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Ke W, Ao C, Wei R, Zhu X, Shui J, Zhao J, Zhang X, Wang L, Huang L, Leng X, Zhu R, Wu J, Huang L, Huang N, Wang H, Weng W, Yang L, Tang S. Evaluating the clinical utility of semi-quantitative luciferase immunosorbent assay using Treponema pallidum antigens in syphilis diagnosis and treatment monitoring. Emerg Microbes Infect 2024; 13:2348525. [PMID: 38661428 PMCID: PMC11100446 DOI: 10.1080/22221751.2024.2348525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/23/2024] [Indexed: 04/26/2024]
Abstract
To assess the clinical applicability of a semi-quantitative luciferase immunosorbent assay (LISA) for detecting antibodies against Treponema pallidum antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) in diagnosing and monitoring syphilis. LISA for detection of anti-TP15, TP17, and TP47 antibodies were developed and evaluated for syphilis diagnosis using 261 serum samples (161 syphilis, 100 non-syphilis). Ninety serial serum samples from 6 syphilis rabbit models (3 treated, 3 untreated) and 110 paired serum samples from 55 syphilis patients were used to assess treatment effects by utilizing TRUST as a reference. Compared to TPPA, LISA-TP15, LISA-TP17, and LISA-TP47 showed a sensitivity of 91.9%, 96.9%, and 98.8%, specificity of 99%, 99%, and 98%, and AUC of 0.971, 0.992, and 0.995, respectively, in diagnosing syphilis. Strong correlations (rs = 0.89-0.93) with TPPA were observed. In serial serum samples from rabbit models, significant differences in the relative light unit (RLU) were observed between the treatment and control group for LISA-TP17 (days 31-51) and LISA-TP47 (day 41). In paired serum samples from syphilis patients, TRUST titres and the RLU of LISA-TP15, LISA-TP17, and LISA-TP47 decreased post-treatment (P < .001). When TRUST titres decreased by 0, 2, 4, or ≥8-folds, the RLU decreased by 17.53%, 31.34%, 48.62%, and 72.79% for LISA-TP15; 8.84%, 17.00%, 28.37%, and 50.57% for LISA-TP17; 22.25%, 29.79%, 51.75%, and 70.28% for LISA-TP47, respectively. Semi-quantitative LISA performs well for syphilis diagnosis while LISA-TP17 is more effective for monitoring syphilis treatment in rabbit models and clinical patients.
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Affiliation(s)
- Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Guangzhou Baiyun District Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People’s Republic of China
| | - Ran Wei
- Department of Dermatology, Tianjin Children Hospital, Tianjin, People’s Republic of China
| | - Xiaozhen Zhu
- Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, People’s Republic of China
- Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, People’s Republic of China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xiaohui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Liuyuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xinying Leng
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Rui Zhu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jiaxin Wu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Lixia Huang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Nanxuan Huang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Chen X, Yuan C, Wang B, Guan M, Zheng X. Development of toluidine red particle agglutination-based turbidimetric immunoassay for anticardiolipin antibody detection in syphilis. J Infect Chemother 2024; 30:899-903. [PMID: 38460614 DOI: 10.1016/j.jiac.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Serological tests of non-treponemal and treponemal types are the most frequently used for syphilis diagnosis. Nontreponemal tests are used to monitor disease activity. Toluidine red unheated serum test (TRUST), as one of nontreponemal tests, is generally applicable to hospitals at different levels. However, accurate judgment of TRUST results is inseparable from an experienced and accurate operator. To reduce current shortcomings of manual TRUST method, we attempted to convert the manual TRUST test into automatic TRUST test, that is, to determine the degree of aggregation of toluidine red particles by detecting the absorbance value of serum after reaction with toluidine red particles. METHODS 50 μL of serum sample and 80 μL toluidine red particles were added to 96-well plate. Then, the 96-well plate was placed on a microplate reader at medium grade for 8 min to mix. Then, plasma reagin reacted with toluidine red particles and promoted the aggregation of toluidine red particles to form a large clot, which eventually caused a decrease in the absorbance at 540 nm. RESULTS The results showed that the specificity of the automatic TRUST test was 100%, the sensitivity was 87%. And this method showed 93.5% correlation with manual TRUST test. The developed method is simple and involves less subjectivity in reading results, opening new avenues for syphilis diagnostic testing. CONCLUSION Turbidimetric immunoassay can avoid the shortcomings of subjective interpretation, time-consuming and manual operation of manual TRUST method, and is more suitable for large-scale screening in health examination.
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Affiliation(s)
- Xi Chen
- Guangshan County People's Hospital, Xinyang, 465450, China
| | - Chengyu Yuan
- Guangshan County People's Hospital, Xinyang, 465450, China
| | - Biwen Wang
- Xinyang Central Hospital, Xinyang, 465450, China
| | - Mengni Guan
- School of Mathematics and Statistics, Anyang Normal University, Anyang, 455000, China.
| | - Xianyu Zheng
- Guangshan County People's Hospital, Xinyang, 465450, China.
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Alamoudi WA, Abdelsayed RA, Sollecito TP, Alhassan GA, Kulkarni R, Bindakhil MA. Causes of Oral Granulomatous Disorders: An Update and Narrative Review of the Literature. Head Neck Pathol 2024; 18:72. [PMID: 39110261 PMCID: PMC11306859 DOI: 10.1007/s12105-024-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
Granulomatous diseases include a diverse range of chronic inflammatory disorders with a wide variety of pathologies and clinical characteristics. In particular, the orofacial region can be affected by granulomatous conditions-whether as an isolated disease or as part of a systemic disorder. Regardless of the nature of the disease or its mechanism of development, precise diagnosis can be challenging, as etiopathogenesis may be driven by several causes. These include reactions to foreign bodies, infections, immune dysregulation, proliferative disorders,, medications, illicit drugs, and hereditary disorders. Granulomas can be identified using histopathological assessment but are not pathognomonic of a specific disease, and therefore require correlation between clinical, serological, radiographical, and histopathological findings. The purpose of this review is to provide a summary of the etiopathogenesis, clinical and histopathologic characteristics, and treatment of oral granulomatous disorders.
