1
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Wu P, Wang X, Wang H. Spatial heterogeneity analysis for the transmission of syphilis disease in China via a data-validated reaction-diffusion model. Math Biosci 2024; 375:109243. [PMID: 38964670 DOI: 10.1016/j.mbs.2024.109243] [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: 02/02/2024] [Revised: 05/05/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
Based on the distinctive spatial diffusion characteristics observed in syphilis transmission patterns, this paper introduces a novel reaction-diffusion model for syphilis disease dynamics, incorporating general incidence functions within a heterogeneous environment. We derive the basic reproduction number essential for threshold dynamics and investigate the uniform persistence of the model. We validate the model and estimate its parameters by employing the multi-objective Markov Chain Monte Carlo (MCMC) method, using real syphilis data from the years 2004 to 2018 in China. Furthermore, we explore the impact of spatial heterogeneity and intervention measures on syphilis transmission. Our findings reveal several key insights: (1) In addition to the original high-incidence areas of syphilis, Xinjiang, Guizhou, Hunan and Northeast China have also emerged as high-incidence regions for syphilis in China. (2) The latent syphilis cases represent the highest proportion of newly reported cases, highlighting the critical importance of considering their role in transmission dynamics to avoid underestimation of syphilis outbreaks. (3) Neglecting spatial heterogeneity results in an underestimation of disease prevalence and the number of syphilis-infected individuals, undermining effective disease prevention and control strategies. (4) The initial conditions have minimal impact on the long-term spatial distribution of syphilis-infected individuals in scenarios of varying diffusion rates. This study underscores the significance of spatial dynamics and intervention measures in assessing and managing syphilis transmission, which offers insights for public health policymakers.
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Affiliation(s)
- Peng Wu
- School of Sciences, Hangzhou Dianzi University, Hangzhou 310018, China.
| | - Xiunan Wang
- Department of Mathematics, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA.
| | - Hao Wang
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB T6G 2G1, Canada.
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2
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Nanoudis S, Pilalas D, Tziovanaki T, Constanti M, Markakis K, Pagioulas K, Papantoniou E, Kapiki K, Chrysanthidis T, Kollaras P, Metallidis S, Tsachouridou O. Prevalence and Treatment Outcomes of Syphilis among People with Human Immunodeficiency Virus (HIV) Engaging in High-Risk Sexual Behavior: Real World Data from Northern Greece, 2019-2022. Microorganisms 2024; 12:1256. [PMID: 39065024 PMCID: PMC11278651 DOI: 10.3390/microorganisms12071256] [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: 06/03/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
In this study, we aimed to assess the prevalence of syphilis among people with human immunodeficiency virus (HIV; PWH) engaging in high-risk sexual behavior, determine the stage of syphilis, and evaluate treatment efficacy. A retrospective single-center cohort study was conducted at the AHEPA University General Hospital of Thessaloniki, focusing on PWH at high risk for sexually transmitted infections (STIs) attending outpatient care from January 2019 to December 2022. Sociodemographic and clinical data were collected, incident syphilis rates were identified, associations with HIV-related characteristics were explored, and the treatment response was assessed. Among 991 participants, 94 PWH were diagnosed with syphilis, representing 9.4% of the cohort. Incident syphilis cases experienced a decrease in the early COVID-19 era compared to 2019, followed by a gradual increase leading up to 2022. The majority of syphilis cases were asymptomatic latent syphilis (71.1%). Men who have sex with men (MSM) and younger individuals exhibited higher rates of co-infection during the study period. No significant association was found between incident syphilis and HIV-related factors. Most syphilis cases (86%) were treated with benzathine penicillin G (BPG). Treatment with BPG and doxycycline showed an increased success rate (96.7% vs. 92.9%), with no statistically significant difference observed between them (p = 0.438). This study highlights the alarming incidence of syphilis among PWH engaging in high-risk sexual behavior, particularly among younger MSM. BPG remains effective, and alternative regimens like doxycycline show promise, especially in settings with penicillin shortages or patient allergies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Olga Tsachouridou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 554 36 Thessaloniki, Greece; (S.N.); (D.P.); (T.T.); (M.C.); (K.M.); (K.P.); (E.P.); (K.K.); (T.C.); (S.M.)
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3
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Hayata E, Suzuki S, Hoshi SI, Sekizawa A, Sagara Y, Ishiwata I, Kitamura T. Trends in Syphilis in Pregnant Women in Japan in 2016 and 2022. Cureus 2024; 16:e56292. [PMID: 38495970 PMCID: PMC10944339 DOI: 10.7759/cureus.56292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 03/19/2024] Open
Abstract
Since 2012, the rate of syphilis infection has increased dramatically in high-income countries including Japan. In this study, we examined the rate of syphilis infection among pregnant women and perinatal outcomes in the syphilis-infected pregnancy in 2022 in Japan, and compared the results with those in 2016. We requested 2,005 obstetric institutes to provide information on syphilis infection in pregnant women who delivered in 2022. A total of 1,346 obstetrical facilities responded with valid information. We compared the results with those in our previous study. The prevalence of syphilis-infected pregnant women was 1/1,215. The incidence of preterm delivery, intrauterine fetal demise and congenital syphilis in surviving neonates in the syphilis-infected pregnancy were 9%, 2% and 7%, respectively. The prevalence of syphilis-infected pregnant women has increased significantly, while the incidence of congenital syphilis seems to have decreased clinically.
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Affiliation(s)
- Eijiro Hayata
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Shunji Suzuki
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Shin-Ichi Hoshi
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Akihiko Sekizawa
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Yoko Sagara
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Isamu Ishiwata
- Division of Maternal and Child Health, Japan Association of Obstetricians and Gynecologists, Tokyo, JPN
| | - Tadaichi Kitamura
- Infectious Diseases, Japanese Foundation for Sexual Health Medicine, Tokyo, JPN
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4
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Majander K, Pla-Díaz M, du Plessis L, Arora N, Filippini J, Pezo-Lanfranco L, Eggers S, González-Candelas F, Schuenemann VJ. Redefining the treponemal history through pre-Columbian genomes from Brazil. Nature 2024; 627:182-188. [PMID: 38267579 PMCID: PMC10917687 DOI: 10.1038/s41586-023-06965-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
The origins of treponemal diseases have long remained unknown, especially considering the sudden onset of the first syphilis epidemic in the late 15th century in Europe and its hypothesized arrival from the Americas with Columbus' expeditions1,2. Recently, ancient DNA evidence has revealed various treponemal infections circulating in early modern Europe and colonial-era Mexico3-6. However, there has been to our knowledge no genomic evidence of treponematosis recovered from either the Americas or the Old World that can be reliably dated to the time before the first trans-Atlantic contacts. Here, we present treponemal genomes from nearly 2,000-year-old human remains from Brazil. We reconstruct four ancient genomes of a prehistoric treponemal pathogen, most closely related to the bejel-causing agent Treponema pallidum endemicum. Contradicting the modern day geographical niche of bejel in the arid regions of the world, the results call into question the previous palaeopathological characterization of treponeme subspecies and showcase their adaptive potential. A high-coverage genome is used to improve molecular clock date estimations, placing the divergence of modern T. pallidum subspecies firmly in pre-Columbian times. Overall, our study demonstrates the opportunities within archaeogenetics to uncover key events in pathogen evolution and emergence, paving the way to new hypotheses on the origin and spread of treponematoses.
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Affiliation(s)
- Kerttu Majander
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria.
