroprevalence of TTIs among blood donors at Shiyan. Methods A retrospective analysis of blood donors’ information was conducted for the presence of HIV, HBV, HCV and T. pallidum. Logistic regression analysis was used to demonstrate risk factors including age, gender and occupation associated with them. The variation tendency in seroprevalence of these TTIs over the study period was evaluated by Cochran-Armitage trend test. Results Of 211 639 blood donors, 2 858 (1.35 %) had serological evidence of TTIs. The seroprevalence of HIV, HBV, HCV and T. pallidum were 0.08 %, 0.51 %, 0.20 % and 0.57 %, respectively. However, the co-infection prevalence of TTIs has not been detected. The HIV seropositivity significantly increased among female donors (OR = 1.63, P < 0.001) and farmers (OR = 2.02, P = 0.020). Significantly increased HBV seropositivity was only observed framers (OR = 1.87, P <0.001) compared to workers. Analogously, significantly increased HCV seropositivity was observed among farmers (OR = 2.59, P < 0.001), students (OR = 2.43, P < 0.001), merchants (OR = 1.70, P = 0.014) and others (OR = 1.78, P =0.001). The T. pallidum seroprevalence was notably increased among female (OR = 1.54, P < 0.001), and farmers (OR = 1.70, P <0.001). Moreover, significantly increasing trends of HIV (Z = −6.88, P < 0.01), HBV (Z = −4.52, P < 0.01), HCV (Z = −4.16, P < 0.01) and T. pallidum (Z = −1.36, P < 0.01) seropositivity were observed over the study period. Conclusions It originally offers a substantial prevalence of TTIs among blood donors at Shiyan, Central China. Severe blood donor selection and all-inclusive screening of blood are highly recommended. It might be helpful for developing and updating guidance for blood safety. Trial registration Retrospectively registered.
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Affiliation(s)
- Shuguo Yang
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Danmei Jiao
- Shiyan Blood Transfusion Center, Laboratory Medical Center, Shiyan, 442000, China
| | - Changjun Liu
- Department of Preventive Medicine, College of Public Health and Management, Hubei University of Medicine, Shiyan, 442000, China
| | - Ming Lv
- Shiyan Blood Transfusion Center, Laboratory Medical Center, Shiyan, 442000, China
| | - Shan Li
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Zongyun Chen
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Yao Deng
- Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Yanqing Zhao
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Jian Li
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China.
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Baussano I, Lazzarato F, Brisson M, Franceschi S. Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior. Emerg Infect Dis 2016; 22:18-23. [PMID: 26691673 PMCID: PMC4696692 DOI: 10.3201/eid2201.150791] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human papillomavirus (HPV) prevalence varies widely worldwide. We used a transmission model to show links between age-specific sexual patterns and HPV vaccination effectiveness. We considered rural India and the United States as examples of 2 heterosexual populations with traditional age-specific sexual behavior and gender-similar age-specific sexual behavior, respectively. We simulated these populations by using age-specific rates of sexual activity and age differences between sexual partners and found that transitions from traditional to gender-similar sexual behavior in women <35 years of age can result in increased (2.6-fold in our study) HPV16 prevalence. Our model shows that reductions in HPV16 prevalence are larger if vaccination occurs in populations before transitions in sexual behavior and that increased risk for HPV infection attributable to transition is preventable by early vaccination. Our study highlights the importance of using time-limited opportunities to introduce HPV vaccination in traditional populations before changes in age-specific sexual patterns occur.
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Wang AL, Peng RR, Tucker JD, Chakraborty H, Cohen MS, Chen XS. Optimizing Partner Notification Programs for Men Who Have Sex with Men: Factorial Survey Results from South China. PLoS One 2016; 11:e0157749. [PMID: 27462724 PMCID: PMC4963097 DOI: 10.1371/journal.pone.0157749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Syphilis is prevalent among men who have sex with men (MSM) in China. Syphilis partner notification (PN) programs targeting MSM has been considered as one of effective strategies to prevention and control of the infection in the population. We examined willingness and preferences for PN among MSM to measure feasibility and optimize uptake. Methods Participation in a syphilis PN program was measured using a factorial survey from both the perspective of the index patient and the partner. Respondents were recruited from April-July 2011 using convenience sampling at two sites—a MSM sexually transmitted disease (STD) clinic and a MSM community based organization (CBO). Respondents first evaluated three factorial survey vignettes to measure probability of participation and then an anonymous sociodemographic questionnaire. A two-level mixed linear model was fitted for the factorial survey analysis. Results In 372 respondents with mean age (± SD) 28.5 (± 6.0) years, most were single (82.0%) and closeted gays (66.7%). The Internet was the most frequent place to search for sex. Few (31.2%) had legal names for casual partners, but most had instant messenger (86.5%) and mobile phone numbers (77.7%). The mean probability of participation in a syphilis PN program was 64.5% (± 32.4%) for index patients and 63.7% (± 32.6%) for partners. Referral of the partner to a private clinic or MSM CBO for follow-up decreased participation compared to the local Center for Disease Control and Prevention (CDC) or public STD clinic. Conclusions Enhanced PN services may be feasible among MSM in South China. Internet and mobile phone PN may contact partners untraceable by traditional PN. Referral of partners to the local CDC or public STD clinic may maximize PN participation.
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Affiliation(s)
- Alberta L. Wang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Joseph D. Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hrishikesh Chakraborty
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, United States of America
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xiang-Sheng Chen
- National Center for Sexually Transmitted Disease Control, Chinese Academy of Medical Science and Peking Union Medical College Institute of Dermatology, Nanjing, China
- * E-mail:
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Jiang Y, Zhang YF, Liu M, Ma LL, Peng FH, Huang QL, Ma XM, Chen XH. Syphilitic dementia and lipid metabolism. Eur J Neurol 2016; 23:1541-7. [PMID: 27415600 DOI: 10.1111/ene.13074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 06/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Chronic syphilitic infection may lead to dementia. It is in general paresis (GP), which is the major late form of neurosyphilis, that cognitive impairment frequently occurs. The association between lipid metabolism and GP is unclear. METHODS In this study, serum lipids were studied in 188 GP patients, in 241 syphilitic patients without neurosyphilis and in 539 healthy controls. The Mini-Mental State Examination (MMSE) was tested in all GP patients. Thirty-five GP patients had a follow-up evaluation 3 months after penicillin treatment. RESULTS Significantly lower apolipoprotein A-I (apoA-I) levels were found in GP and in syphilitic patients without neurosyphilis compared to controls. In the 25-44-year-old groups, the male syphilitic patients without neurosyphilis had lower serum apoA-I levels and higher apolipoprotein B (apoB)/apoA-I ratios compared with female patients. A follow-up evaluation of 35 GP patients 3 months after penicillin treatment showed a significant positive correlation between increased apoA-I levels and MMSE scores. CONCLUSION Abnormal apoA-I metabolism may be associated with the decline of cognitive performance. Long-term decrease of apoA-I level and higher apoB/apoA-I ratio may be contributing factors in syphilitic dementia. These results suggest a similar overlap between syphilitic dementia and lipid metabolism to that occurring in Alzheimer's disease.