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Affiliation(s)
- Waleed A Alamoudi
- Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
- Division of Oral Medicine, UCL Eastman Dental Institute, University College London, London, UK.
| | - Rafik A Abdelsayed
- Division of Oral and Maxillofacial Pathology, Augusta University, Augusta, GA, USA
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ghaida A Alhassan
- Division of Infectious Diseases, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Roopali Kulkarni
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohammed A Bindakhil
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Medicine and Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
- Division of Oral Medicine, Augusta University, Augusta, GA, USA
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. [Translated article] AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00651-3. [PMID: 39111574 DOI: 10.1016/j.ad.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 09/01/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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Pedrosa NL, Pinheiro PM, Filho FWBH, de Araujo WN. Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users. PLoS One 2024; 19:e0303320. [PMID: 38968238 PMCID: PMC11226132 DOI: 10.1371/journal.pone.0303320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/08/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Acquired syphilis continues to affect millions of people around the world. It is crucial to study it in the context of HIV Pre-Exposure Prophylaxis (PrEP) to achieve the goals set out in the 2030 Agenda since the literature suggests increased risk behaviors for sexually transmitted infections. This study aimed to investigate the incidence and factors associated with acquired syphilis among PrEP users. MATERIALS AND METHODS This retrospective cohort included data on PrEP users from all over Brazil from 2018 to 2020, retrieved from the national antiretroviral logistics system. We calculated the proportion of syphilis before PrEP, the incidence during the user's follow-up, reinfections, and their possible associated factors. We conducted descriptive, bivariate, and multivariate analysis, estimating the crude Relative Risk, adjusted Odds Ratio (aOR), and their respective confidence intervals (95%CI). RESULTS Most of the 34,000 individuals who started PrEP were male (89.0%), white (53.7%), self-identified as male (85.2%), homosexual, gay, or lesbian (72.2%), and had 12 schooling years or more (67.8%). Of these, 8.3% had syphilis in the six months before starting PrEP, and 4% had it in the first 30 days of using the prophylaxis. We identified a loss-to-follow-up rate of 41.7%, although the loss and the cohort shared similar characteristics. The proportion of missed syphilis tests was high: 33.4% in the 30 days and 38.8% in the follow-up period. In the 19,820 individuals effectively monitored, the incidence of acquired syphilis was 19.1 cases per 100 person-years, and 1.9% of users had reinfection. The rate of missed syphilis tests at the 30-day follow-up was 33.4%, and the total follow-up test period was 38.8%. The multivariate analysis identified female gender (aOR 0.3; 95%CI 0.2-0.5), being white or Black (aOR 0.9; 95%CI 0.7-0.9 and aOR 0.7; 95%CI 0.7-0.99, respectively) as protective factors for syphilis. Being homosexual, gay, lesbian (aOR 2.7; 95%CI 2.0-3.7), or having a history of syphilis in the six months before PrEP (aOR 2.2; 95%CI 1.9-2.5) were risk factors for syphilis during PrEP use. Behaviors related to the risk of syphilis included accepting something in exchange for sex (aOR 1.6; 95%CI 1.3-1.9), irregular condom use (use in less than half of sexual intercourse sessions; aOR 1.7; 95%CI 1.53-2.1) and recreational drug use (poppers; aOR 1.5; 95%CI 1.53-2.1). CONCLUSION Syphilis in the context of PrEP has high rates and is associated with sociodemographic and behavioral factors. We recommend additional studies targeting prevention in this population to curb these figures.
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Affiliation(s)
| | | | | | - Wildo Navegantes de Araujo
- Tropical Medicine Center, University of Brasília, Brasília, Brazil
- UnB Faculty Ceilândia, University of Brasilia, Brasília, Brazil
- National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil
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Ke W, Ao C, Wang L, Zhang X, Shui J, Zhao J, Huang L, Leng X, Zhu R, Wang H, Weng W, Zheng L, Ligang Yang, Tang S. Refining a non-invasive prediction model for neurosyphilis diagnosis by using immunoassay to detect serum anti-TP0435 (TP17) and TP0574 (TP47) IgG antibodies: two-centre cross-sectional retrospective study in China. Clin Microbiol Infect 2024:S1198-743X(24)00293-3. [PMID: 38909686 DOI: 10.1016/j.cmi.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Invasive lumbar puncture is the conventional method for diagnosing neurosyphilis (NS). We investigated a non-invasive alternative method to detect serum Treponema pallidum-specific antibodies against highly immunogenic antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) by using luciferase immunosorbent assay. METHODS A total of 816 HIV-negative patients suspected of NS from the Beijing and Guangzhou cohorts were retrospectively selected and tested for serum anti-TP15, TP17, and TP47 IgG antibodies. Two diagnostic prediction models were developed using stepwise logistic regression in the Beijing cohort, and evaluated in the Guangzhou cohort for external validation. RESULTS Serum antibodies against TP15, TP17, and TP47 showed moderate capability for NS diagnosis in the Beijing cohort and the corresponding area under the receiver operating characteristic curves (AUCs) were 0.722 [95% confidence interval (CI): 0.680-0.762)], 0.780 (95% CI: 0.741-0.817), and 0.774 (95% CI: 0.734-0.811), respectively. An expanded NS prediction model integrated with anti-TP17 and anti-TP47 antibodies showed better performance than the base NS diagnostic model without anti-TP17 and anti-TP47 antibodies with the AUC of 0.874 (95% CI: 0.841-0.906) vs. 0.845 (95% CI: 0.809-0.881) (p = 0.007) in the development cohort, and 0.934 (95% CI: 0.909-0.960) vs. 0.877 (95% CI: 0.840-0.914) (p < 0.001) in validation cohort, respectively. Decision curve analysis revealed that the net benefit of the expanded model exceeded that of the base model when the threshold probability was between 0.10 and 0.95 in both the development and external validation cohorts. DISCUSSION Serum antibodies against TP17 and TP47 exhibited promising diagnostic capability for NS and significantly enhanced the predictive accuracy of model for NS diagnosis. Our study highlights the potential of serum treponemal antibody detection as a non-invasive method for NS diagnosis to substitute invasive lumbar puncture in NS diagnosis.
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Affiliation(s)
- Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, Guangdong, China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Baiyun District Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Liuyuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Leng
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Zhu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lianhong Zheng
- Department of Neurology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
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Sagut P, Khamdan F, Al Awadhi A, Hua-Liang Lim J, Chosidow O, Elston DM. Dermatology images: Syphilis. J Am Acad Dermatol 2024:S0190-9622(24)00967-8. [PMID: 38914204 DOI: 10.1016/j.jaad.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Pelin Sagut
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Fatema Khamdan
- Department of Dermatology, Salmaniya Medical Complex, Manama, Bahrain
| | - Ameen Al Awadhi
- Department of Dermatology, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Olivier Chosidow
- AP-HP, Department of Dermatology, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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Yang L, Zhang X, Chen W, Seña AC, Zheng H, Jiang Y, Zhao P, Chen R, Wang L, Ke W, Salazar JC, Parr JB, Tucker JD, Hawley KL, Caimano MJ, Hennelly CM, Aghakanian F, Bettin EB, Zhang F, Chen JS, Moody MA, Radolf JD, Yang B. Clinical presentation of early syphilis and genomic sequences of Treponema pallidum strains in patient specimens and isolates obtained by rabbit inoculation. J Infect Dis 2024:jiae322. [PMID: 38884588 DOI: 10.1093/infdis/jiae322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The global resurgence of syphilis necessitates vaccine development. METHODS We collected ulcer exudates and blood from 17 primary syphilis (PS) participants and skin biopsies and blood from 51 secondary syphilis (SS) participants in Guangzhou, China for Treponema pallidum subsp. pallidum (TPA) qPCR, whole genome sequencing (WGS), and isolation of TPA in rabbits. RESULTS TPA DNA was detected in 15 of 17 ulcer exudates and 3 of 17 blood PS specimens. TPA DNA was detected in 50 of 51 SS skin biopsies and 27 of 51 blood specimens. TPA was isolated from 47 rabbits with success rates of 71% (12/17) and 69% (35/51), respectively, from ulcer exudates and SS bloods. We obtained paired genomic sequences from 24 clinical samples and corresponding rabbit isolates. Six SS14- and two Nichols-clade genome pairs contained rare discordances. Forty-one of the 51 unique TPA genomes clustered within SS14 subgroups largely from East Asia, while 10 fell into Nichols C and E subgroups. CONCLUSIONS Our TPA detection rate was high from PS ulcer exudates and SS skin biopsies and over 50% from SS blood, with TPA isolation in over two-thirds of samples. Our results support the use of WGS from rabbit isolates to inform vaccine development.