- Department of Environmental Sciences, University of Basel, Basel, Switzerland.
| | - Marta Pla-Díaz
- Unidad Mixta Infección y Salud Pública, FISABIO/Universidad de Valencia-I2SysBio, Valencia, Spain
- CIBER in Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Louis du Plessis
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
- Swiss Institute of Bioinformatics, Quartier Sorge, Lausanne, Switzerland
| | - Natasha Arora
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Jose Filippini
- Department of Genetic and Evolutionary Biology, University of São Paulo, São Paulo, Brazil
| | - Luis Pezo-Lanfranco
- Department of Genetic and Evolutionary Biology, University of São Paulo, São Paulo, Brazil
- Institute of Environmental Science and Technology (ICTA) and Prehistory Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sabine Eggers
- Department of Genetic and Evolutionary Biology, University of São Paulo, São Paulo, Brazil
- Department of Anthropology, Natural History Museum Vienna, Vienna, Austria
| | - Fernando González-Candelas
- Unidad Mixta Infección y Salud Pública, FISABIO/Universidad de Valencia-I2SysBio, Valencia, Spain.
- CIBER in Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.
| | - Verena J Schuenemann
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria.
- Department of Environmental Sciences, University of Basel, Basel, Switzerland.
- Human Evolution and Archaeological Sciences (HEAS), University of Vienna, Vienna, Austria.
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Song YJ, Choi H. Seasonality of syphilis in males through the 2011 to 2019 mandatory surveillance period: A cross-sectional study in South Korea. Medicine (Baltimore) 2023; 102:e36723. [PMID: 38115249 PMCID: PMC10727654 DOI: 10.1097/md.0000000000036723] [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: 02/14/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
Although the effects of seasonality on syphilis have been discussed previously, no previous study has evaluated the seasonality of syphilis incidence by sex and age group. We examined the seasonality of syphilis incidence by sex and age group in Korea from 2011 to 2019. The incidence of syphilis was calculated on the basis of Korea Diseases Control and Prevention Agency data, and an autoregressive integrated moving average (ARIMA) model and seasonal and trend decomposition using Loess were used to analyze the seasonality of the incidence in relation to epidemiological factors. The annual age-standardized incidence rates of primary, secondary, and congenital syphilis were 21.1, 8.8, and 64.0 cases/million persons, respectively, from 2011 to 2019. The highest incidence rates for primary and secondary syphilis were observed among those aged 20 to 29, 13 to 19, and 30 to 49 years, but not among the lower age groups. In analyses based on the ARIMA model, all univariate time series showed the highest goodness-of-fit results with ARIMA for primary syphilis (1,1,2), secondary syphilis (1,1,1), and congenital syphilis (0,1,2) (2,0,0) models. This study suggests that the incidence of secondary syphilis shows a summer seasonality for males and the highest incidence rate in the 20 to 29-year age group for both males and females in Korea. Public health action is needed to prevent an increase in syphilis incidence associated with sex, age group, and seasonal patterns.
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Affiliation(s)
- Yeong-Jun Song
- Division of HIV/AIDS Prevention and Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Hoyong Choi
- Division of HIV/AIDS Prevention and Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
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Beale MA, Thorn L, Cole MJ, Pitt R, Charles H, Ewens M, French P, Guiver M, Page EE, Smit E, Vera JH, Sinka K, Hughes G, Marks M, Fifer H, Thomson NR. Genomic epidemiology of syphilis in England: a population-based study. THE LANCET. MICROBE 2023; 4:e770-e780. [PMID: 37722404 PMCID: PMC10547597 DOI: 10.1016/s2666-5247(23)00154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Syphilis is a sexually transmitted bacterial infection caused by Treponema pallidum subspecies pallidum. Since 2012, syphilis rates have risen dramatically in many high-income countries, including England. Although this increase in syphilis prevalence is known to be associated with high-risk sexual activity in gay, bisexual, and other men who have sex with men (GBMSM), cases are rising in heterosexual men and women. The transmission dynamics within and between sexual networks of GBMSM and heterosexual people are not well understood. We aimed to investigate if whole genome sequencing could be used to supplement or enhance epidemiological insights around syphilis transmission. METHODS We linked national patient demographic, geospatial, and behavioural metadata to whole T pallidum genome sequences previously generated from patient samples collected from across England between Jan 1, 2012, and Oct 31, 2018, and performed detailed phylogenomic analyses. FINDINGS Of 497 English samples submitted for sequencing, we recovered 240 genomes (198 from the UK Health Security Agency reference laboratory and 42 from other laboratories). Three duplicate samples (same patient and collection date) were included in the main phylogenies, but removed from further analyses of English populations, leaving 237 genomes. 220 (92·8%) of 237 samples were from men, nine (3·8%) were from women, and eight (3·4%) were of unknown gender. Samples were mostly from London (n=118 [49·8%]), followed by southeast England (n=29 [12·2%]), northeast England (n=24 [10·1%]), and southwest England (n=15 [6·3%]). 180 (76·0%) of 237 genomes came from GBMSM, compared with 25 (10·5%) from those identifying as men who have sex with women, 15 (6·3%) from men with unrecorded sexual orientation, nine (3·8%) from those identifying as women who have sex with men, and eight (3·4%) from people of unknown gender and sexual orientation. Phylogenomic analysis and clustering revealed two dominant T pallidum sublineages in England. Sublineage 1 was found throughout England and across all patient groups, whereas sublineage 14 occurred predominantly in GBMSM older than 34 years and was absent from samples sequenced from the north of England. These different spatiotemporal trends, linked to demography or behaviour in the dominant sublineages, suggest they represent different sexual networks. By focusing on different regions of England we were able to distinguish a local heterosexual transmission cluster from a background of transmission in GBMSM. INTERPRETATION These findings show that, despite extremely close genetic relationships between T pallidum genomes globally, genomics can still be used to identify putative transmission clusters for epidemiological follow-up. This could be of value for deconvoluting putative outbreaks and for informing public health interventions. FUNDING Wellcome funding to the Sanger Institute, UK Research and Innovation, National Institute for Health and Care Research, European and Developing Countries Clinical Trials Partnership, and UK Health Security Agency.
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Affiliation(s)
- Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
| | - Louise Thorn
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Michelle J Cole
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Rachel Pitt
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Hannah Charles
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Michael Ewens
- Brotherton Wing Clinic, Brotherton Wing, Leeds General Infirmary, Leeds, UK
| | - Patrick French
- The Mortimer Market Centre, Central and North West London NHS Trust, London, UK
| | - Malcolm Guiver
- Laboratory Network, Manchester, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Emma E Page
- Virology Department, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Erasmus Smit
- Clinical Microbiology Department, Queen Elizabeth Hospital, Birmingham, UK; Institute of Environmental Science and Research, Wellington, New Zealand
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Gwenda Hughes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK.
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Sha Z, Jing S, Feng G, Hongjun H, Xianzeng L. Neurosyphilis with positive anti-N-methyl-D-aspartate receptor antibody: a case report. Front Neurol 2023; 14:1164605. [PMID: 37273698 PMCID: PMC10232843 DOI: 10.3389/fneur.2023.1164605] [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: 03/07/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
A case of neurosyphilis with a positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody was reported. A 54-year-old man who presented with acute memory deficits was admitted to our hospital. Acute ischemic stroke (AIS) was initially considered, and he was prescribed intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). However, the intermittent onset of episodic memory and orientation disorder still occurred. No diffusion restriction was indicated by magnetic resonance imaging (MRI), and subclinical seizures were frequently found by electroencephalogram (EEG). Rapid plasma reagin (RPR) test of serum showed positive results for syphilis. Analysis of cerebrospinal fluid (CSF) revealed elevated leukocyte count and protein level. RPR test, Treponema pallidum particle agglutination (TPPA) assay, and Treponema pallidum antibody (TP-Ab) in CSF showed positive results, and the anti-NMDAR antibodies were positive in CSF and serum. Finally, the patient was diagnosed with neurosyphilis with a positive anti-NMDAR antibody. The clinical symptoms were improved, and the leukocyte count in CSF was reduced after treatment with intravenous penicillin G and levetiracetam. This case suggests that in cases with positive results for neurosyphilis and NMDAR antibodies, the proper treatment has to be decided based on all of the available clinical and diagnostic testing data.