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Affiliation(s)
- Y Jiang
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Y F Zhang
- Department of Neurology, Guangzhou Brain Hospital, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - M Liu
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - L L Ma
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - F H Peng
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Q L Huang
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - X M Ma
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - X H Chen
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Dai T, Wu X, Zhou S, Wang Q, Li D. Clinical manifestations and cerebrospinal fluid status in ocular syphilis in HIV-Negative patients. BMC Infect Dis 2016; 16:245. [PMID: 27266701 PMCID: PMC4895961 DOI: 10.1186/s12879-016-1586-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/19/2016] [Indexed: 01/09/2023] Open
Abstract
Background Syphilis with ocular involvement has reemerged as a critical health problem. The aim of the present study was to explore the clinical manifestations and cerebrospinal fluid (CSF) status in ocular syphilis in human immunodeficiency virus (HIV)-negative patients. Methods The clinical records of patients with ocular syphilis presenting to the Shanghai Xuhui Central Hospital in the period from January 2011 to December 2012 were retrospectively reviewed. Results The median age of 25 HIV-negative patients with ocular syphilis was 53 years, 18 patients (72.0 %) were males and 7 (28.0 %) were females. None of them self-identified themselves as men who had sex with men (MSM). The ocular lesions included: uveitis (13 cases), optic neuropathy (6 cases), retinal vasculitis (5 cases), retinal detachment (3 cases), and neuroretinitis (4 cases). Serum toluidine red unheated serum test (TRUST) titer ranged from 1 to 512, with a median of 64. Overall, 18 (72.0 %) of the 25 patients had abnormal CSF results, 15 (60.0 %) CSF samples had elevated white blood cell counts, 13 (52.0 %) had elevated protein levels, and 9 (36.0 %) had reactive CSF Venereal Disease Research Laboratory (VDRL) test, respectively. Mann–Whitney U tests showed higher serum TRUST titer (>32) correlated with the abnormal CSF results. Conclusions The demographic characteristics of patients with ocular syphilis in this study were different from previous reports. The study showed a high CSF abnormal rate in HIV-negative patients. The recommendation for CSF examination from all patients with ocular syphilis, including HIV-negative cases, is strongly supported by the present data.
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Affiliation(s)
- Ting Dai
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China.
| | - Xinjun Wu
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Shaona Zhou
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Qianqiu Wang
- Department of Clinical Management, National Center for STD Control, Nanjing, Jiangsu, People's Republic of China
| | - Daning Li
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China.
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Khairullin R, Vorobyev D, Obukhov A, Kuular UH, Kubanova A, Kubanov A, Unemo M. Syphilis epidemiology in 1994-2013, molecular epidemiological strain typing and determination of macrolide resistance in Treponema pallidum in 2013-2014 in Tuva Republic, Russia. APMIS 2016; 124:595-602. [PMID: 27102715 DOI: 10.1111/apm.12541] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
The incidence of syphilis in the Tuva Republic (geographical centre of Asia), Russia has been exceedingly high historically. No detailed examinations and no molecular investigations of Treponema pallidum strains transmitted in the Tuva Republic, or in general, in Russia, were published internationally. We examined the syphilis epidemiology in 1994-2013, and the molecular epidemiology and macrolide resistance in T. pallidum strains in 2013-2014 in the Tuva Republic. Among 95 mainly primary or secondary syphilis patients, the arp, tpr, tp0548 and 23S rRNA genes in 85 polA gene-positive genital ulcer specimens were characterized. The syphilis incidence in Tuva Republic peaked in 1998 (1562), however declined to 177 in 2013. Among the 70 (82%) completely genotyped specimens, six molecular strain types were found. Strain type 14d/f accounted for 91%, but also 14c/f, 14d/g, 14b/f, 14i/f, 9d/f, and 4d/f were identified. Two (2.4%) specimens contained the 23S rRNA A2058G macrolide resistance mutation. This is the first internationally published typing study regarding T. pallidum in Russia, performed in the Tuva Republic with the highest syphilis incidence in Russia. The two molecular strain types 4d/f and 9d/f have previously been described only in Eastern and Northern China and for the first time, macrolide-resistant syphilis was described in Russia.
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Affiliation(s)
- Rafil Khairullin
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia.,The State Research Center of Dermatology, Venereology and Cosmetology of The Russian Ministry of Health (SRCDVC), Moscow, Russia
| | - Denis Vorobyev
- The State Research Center of Dermatology, Venereology and Cosmetology of The Russian Ministry of Health (SRCDVC), Moscow, Russia
| | - Andrey Obukhov
- Tuvan Republican Skin and Venereal Diseases Dispensary, Tuva, Russia
| | - Ural-Herel Kuular
- Tuvan Republican Skin and Venereal Diseases Dispensary, Tuva, Russia
| | - Anna Kubanova
- The State Research Center of Dermatology, Venereology and Cosmetology of The Russian Ministry of Health (SRCDVC), Moscow, Russia
| | - Alexey Kubanov
- The State Research Center of Dermatology, Venereology and Cosmetology of The Russian Ministry of Health (SRCDVC), Moscow, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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71
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Saad-Roy CM, Shuai Z, van den Driessche P. A mathematical model of syphilis transmission in an MSM population. Math Biosci 2016; 277:59-70. [PMID: 27071977 DOI: 10.1016/j.mbs.2016.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/01/2016] [Accepted: 03/31/2016] [Indexed: 10/22/2022]
Abstract
Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum, and is a sexually transmitted disease with multiple stages. A model of transmission of syphilis in an MSM population (there has recently been a resurgence of syphilis in such populations) that includes infection stages and treatment is formulated as a system of ordinary differential equations. The control reproduction number is calculated, and it is proved that if this threshold parameter is below one, syphilis dies out; otherwise, if it is greater than one, it is shown that there exists a unique endemic equilibrium and that for certain special cases, this equilibrium is globally asymptotically stable. Using data from the literature on MSM populations, numerical methods are used to determine the variation and robustness of the control reproduction number with respect to the model parameters, and to determine adequate treatment rates for syphilis eradication. By assuming a closed population and no return to susceptibility, an epidemic model is obtained. Final outbreak sizes are numerically determined for various parameter values, and its variation and robustness to parameter value changes is also investigated. Results quantify the importance of early treatment for syphilis control.
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Affiliation(s)
- C M Saad-Roy
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Zhisheng Shuai
- Department of Mathematics, University of Central Florida, Orlando, FL 32816, USA.
| | - P van den Driessche
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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72
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Li Z, Wang P, Gao G, Xu C, Chen X. Age-period-cohort analysis of infectious disease mortality in urban-rural China, 1990-2010. Int J Equity Health 2016; 15:55. [PMID: 27036223 PMCID: PMC4815076 DOI: 10.1186/s12939-016-0343-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 03/03/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although a number of studies on infectious disease trends in China exist, these studies have not distinguished the age, period, and cohort effects simultaneously. Here, we analyze infectious disease mortality trends among urban and rural residents in China and distinguish the age, period, and cohort effects simultaneously. METHODS Infectious disease mortality rates (1990-2010) of urban and rural residents (5-84 years old) were obtained from the China Health Statistical Yearbook and analyzed with an age-period-cohort (APC) model based on Intrinsic Estimator (IE). RESULTS Infectious disease mortality is relatively high at age group 5-9, reaches a minimum in adolescence (age group 10-19), then rises with age, with the growth rate gradually slowing down from approximately age 75. From 1990 to 2010, except for a slight rise among urban residents from 2000 to 2005, the mortality of Chinese residents experienced a substantial decline, though at a slower pace from 2005 to 2010. In contrast to the urban residents, rural residents experienced a rapid decline in mortality during 2000 to 2005. The mortality gap between urban and rural residents substantially narrowed during this period. Overall, later birth cohorts experienced lower infectious disease mortality risk. From the 1906-1910 to the 1941-1945 birth cohorts, the decrease of mortality among urban residents was significantly faster than that of subsequent birth cohorts and rural counterparts. CONCLUSIONS With the rapid aging of the Chinese population, the prevention and control of infectious disease in elderly people will present greater challenges. From 1990 to 2010, the infectious disease mortality of Chinese residents and the urban-rural disparity have experienced substantial declines. However, the re-emergence of previously prevalent diseases and the emergence of new infectious diseases created new challenges. It is necessary to further strengthen screening, immunization, and treatment for the elderly and for older cohorts at high risk.