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Affiliation(s)
- Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohui Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wentao Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China
| | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China
| | - Yinbo Jiang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Rongyi Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Liuyuan Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, China
| | - Juan C Salazar
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Connecticut Children's Research Institute, Connecticut Children's, Hartford, Connecticut, USA
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelly L Hawley
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Connecticut Children's Research Institute, Connecticut Children's, Hartford, Connecticut, USA
| | - Melissa J Caimano
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Christopher M Hennelly
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Farhang Aghakanian
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Everton B Bettin
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Feifei Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jane S Chen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Justin D Radolf
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Connecticut Children's Research Institute, Connecticut Children's, Hartford, Connecticut, USA
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00339-9. [PMID: 38663730 DOI: 10.1016/j.ad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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10
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Abstract
Dermatologists are familiar with the classic aspects of syphilis. Our objective in this update is to display novel features of sexually acquired syphilis, its pathophysiology, natural history, atypical clinical variants, skin of color, clinical pearls, and prospects. Textbook knowledge, congenital syphilis, epidemiology, and historical data are excluded.
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Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital Padre Hurtado, Santiago, Chile.
| | - Stephanie Saavedra-Portales
- Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital San Juan de Dios, Santiago, Chile
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11
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Silva ÂAO, Lima AA, Vasconcelos LCM, Almeida RA, Freitas NEM, Oliva TA, de Carvalho Ribeiro da Silva MF, Marchini FK, Zanchin NIT, de Siqueira IC, Santos FLN. Evaluating the diagnostic accuracy of TpN17 and TmpA recombinant proteins in syphilis detection: a phase II study. Front Microbiol 2024; 15:1348437. [PMID: 38476951 PMCID: PMC10929016 DOI: 10.3389/fmicb.2024.1348437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Syphilis is a sexually transmitted infection (STI) caused by the spiral bacterium Treponema pallidum. Diagnosis is based on epidemiology, clinical and serology, but serodiagnosis is challenging because distinct clinical forms of the infection may influence serological performance. Several recombinant Treponema pallidum-proteins have already been tested for syphilis diagnosis and they are critical to achieve high accuracy in serological testing. A total of 647 samples were included in the study: 180 T. pallidum-positive samples, 191 T. pallidum-negative samples and 276 sera from individuals infected with unrelated diseases. The diagnostic potential was validated by analysis of ROC curves. For the indirect ELISA, TpN17 (100%) and TmpA (99%) showed excellent AUC values. Sensitivity values were 97.2% for TpN17 and 90.6% for TmpA, while specificity was 100% for both molecules. According to the clinical phase, TmpA ranged from 84% to 97%, with the highest value for secondary syphilis. TpN17 was 100% sensitive for the primary and secondary stages and 93.2% for recent latent syphilis. All clinical phases achieved 100% specificity. Accuracy values showed that TmpA (> 95%) and TpN17 (> 98%) presented high diagnostic accuracy for all clinical stages of syphilis. Cross-reactivity was only observed in one sample positive for Chagas disease (1.5%), when TpN17 was evaluated. On the other hand, TmpA showed reactivity for two samples positive for Chagas disease (3.1%), one sample positive for HBV (1.25%), two samples positive for HIV (9.5%) and one sample positive for HTLV (1.6%). The TmpA antigen's performance was evaluated in multiple studies for syphilis diagnosis, corroborating our findings. However, TpN17 sensitivity values have ranged in other studies. According to clinical stages of the infection, our findings obtained close performance values.
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Affiliation(s)
- Ângelo Antônio Oliveira Silva
- Advanced Public Health Laboratory, Gonçalo Moniz Institute (IGM) Foundation Oswaldo Cruz (Fiocruz-BA), Salvador, Brazil
- Salvador University (UNIFACS), Salvador, Brazil
| | - Ayla Araújo Lima
- Advanced Public Health Laboratory, Gonçalo Moniz Institute (IGM) Foundation Oswaldo Cruz (Fiocruz-BA), Salvador, Brazil
| | | | - Rosângela Andrade Almeida
- Advanced Public Health Laboratory, Gonçalo Moniz Institute (IGM) Foundation Oswaldo Cruz (Fiocruz-BA), Salvador, Brazil
| | - Natália Erdens Maron Freitas
- Advanced Public Health Laboratory, Gonçalo Moniz Institute (IGM) Foundation Oswaldo Cruz (Fiocruz-BA), Salvador, Brazil
| | | | | | - Fabricio Klerynton Marchini
- Molecular Biology Institute of Paraná, Curitiba, Brazil
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute (ICC) Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba, Brazil
| | - Nilson Ivo Tonin Zanchin
- Structural Biology and Protein Engineering Laboratory, Carlos Chagas Institute (ICC) Oswaldo Cruz Foundation (Fiocruz-PR), Curitiba, Brazil
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro, Brazil
| | - Isadora Cristina de Siqueira
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro, Brazil
- Laboratory of Investigation in Global Health and Neglected Diseases, Gonçalo Moniz Institute (IGM) Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Brazil
| | - Fred Luciano Neves Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute (IGM) Foundation Oswaldo Cruz (Fiocruz-BA), Salvador, Brazil
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro, Brazil
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12
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Hartmane I, Ivdra I, Mikazans I, Princevs A, Teterina I, Bondare-Ansberga V, Reinberga L. Use of ceftriaxone as an alternative treatment method in pregnant women diagnosed with syphilis - a single centre experience. Int J STD AIDS 2024; 35:130-135. [PMID: 37870192 DOI: 10.1177/09564624231206845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND There are few data on the use of ceftriaxone in pregnant women diagnosed with syphilis. The aim of this study was to investigate the safety and efficacy of ceftriaxone as an alternative treatment option for syphilis during pregnancy. METHODS A retrospective analysis of 79 pregnant women diagnosed with syphilis and treated with ceftriaxone was conducted. RESULTS No cases of intolerance, Jarisch-Herxheimer reactions, or allergic reactions were recorded. The average time to seronegativation for secondary syphilis with symptoms was 6.14 months ± 2.76, and for latent forms, it was 7.52 months ± 1.84. Patients received no additional treatment. No serious adverse drug reactions were reported. CONCLUSIONS Data from our study support the use of ceftriaxone as an effective and safe alternative treatment for pregnant women diagnosed with syphilis when penicillin therapy is contraindicated or unavailable.