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Affiliation(s)
- Zhu Sha
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Shi Jing
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Gao Feng
- Department of Neurology, Peking University International Hospital, Beijing, China
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Hao Hongjun
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Liu Xianzeng
- Department of Neurology, Peking University International Hospital, Beijing, China
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Fukumoto C, Zama M, Hyodo T, Shiraishi R, Kamimura R, Yagisawa S, Hasegawa T, Komiyama Y, Izumi S, Wakui T, Kawamata H. Primary syphilis with a tongue ulcer mimicking tongue cancer: a case report. J Int Med Res 2023; 51:3000605231161223. [PMID: 36942446 PMCID: PMC10034294 DOI: 10.1177/03000605231161223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
The main symptom in primary syphilis is a small, painless, sore or ulcer called a chancre on the penis, vagina, or around the anus, although chancres can sometimes appear in the mouth or on the lips, fingers, or buttocks. We present the case of a man in his early 60 s with a chief complaint of a painful tongue ulcer. An ulcerated, indurated, and hemorrhagic lesion (23 × 14 mm) was found on the ventral tongue surface, near the oral floor. Palpation identified several swollen, mobile, elastic cervical lymph nodes, with no tenderness. We initially diagnosed tongue cancer; however, during a subsequent detailed examination for a malignant tumor, including biopsy and obtaining additional history, his disease was finally identified as primary syphilis with multiple swollen cervical lymph nodes. Oral amoxicillin and probenecid were started, and after 14 days, there was partial reduction in the size of the submandibular lymph nodes and the ulcer on the left tongue margin. The number of patients with syphilis in Japan increased by eight times from 2012 to 2018. We suggest that dentists consider primary syphilis as a differential diagnosis for oral refractory ulcer with induration and obtain a detailed patient history.
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Affiliation(s)
- Chonji Fukumoto
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Manabu Zama
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Toshiki Hyodo
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Ryo Shiraishi
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Ryouta Kamimura
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Shuma Yagisawa
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Tomonori Hasegawa
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Yuske Komiyama
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Sayaka Izumi
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Takahiro Wakui
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Hitoshi Kawamata
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
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9
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Wang R, Li X, Hu Z, Jing W, Zhao Y. Spatial Heterogeneity and Its Influencing Factors of Syphilis in Ningxia, Northwest China, from 2004 to 2017: A Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10541. [PMID: 36078254 PMCID: PMC9518519 DOI: 10.3390/ijerph191710541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Syphilis remains a growing and resurging infectious disease in China. However, exploring the influence of environmental factors on the spatiotemporal distribution of syphilis remains under explore. This study aims to analyze the spatiotemporal distribution characteristics of syphilis in Ningxia, Northwest China, and its potential environmental influencing factors. Based on the standardized incidence ratio of syphilis for 22 administrative areas in Ningxia from 2004 to 2017, spatiotemporal autocorrelation and scan analyses were employed to analyze the spatial and temporal distribution characteristics of syphilis incidence, while a fixed-effect spatial panel regression model identified the potential factors affecting syphilis incidence. Syphilis incidence increased from 3.78/100,000 in 2004 to 54.69/100,000 in 2017 with significant spatial clustering in 2007 and 2009-2013. The "high-high" and "low-low" clusters were mainly distributed in northern and southern Ningxia, respectively. The spatial error panel model demonstrated that the syphilis incidence may be positively correlated with the per capita GDP and tertiary industry GDP and negatively correlated with the number of health facilities and healthcare personnel. Sex ratio and meteorological factors were not significantly associated with syphilis incidence. These results show that the syphilis incidence in Ningxia is still increasing and has significant spatial distribution differences and clustering. Socio-economic and health-resource factors could affect the incidence; therefore, strengthening syphilis surveillance of migrants in the economically developed region and allocating health resources to economically underdeveloped areas may effectively help prevent and control syphilis outbreaks in high-risk cluster areas of Ningxia.
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Affiliation(s)
- Ruonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Xiaolong Li
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Zengyun Hu
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi 830011, China
| | - Wenjun Jing
- School of Statistics, Shanxi University of Finance and Economics, Taiyuan 030006, China
| | - Yu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
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10
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Eijmael MJP, Bruin RGD, Hira V, Koster T. A peculiar case of syphilis infection: The great imitator is on the rise. IDCases 2022; 28:e01521. [PMID: 35646595 PMCID: PMC9136118 DOI: 10.1016/j.idcr.2022.e01521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
The incidence of syphilis is on the rise worldwide and can pose many diagnostic and therapeutic difficulties for doctors. Given the wide variety of presenting symptoms, syphilis is also known as the great imitator, which in turn frequently leads to a pronounced diagnostic- and therapeutic delay for patients. Here we present a case report of syphilitic uveitis and papillitis accompanied by acute vision loss, a rare presentation of a tertiary syphilis infection that clinically mimicked a giant cell arteritis (GCA) or arteritic anterior ischemic optic neuropathy (AAION). The patient was treated with high-dose intravenous benzyl penicillin after which full vision was restored. By presenting this case, we hope to raise awareness for the increasing incidence of syphilis infections and stress the importance of syphilis testing in patients with otherwise unexplained uveitis.
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Affiliation(s)
- MJP Eijmael
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - RG de Bruin
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - V. Hira
- Department of Medical Microbiology and Infection Prevention, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - T. Koster
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
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11
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Truong R, Tang V, Grennan T, Tan DHS. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac009. [PMID: 35198979 PMCID: PMC8855662 DOI: 10.1093/jacamr/dlac009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Robinson Truong
- Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada
| | - Vincent Tang
- Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
| | - Troy Grennan
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
- Division of Infectious Diseases and Department of Medicine, University of British Columbia, 317–2194 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada
| | - Darrell H. S. Tan
- Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada
- Division of Infectious Diseases, St. Michael’s Hospital, 36 Queen St E, Toronto, ON M5B 1W8, Canada
- Department of Medicine, St. Michael’s Hospital, 36 Queen St E, Toronto, ON M5B 1W8, Canada
- Corresponding author. E-mail:
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12
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Luo Z, Ding Y, Yuan J, Wu Q, Tian L, Zhang L, Li B, Mou J. Predictors of Seronegative Conversion After Centralized Management of Syphilis Patients in Shenzhen, China. Front Public Health 2021; 9:755037. [PMID: 34900903 PMCID: PMC8655675 DOI: 10.3389/fpubh.2021.755037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to explore the seronegative conversion status of syphilis patients after centralized management and to analyze potential determinants. Materials and Methods: A retrospective population-based cohort study was conducted, and data for individuals who had been diagnosed with syphilis between 2011 and 2019 were retrieved from the Shenzhen Nanshan Center for Chronic Disease Control. Seroconversion statuses were summarized as percentages. Univariable and multiple Cox proportional hazard regression models were used to analyze the factors associated with seronegative conversion among syphilis patients. Results: During the study period, 1,545 patients with syphilis participated in the syphilis convergence case management program on a voluntary basis, of whom 290 were excluded due to missing follow-up data. A total of 27.6% (346/1255) of patients with syphilis showed seronegative conversion. Multivariable analysis revealed that the following significantly determined syphilis seroconversion from positive to negative: younger age (15–19 years vs. ≥30 years: HR = 2.18), male gender (HR = 1.45), lower baseline toluidine red unheated serum test (TRUST) titer of ≤ 1:8 (HR = 2.23), and different disease stages, including latent syphilis (HR = 1.98), primary syphilis (HR = 7.67), and secondary syphilis (HR = 4.83). Conclusions: Few patients with syphilis tested negative after treatment at the end of the study. Seronegative conversion in the patients was associated with age, sex, baseline TRUST titer, and syphilis stage.