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Affiliation(s)
- Zhi Li
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
| | - Peigang Wang
- Global Health Institute, Wuhan University, Wuhan, China.
| | - Ge Gao
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
| | - Chunling Xu
- School of Basic Medical Sciences, Peking University, Beijing, China
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, FLorida, USA
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73
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Zhang X, Zhang T, Pei J, Liu Y, Li X, Medrano-Gracia P. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012. PLoS One 2016; 11:e0149401. [PMID: 26901682 PMCID: PMC4763154 DOI: 10.1371/journal.pone.0149401] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. METHODS In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). RESULTS The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. CONCLUSION Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis.
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Affiliation(s)
- Xingyu Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Jiao Pei
- Department of Science and Education, Sichuan Cancer Hospital & Institute, Sichuan, China
| | - Yuanyuan Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Xiaosong Li
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
- * E-mail:
| | - Pau Medrano-Gracia
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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Epidemic Profile of Maternal Syphilis in China in 2013. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9194805. [PMID: 26981537 PMCID: PMC4766319 DOI: 10.1155/2016/9194805] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/14/2016] [Indexed: 11/21/2022]
Abstract
Objective. The aim of this study was to investigate the epidemiological characteristics and adverse pregnancy outcomes of pregnant women with syphilis infection in China. Methods. Data were from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Women who were registered in the system and delivered in 2013 were included in the analysis. Results. A total of 15884 pregnant women with syphilis infection delivered in China in 2013. 79.1% of infected women attended antenatal care at or before 37 gestational weeks; however, 55.4% received no treatment or initiated the treatment after 37 gestational weeks. 14.0% of women suffered serious adverse pregnancy outcomes including stillbirth/neonatal death, preterm delivery/low birth weight, or congenital syphilis in newborns. High maternal titer (≥1 : 64) and late treatment (>37 gestational weeks)/nontreatment were significantly associated with increased risk of congenital syphilis and the adjusted ORs were 1.88 (95% CI 1.27 to 2.80) and 3.70 (95% CI 2.36 to 5.80), respectively. Conclusion. Syphilis affects a great number of pregnant women in China. Large proportions of women are not detected and treated at an early pregnancy stage. Burden of adverse pregnancy outcomes is high among infected women. Comprehensive interventions still need to be strengthened to improve uptake of screening and treatment for maternal syphilis.
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75
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Benzathine penicillin G for the management of early syphilis among HIV co-infected persons: A systematic review. ACTA ACUST UNITED AC 2016; 42:30-36. [PMID: 29770001 DOI: 10.14745/ccdr.v42i02a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The optimal treatment for syphilis in people who are human immunodeficiency virus (HIV) positive is controversial. Objective To assess the efficacy of three doses versus a single dose of long acting Benzathine Penicillin G (BP-G) for the effective management of early syphilis among HIV co-infected populations. Methods A systematic search of the published literature was conducted using MEDLINE and EMBASE databases to identify clinical and observational studies published between January 2010 and May 2015. Inclusion criteria were: publication in English or French, populations co-infected with HIV and early syphilis, treatment with BP-G and outcomes related to syphilis treatment. All articles underwent a risk of bias assessment and data extraction was completed on all included studies. Results Seven studies were eligible for final inclusion, data extraction and analysis. The evidence from the final included studies were from non-randomized controlled trials. In general, no significant differences were found between groups treated with one versus two or more doses of BP-G; but there was a trend toward longer time to treatment failure with three doses. Differences in methodology limit the ability to draw any firm conclusions on the relative efficacy between these two treatment regimens. Conclusion Insufficient data exist to ascertain whether or not there is an added benefit from additional doses of BP-G for the treatment of early syphilis with HIV co-infection. A high-quality, randomized controlled trial is needed to definitively nswer this question.
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76
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Liu Z, Zhang C, Kakudo K, Cui X, Mu K, Zhou C, Wang Y, Chen S, Zhou G. Diagnostic pitfalls in pathological diagnosis of infectious disease: patients with syphilitic lymphadenitis often present with inconspicuous history of infection. Pathol Int 2016; 66:142-147. [PMID: 28544669 DOI: 10.1111/pin.12384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
Retrospective study was applied to 16 cases of syphilitic lymphadenitis to elucidate the pathological diagnostic features. The typical morphology of syphilitic lymphadenitis includes: (i) well preserved or partially destroyed lymph node structure; (ii) reactive hyperplasia of lymph follicles with broadened germinal centers in the cortex and medulla of the lymph node; (iii) thickened fibrotic lymph node capsules with infiltration of plasma cells; and (iv) phlebitis and endarteritis in varying degree. Additional morphology includes: (i) focal histiocytes with ingested debris; (ii) noncaseating granuloma with epithelioid histiocytes and disperse giant cells; and (iii) hyperplastic centroblast and occasionally isolated mononuclear Reed-Sternberg cell-like giant cells. Treponema pallidum was identified in 15 of the 16 cases by immunohistochemical staining. The histopathological diagnosis of syphilitic lymphadenitis poses difficulty in differentiation from other infectious or neoplastic lymphadenopathies. The newly established Treponema pallidum antibody is sensitive to identification of Treponema pallidum in formalin fixed paraffin embedded tissue.
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Affiliation(s)
- Zhiyan Liu
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Chunyan Zhang
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Nara, Japan
| | - Xiujie Cui
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Kun Mu
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Chengjun Zhou
- Department of Pathology, The second Hospital of Shandong University, Jinan, Shandong, China
| | - Yan Wang
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Shiming Chen
- Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Gengyin Zhou
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China
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77
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Kim WJ, Ahn JH, Kim MM. Ocular Syphilis Presenting as both Optic Neuritis and Chorioretinitis in both Eyes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.5.857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won-Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jang-Hwan Ahn
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung-Mi Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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78
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Li Z, Feng Z, Liu P, Yan C. Screening for antibodies against Treponema pallidum with chemiluminescent microparticle immunoassay: analysis of discordant serology results and clinical characterization. Ann Clin Biochem 2015; 53:588-92. [PMID: 26680646 DOI: 10.1177/0004563215623806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traditionally, testing for syphilis has consisted of initial screening with a non-treponemal test, then retesting reactive specimens with a treponemal test. Recent availability of a chemiluminescent microparticle immunoassay for detecting antibodies against Treponema pallidum has led several laboratories in China to adopt chemiluminescent microparticle immunoassay for screening of syphilis, with subsequent testing of reactive serum samples with non-treponemal tests. We evaluated the utility of chemiluminescent microparticle immunoassay for routine screening of syphilis. METHODS Antibodies against Treponema pallidum were screened in 20,550 serum samples using chemiluminescent microparticle immunoassay. Chemiluminescent microparticle immunoassay-positive samples were reflexively tested with rapid plasma reagin tests and Treponema pallidum particle agglutination assays. Dot-immunoblot assays were used to confirm results of chemiluminescent microparticle immunoassay-positive and Treponema pallidum particle agglutination-negative serum samples. RESULTS Overall, 267 samples (1.3%) were chemiluminescent microparticle immunoassay-positive, and 185 (69.3%) of those chemiluminescent microparticle immunoassay-positive serum samples were also Treponema pallidum particle agglutination-positive. Samples' signal to cut-off ratio for chemiluminescent microparticle immunoassay correlated with diagnostic reliability, as greater samples' signal to cut-off ratio corresponded with greater concordance between chemiluminescent microparticle immunoassay and Treponema pallidum particle agglutination results. Dot-immunoblot testing of 82 chemiluminescent microparticle immunoassay-positive and Treponema pallidum particle agglutination-negative serum samples showed that 16 samples (19.5%) were Dot-immunoblot-positive, 28 (34.2%) were indeterminate and 38 (46.3%) were negative. CONCLUSIONS Because there is a certain percentage of false-positive results using chemiluminescent microparticle immunoassay for routine screening of syphilis, further analysis by Treponema pallidum particle agglutination is recommended to confirm diagnostic results. While in screening populations discrepancies between chemiluminescent microparticle immunoassay and Treponema pallidum particle agglutination results are quite prevalent, confirmation by immunoblot assay may be useful.