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Affiliation(s)
- Ilona Hartmane
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Iveta Ivdra
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Ingmars Mikazans
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Aleksejs Princevs
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
| | - Irena Teterina
- Department of Pharmacology, Rīga Stradiņš University, Rīga, Latvia
| | - Vanda Bondare-Ansberga
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Lelde Reinberga
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
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13
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Xiong S, Liu Z, Zhang X, Huang S, Ding X, Zhou J, Yao J, Li W, Liu S, Zhao F. Resurgence of syphilis: focusing on emerging clinical strategies and preclinical models. J Transl Med 2023; 21:917. [PMID: 38105236 PMCID: PMC10726518 DOI: 10.1186/s12967-023-04685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Syphilis, a sexually transmitted disease (STD) caused by Treponema pallidum (T. pallidum), has had a worldwide resurgence in recent years and remains a public health threat. As such, there has been a great deal of research into clinical strategies for the disease, including diagnostic biomarkers and possible strategies for treatment and prevention. Although serological testing remains the predominant laboratory diagnostic method for syphilis, it is worth noting that investigations pertaining to the DNA of T. pallidum, non-coding RNAs (ncRNAs), chemokines, and metabolites in peripheral blood, cerebrospinal fluid, and other bodily fluids have the potential to offer novel perspectives on the diagnosis of syphilis. In addition, the global spread of antibiotic resistance, such as macrolides and tetracyclines, has posed significant challenges for the treatment of syphilis. Fortunately, there is still no evidence of penicillin resistance. Hence, penicillin is the recommended course of treatment for syphilis, whereas doxycycline, tetracycline, ceftriaxone, and amoxicillin are viable alternative options. In recent years, efforts to discover a vaccine for syphilis have been reignited with better knowledge of the repertoire of T. pallidum outer membrane proteins (OMPs), which are the most probable syphilis vaccine candidates. However, research on therapeutic interventions and vaccine development for human subjects is limited due to practical and ethical considerations. Thus, the preclinical model is ideal for conducting research, and it plays an important role in clinical transformation. Different preclinical models have recently emerged, such as in vitro culture and mouse models, which will lay a solid foundation for clinical treatment and prevention of syphilis. This review aims to provide a comprehensive summary of the most recent syphilis tactics, including detection, drug resistance treatments, vaccine development, and preclinical models in clinical practice.
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Affiliation(s)
- Shun Xiong
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Zhaoping Liu
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Xiaohong Zhang
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Shaobin Huang
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Xuan Ding
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Jie Zhou
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Jiangchen Yao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Weiwei Li
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Shuangquan Liu
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China.
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital, Institution of Microbiology and Infectious Diseases, Hengyang Medical College, University of South China, Hengyang, 421001, China.
| | - Feijun Zhao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China.
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital, Institution of Microbiology and Infectious Diseases, Hengyang Medical College, University of South China, Hengyang, 421001, China.
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14
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Yang L, Zhang X, Chen W, Seña AC, Zheng H, Jiang Y, Zhao P, Chen R, Wang L, Ke W, Salazar JC, Parr JB, Tucker JD, Hawley KL, Caimano MJ, Hennelly CM, Aghakanian F, Zhang F, Chen JS, Moody MA, Radolf JD, Yang B. Early syphilis in Guangzhou, China: presentation, molecular detection of Treponema pallidum , and genomic sequences in clinical specimens and isolates obtained by rabbit infectivity testing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.17.23297169. [PMID: 37905017 PMCID: PMC10614984 DOI: 10.1101/2023.10.17.23297169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background The global resurgence of syphilis requires novel prevention strategies. Whole genome sequencing (WGS) of Treponema pallidum ( TPA ) using different specimen types is essential for vaccine development. Methods Patients with primary (PS) and secondary (SS) syphilis were recruited in Guangzhou, China. We collected ulcer exudates and blood from PS participants, and skin biopsies and blood from SS participants for TPA polA polymerase chain reaction (PCR); ulcer exudates and blood were also used to isolate TPA strains by rabbit infectivity testing (RIT). TPA WGS was performed on 52 ulcer exudates and biopsy specimens and 25 matched rabbit isolates. Results We enrolled 18 PS and 51 SS participants from December 2019 to March 2022. Among PS participants, TPA DNA was detected in 16 (89%) ulcer exudates and three (17%) blood specimens. Among SS participants, TPA DNA was detected in 50 (98%) skin biopsies and 27 (53%) blood specimens. TP A was isolated from 48 rabbits, with a 71% (12/17) success rate from ulcer exudates and 69% (36/52) from SS bloods. Twenty-three matched SS14 clade genomes were virtually identical, while two Nichols clade pairs had discordant tprK sequences. Forty-two of 52 unique TPA genomes clustered in an SS14 East Asia subgroup, while ten fell into two East Asian Nichols subgroups. Conclusions Our TPA detection rate was high from PS ulcer exudates and SS skin biopsies and over 50% from SS whole blood, with RIT isolation in over two-thirds of samples. Our results support the use of WGS from rabbit isolates to inform vaccine development. Summary We performed Treponema pallidum molecular detection and genome sequencing from multiple specimens collected from early syphilis patients and isolates obtained by rabbit inoculation. Our results support the use of whole genome sequencing from rabbit isolates to inform syphilis vaccine development.
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15
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Cao W, Thorpe PG, O'Callaghan K, Kersh EN. Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis. Expert Rev Anti Infect Ther 2023; 21:1339-1354. [PMID: 37934903 PMCID: PMC10958575 DOI: 10.1080/14787210.2023.2280214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment. AREA COVERED This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis. EXPERT OPINION In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.
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Affiliation(s)
- Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin O'Callaghan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Ying S, Li S, Qiao J. A Man With Asymptomatic Ulcerated White Plaques on the Soft Palate. JAMA 2023; 329:680-681. [PMID: 36729464 DOI: 10.1001/jama.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A man in his 60s had irregular gray-white ulcers with a surrounding erythema on the soft palate, uvula, and tonsils that did not improve with oral cefuroxime. He reported sexual contact with 1 male partner over the prior 6 months; history and physical examination findings were otherwise unremarkable. What is the diagnosis and what would you do next?
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Affiliation(s)
- Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Human Immunodeficiency Virus and Uveitis. Viruses 2023; 15:v15020444. [PMID: 36851658 PMCID: PMC9962278 DOI: 10.3390/v15020444] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Uveitis is one of the most common ocular complications in people living with the Human immunodeficiency virus (HIV) and can be classified into HIV-induced uveitis, co-infection related uveitis, immune recovery uveitis, and drug-induced uveitis. The introduction of antiretroviral therapy has considerably changed the incidence, diagnosis, and treatment of different types of HIV-related uveitis. Furthermore, the specific immune condition of patients infected with HIV makes diagnosing HIV-related uveitis difficult. Recent studies have focused on the growing prevalence of syphilis/tuberculosis co-infection in uveitis. Simultaneously, more studies have demonstrated that HIV can directly contribute to the incidence of uveitis. However, the detailed mechanism has not been studied. Immune recovery uveitis is diagnosed by exclusion, and recent studies have addressed the role of biomarkers in its diagnosis. This review highlights recent updates on HIV-related uveitis. Furthermore, it aims to draw the attention of infectious disease physicians and ophthalmologists to the ocular health of patients infected with HIV.