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Affiliation(s)
- Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yi Ding
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jun Yuan
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Qiuhong Wu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lishan Tian
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bo Li
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jinsong Mou
- Pingshan District Maternal and Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
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13
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Im JJ, Jeong H, Kim YD, Jang KS, Song IU, Chung YA. Regional Cerebral Blood Flow Abnormalities in Neurosyphilis: A Pilot SPECT Study. Front Neurol 2021; 12:726006. [PMID: 34858307 PMCID: PMC8631505 DOI: 10.3389/fneur.2021.726006] [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: 06/16/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Clinical and radiological findings on neurosyphilis are fairly non-specific and there is a paucity of functional neuroimaging studies on neurosyphilis other than case reports and case series. The purpose of this study was to investigate brain perfusion abnormalities in patients with neurosyphilis. Methods: Four HIV-negative neurosyphilis patients and 4 healthy controls underwent clinical evaluation, brain technetium-99m ethyl cysteinate dimer (99mTc-ECD) single-photon emission computed tomography (SPECT) imaging, and neuropsychological assessments which included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and Global Deterioration Scale (GDS). Voxel-wise differences in regional cerebral blood flow were compared between the two groups. Results: Neuropsychological test results indicated cognitive impairment in all patients. SPECT analysis revealed multifocal hypoperfusion predominantly in the frontal, insular, and posterior cingulate regions in neurosyphilis patients compared with healthy controls (family-wise error corrected p < 0.05). Conclusions: Together with previous findings, our results suggest that the hypoperfusion in the frontal, insular, and posterior cingulate regions may reflect cognitive impairments observed in neurosyphilis patients. Further studies with larger samples are needed to confirm our findings.
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Affiliation(s)
- Jooyeon J Im
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyeonseok Jeong
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Do Kim
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Sool Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-An Chung
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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14
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Beale MA, Marks M, Cole MJ, Lee MK, Pitt R, Ruis C, Balla E, Crucitti T, Ewens M, Fernández-Naval C, Grankvist A, Guiver M, Kenyon CR, Khairullin R, Kularatne R, Arando M, Molini BJ, Obukhov A, Page EE, Petrovay F, Rietmeijer C, Rowley D, Shokoples S, Smit E, Sweeney EL, Taiaroa G, Vera JH, Wennerås C, Whiley DM, Williamson DA, Hughes G, Naidu P, Unemo M, Krajden M, Lukehart SA, Morshed MG, Fifer H, Thomson NR. Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. Nat Microbiol 2021; 6:1549-1560. [PMID: 34819643 PMCID: PMC8612932 DOI: 10.1038/s41564-021-01000-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
Syphilis, which is caused by the sexually transmitted bacterium Treponema pallidum subsp. pallidum, has an estimated 6.3 million cases worldwide per annum. In the past ten years, the incidence of syphilis has increased by more than 150% in some high-income countries, but the evolution and epidemiology of the epidemic are poorly understood. To characterize the global population structure of T. pallidum, we assembled a geographically and temporally diverse collection of 726 genomes from 626 clinical and 100 laboratory samples collected in 23 countries. We applied phylogenetic analyses and clustering, and found that the global syphilis population comprises just two deeply branching lineages, Nichols and SS14. Both lineages are currently circulating in 12 of the 23 countries sampled. We subdivided T. p. pallidum into 17 distinct sublineages to provide further phylodynamic resolution. Importantly, two Nichols sublineages have expanded clonally across 9 countries contemporaneously with SS14. Moreover, pairwise genome analyses revealed examples of isolates collected within the last 20 years from 14 different countries that had genetically identical core genomes, which might indicate frequent exchange through international transmission. It is striking that most samples collected before 1983 are phylogenetically distinct from more recently isolated sublineages. Using Bayesian temporal analysis, we detected a population bottleneck occurring during the late 1990s, followed by rapid population expansion in the 2000s that was driven by the dominant T. pallidum sublineages circulating today. This expansion may be linked to changing epidemiology, immune evasion or fitness under antimicrobial selection pressure, since many of the contemporary syphilis lineages we have characterized are resistant to macrolides.
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Affiliation(s)
- Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michelle J Cole
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Min-Kuang Lee
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Rachel Pitt
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
| | - Christopher Ruis
- Molecular Immunity Unit, MRC-Laboratory of Molecular Biology, Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Eszter Balla
- Bacterial STIs Reference Laboratory, Department of Bacteriology, National Public Health Centre, Budapest, Hungary
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Michael Ewens
- Brotherton Wing Clinic, Brotherton Wing, Leeds General Infirmary, Leeds, UK
| | - Candela Fernández-Naval
- Microbiology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Grankvist
- National Reference Laboratory for STIs, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malcolm Guiver
- Laboratory Network, Manchester, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Chris R Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Rafil Khairullin
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Ranmini Kularatne
- Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Maider Arando
- STI Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Barbara J Molini
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Andrey Obukhov
- Tuvan Republican Skin and Venereal Diseases Dispensary, Ministry of Health of Tuva Republic, Kyzyl, Russia
| | - Emma E Page
- Virology Department, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Fruzsina Petrovay
- Bacterial STIs Reference Laboratory, Department of Bacteriology, National Public Health Centre, Budapest, Hungary
| | | | | | | | - Erasmus Smit
- Clinical Microbiology Department, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Emma L Sweeney
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George Taiaroa
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Christine Wennerås
- National Reference Laboratory for STIs, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - David M Whiley
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gwenda Hughes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Prenilla Naidu
- Alberta Precision Laboratories, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mel Krajden
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila A Lukehart
- Departments of Medicine/Infectious Diseases and Global Health, University of Washington, Seattle, WA, USA
| | - Muhammad G Morshed
- British Columbia Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Fifer
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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15
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Tsuboi M, Evans J, Davies EP, Rowley J, Korenromp EL, Clayton T, Taylor MM, Mabey D, Chico RM. Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000-20. LANCET GLOBAL HEALTH 2021; 9:e1110-e1118. [PMID: 34246332 PMCID: PMC9150735 DOI: 10.1016/s2214-109x(21)00221-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND The WHO Global Health Sector Strategy aims to reduce worldwide syphilis incidence by 90% between 2018 and 2030. If this goal is to be achieved, interventions that target high-burden groups, including men who have sex with men (MSM), will be required. However, there are no global prevalence estimates of syphilis among MSM to serve as a baseline for monitoring or modelling disease burden. We aimed to assess the global prevalence of syphilis among MSM using the available literature. METHODS In this global systematic review and meta-analysis, we searched MEDLINE, Embase, LILACS, and AIM databases, and Integrated Bio-Behavioral Surveillance (IBBS) reports between April 23, 2019, and Feb 1, 2020, to identify studies done between Jan 1, 2000, and Feb 1, 2020, with syphilis point prevalence data measured by biological assay among MSM (defined as people who were assigned as male at birth and had oral or anal sex with at least one other man in their lifetime). Studies were excluded if participants were exclusively HIV-infected MSM, injection-drug users, only seeking care for sexually transmitted infections (STIs) or genital symptoms, or routine STI clinic attendees. Data were extracted onto standardised forms and cross-checked for accuracy and validity. We used random-effects models to generate pooled prevalence estimates across the eight regions of the Sustainable Development Goals. We calculated risk of study bias based on the Appraisal tool for Cross-Sectional Studies, and stratified results based on low versus high risk of bias. This systematic review and meta-analysis was registered with PROSPERO, CRD42019144594. FINDINGS We reviewed 4339 records, 228 IBBS reports, and ten articles from other sources. Of these, 1301 duplicate records were excluded, 2467 records were excluded after title and abstract screening, and 534 articles were excluded after full-text analysis. We identified 345 prevalence data points from 275 studies across 77 countries, with a total of 606 232 participants. Global pooled prevalence from 2000-20 was 7·5% (95% CI 7·0-8·0%), ranging from 1·9% (1·0-3·1%) in Australia and New Zealand to 10·6% (8·5-12·9%) in Latin America and the Caribbean. INTERPRETATION Unacceptably high syphilis prevalence among MSM warrants urgent action. FUNDING Wellcome Trust.