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Affiliation(s)
- Zhiyan Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Zhenru Feng
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Ping Liu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Cunling Yan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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79
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Cheng Z, Luo SX, Sun X, Sun S, Wang Z, Jiang Y, An Z, Wang Q. Surgical treatment of syphilitic superficial femoral artery aneurysm: a rare case report. BMC Infect Dis 2015; 15:540. [PMID: 26589681 PMCID: PMC4654907 DOI: 10.1186/s12879-015-1239-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022] Open
Abstract
Background Arterial aneurysm is a known complication of syphilis, but the occurrence of femoral artery aneurysm secondary to the syphilitic disease has never been reported. Case presentation The present study described a 60-year-old Chinese male who presented with two aneurysms in the middle and lower segment of the right superficial femoral artery causing the symptoms of pain, coldness and numbness in the right lower limb. This case was diagnosed with syphilitic superficial femoral aneurysm because of positive syphilitic testing and the inflammatory cell infiltration around the adventitial vasa vasorum under the pathological examination. Anti-syphilis treatment, stent graft implantation and open surgery were attempted to eliminate the syphilis and aneurysm, which was ultimately successful, with no symptoms after a follow-up of 3 months. Conclusion Combined open and endovascular repair may be effective and safe for treatment of syphilitic femoral artery aneurysms.
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Affiliation(s)
- Zhihua Cheng
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Sean X Luo
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Xiwei Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Siqiao Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Zhongying Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Yuzhu Jiang
- Department of Vascular Surgery, Panshi City Hospital, Panshi, 132300, Jilin Province, China.
| | - Zhiyuan An
- Department of Vascular Surgery, Panshi City Hospital, Panshi, 132300, Jilin Province, China.
| | - Qi Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
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Xu S, Wang Q, Zhang W, Qiu Z, Cui J, Yan W, Ni A. Seroprevalence of the Hepatitis B, Hepatitis C, and Human Immunodeficiency Viruses and Treponema pallidum at the Beijing General Hospital from 2010 to 2014: A Cross-Sectional Study. PLoS One 2015; 10:e0140854. [PMID: 26502175 PMCID: PMC4621017 DOI: 10.1371/journal.pone.0140854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022] Open
Abstract
Background The hepatitis B, hepatitis C, human immunodeficiency viruses and Treponema pallidum are important causes of infectious diseases concern to public health. Methods Between 2010 and 2014, we used an automated chemiluminescence microparticle immunoassay to detect the hepatitis B, hepatitis C, and human immunodeficiency viruses as well as Treponema pallidum (the rapid plasma regain test was used in 2010–2011). Positive human immunodeficiency virus tests were confirmed via western blotting. Results Among 416,130 subjects, the seroprevalences for hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and Treponema pallidum were 5.72%, 1.23%, 0.196%, and 0.76%, respectively. Among 671 patients with positive human immunodeficiency virus results, 392 cases were confirmed via western blotting. Hepatitis B and human immunodeficiency virus infections were more frequent in men (7.78% and 0.26%, respectively) than in women (4.45% and 0.021%, respectively). The hepatitis B and C virus seroprevalences decreased from 6.21% and 1.58%, respectively, in 2010, to 5.37% and 0.988%, respectively, in 2014. The human immunodeficiency virus seroprevalence increased from 0.04% in 2010 to 0.17% in 2014, and was elevated in the Infectious Disease (2.65%), Emergency (1.71%), and Dermatology and Sexually Transmitted Diseases (1.12%) departments. The specificity of the human immunodeficiency virus screening was 71.4%. The false positive rates for the Treponema pallidum screening tests increased in patients who were 60–70 years old. The co-infection rates for the hepatitis C and human immunodeficiency viruses were 0.47% in hepatitis C virus-positive patients and 7.33% in human immunodeficiency virus-positive patients. Conclusions During 2010–2014, hepatitis B virus and human immunodeficiency virus infections were more frequent among men at our institution. Although the seroprevalences of hepatitis B and C viruses decreased, the seroprevalence of human immunodeficiency virus infection increased (with higher seroprevalences in high-risk departments). Older patients were more likely to exhibit false positive findings for syphilis.
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Affiliation(s)
- Shaoxia Xu
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaofeng Wang
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihong Zhang
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhifeng Qiu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingtao Cui
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjuan Yan
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anping Ni
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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81
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Factors associated with syphilis infection: a comprehensive analysis based on a case-control study. Epidemiol Infect 2015; 144:1165-74. [PMID: 26467944 DOI: 10.1017/s0950268815002344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study aimed to comprehensively evaluate factors that influence the likelihood of syphilis infection from risk-taking behaviours and medical conditions. A retrospective case-control study was conducted by enrolling 664 syphilis inpatients (excluding 11 congenital syphilis patients) and 800 sex- and age-matched controls. Medical histories, clinical data and patient interview data were collected and subjected to logistic regression analyses. The prevalence of syphilis in the study population was 3·9% (675/17,304). By univariate analysis, syphilis infection was associated with migration between cities, marital status, smoking, reproductive history, hypertension, elevated blood urea nitrogen (BUN) and infection with hepatitis B virus (HBV) (P < 0·05). A high rate of syphilis-HBV co-infection was observed in HIV-negative patients and further research revealed an association between syphilis and specific HBV serological reactivity. Syphilis was also associated with the frequency, duration and status of tobacco use. Multivariate analysis indicated that syphilis infection was independently associated with migration between cities [adjusted odds ratio (aOR) 1·368, 95% confidence interval (CI) 1·048-1·785], current smoking (aOR 1·607, 95% CI 1·177-2·195), elevated BUN (aOR 1·782, 95% CI 1·188-2·673) and some serological patterns of HBV infection. To prevent the spread of infectious diseases, inpatients and blood donors should be tested for HIV, syphilis, HBV and HCV simultaneously.