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Cantisani C, Rega F, Ambrosio L, Grieco T, Kiss N, Meznerics FA, Bánvölgyi A, Vespasiani G, Arienzo F, Rossi G, Soda G, Pellacani G. Syphilis, the Great Imitator-Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1339. [PMID: 36674095 PMCID: PMC9859468 DOI: 10.3390/ijerph20021339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as "The Great Imitator". Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett's sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.
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Affiliation(s)
- Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Federica Rega
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Luca Ambrosio
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Teresa Grieco
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Norbert Kiss
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Giordano Vespasiani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Rossi
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Giuseppe Soda
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
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Whiting C, Schwartzman G, Khachemoune A. Syphilis in Dermatology: Recognition and Management. Am J Clin Dermatol 2023; 24:287-297. [PMID: 36689103 PMCID: PMC9869822 DOI: 10.1007/s40257-022-00755-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/24/2023]
Abstract
The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.
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Affiliation(s)
- Cleo Whiting
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Gabrielle Schwartzman
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA. .,Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA.
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20
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Anjaneyan G, Kumar A, Thomas J. Masson-Fontana stain: A silver lining for diagnosis of primary syphilitic chancre. Indian J Dermatol Venereol Leprol 2022; 88:822-824. [PMID: 35962493 DOI: 10.25259/ijdvl_581_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 05/01/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Gopikrishnan Anjaneyan
- Department of Dermatology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jacob Thomas
- Department of Dermatology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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21
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Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne) 2022; 9:800383. [PMID: 36203756 PMCID: PMC9530046 DOI: 10.3389/fmed.2022.800383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Neurosyphilis is caused by Treponema pallidum invading the central nervous system, of which the incidence is increasing worldwide. Due to its variable clinical manifestations, diagnosis of neurosyphilis remains challenging, especially the asymptomatic form. This review focuses on recent advances in neurosyphilis, including epidemiology, clinical manifestations, laboratory findings, comorbidities, diagnosis, treatment, prognosis, and basic research. The expansion of men who have sex with men and the infection of human immunodeficiency virus mainly accounted for the increasing incidence of neurosyphilis. The rate of some historically described forms of neurosyphilis in the pre-antibiotic era declined significantly; atypical features are more prevalent. Neurosyphilis, regarded as a great mimicker for neuro-ophthalmic, audio-vestibular, and psychiatric disorders, often presents concomitantly with other diseases, including metabolic disorders. Studies on long non-coding RNAs, miRNAs, chemokines, and metabolites in peripheral blood and cerebrospinal fluid may facilitate exploring the pathogenesis and identifying novel biomarkers of neurosyphilis. The drug resistance of Treponema pallidum to penicillin has not been reported; ceftriaxone was proposed to be more effective than penicillin, whereas few randomized controlled trials supported this view. This study may pave the way for further research, especially the diagnosis and treatment of neurosyphilis.
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Affiliation(s)
- Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhu Liu
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jun Li
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22
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Margulies S, Patel SP, Motaparthi K. Ulceronecrotic rash in an immunocompetent individual. JAAD Case Rep 2022; 27:29-31. [PMID: 35990229 PMCID: PMC9389133 DOI: 10.1016/j.jdcr.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shae Margulies
- University of Florida College of Medicine, Gainesville, Florida
| | - Sagar P Patel
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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23
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Cunha Ramos M, Nicola MRC, Bezerra NTC, Sardinha JCG, Sampaio de Souza Morais J, Schettini AP. Genital ulcers caused by sexually transmitted agents. An Bras Dermatol 2022; 97:551-565. [PMID: 35868971 PMCID: PMC9453525 DOI: 10.1016/j.abd.2022.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/11/2022] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
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Affiliation(s)
- Mauro Cunha Ramos
- Sanitary Dermatology Outpatient Clinic, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Maria Rita Castilhos Nicola
- Sanitary Dermatology Outpatient Clinic, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | - José Carlos Gomes Sardinha
- Fundação Alfredo da Matta, Instituição ligada à Secretaria de Estado de Saúde do Governo do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Antônio Pedro Schettini
- Fundação Alfredo da Matta, Instituição ligada à Secretaria de Estado de Saúde do Governo do Estado do Amazonas, Manaus, AM, Brazil
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24
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Bastard L, Hagege B, Breban M, Gouze H. Clinical image: bone erosions in a young man. Ann Rheum Dis 2022; 81:1330. [PMID: 35697488 DOI: 10.1136/annrheumdis-2022-222609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Léa Bastard
- Rheumatology Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
| | - Benjamin Hagege
- Rheumatology Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
| | - Maxime Breban
- Rheumatology Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/ Paris Saclay, Montigny-le-Bretonneux, France
| | - Hélène Gouze
- Rheumatology Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
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25
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Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138172. [PMID: 35805831 PMCID: PMC9265885 DOI: 10.3390/ijerph19138172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
Syphilis, a curable sexually transmitted infection, has re-emerged as a global public health threat with an estimated 5.6 million new cases every year. Pregnant women and men who have sex with men are key target populations for syphilis control and prevention programs. Frequent syphilis testing for timely and accurate diagnosis of active infections for appropriate clinical management is a key strategy to effectively prevent disease transmission. However, there are persistent challenges in the diagnostic landscape and service delivery/testing models that hinder global syphilis control efforts. In this commentary, we summarise the current trends and challenges in diagnosis of active syphilis infection and identify the data gaps and key areas for research and development of novel point-of-care diagnostics which could help to overcome the present technological, individual and structural barriers in access to syphilis testing. We present expert opinion on future research which will be required to accelerate the validation and implementation of new point-of-care diagnostics in real-world settings.
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26
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Chen X, Mi X, Gan Y, Chang D, Liu D. Disparity in Availability of Laboratory Testing for Syphilis Among Different Hospitals in Shandong Province, Eastern China. Asia Pac J Public Health 2022; 34:346-353. [PMID: 35168408 DOI: 10.1177/10105395221078762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to understand the availability of laboratory testing for syphilis among hospitals in Shandong province. Basic information on hospitals that provide clinical health service for sexually transmitted infections (STIs) and the type of laboratory tests for syphilis provided was collected and analyzed using the chi-square test. A total of 410 and 456 hospitals that provided clinical services for STI were surveyed in 2012 and 2018. Significant differences in the availability of nontreponemal tests were observed among different levels (χ2 = 6.624, P = .010) and types (χ2 = 17.752, P = .001) of hospitals in 2012, but not in 2018. A significant difference in the availability of treponemal tests was observed among different levels of hospitals in 2012 (χ2 = 9.937, P = .002) but not in 2018. Significant differences in the availability of nontreponemal tests, titer of nontreponemal tests, and treponemal tests were observed among hospitals with different affiliations in 2018 (P = 0.000; χ2 = 15.274, P = .000; P = .021) but not in 2012. The availability of nontreponemal and treponemal tests for syphilis among hospitals in 2018 was higher than that in 2012 (90.13% vs. 57.56%, χ2 = 121.219, P = .000). The availability of laboratory testing has been much improved. Further efforts are needed to reduce the disparity in the availability among different hospitals.