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Affiliation(s)
- Motoyuki Tsuboi
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jayne Evans
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ella P Davies
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Tim Clayton
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - David Mabey
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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16
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Nishiki S, Lee K, Kanai M, Nakayama SI, Ohnishi M. Phylogenetic and genetic characterization of Treponema pallidum strains from syphilis patients in Japan by whole-genome sequence analysis from global perspectives. Sci Rep 2021; 11:3154. [PMID: 33542273 PMCID: PMC7862685 DOI: 10.1038/s41598-021-82337-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Japan has had a substantial increase in syphilis cases since 2013. However, research on the genomic features of the Treponema pallidum subspecies pallidum (TPA) strains from these cases has been limited. Here, we elucidated the genetic variations and relationships between TPA strains in Japan (detected between 2014 and 2018) and other countries by whole-genome sequencing and phylogenetic analyses, including syphilis epidemiological surveillance data and information on patient sexual orientation. Seventeen of the 20 strains in Japan were SS14- and the remaining 3 were Nichols-lineage. Sixteen of the 17 SS14-lineage strains were classified into previously reported Sub-lineage 1B. Sub-lineage 1B strains in Japan have formed distinct sub-clusters of strains from heterosexuals and strains from men who have sex with men. These strains were closely related to reported TPA strains in China, forming an East-Asian cluster. However, those strains in these countries evolved independently after diverging from their most recent common ancestor and expanded their genetic diversity during the time of syphilis outbreak in each country. The genetic difference between the TPA strains in these countries was characterized by single-nucleotide-polymorphism analyses of their penicillin binding protein genes. Taken together, our results elucidated the detailed phylogenetic features and transmission networks of syphilis.
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Affiliation(s)
- Shingo Nishiki
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.,Division of Environmental and Preventive Medicine, Department of Social Medicine, Graduate School of Medicine, Tottori University, 86 Nishi-machi, Yonago, Tottori, 683-8503, Japan
| | - Kenichi Lee
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Mizue Kanai
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.,Osaka City Public Health Office, 1-2-7-1,000 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-0051, Japan
| | - Shu-Ichi Nakayama
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
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17
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Santacroce L, Bottalico L, Topi S, Castellaneta F, Charitos IA. The "Scourge of the Renaissance". A Short Review About Treponema pallidum infection. Endocr Metab Immune Disord Drug Targets 2021; 20:335-343. [PMID: 31625831 DOI: 10.2174/1871530319666191009144217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is not a time in the history when epidemics did not loom large: infectious diseases have always had civilisation and evolution-altering consequences. Throughout history, there have been a number of pandemics: cholera, bubonic plague, influenza, smallpox are some of the most brutal killers in human history. Historical accounts of pandemics clearly demonstrate that war, unhygienic conditions, social and health inequality create conditions for the transmission of infectious diseases, and existing health disparities can contribute to unequal morbidity and mortality. The Renaissance was a period of European cultural, artistic, political and economic "rebirth" following the Middle Ages, but it was also the time when new infectious disease appeared, such as Syphilis. The epidemic spread of Syphilis began between the late 15th century and early 16th century due to the increased migration of peoples across Europe. The rapid spread of venereal syphilis throughout Europe suggests the introduction of a disease into a population that had not previously been exposed. Syphilis is a type of treponematosis, which includes syphilis, bejel, yaws, and pinta, but, while syphilis is venereal disease, the others are nonvenereal. Syphilis was, at the beginning, a disease of great severity due to its novelty, as the population had no time to gain any immunity against this venereal disease. METHODS The purpose of this study is to investigate the origin of syphilis and the evolution of the treatments from the empiric means to the discovery of penicillin, but also to understand how this venereal disease has largely influenced human lifestyle and evolution. CONCLUSION The first of the three hypotheses about its origins is the Columbian hypothesis, which states that Columbus's crew acquired syphilis from Native Americans and carried it back to Europe in 1493 A. D. On the contrary, the second hypothesis (pre-Columbian) asserts that syphilis was present in Europe long before Columbus's voyage and was transferred to the New World by Columbus's men. The Unitarian theory argues that syphilis, bejel, yaws, and pinta are not separate diseases but they represent syndromes caused by slightly different strains of one organism. Nowadays, Syphilis' origin is still uncertain and remains controversial. However, the large impact on the social behavior and international public health is an important reason to investigate about its origins and how to prevent the transmission.
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Affiliation(s)
- Luigi Santacroce
- Ionian Department, University of Bari "A. Moro", Bari, Italy.,Clinical Department of Microbiology & Virology, University Hospital of Bari, Bari, Italy.,Department of Clinical Subjects, School of Technical Medical Sciences, "A. Xhuvani" University of Elbasan, Elbasan, Albania
| | - Lucrezia Bottalico
- Ionian Department, Polypheno srl Academic Spin Off, "Aldo Moro" University of Bari, Bari, Italy
| | - Skender Topi
- Ionian Department, University of Bari "A. Moro", Bari, Italy.,Department of Clinical Subjects, School of Technical Medical Sciences, "A. Xhuvani" University of Elbasan, Elbasan, Albania
| | - Francesca Castellaneta
- Department of Internal Medicine and Oncology, School of Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Ioannis A Charitos
- Department of Emergency/Urgent, National Poison Center, Riuniti University Hospital (OO.RR.) of Foggia, Foggia, Italy
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18
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Mitra D, Singh GK, Mitra B, Talukdar K, Dhillon A, Singh T. A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome. Indian J Sex Transm Dis AIDS 2021; 42:156-158. [PMID: 34909622 PMCID: PMC8628094 DOI: 10.4103/ijstd.ijstd_58_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a condition during the clinical course of HIV infection in which there is paradoxical worsening and/or new onset of opportunistic infections in a HIV-positive patient who has recently been started on anti-retroviral therapy (ART). We present a case of AIDS with CD4 count of 20 cells/μl who presented within 6 weeks of starting ART with a CD4 count of 160 cells/μl and a painless solitary genital ulcer along with annular dark-colored plaques over soles. His screening test for syphilis was negative both during baseline evaluation, prior to initiation of ART, and during his clinical presentation. His disease was confirmed based on a positive treponema pallidum hemagglutination test report and a suggestive skin biopsy. He responded well to three doses of Benzathine Penicillin and continuation of ART. There are very few case reports of syphilis presenting as IRIS and this case is all the more unique as he had features of both primary and secondary syphilis occurring together within 6 weeks of starting ART. This report would reiterate the fact that syphilis and HIV co-infection can alter the natural course of both the diseases and a high index of suspicion is required for treating them.
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Affiliation(s)
- Debdeep Mitra
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India,Address for correspondence: Dr. Debdeep Mitra, Base Hospital Delhi Cantt, New Delhi - 110 010, India. E-mail:
| | - Gautam Kumar Singh
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Barnali Mitra
- Department of Pediatrics, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Krishna Talukdar
- Department of Dermatology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Amen Dhillon
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Tegveer Singh
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
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19
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Wang H, Chen R, Zhang R. An unusual case of secondary syphilis misdiagnosed as allergic dermatitis for 2 years. Clin Case Rep 2020; 8:2610-2612. [PMID: 33363789 PMCID: PMC7752569 DOI: 10.1002/ccr3.3229] [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: 05/25/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
Dermatologists should be aware that the clinical manifestations of syphilis are very complex and changeable. Unilaterally distributed skin lesions and painless lip ulcers may also be the clinical manifestations of secondary syphilis.