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82
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Zhang W, Du Z, Tang S, Guo P, Ye X, Hao Y. Syphilis in the economic center of South China: results from a real-time, web-based surveillance program. BMC Infect Dis 2015; 15:318. [PMID: 26253119 PMCID: PMC4545813 DOI: 10.1186/s12879-015-1072-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Guangzhou is the economic center of South China, which is currently suffering an insidious re-emergence of syphilis. Syphilis epidemic in this area is a matter of serious concern, because of the special economic position of Guangzhou and its large migrant population. Therefore, a comprehensive analysis of surveillance data is needed to provide further information for developing targeted control programs. Method Case-based surveillance data obtained from a real-time, web-based system were analyzed. A hierarchical clustering method was applied to classify the 12 districts of Guangzhou into several epidemiological regions. The district-level annual incidence and clustering results were displayed on the same map to show the spatial patterns of syphilis in Guangzhou. Results A total of 60,178 syphilis cases were reported during the period from 2005 to 2013, among which primary/secondary syphilis accounted for 15,864 cases (26.36 %), latent syphilis for 41,078 cases (68.26 %) and congenital syphilis for 2,090 cases (3.47 %). Moreover, primary/secondary syphilis burden slightly decreased from 17.5-18.0 cases per 100,000 people in the first years to 10.6 cases per 100,000 in 2013, with latent syphilis largely increasing from 18.5 cases per 100,000 to 43.4 cases per 100,000. Districts of Guangzhou could be classified into 3 epidemiological regions according to the syphilis burden over the last 3 years of the study period. Conclusions The burden of primary/secondary syphilis appears to be decreasing in recent years, whereas that of latent syphilis is increasing. Given the epidemiological features and the annual changes found in this study, it is suggested that future control programs should be more population-specific and spatially targeted. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1072-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wangjian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
| | - Shaokai Tang
- Guangzhou Institute of Dermatology, Guangzhou, 510095, Guangdong Province, China.
| | - Pi Guo
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
| | - Xingdong Ye
- Guangzhou Institute of Dermatology, Guangzhou, 510095, Guangdong Province, China.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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83
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Wu L, Yin YL, Song JL, Chen Y, Wu YF, Zhao L. Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools. EUROPEAN JOURNAL OF DENTAL EDUCATION 2015; 20:206-212. [PMID: 26184829 DOI: 10.1111/eje.12162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst dental students at two Chinese dental schools, as well as important factors that are associated with their career choice and attitudes towards infected patients. SUBJECT AND METHODS The study was conducted using a student self-administered questionnaire from March to June 2013 at two Chinese dental schools. Chi-square tests and multivariable logistic regression were used to compare the categorical variables and identify the variables related to attitudes. RESULTS One hundred and seventy-one students answered the questionnaire (response rate 83%). Most participants had incomplete knowledge about occupational exposure and participants' compliance with the infection control programme during routine clinical work was low. Fifty-six participants (34%) experienced at least one occupational exposure, but only one reported the incident. Percutaneous injuries and mucous membrane exposures were the main causes for exposure. Protection of the eyes and post-exposure management were inadequate. According to most participants, they had received insufficient education. Their concerns about the risk of infectious professional exposure would influence their career choice and approach to patients. Only 14% and 26% of the participants were willing to treat human immunodeficiency virus- and hepatitis B virus-infected patients, respectively. CONCLUSIONS More effective education on prevention and management is required for dental students to reduce the harm caused by occupational exposure. It is important to ensure dental students' knowledge and understanding before allowing them to enter clinical training.
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Affiliation(s)
- L Wu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y-L Yin
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - J-L Song
- Hospital of Stomatology, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Y Chen
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y-F Wu
- Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - L Zhao
- Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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84
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Merli MG, Moody J, Mendelsohn J, Gauthier R. Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic? Demography 2015; 52:919-42. [PMID: 25904346 PMCID: PMC4466078 DOI: 10.1007/s13524-015-0383-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
China's HIV prevalence is low, mainly concentrated among female sex workers (FSWs), their clients, men who have sex with men, and the stable partners of members of these high-risk groups. We evaluate the contribution to the spread of HIV of China's regime of heterosexual relations, of the structure of heterosexual networks, and of the attributes of key population groups with simulations driven by data from a cross-sectional survey of egocentric sexual networks of the general population of Shanghai and from a concurrent respondent-driven sample of FSWs. We find that the heterosexual network generated by our empirically calibrated simulations has low levels of partner change, strong constraints on partner selection by age and education, and a very small connected core, mainly comprising FSWs and their clients and characterized by a fragile transmission structure. This network has a small HIV epidemic potential but is compatible with the transmission of bacterial sexually transmitted infections (STIs), such as syphilis, which are less susceptible to structural breaks in transmission of infection. Our results suggest that policies that force commercial sex underground could have an adverse effect on the spread of HIV and other STIs.
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Affiliation(s)
- M Giovanna Merli
- Duke Population Research Institute, Sanford School of Public Policy, Department of Sociology and Duke Global Health Institute, Duke University, Box 90312, Durham, NC, 27708, USA,
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85
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Wu D, Hawkes S, Buse K. Prevention of mother-to-child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination? Int J Gynaecol Obstet 2015; 130 Suppl 1:S32-6. [PMID: 25968490 PMCID: PMC4510314 DOI: 10.1016/j.ijgo.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20 years prior to 2010. Methods We undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010. Results We identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization. Conclusion A dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.
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Affiliation(s)
- Dadong Wu
- Institute for Global Health, University College London, London, UK
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK.
| | - Kent Buse
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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Muessig KE, Bien CH, Wei C, Lo EJ, Yang M, Tucker JD, Yang L, Meng G, Hightow-Weidman LB. A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China. J Med Internet Res 2015; 17:e100. [PMID: 25900881 PMCID: PMC4420841 DOI: 10.2196/jmir.3370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/19/2014] [Accepted: 02/05/2015] [Indexed: 01/16/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care. Objective This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns. Conclusions MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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87
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Ren RX, Wang LN, Zheng HY, Li J. No improvement in serological response among serofast latent patients retreated with benzathine penicillin. Int J STD AIDS 2015; 27:58-62. [PMID: 25691394 DOI: 10.1177/0956462415573677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 11/17/2022]
Abstract
Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.
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Affiliation(s)
- Rong-Xin Ren
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin-Na Wang
- Department of Dermatology and Venereology, Coal General Hospital, Beijing, China
| | - He-Yi Zheng
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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88
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Ye X, Tang SK, Dai X, He W, Zhu H, Zhang X. Over reporting of congenital syphilis in Guangzhou, China. Sex Health 2015; 12:174-5. [PMID: 25587890 DOI: 10.1071/sh14142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to evaluate the rationality of congenital syphilis (CS) cases reported by physicians in hospitals of various levels in Guangzhou, China. The over-reporting rate was calculated. The results suggested that 49.1% (54 out of 110) of the CS cases reviewed were identified as cases that should be reported; 18 of the 54 CS case were confirmed CS cases and 50.9% (56 out of 110) were identified as over reported. Factors associated with CS case misclassification were analysed. To decrease the incidence of CS, antenatal care management and rapid plasma reagin titres should be provided and the follow up for children should be raised.
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Affiliation(s)
- Xingdong Ye
- Department of Health Care, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
| | - Shao-Kai Tang
- Department of Health Care, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
| | - Xiangnong Dai
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
| | - Wanping He
- Department of Health Care, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
| | - Huilan Zhu
- Department of Health Care, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
| | - Xibao Zhang
- Department of Health Care, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, 510095, China
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Zheng N, Guo Y, Padmadas S, Wang B, Wu Z. The increase of sexually transmitted infections calls for simultaneous preventive intervention for more effectively containing HIV epidemics in China. BJOG 2014; 121 Suppl 5:35-44. [PMID: 25335839 DOI: 10.1111/1471-0528.12999] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the priority public health challenges with respect to the development of multipurpose prevention technologies in China. DESIGN Review of published literature, databases of state and local disease control agencies and unpublished data relating to HIV and other sexually transmitted infections (STIs). SETTING China. POPULATION General and migrant populations. METHODS Review of published data, government reports and databases of China Disease Control agencies, and our unpublished studies. MAIN OUTCOME MEASURES Reported STI incidence, particularly HIV, syphilis, chlamydia and genital herpes, and the migrant population with respect to disease transmission. RESULTS We found that the reported STI incidence increases along with that of HIV and showed significant geographic overlap with HIV. Economic migrant workers may facilitate the spread of STIs, including HIV. CONCLUSIONS To more effectively contain the HIV epidemic, it is imperative to develop preventive measures to simultaneously target HIV and other STIs. We recommend that the development of multipurpose prevention technologies in China should target HIV and STIs.