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Affiliation(s)
- Xinlong Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiongfei Mi
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanling Gan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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27
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Expressions of interferon-stimulated genes in peripheral blood mononuclear cells from patients with secondary syphilis. INFECTION GENETICS AND EVOLUTION 2021; 96:105137. [PMID: 34781038 DOI: 10.1016/j.meegid.2021.105137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Syphilis is a sexually transmitted disease that threatens human health worldwide. However, the immune regulation cascade caused by treponemia pallidum (TP) infection remains still largely unclear. METHODS To investigate the expression of ISGs in secondary syphilis (SS), we recruited 64 patients with SS and equal number of healthy participants to obtain their peripheral blood mononuclear cells (PBMCs). qRT-PCR was performed to estimate the expression of interferon-stimulated genes (ISGs) including CXCL10, OAS3, OAS1, MX1, IFIT3, IFIT2, IFI6 and AIM2. Receiver-operating characteristic (ROC) analysis was adapted to diagnostic value of these genes to distinguish healthy controls and patients with SS. RESULTS ISGs including CXCL10, OAS3, OAS1, MX1, IFIT3, IFIT2, IFI6 and AIM2 were all upregulated in PBMCs of patients with SS. Area under the ROC curve (AUC) of the 8 ISGs were all more than 0.5. IFIT3 exhibited the highest diagnostic value, followed by AIM2, IFIT2 and CXCL10, according to the Yoden Index. CONCLUSION ISGs including CXCL10, OAS3, OAS1, MX1, IFIT3, IFIT2, IFI6 and AIM2 were upregulated in patients with SS and they have diagnostic value for syphilis.
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28
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Tiecco G, Degli Antoni M, Storti S, Marchese V, Focà E, Torti C, Castelli F, Quiros-Roldan E. A 2021 Update on Syphilis: Taking Stock from Pathogenesis to Vaccines. Pathogens 2021; 10:1364. [PMID: 34832520 PMCID: PMC8620723 DOI: 10.3390/pathogens10111364] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
In 2021 the scientific community's efforts have been focused on solving the back-breaking challenge of the COVID-19 pandemic, but sexually transmitted infections (STI) are still one of the most common global health problems. Syphilis is a systemic disease caused by the spirochaete Treponema pallidum (TP) and is one of the oldest known diseases. Its incidence has increased in the last few years and syphilis still remains a contemporary plague that continues to afflict millions of people worldwide. Despite research improvements, syphilis pathogenesis is not completely clear; clinical presentation is very heterogeneous and the diagnosis can sometimes be difficult. Furthermore, few therapeutic options are available, and a vaccine has not been found yet. In this review, we describe the most recent evidence concerning the clinical manifestation, diagnosis, treatment and vaccine prospectives for this disease.
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Affiliation(s)
- Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Melania Degli Antoni
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Samuele Storti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Valentina Marchese
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
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29
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de Morais Pinto R, de Medeiros Valentim RA, Fernandes da Silva L, Góis Farias de Moura Santos Lima T, Kumar V, Pereira de Oliveira CA, Martins Gomes de Gusmão C, de Paiva JC, de Andrade I. Analyzing the reach of public health campaigns based on multidimensional aspects: the case of the syphilis epidemic in Brazil. BMC Public Health 2021; 21:1632. [PMID: 34488689 PMCID: PMC8422753 DOI: 10.1186/s12889-021-11588-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Public health campaigns aim to promote awareness, increase knowledge, and encourage a target population to adopt desirable attitudes and behaviors. Assessing their reach from a multidimensional perspective through information technology can facilitate the development of more effective campaigns in public health response. Methods We scrutinized seven data sources from different perspectives to assess a health campaign launched in Brazil named “Syphilis No!”. This campaign is part of an Agenda for strategic actions to reduce syphilis in Brazil which includes dissemination of educommunication materials to remind people of the importance of syphilis prevention, emphasizing “test, treat and cure” concept. We developed a multidimensional analysis framework and implemented an information system to process the data from a time series perspective, and assessed the effects over time, both before and after the campaign. We descriptively analyzed data related to the campaign, including e-news, search engine activity, online courses, serological tests, medication distribution and case notification rates. Findings Regarding search engine activity, we observed the highest volume of search during the first week of campaigns in 2018 (between November 25th and December 7th). Nevertheless, analyzing this data in a trend plot revealed sustained growth until the end of 2019. From March 2018, the amount of e-news posts related to syphilis in Brazil, indexed by Google, followed an increasing slope, with a record peak in October 2019. In addition, data showed that 12 new online courses related to syphilis disease were available on the AVASUS Platform Learning Management System (LMS), to support efforts to promote lifelong learning for health professionals, teachers, and students. These courses reached more than 22,000 students between February 2019 and September 2020. Serological test data showed that the number of tests carried out in 2019 were 375·18% more than in 2015, even accounting for population growth. Finally, starting from the middle of 2018, the syphilis case notification rates followed a decreasing curve. Interpretation From this perspective, the “Syphilis No!” Project was a positive influence, inducing policy to fight syphilis in Brazil by supporting the implementation of a testing, treatment, and cure agenda (#TesteTrateCure). Certainly, this inference was made by analyzing multidimensional aspects and because, prior to 2018, the country had largely neglected this disease, with no records of communication actions during that period.
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Affiliation(s)
- Rafael de Morais Pinto
- Federal University of Rio Grande do Norte, Natal, RN, Brazil. .,Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil. .,Federal Institute of Rio Grande do Norte, Natal, RN, Brazil.
| | | | | | | | | | - Carlos Alberto Pereira de Oliveira
- Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil.,State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cristine Martins Gomes de Gusmão
- Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil.,Federal University of Pernambuco, Recife, PE, Brazil
| | - Jailton Carlos de Paiva
- Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil.,Federal Institute of Rio Grande do Norte, Natal, RN, Brazil
| | - Ion de Andrade
- Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil.,State Secretariat of Public Health of Rio Grande do Norte, Natal, RN, Brazil
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30
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Pagani DM, Pacheco FB, Venier NAB, Silva IDL, Richter GK, Luzzatto L, Scroferneker ML. Atypical presentation of secondary syphilis: annular lesions in an elderly patient. Rev Inst Med Trop Sao Paulo 2021; 63:e68. [PMID: 34495265 PMCID: PMC8428879 DOI: 10.1590/s1678-9946202163068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Syphilis is a chronic bacterial sexually transmitted infectious disease caused by Treponema pallidum. Different age groups are affected by heterogeneous clinical forms of the disease. We report a case of atypical secondary syphilis in an elderly patient with diffuse annular erythematous lesions on the chest, back, upper and lower limbs diagnosed by histopathological, immunohistochemical and serological tests.
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Affiliation(s)
- Danielle Machado Pagani
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação
em Microbiologia Agrícola e do Ambiente, Porto Alegre, Rio Grande do Sul,
Brazil
| | - Fernanda Brandão Pacheco
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Rio Grande do Sul, Brazil
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Natália Andressa Buss Venier
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Rio Grande do Sul, Brazil
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Isadora da Luz Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Rio Grande do Sul, Brazil
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande
do Sul, Brazil
| | | | - Laura Luzzatto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Rio Grande do Sul, Brazil
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Maria Lúcia Scroferneker
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação
em Medicina: Ciências Médicas, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de
Microbiologia, Imunologia e Parasitologia, Porto Alegre, Rio Grande do Sul,
Brazil
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31
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Abstract
Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.