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Affiliation(s)
- Hong‐wei Wang
- Department of DermatologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
- LiYang Institute of DermatologyLiYangChina
| | - Ren‐he Chen
- Department of DermatologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
| | - Ru‐zhi Zhang
- Department of DermatologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
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20
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Wu MY, Gong HZ, Hu KR, Zheng HY, Wan X, Li J. Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis. Sex Transm Infect 2020; 97:525-533. [PMID: 33219164 PMCID: PMC8543214 DOI: 10.1136/sextrans-2020-054706] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Co-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations. Methods Five electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics. Results A total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)). Conclusions Syphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.
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Affiliation(s)
- Meng Yin Wu
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zi Gong
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kui Ru Hu
- Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China
| | - He-Yi Zheng
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Wan
- Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Importance of Serological Tests in the Diagnosis of Asymptomatic Congenital Syphilis in Neonates: A Case Report. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests. Case Presentation: The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests. Conclusions: It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.
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22
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Nishiki S, Arima Y, Yamagishi T, Hamada T, Takahashi T, Sunagawa T, Matsui T, Oishi K, Ohnishi M. Syphilis in heterosexual women: case characteristics and risk factors for recent syphilis infection in Tokyo, Japan, 2017-2018. Int J STD AIDS 2020; 31:1272-1281. [PMID: 33059539 DOI: 10.1177/0956462420945928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In response to an increase in heterosexual syphilis notifications in Tokyo, we conducted a questionnaire-based case-control study among women aged ≥20 years and sexually active in the past six months who sought a syphilis test in Tokyo during 2017-2018. Cases were women diagnosed as recent syphilis infection based on serological tests. Controls were serologically non-reactive or those with only a past syphilis infection. We described cases and assessed for risk factors of recent syphilis using logistic regression. A total of 524 women (60 cases, 464 controls) were enrolled. Notably, among cases, 10 (16.7%) were students, 3 (5.0%) had a history of syphilis, and 14 (23.3%) had a single sex partner in the past six months. Female sex worker (FSW) status was strongly associated with syphilis (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.96-5.90). In multivariable analysis, recent syphilis was associated with inconsistent condom use for vaginal/anal sex among FSWs (adjusted OR [aOR] = 3.42; 95%CI = 0.92-12.70) and among non-FSWs, with younger age (aOR = 0.36; 95%CI = 0.19-0.70; increase per category from 20-24, 25-29 to ≥30 years) and ≤high school education (aOR = 5.24; 95%CI = 1.95-14.10). A notable proportion of cases were those with first time infection and those with only a single partner. Moreover, risk factors differed between FSWs and non-FSWs, and a multi-pronged approach to prevent syphilis is required.
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Affiliation(s)
- Shingo Nishiki
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan.,Division of Environmental and Preventive Medicine, Department of Social Medicine, Graduate School of Medicine, Tottori University, Tottori, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takuya Yamagishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Takuri Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
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23
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Majander K, Pfrengle S, Kocher A, Neukamm J, du Plessis L, Pla-Díaz M, Arora N, Akgül G, Salo K, Schats R, Inskip S, Oinonen M, Valk H, Malve M, Kriiska A, Onkamo P, González-Candelas F, Kühnert D, Krause J, Schuenemann VJ. Ancient Bacterial Genomes Reveal a High Diversity of Treponema pallidum Strains in Early Modern Europe. Curr Biol 2020; 30:3788-3803.e10. [PMID: 32795443 DOI: 10.1016/j.cub.2020.07.058] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 12/30/2022]
Abstract
Syphilis is a globally re-emerging disease, which has marked European history with a devastating epidemic at the end of the 15th century. Together with non-venereal treponemal diseases, like bejel and yaws, which are found today in subtropical and tropical regions, it currently poses a substantial health threat worldwide. The origins and spread of treponemal diseases remain unresolved, including syphilis' potential introduction into Europe from the Americas. Here, we present the first genetic data from archaeological human remains reflecting a high diversity of Treponema pallidum in early modern Europe. Our study demonstrates that a variety of strains related to both venereal syphilis and yaws-causing T. pallidum subspecies were already present in Northern Europe in the early modern period. We also discovered a previously unknown T. pallidum lineage recovered as a sister group to yaws- and bejel-causing lineages. These findings imply a more complex pattern of geographical distribution and etiology of early treponemal epidemics than previously understood.
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Affiliation(s)
- Kerttu Majander
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany; Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland.
| | - Saskia Pfrengle
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany
| | - Arthur Kocher
- Transmission, Infection, Diversification and Evolution Group, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany
| | - Judith Neukamm
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Institute for Bioinformatics and Medical Informatics, University of Tübingen, Sand 14, 72076 Tübingen, Germany
| | | | - Marta Pla-Díaz
- Joint Research Unit "Infection and Public Health" FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Natasha Arora
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Gülfirde Akgül
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Kati Salo
- Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland; Archaeology, Faculty of Arts, University of Helsinki, Unioninkatu 38F, 00014 Helsinki, Finland
| | - Rachel Schats
- Laboratory for Human Osteoarchaeology, Faculty of Archaeology, Leiden University, Einsteinweg 2, 2333CC Leiden, the Netherlands
| | - Sarah Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, UK
| | - Markku Oinonen
- Laboratory of Chronology, Finnish Museum of Natural History, University of Helsinki, Gustaf Hällströmin katu 2, 00560 Helsinki, Finland
| | - Heiki Valk
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Martin Malve
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Aivar Kriiska
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Päivi Onkamo
- Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland; Department of Biology, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Fernando González-Candelas
- Joint Research Unit "Infection and Public Health" FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Denise Kühnert
- Transmission, Infection, Diversification and Evolution Group, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany
| | - Johannes Krause
- Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany; Senckenberg Centre for Human Evolution and Palaeoenvironment (S-HEP), University of Tübingen, Tübingen, Germany.
| | - Verena J Schuenemann
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Senckenberg Centre for Human Evolution and Palaeoenvironment (S-HEP), University of Tübingen, Tübingen, Germany.
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24
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Epidemiological behavior and current forecast of syphilis in Mexico: increase in male population. Public Health 2020; 185:386-393. [PMID: 32758762 DOI: 10.1016/j.puhe.2020.05.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/28/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Even when new cases of syphilis are notifiable since 1944, the Mexican National Epidemiological Surveillance System lacks information on the changes of the rate of case reports considering the geographic and demographic variables. Therefore, it is necessary to have evidence, with particular attention to the study of the epidemiological behavior by the identification of risk factors and groups. The objective of this study was to analyze the epidemiology, geographical distribution, and forecast of syphilis in Mexico. STUDY DESIGN The design of the study was a secondary research of epidemiological databases. METHODS A retrospective analysis of the national surveillance data (2007-2017) of acquired and congenital syphilis (CS) issued by the General Directorate of Epidemiology was performed. RESULTS Of all cases, 34,998 and 1030 cases were reported for acquired syphilis (AS) and CS , respectively, reflecting an increasing trend in the whole country for both diseases. Cases and incidence of AS per year showed that, male gender presented an increase in reproductive age. Distribution of the rate of case reports is mostly commanded by the states in the extreme north (Gulf of California and northern Gulf of Mexico) and south (Gulf of southern Mexico and the Caribbean Sea). Likewise, the Seasonal Autoregressive Integrated Moving Average model was selected as the best-fit model for the forecast analysis. This model was used to forecast AS cases during 2018-2019. AS may have a slight fluctuation (on the rise) during the following 24 months. CONCLUSIONS These findings underscore the importance of intensifying, as well as expanding screening and treatment in adult population, including men, who are not routinely benefiting from maternal and reproductive service-based syphilis screening and treatment.