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Affiliation(s)
- N Zheng
- Centre for Public Health Research, Nanjing University, Nanjing, China; State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, China
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Hu QH, Xu JJ, Zou HC, Liu J, Zhang J, Ding HB, Qian HZ, Li SR, Liu Y, Jiang YJ, Shang H, Wang N. Risk factors associated with prevalent and incident syphilis among an HIV-infected cohort in Northeast China. BMC Infect Dis 2014; 14:658. [PMID: 25471736 PMCID: PMC4265485 DOI: 10.1186/s12879-014-0658-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022] Open
Abstract
Background Sexually transmitted infections (STIs) increase HIV infectivity through local inflammatory processes. Prevalent and incident STIs among people who live with HIV/AIDS (PLWHA) are indicators of high-risk sexual behaviors and imply potential spread of HIV. Little is known about the prevalence and incidence of concurrent syphilis and associated risk behaviors among PLWHA in China. Methods A retrospective cohort study was conducted among PLWHA who attended the outpatient clinic of a designated AIDS treatment hospital in Shenyang, China, between March 2009 and May 2013. Physical examinations and syphilis serology were conducted at each visit. A questionnaire on demographic characteristics was also collected. Results A total of 1010 PLWHA were enrolled, of whom 77.0% were men who have sex with men (MSM). The baseline syphilis prevalence among PLWHA was 19.8% (95% confidence interval [CI]:17.3–22.3%). During follow-up, 78.3% retained in the cohort, and contributed a median follow-up of 9.4 months (interquartile range: 5.9-18.7 months). Syphilis incidence among PLWHA was 18.7 (95% CI: 15.5–21.8) per 100 person years. Mulitvariate logistic analysis showed that receiving antiretroviral therapy (ART) (adjusted OR [aOR] = 0.48), older age (≥40 years vs. ≤24 years, aOR = 2.43), being MSM (aOR = 2.30) and having higher baseline HIV viral load (>100000 copies/mL vs. ≤100000 copies/mL, aOR = 1.56) were independent predictors for syphilis infection among PLWHA at enrollment (p < 0.05 for all). Mulivariate Cox regression found that receiving ART (adjusted hazard ratio [aHR] = 1.81), older age (≥40 years vs. ≤24 years, aHR: 5.17) and MSM status (aHR = 2.68) were independent risk factors for syphilis seroconversion (each p < 0.05). Conclusions Syphilis prevalence and incidence were high among PLWHA in Shenyang. A campaign focusing on detection and treatment of syphilis among PLWHA is urgently needed, especially one with a focus on MSM who are at a higher risk for syphilis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0658-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing-hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jun-jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hua-chun Zou
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, 2052, Australia.
| | - Jing Liu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hai-bo Ding
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Si-ruo Li
- English Department, University of Tennessee at Chattanooga, Chattanooga, TN, USA.
| | - Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Yong-jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Ning Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Reduction in mother-to-child transmission of syphilis for 10 years in Shenzhen, China. Sex Transm Dis 2014; 41:188-93. [PMID: 24521725 DOI: 10.1097/olq.0000000000000097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Untreated maternal syphilis can result in the fetuses being infected. Severe adverse pregnancy outcomes include stillbirth, perinatal death, low birth weight, and congenital syphilis (CS). The World Health Organization has already classified global elimination of CS as a priority. However, this preventable disease is still threatening people's health in the world. METHODS A Programme of Prevention of Mother-to-Child Transmission of Syphilis in Shenzhen was launched in 2002. All pregnant women in Shenzhen were screened for syphilis by serological methods at their first prenatal care visit. The infected individuals were treated with 3 weekly injections of 2.4 million units of benzathine penicillin. The babies were followed up until 18 months old to diagnose CS. RESULTS Up to 2011, the Programme of Prevention of Mother-to-Child Transmission of Syphilis in Shenzhen screened 2,077,362 pregnant women and intervened in 7668 mothers infected with syphilis. The screened rate among pregnant women increased from 89.8% in 2002 to 97.4% in 2011. The proportion of those having adverse pregnant outcomes (including spontaneous abortion, premature delivery, and stillbirth) decreased from 27.3% in 2003 to 8.2% in 2011. The incidence of CS decreased from 115/100,000 in 2002 to 10/100,000 (live births) in 2011. CONCLUSIONS In 2002, in the face of rising CS numbers, Shenzhen adapted a syphilis control program that involved cost-free testing for pregnant women, commitment and collaboration at multiple levels of the health system, and strong supervision and government guidance. Local program and surveillance data suggest that the program has been very successful in reducing CS incidence.
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92
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Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China. Sex Transm Dis 2014; 41:103-10. [PMID: 24413489 DOI: 10.1097/olq.0000000000000085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In China, recent rises in syphilis and HIV cases have increased the focus on preventing mother-to-child transmission of these infections. We assess the health and economic outcomes of different strategies of prenatal HIV and syphilis screening from the local health department's perspective. METHODS A Markov cohort decision analysis model was used to estimate the health and economic outcomes of pregnancy using disease prevalence and cost data from local sources and, if unavailable, from published literature. Adverse pregnancy outcomes included induced abortion, stillbirth, low birth weight, neonatal death, congenital syphilis in live-born infants, and perinatal HIV infection. We examined 4 screening strategies: no screening, screening for HIV only, for syphilis only, and for both HIV and syphilis. We estimated disability-adjusted life years (DALYs) for each health outcome using life expectancies and infections for mothers and newborns. RESULTS For a simulated cohort of 10,000 pregnant women (0.07% prevalence for HIV and 0.25% for syphilis; 10% of HIV-positives were coinfected with syphilis), the estimated costs per DALY prevented were as follows: syphilis-only, $168; HIV-and-syphilis, $359; and HIV-only, $5636. The estimated incremental cost-effectiveness ratio if an existing HIV-only strategy added syphilis screening (i.e., move from the HIV-only strategy to the HIV-and-syphilis strategy) was $140 per additional DALY prevented. CONCLUSIONS Given the increasing prevalence of syphilis and HIV among pregnant women in China, prenatal HIV screening programs that also include syphilis screening are likely to be substantially more cost-effective than HIV screening alone and prevent many more adverse pregnancy outcomes.