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32
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Bond SM, Blain MLM. Diagnosis and Treatment of Secondary Syphilis in Women. J Midwifery Womens Health 2021; 66:372-379. [PMID: 34101969 DOI: 10.1111/jmwh.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023]
Abstract
Secondary syphilis develops approximately 3 to 12 weeks following undetected and untreated primary syphilis. Despite historically low rates of syphilis infection in 2000, the United States is now experiencing an alarming resurgence in primary, secondary, and congenital syphilis. This case report describes an unexpected presentation in a young woman presenting for an initial well-woman examination. Social and behavioral drivers of syphilis infection, diagnosis, and treatment are presented. Implications for women's health are examined. The need for new and more effective preventive health strategies is reviewed.
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Affiliation(s)
- Sharon M Bond
- Department of Obstetrics and Gynecology, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Michela L M Blain
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Seattle, Washington
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33
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Darraj M, Walkty A, Toole J, Marrie T, Huzel L, Embil JM. A 42-year-old man with nodular skin lesions. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:168-172. [PMID: 36341030 PMCID: PMC9608693 DOI: 10.3138/jammi-2020-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/20/2021] [Indexed: 06/16/2023]
Abstract
Nodular skin lesions are infrequently reported among patients with syphilis. We describe a 42-year-old man with secondary syphilis who presented with a nodular cutaneous eruption involving his neck, upper chest, back, arms, and legs. Because there was uncertainty regarding the diagnosis at presentation, the patient underwent a punch biopsy of one of the lesions. Spirochetes were not seen with a Steiner silver stain, but they were visualized on subsequent immunohistochemical staining. The diagnosis was confirmed with serology, and the patient responded well to treatment with benzathine penicillin G. Given the current increase in syphilis cases across North America, it is critical that clinicians become familiar with some of the less common dermatologic manifestations of this infection so that the diagnosis is entertained and appropriate serologic testing is ordered in a timely fashion.
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Affiliation(s)
- Majid Darraj
- Department of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Andrew Walkty
- Department of Internal Medicine, Section of Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health, Winnipeg, Manitoba, Canada
| | - John Toole
- Department of Internal Medicine, Section of Dermatology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas Marrie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Huzel
- Department of Pathology, DynaCare Laboratories, Winnipeg, Manitoba, Canada
| | - John M Embil
- Department of Internal Medicine, Section of Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Syphilis is a multisystem infection caused by the spirochaete Treponema pallidum Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. pallidum IgG chemiluminescence immunoassay (CLIA) and the T. pallidum particle agglutination (TPPA). The non-treponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity. There has been a resurgence of syphilis diagnoses in Australia. Large foci of infection have been identified in isolated communities. The remoteness of these locations, in conjunction with the particular socio-cultural characteristics of the population, pose unique challenges to the traditional diagnostic and treatment paradigms for syphilis. As a consequence of this increased incidence of syphilis, there has been interest in the utility of point of care tests (POCT), nucleic acid amplification tests (NAAT), the role of IgM testing in suspected congenital syphilis, and the laboratory investigation of possible neurosyphilis. This review looks at the current status of traditional serological assays and provides an update on more recent methods. It assesses the published literature in this area and makes recommendations for the rational use of pathology testing to aid in the diagnosis of the many facets of syphilis.
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Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052385. [PMID: 33804487 PMCID: PMC7957747 DOI: 10.3390/ijerph18052385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.
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Luo Y, Xie Y, Xiao Y. Laboratory Diagnostic Tools for Syphilis: Current Status and Future Prospects. Front Cell Infect Microbiol 2021; 10:574806. [PMID: 33628742 PMCID: PMC7897658 DOI: 10.3389/fcimb.2020.574806] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022] Open
Abstract
With the increasing number of patients infected with syphilis in the past 20 years, early diagnosis and early treatment are essential to decline syphilis prevalence. Owing to its diverse manifestations, which may occur in other infections, the disease often makes clinicians confused. Therefore, a sensitive method for detecting T. pallidum is fundamental for the prompt diagnosis of syphilis. Morphological observation, immunohistochemical assay, rabbit infectivity test, serologic tests, and nucleic acid amplification assays have been applied to the diagnosis of syphilis. Morphological observation, including dark-field microscopy, silver-staining, and direct fluorescent antibody staining for T. pallidum, can be used as a direct detection method for chancre specimens in primary syphilis. Immunohistochemistry is a highly sensitive and specific assay, especially in the lesion biopsies from secondary syphilis. Rabbit infectivity test is considered as a sensitive and reliable method for detecting T. pallidum in clinical samples and used as a historical standard for the diagnosis of syphilis. Serologic tests for syphilis are widely adopted using non-treponemal or treponemal tests by either the traditional or reverse algorithm and remain the gold standard in the diagnosis of syphilis patients. In addition, nucleic acid amplification assay is capable of detecting T. pallidum DNA in the samples from patients with syphilis. Notably, PCR is probably a promising method but remains to be further improved. All of the methods mentioned above play important roles in various stages of syphilis. This review aims to provide a summary of the performance characteristics of detection methods for syphilis.
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Affiliation(s)
- Yuting Luo
- Department of Clinical Laboratory, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Yafeng Xie
- Department of Clinical Laboratory, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Yongjian Xiao
- Department of Clinical Laboratory, The Second Affiliated Hospital of University of South China, Hengyang, China
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de Souza TA, Teixeira KK, Santana RL, Penha CB, Medeiros ADA, de Lima KC, Barbosa IR. Intra-urban differentials of congenital and acquired syphilis and syphilis in pregnant women in an urban area in northeastern Brazil. Trans R Soc Trop Med Hyg 2021; 115:1010-1018. [PMID: 33547898 PMCID: PMC8417086 DOI: 10.1093/trstmh/trab011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Currently syphilis is considered an epidemic disease worldwide. The objective of this study was to identify intra-urban differentials in the occurrence of congenital and acquired syphilis and syphilis in pregnant women in the city of Natal, in northeast Brazil. Methods Cases of syphilis recorded by the municipal surveillance system from 1 January 2011 to 30 December 2018 were analysed. Spatial statistical analyses were performed using the kernel density estimator of the quadratic smoothing function (weighted). SaTScan software was applied for the calculation of risk based on a discrete Poisson model. Results There were 2163 cases of acquired syphilis, 738 cases of syphilis in pregnant women and 1279 cases of congenital syphilis. Kernel density maps showed that the occurrence of cases is more prevalent in peripheral areas and in areas with more precarious urban infrastructure. In 2011–2014 and 2015–2018, seven statistically significant clusters of acquired syphilis were identified. From 2011 to 2014, the most likely cluster had a relative risk of 3.54 (log likelihood ratio [LLR] 38 895; p<0.001) and from 2015 to 2018 the relative risk was 0.54 (LLR 69 955; p<0.001). Conclusions In the municipality of Natal, there was a clustered pattern of spatial distribution of syphilis, with some areas presenting greater risk for the occurrence of new cases.