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25
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Knight J, Baral SD, Schwartz S, Wang L, Ma H, Young K, Hausler H, Mishra S. Contribution of high risk groups' unmet needs may be underestimated in epidemic models without risk turnover: A mechanistic modelling analysis. Infect Dis Model 2020; 5:549-562. [PMID: 32913937 PMCID: PMC7452422 DOI: 10.1016/j.idm.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Epidemic models of sexually transmitted infections (STIs) are often used to characterize the contribution of risk groups to overall transmission by projecting the transmission population attributable fraction (tPAF) of unmet prevention and treatment needs within risk groups. However, evidence suggests that STI risk is dynamic over an individual’s sexual life course, which manifests as turnover between risk groups. We sought to examine the mechanisms by which turnover influences modelled projections of the tPAF of high risk groups. Methods We developed a unifying, data-guided framework to simulate risk group turnover in deterministic, compartmental transmission models. We applied the framework to an illustrative model of an STI and examined the mechanisms by which risk group turnover influenced equilibrium prevalence across risk groups. We then fit a model with and without turnover to the same risk-stratified STI prevalence targets and compared the inferred level of risk heterogeneity and tPAF of the highest risk group projected by the two models. Results The influence of turnover on group-specific prevalence was mediated by three main phenomena: movement of previously high risk individuals with the infection into lower risk groups; changes to herd effect in the highest risk group; and changes in the number of partnerships where transmission can occur. Faster turnover led to a smaller ratio of STI prevalence between the highest and lowest risk groups. Compared to the fitted model without turnover, the fitted model with turnover inferred greater risk heterogeneity and consistently projected a larger tPAF of the highest risk group over time. Implications If turnover is not captured in epidemic models, the projected contribution of high risk groups, and thus, the potential impact of prioritizing interventions to address their needs, could be underestimated. To aid the next generation of tPAF models, data collection efforts to parameterize risk group turnover should be prioritized. A new framework for parameterizing turnover in risk groups is developed. Mechanisms by which turnover influences sexually transmitted infection (STI), prevalence in risk groups are examined. Turnover reduces the ratio of equilibrium STI prevalence in high vs low risk groups. Inferred risk heterogeneity is higher when fitting transmission models with turnover. Ignoring turnover in risk could underestimate the transmission population attributable fraction (tPAF), of high risk groups to the overall epidemic.
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Affiliation(s)
- Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | - Stefan D Baral
- Deptartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Sheree Schwartz
- Deptartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | | | | | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada.,Division of Infectious Disease, Department of Medicine, University of Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Canada
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26
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Nishiki S, Arima Y, Kanai M, Shimuta K, Nakayama SI, Ohnishi M. Epidemiology, molecular strain types, and macrolide resistance of Treponema pallidum in Japan, 2017-2018. J Infect Chemother 2020; 26:1042-1047. [PMID: 32624340 DOI: 10.1016/j.jiac.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/16/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Japan has seen a substantial increase in syphilis cases since 2013 and Tokyo and Osaka prefectures accounted for about 40% of all cases in Japan. Therefore, focusing on these 2 prefectures, we assessed syphilis cases detected during 2017-2018, combining epidemiological information with molecular typing data. METHODS Using data from surveillance reports, we described syphilis cases by gender, age, transmission route, and stage of syphilis. Clinical specimens were collected from syphilis patients in Tokyo and Osaka prefectures. Molecular typing was performed by analyzing Treponema pallidum arp, tpr, and tp0548 genes, with partial sequencing of the 23S rRNA genes for macrolide resistance. RESULTS Between 2017 and 2018, the number of syphilis cases increased from 3934 to 4588 among males and 1895 to 2414 among females, with similar age and gender distributions during the period. The predominant strain type was 14d/f (71%, 73/103), found more frequently in women who have sex with men (86%, 25/29) and men who have sex with women (83%, 39/47) than in men who have sex with men (MSM) (33%, 9/27). The majority of the strains from heterosexuals (97%, 76/78) were macrolide-resistant, considerably higher than those from MSM (59%, 20/34). The molecular profiles in each sexual-transmission group remained similar during the 2 years. CONCLUSIONS The epidemiological and molecular features of syphilis remained similar throughout the period, with consistent differences in strain type and macrolide resistance distributions between MSM and heterosexual cases. These findings suggest a predominantly heterosexual epidemic where the dynamics of syphilis transmission remained unchanged during 2017-2018.
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Affiliation(s)
- Shingo Nishiki
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan; Division of Environmental and Preventive Medicine, Department of Social Medicine, Graduate School of Medicine, Tottori University, Tottori, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mizue Kanai
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan; Osaka City Public Health Office, Osaka, Japan
| | - Ken Shimuta
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan; Antimicrobial Resistance Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shu-Ichi Nakayama
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
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27
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Daey Ouwens IM, Fiolet ATL, Thijs RD, Koehler PJ, Verhoeven WMA. Neurosyphilis Mimicking Autoimmune Encephalitis: A Case Report and Review of the Literature. CLINICAL NEUROPSYCHIATRY 2020; 17:175-180. [PMID: 34908989 PMCID: PMC8650208 DOI: 10.36131/cnfioritieditore20200305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurosyphilis may imitate a wide range of neurological and psychiatric diseases, including autoimmune encephalitis. To avoid further cognitive decline and morbidity, early recognition and adequate treatment are of particular importance in both neurosyphilis and autoimmune encephalitis. In case of a strong clinical suspicion of a diagnosis of autoimmune encephalitis, guidelines recommend initiating immunotherapy even in the absence of immunological confirmation. Here, a case of neurosyphilis is reported in which the potential overlap in clinical presentation of autoimmune encephalitis and parenchymatous neurosyphilis is discussed. The here reported data suggest that, in cases presenting with new onset focal epilepsy, slowing of electroencephalographic activity over the temporal regions and magnetic resonance imaging suggestive of swelling of the amygdala, neurosyphilis should be excluded prior to initiation of immunotherapy for suspected autoimmune encephalitis.
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Affiliation(s)
- Ingrid M Daey Ouwens
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Aernoud T L Fiolet
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Peter J Koehler
- Department of Neurology, Zuyderland Ziekenhuis, Sittard-Geleen, The Netherlands.
| | - Willem M A Verhoeven
- Erasmus Medical Centre, Department of psychiatry, Rotterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
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28
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Neurosyphilis Presenting as Mania and Psychosis After Incidental Treatment With Cephalexin: A Case Report and Literature Review of Jarisch-Herxheimer Reactions. PSYCHOSOMATICS 2020; 61:177-180. [DOI: 10.1016/j.psym.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
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29
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Echigoya Y, Yamaguchi T, Imamura A, Nishiura H. Estimating the syphilis incidence and diagnosis rate in Japan: a mathematical modelling study. Sex Transm Infect 2020; 96:516-520. [PMID: 31988221 DOI: 10.1136/sextrans-2019-054421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/11/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The reported number of syphilis cases is increasing in Japan. In this study, we aimed to estimate both the incidence of infection and diagnosis-and-reporting rate using a mathematical model that captures the time course of infection. METHODS We analysed yearly notification data from 1961 to 2016 and stratified according to clinical stage and sex. We built a compartmental ordinary differential equations model to describe the natural epidemiological course of syphilis in which the incidence of infection and diagnosis-and-reporting rate were included as time-varying parameters that we estimated via the maximum likelihood method. RESULTS From 2008 to 2016, the estimated number of new syphilis cases among men and women was 1070 (95% CI 1037 to 1104) and 302 (95% CI 287 to 318), respectively, which was increased from the previous period (1999-2007) with 269 (95% CI 256 to 282) and 71 (95% CI 64 to 78) cases, respectively. The diagnosis-and-reporting rate did not vary greatly over time. We estimated the number of undiagnosed syphilis cases from either incubating or early clinical (ie, primary or secondary) infections in 2016 to be 262 (95% CI 249 to 275) and 79 (95% CI 74 to 84) for men and women, respectively. CONCLUSIONS The recent increase in reported cases of syphilis is owing to an increase in the number of infections. We found no evidence of time-dependent improvement in detection or reporting.