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Abstract
OBJECTIVE The present study aimed to estimate the prevalence of syphilis among men who have sex with men (MSM) currently married with women in cities of China and examine the related factors for syphilis among them. METHODS "Snowballing" sampling was used to recruit participants in 4 cities from April 2008 to August 2009. Information of participants was collected anonymously and remained confidential. Blood samples were collected from all eligible participants for HIV and syphilis tests. RESULTS A total of 858 men participated in the study, and their average age was 38.3 years (ranged from 21 to 75 years). Fifty-three percent did not have residence cards, 37% accepted junior high school education or less, and 41% identified themselves as gay. The prevalence of HIV and syphilis was 8.0% and 17.9%, respectively. Older age, less education, homosexual orientation, the sex of the first sexual partner, residential places, and HIV infection were significantly associated with syphilis infection. Gay had higher proportions of some risk sexual behaviors than did non-gay-identified participants, including the first insert sex before 18 years (17.9% vs. 13.0%), the first male sex partner (49.0% vs. 34.3%) anal sex in the last 6 months (88.0% vs. 83.0%), noncondom use in the last anal sex (35.9% vs. 28.0%), and never use condom in anal sex in the last 6 months (14.8% vs. 9.1%). Non-gay-identified participants had a higher proportion of having opposite sex than did gay participants (70.8% vs. 43.0%). CONCLUSIONS Currently married MSM had a high prevalence of syphilis, and preventive interventions should be developed to control syphilis transmissions among currently married MSM via extromarital sex and intromarital opposite sex.
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Tang W, Babu GR, Li J, Zhang Y, Fu G, Huan X, Tucker JD, Zhao J, Detels R. The difference between HIV and syphilis prevalence and incidence cases: results from a cohort study in Nanjing, China, 2008-2010. Int J STD AIDS 2014; 26:648-55. [PMID: 25249593 DOI: 10.1177/0956462414550170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Abstract
The available estimates of incidence and prevalence of syphilis among men who have sex with men (MSM) in Mainland China are high. We used respondent-driven sampling to recruit MSM in the study population. The participants were followed up to monitor the incidence and change of risk behaviours. A face-to-face interview was used to collect information about high-risk behaviours, demographics and recreational drug use. To test the difference between prevalent and incident cases, two nested matched case-control studies were carried out. The cases were the HIV or syphilis positives found at baseline and during follow-up. We used density sampling to sample six controls for each case. Our results indicate that compared to incident cases, prevalent cases had a higher proportion of reported unprotected anal intercourse for both HIV and syphilis. Regression analysis indicated that unprotected anal intercourse was the main risk factor among HIV-prevalent cases but not in HIV-incident cases. These differences could possibly be explained by the implementation of the risk reduction interventions. Syphilis was not a risk factor for HIV-prevalent cases but was highly associated with HIV-incident cases. Tailored interventions addressing unprotected anal intercourse and other risk factors can help to reduce the prevalence and incidence of HIV and syphilis.
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Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Giridhara R Babu
- Public Health Foundation of India, IIPH-H wing, Bangalore, India
| | - Jianjun Li
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ye Zhang
- University of North Carolina Project-China, Guangzhou, China
| | - Gengfeng Fu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiping Huan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Joseph D Tucker
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jinkou Zhao
- Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Roger Detels
- Department of Epidemiology, University of California, Los Angeles, CA, USA
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95
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Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China. Eur J Clin Microbiol Infect Dis 2014; 33:2183-98. [PMID: 24973132 DOI: 10.1007/s10096-014-2186-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this investigation was to assess the effectiveness of an intervention program on mother-to-child transmission (MTCT) of syphilis and investigate determinants of congenital syphilis (CS) and adverse pregnancy outcomes (APOs). The Shenzhen local government initiated an intervention program of MTCT of syphilis in 2001. Based on this program, maternal and paternal factors associated with CS and APOs among syphilitic women were investigated from 2007 to 2012 by a prospective cohort study. From 2002 to 2012, 2,441,237 pregnant women were screened and screening coverage reached 97.2 % in 2012. In the background of continuing growth of CS in China, CS in Shenzhen significantly decreased from 109.3 cases in 2002 to 9.9 cases in 2012 per 100,000 live births. Maternal education (adjusted odds ratio [aOR]CS = 0.65; aORAPOs = 0.79) and history of syphilis (aORCS = 0.28; aORAPOs = 0.61), as well as paternal age (aORCS = 0.62; aORAPOs = 0.86) and education (aORCS = 0.66; aORAPOs = 0.86) were negatively associated with CS and APOs, but maternal unmarried status (aORCS = 1.95; aORAPOs = 2.61), inadequate antenatal care (ANC) (aORCS = 3.61; aORAPOs = 1.79), more sexual partners (aORCS = 1.51; aORAPOs = 1.39), every week of delay in treatment (aORCS = 2.82; aORAPOs = 1.27), higher baseline titers of nontreponemal antibodies (aORCS = 5.65; aORAPOs = 1.47), early syphilis (aORCS = 23.24; aORAPOs = 26.95), and non-penicillin treatment (aORCS = 3.00; aORAPOs = 2.16), as well as paternal history of cocaine use (aORCS = 2.70; aORAPOs = 2.44) and positive (aORCS = 4.14; aORAPOs = 1.50) or unknown (aORCS = 2.37; aORAPOs = 2.06) status of syphilis increased the risk of CS and APOs. Condom use (aOR = 0.70) decreased MTCT of syphilis. A ten-year program consisting of screening and treatment, early ANC, health education, partners tracking, detection, and treatment, follow-up visits, and information management is an effective means to block MTCT of syphilis. Maternal and paternal factors constituted two separate profiles associated with MTCT of syphilis.
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96
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Cohen SE, Klausner JD, Engelman J, Philip S. Syphilis in the modern era: an update for physicians. Infect Dis Clin North Am 2014; 27:705-22. [PMID: 24275265 DOI: 10.1016/j.idc.2013.08.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Syphilis is a complex, systemic disease caused by the spirochete Treponema pallidum. Syphilis is most commonly transmitted sexually or congenitally and can involve nearly every organ system. Its clinical progression involves several well-characterized stages: an incubation period, a primary stage, a secondary stage, a latent stage, and a late or tertiary stage. Syphilis during pregnancy is a leading cause of perinatal mortality in sub-Saharan Africa and can cause spontaneous abortion, stillbirth, prematurity, low birth weight, or congenital syphilis. Penicillin is highly effective against syphilis and remains the treatment of choice. This article reviews the epidemiology, clinical features, diagnostic approach, treatment, and prevention of syphilis.
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Affiliation(s)
- Stephanie E Cohen
- Population Health Division, San Francisco City Clinic, San Francisco Department of Public Health, 356 7th Street, San Francisco, CA 94103, USA.
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97
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Molecular typing of Treponema pallidum causing early syphilis in China: a cross-sectional study. Sex Transm Dis 2014; 39:42-5. [PMID: 22183845 DOI: 10.1097/olq.0b013e318232697d] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There have been limited data on molecular epidemiology of syphilis in China. This study aimed to analyze strain type distribution of Treponema pallidum causing early syphilis across geographic areas in China using an enhanced method. METHODS Genital samples were collected from patients in East, South, and North China. Positive DNA of T. pallidum was analyzed by arp, tpr, and tp0548 genes. RESULTS Sufficient DNA for full molecular typing existed in 197 of 324 samples, and 27 strain types were identified. A range of 3 to 20 repeats (except 4, 11, and 19 repeats) and 25 repeats were found for the 60-bp tandem repeats of the arp gene. This was the first time the 9 and 25 repeats were detected. For the RFLP analysis of the tpr genes, patterns a, d, h, j, and l were identified. This was the first time the h, j, and l patterns were observed in China. For the sequence analysis of the tp0548 gene, sequences c, e, and f were identified. Strain type distribution was significantly different across geographic areas (χ² = 20.6, P = 0.006). Overall, 14d/f was most predominant (39% of fully typed samples, 95% CI = 32%-46%); 13d/f, 15d/f, and 16d/f were next most common (each 13% of fully typed samples, 95% CI = 9%-18%). CONCLUSIONS There is substantial genetic diversity of T. pallidum in China. The broad and ununiform distribution of strain types may reflect differences in regional sexual network patterns. Predominance of few strain types may indicate a linked transmission.