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Affiliation(s)
- Talita Araujo de Souza
- Health Sciences Postgraduate Program, Federal University Of Rio Grande do Norte, Natal, Rio Grande do Norte 59056-150, Brazil
| | - Karen Kaline Teixeira
- Health Surveillance Department, Municipal Health Secretary, Natal, Rio Grande do Norte 59025-090, Brazil
| | - Reginaldo Lopes Santana
- Health Surveillance Department, Municipal Health Secretary, Natal, Rio Grande do Norte 59025-090, Brazil
| | - Cinthia Barros Penha
- Health Surveillance Department, Municipal Health Secretary, Natal, Rio Grande do Norte 59025-090, Brazil
| | - Arthur de Almeida Medeiros
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Brazil.,Public Health Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59056-000, Brazil
| | - Kenio Costa de Lima
- Public Health Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59056-000, Brazil
| | - Isabelle Ribeiro Barbosa
- Public Health Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59056-000, Brazil
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Barbosa MDS, Lima LAD, Ribeiro SM, Croda J, Queiroz JHFDS, Ortolani LG, Negrão FJ, Souza EC, Silva KED, Souza ROD, Simionatto S. Epidemiological study in Brazilian women highlights that syphilis remains a public health problem. Rev Inst Med Trop Sao Paulo 2021; 63:e4. [PMID: 33533807 PMCID: PMC7845940 DOI: 10.1590/s1678-9946202163004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
Syphilis, an infectious disease considered a global public health concern, can cause stillbirths and neonatal deaths. This highlights the importance of continuous surveillance studies among women of reproductive age. A cross-sectional study was carried out to analyze the prevalence and risk factors associated with Treponema pallidum infection in women assisted by primary health care units in Dourados, a city located in Mato Grosso do Sul State, Brazil, which borders Paraguay. A questionnaire was applied to a population-based sample, blood samples were collected for syphilis testing and multivariable analyses were performed to screen associations with T. pallidum infection. The prevalence of T. pallidum infection was 6.04%. Bivariate analysis showed that women referring multiple sexual partners (c2: 6.97 [p=0.014]), income less 2 minimal wages (c2: 15.93 [p=0.003]), who did not have high school (c2: 12.64 [p=0.005]), and reporting history of STIs (c2: 7.30 [p=0.018]) are more likely to have syphilis. In the multivariate analysis, a highest prevalence ratio was observed in women with income less than 2 minimal wages (PR: 0.96 [95% CI: 0.85 - 0.97]), and who did not have high school (PR: 0.94 [95% CI: 0.90 - 0.98]). In addition, 80% of the women reported irregular use of condoms and 63.89% declared having sexual intercourses with multiple partners, which creates more opportunities for the transmission of the infection. These results highlight the need for healthcare systems to implement initiatives to monitor syphilis screening and the commitment of patients and their sexual partners to the treatment in order to achieve a decrease of new cases.
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Affiliation(s)
- Marcelo Dos Santos Barbosa
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Leticya Aparecida de Lima
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Suzana Meira Ribeiro
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Julio Croda
- Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil.,Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Lais Gonçalves Ortolani
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Fábio Juliano Negrão
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Elaine Costa Souza
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Kesia Esther da Silva
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Ronaldo Omizolo de Souza
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Simone Simionatto
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
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Caruso G, Giammanco A, Virruso R, Fasciana T. Current and Future Trends in the Laboratory Diagnosis of Sexually Transmitted Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1038. [PMID: 33503917 PMCID: PMC7908473 DOI: 10.3390/ijerph18031038] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
Abstract
Sexually transmitted infections (STIs) continue to exert a considerable public health and social burden globally, particularly for developing countries. Due to the high prevalence of asymptomatic infections and the limitations of symptom-based (syndromic) diagnosis, confirmation of infection using laboratory tools is essential to choose the most appropriate course of treatment and to screen at-risk groups. Numerous laboratory tests and platforms have been developed for gonorrhea, chlamydia, syphilis, trichomoniasis, genital mycoplasmas, herpesviruses, and human papillomavirus. Point-of-care testing is now a possibility, and microfluidic and high-throughput omics technologies promise to revolutionize the diagnosis of STIs. The scope of this paper is to provide an updated overview of the current laboratory diagnostic tools for these infections, highlighting their advantages, limitations, and point-of-care adaptability. The diagnostic applicability of the latest molecular and biochemical approaches is also discussed.
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Affiliation(s)
- Giorgia Caruso
- U.O.C. of Microbiology and Virology, ARNAS “Civico, Di Cristina and Benfratelli”, 90127 Palermo, Italy
| | - Anna Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.G.); (T.F.)
| | - Roberta Virruso
- U.O.C. of Microbiology, Virology and Parassitology, A.O.U.P. “Paolo Giaccone”, 90127 Palermo, Italy;
| | - Teresa Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (A.G.); (T.F.)
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Abstract
Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.
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Wang CJ, Leavens J, Thorpe J, Crew A, Kim G, Ahronowitz I, Worswick S. Nodular secondary syphilis in three HIV-positive patients: a case series. Int J STD AIDS 2020; 31:1004-1007. [PMID: 32693735 DOI: 10.1177/0956462420933787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nodular secondary syphilis is an uncommon variant of secondary syphilis. We identified three cases of nodular secondary syphilis at our institution. The first patient presented with a diffuse nodular rash that included his scrotum and penis. The second patient had disseminated skin-colored nodules with serosanguinous crust on his face, trunk, and extremities. The third patient had a pruritic papular and nodular rash with overlying crust. All three patients had a reactive rapid plasma reagin and tested positive for fluorescent treponemal antibody absorption. All were eventually confirmed to be human immunodeficiency virus-positive. Histopathological examination demonstrated inflammatory infiltrate in the dermis composed of lymphocytes, histiocytes, and plasma cells, and treponemal staining highlighted spirochetes in the dermis. The patients were successfully treated with intramuscular penicillin benzathine G. Physicians should be aware of nodular syphilis as a less common cutaneous manifestation of secondary syphilis. Prompt diagnosis of secondary syphilis can expedite resolution of the infection and avoid progression to tertiary syphilis.
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Affiliation(s)
- Catherine J Wang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joan Leavens
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joseph Thorpe
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashley Crew
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gene Kim
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Iris Ahronowitz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Comment on: “Sexually acquired syphilis: Laboratory diagnosis, management, and prevention”. J Am Acad Dermatol 2020; 82:e241. [DOI: 10.1016/j.jaad.2020.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
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Khafaja S, Youssef Y, Darjani N, Youssef N, Fattah CM, Hanna-Wakim R. Case Report: A Delayed Diagnosis of Congenital Syphilis-Too Many Missed Opportunities. Front Pediatr 2020; 8:499534. [PMID: 33553061 PMCID: PMC7855964 DOI: 10.3389/fped.2020.499534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/24/2020] [Indexed: 11/13/2022] Open
Abstract
Congenital syphilis remains a significant public health problem nowadays. We describe the presentation of an infant with a delayed diagnosis of congenital syphilis, with a negative initial non-treponemal test. Our aim is to shed light on the incidence of missed prevention, the importance of awareness, maternal screening, and early diagnosis.
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Affiliation(s)
- Sarah Khafaja
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yolla Youssef
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Darjani
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Youssef
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
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