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98
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Zhiyan L, Meiling W, Ping L, Jinhua D, Zhenlin Y, Zhenru F. Consistency Between Treponema pallidum Particle Agglutination Assay and Architect Chemiluminescent Microparticle Immunoassay and Characterization of Inconsistent Samples. J Clin Lab Anal 2014; 29:281-4. [PMID: 24840601 DOI: 10.1002/jcla.21765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 01/13/2014] [Accepted: 03/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Treponema pallidum particle agglutination assay (TPPA) has been shown to be highly sensitive and specific at detecting treponemal antibodies and is still used as a confirmatory method in many laboratories, in China. In clinical practice, we found that a significant number of TPPA-negative sera were identified when TPPA was used as a confirmatory assay of Architect chemiluminescent microparticle immunoassay (CMIA) screening-reactive sera. AIMS To investigate the consistency between Architect CMIA and TPPA, and analyzed the characterization of TPPA-negative sera following Screening by Architect CMIA. METHODS According to the laboratory syphilis confirmatory testing protocol, a total of 4870 sera were initially tested by Architect CMIA and ELISA, and then the samples which shown positive results were tested by TPPA and rapid plasma reagin tests (RPR). Further analysis using Euroimmun dot-immunoblot (dot-IBT) assay was performed to the CMIA positive and TPPA negative samples. RESULTS In our cohort, we found that the positive rate of CMIA was 3.1% (149/4870). One hundred and twelve of 112 (75.2%) CMIA-positive sera were TPPA reactive, while 37 (24.8%) sera which were reactive in CMIA were nonreactive by TPPA. Dot-IBT testing was performed on these 37 sera: 8 (21.6%) were dot-IBT positive, 11 (29.7%) were indeterminate and 18 (48.6%) negative. DISCUSSION In this study, we observed that 18 CMIA-positive sera were false positives confirmed by dot-IBT. But, given the relatively high levels of early syphilis, we consider a small increase in the number of confirmatory tests is worthwhile if we can increase the detection of primary syphilis by 20%. We also found that significant numbers (8/37) of CMIA-positive and TPPA-negative sera were shown by further dot-IBT testing to be positive. The reason why certain sera are negative by TPPA but reactive by CMIA and other syphilis confirmatory assays is not clear, and these initial findings should be further explored. CONCLUSION The Architect CMIA is a highly sensitive screening assay for detecting syphilis but it is significantly less specific. Further analysis by TPPA is recommended to confirm the results. We would highlight the fact that in repeatedly screened populations discrepancies between treponemal CMIA and TPPA results are quite prevalent. This seems to be a function of very low levels of syphilis-specific antibodies. Confirmation by immunoblot assay may be useful.
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Affiliation(s)
- Li Zhiyan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Wang Meiling
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Liu Ping
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Dong Jinhua
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Yan Zhenlin
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Feng Zhenru
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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99
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Merli MG, Moody J, Smith J, Li J, Weir S, Chen X. Challenges to recruiting population representative samples of female sex workers in China using Respondent Driven Sampling. Soc Sci Med 2014; 125:79-93. [PMID: 24834869 DOI: 10.1016/j.socscimed.2014.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 03/03/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022]
Abstract
We explore the network coverage of a sample of female sex workers (FSWs) in China recruited through Respondent Drive Sampling (RDS) as part of an effort to evaluate the claim of RDS of population representation with empirical data. We take advantage of unique information on the social networks of FSWs obtained from two overlapping studies--RDS and a venue-based sampling approach (PLACE)--and use an exponential random graph modeling (ERGM) framework from local networks to construct a likely network from which our observed RDS sample is drawn. We then run recruitment chains over this simulated network to assess the assumption that the RDS chain referral process samples participants in proportion to their degree and the extent to which RDS satisfactorily covers certain parts of the network. We find evidence that, contrary to assumptions, RDS oversamples low degree nodes and geographically central areas of the network. Unlike previous evaluations of RDS which have explored the performance of RDS sampling chains on a non-hidden population, or the performance of simulated chains over previously mapped realistic social networks, our study provides a robust, empirically grounded evaluation of the performance of RDS chains on a real-world hidden population.
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Affiliation(s)
- M Giovanna Merli
- Sanford School of Public Policy & Duke Global Health Institute, Duke Population Research Institute, Duke University, Box 90312, Durham, NC 27708, USA; Department of Sociology, Duke University, Durham, NC 27708, USA.
| | - James Moody
- Department of Sociology, Duke University, Durham, NC 27708, USA
| | - Jeffrey Smith
- Department of Sociology, University of Nebraska, Lincoln, NE 68508, USA
| | - Jing Li
- National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China
| | - Sharon Weir
- The Carolina Population Center and the Department of Epidemiology, Gillings School of Global Public Health, Campus Box 8120, University of North Carolina at Chapel Hill, Chapel Hill, NC 27546, USA
| | - Xiangsheng Chen
- National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China
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100
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Liu XY, Hao C, Jiang H, Sun L, Zhou JB, Yin YP, Tang W, Jiang N, Mahapatra T, Mahapatra S, Chen XS, Yang HT, Fu GF, Huan XP. Syphilis and its correlates among heterosexual males attending sexually transmitted infection clinics - observation from a multicity cohort in Jiangsu Province, China. PLoS One 2014; 9:e95289. [PMID: 24743839 PMCID: PMC3990697 DOI: 10.1371/journal.pone.0095289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives To estimate the prevalence of HIV and syphilis, incidence of syphilis and to identify the correlates of syphilis infection among heterosexual male attendees of sexually transmitted infection (STI) clinics (MSC). Methods A cohort study of one-year duration was conducted in Yangzhou and Changzhou cities in Jiangsu province of China. The baseline survey commenced in June 2009, recruited 1225 consenting adult MSCs (609 in Yangzhou and 617 in Changzhou) through STI-clinic based convenience sampling. Results Baseline HIV and syphilis prevalence were 0.49% and 17.29% respectively. Syphilis incidence rate was 7.22 per 100 person-years (6.53 in Yangzhou and 7.76 in Changzhou) during the 6-month follow-up with retention fractions of 27.38% and 35.15% for Yangzhou and Changzhou respectively. Majority of the participants were middle-aged, high school educated, married, living with partners and non-migrants. Very few subjects reported recent and consistent condom-use with regular partners. Although considerable number of MSCs reported recent sexual exposure with female sex workers (FSW) and non-FSW casual partners, the proportion of reported condom use was very low during those exposures. In multivariate analyses higher age, having recent sex with FSWs and being HIV-positive were associated with higher syphilis sero-positivity while higher education was protective. In bivariate analyses, being married, divorced/widowed, official residency of the study cities and non-use of condom with regular partners predicted higher risk. Conclusions Considering the potential bridging role of MSCs between high and low-risk populations, effective intervention strategies among them targeting the correlates of syphilis infection are urgently called for in Jiangsu province of China.
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Affiliation(s)
- Xiao-Yan Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Chao Hao
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Hui Jiang
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Lin Sun
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Jian-Bo Zhou
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Yue-Ping Yin
- National Center for STDs Control, China CDC, Nanjing, China
| | - Weiming Tang
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ning Jiang
- National Center for STDs Control, China CDC, Nanjing, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sanchita Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Hai-Tao Yang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
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