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Affiliation(s)
- Yuri Echigoya
- Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takayuki Yamaguchi
- Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.,The Center for Data Science Education and Research, Shiga University, Hikone, Shiga, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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30
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Cui L, Xu Z, Hou H. Diagnosis and Treatment of Spinal Syphilitic Gumma: A Case Report. Front Neurol 2020; 10:1352. [PMID: 32010040 PMCID: PMC6974620 DOI: 10.3389/fneur.2019.01352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/09/2019] [Indexed: 12/01/2022] Open
Abstract
Neurosyphilis, which is caused by Treponema pallidum, is a rare sexually transmitted disease involving the central nervous system (CNS). Among all the sub-categories, spinal syphilitic gumma is extremely rare. In previous literature, limited cases of spinal syphilitic gumma have been reported, most of which underwent surgery treatment. In this study, we reported a 46-year-old man, who presented with 5-day numbness of bilateral lower limbs, lower back pain, and irregular defecation. Magnetic resonance imaging (MRI) revealed a homogeneous peripheral enhancement and intramedullary nodule at the T7 level with extensive thoracic cord edema. Combining with laboratory examination results, the syphilitic gumma was considered. One month after the administration of penicillin G, the symptoms vanished. Six months later, MRI indicated no intramedullary nodule.
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Affiliation(s)
- Linyang Cui
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Zushan Xu
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Hongjun Hou
- Department of Radiology, Weihai Central Hospital, Weihai, China
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Kawahata T, Kojima Y, Furubayashi K, Shinohara K, Shimizu T, Komano J, Mori H, Motomura K. Bejel, a Nonvenereal Treponematosis, among Men Who Have Sex with Men, Japan. Emerg Infect Dis 2019; 25:1581-1583. [PMID: 31310214 PMCID: PMC6649352 DOI: 10.3201/eid2508.181690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bejel, an endemic treponematosis caused by infection with Treponema pallidum subspecies endemicum, has not been reported in eastern Asia and the Pacific region. We report local spread of bejel among men who have sex with men in Japan. Spread was complicated by venereal syphilis.
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Wu Y, Wu W. Neurosyphilis presenting with myelitis-case series and literature review. J Infect Chemother 2019; 26:296-299. [PMID: 31859039 DOI: 10.1016/j.jiac.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/21/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Syphilitic myelitis is an extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature describe its clinical manifestations and neuroimaging features, and there is no relevant data on the prognosis, especially the long follow-up prognosis. In this paper, four syphilitic myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. Of the four patients, two females and two males. Treatment included intravenous penicillin G, with 24 million units of penicillin G per day administered intravenously for 14 days. Three patients were also treated with corticosteroids. The prognosis were well in three cases who received early anti-syphilis treatment, but one case who received delayed treatment due to misdiagnosis had no improvement. Neurosyphilis should be considered when there is long-segment myelopathy. Anti-treponemal antibiotics and corticosteroid therapy may improve neurological prognosis.
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Affiliation(s)
- Yali Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, No. 8 East Jing Shun Rd, Chaoyang District, Beijing, 100015, China
| | - Wenqing Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, No. 8 East Jing Shun Rd, Chaoyang District, Beijing, 100015, China.
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Peng J, Lu Y, Yu H, Wu S, Li T, Li H, Deng L, Sun Z. Analysis of 2 Reverse Syphilis Testing Algorithms in Diagnosis of Syphilis: A Large-Cohort Prospective Study. Clin Infect Dis 2019; 67:947-953. [PMID: 30059969 DOI: 10.1093/cid/ciy198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background Two serologic syphilis screening algorithms recommended by the US Centers for Disease Control and Prevention (US CDC) and the European Centre for Disease Prevention and Control (ECDC), respectively, are commonly used for syphilis screening; however, which one is optimal remains to be determined. Methods We conducted a prospective study of 119891 subjects to analyze the consistency of the US CDC- and ECDC-recommended algorithms. The US CDC-recommended algorithm begins with a treponemal immunoassay, followed by a rapid plasma reagin (RPR) test. RPR-nonreactive samples are confirmed by the Treponema pallidum particle agglutination assay (TPPA). The ECDC-recommended algorithm begins with a treponemal immunoassay, followed by a confirmatory treponemal test. If the confirmatory test is reactive, a quantitative nontreponemal assay is used to assess the disease activity and treatment response. In the present study, a total of 119891 serum samples from a large hospital (sixth largest in China) were included, and each sample was screened with a chemiluminescent immunoassay (CIA). CIA-reactive samples were then simultaneously tested with RPR and TPPA. The consistency of these 2 algorithms was determined by calculating the percentage of agreement and κ coefficient. Results The overall percentage of agreement and κ value between these 2 algorithms were 99.996% and 0.999, respectively. The positivity rate for syphilis as determined by the US CDC- and ECDC-recommended algorithms was 1.43% and 1.42%, respectively. Conclusions Our results suggest that the US CDC-recommended algorithm and the ECDC-recommended algorithm have comparable performances for syphilis screening in low-prevalence populations.
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Affiliation(s)
- Jing Peng
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanfang Lu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbing Yu
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Shiji Wu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijun Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingyan Deng
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Feldman J, Mishra S. What could re-infection tell us about R 0? A modeling case-study of syphilis transmission. Infect Dis Model 2019; 4:257-264. [PMID: 31667445 PMCID: PMC6806446 DOI: 10.1016/j.idm.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
Many infectious diseases can lead to re-infection. We examined the relationship between the prevalence of repeat infection and the basic reproductive number (R0). First we solved a generic, deterministic compartmental model of re-infection to derive an analytic solution for the relationship. We then numerically solved a disease-specific model of syphilis transmission that explicitly tracked re-infection. We derived a generic expression that reflects a non-linear and monotonically increasing relationship between proportion re-infection and R0 and which is attenuated by entry/exit rates and recovery (i.e. treatment). Numerical simulations from the syphilis model aligned with the analytic relationship. Re-infection proportions could be used to understand how far regions are from epidemic control, and should be included as a routine indicator in infectious disease surveillance.
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Affiliation(s)
- Joshua Feldman
- Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, Canada
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, Canada
- Department of Medicine, Division of Infectious Disease, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Canada
- Corresponding author. Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, Canada.
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Ekouevi DK, Bitty-Anderson AM, Gbeasor-Komlanvi FA, Konu YR, Sewu EK, Salou M, Dagnra CA. Low prevalence of syphilis infection among key populations in Togo in 2017: a national cross-sectional survey. ACTA ACUST UNITED AC 2019; 77:39. [PMID: 31508231 PMCID: PMC6727363 DOI: 10.1186/s13690-019-0365-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
Abstract
Background The World Health Organisation (WHO) recommends the screening of syphilis among populations highly exposed to HIV. However, data on the prevalence of syphilis in these populations are scarce in Togo. This study aimed at estimating the prevalence of syphilis among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo. Methods A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method in eight major cities in Togo. A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. A blood sample was taken and SD Bioline Duo VIH/Syphilis rapid test was used to test for HIV and syphilis. Results A total of 2158 key populations (678 MSM, 1003 FSW and 477 DU), with an average age of 27.6 years (standard deviation 8.8 years) participated in the study. Prevalence of syphilis was 0.6% (95% CI = [0.3–1.0]) with no statistical significance between the three groups: null among MSM, 0.8% among FSW (95% CI = [0.37–1.63]) and 1.1% among DU (95% CI = [0.39–2.57]). There was no relation between HIV status and syphilis (p = 0.236). Among the 298 HIV-positive people, none was diagnosed with syphilis. Conclusions Findings from this study reveal a low prevalence rate of syphilis among key populations in Togo. Specific interventions into HIV prevention programs should be reinforced to eliminate syphilis in Togo.
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Affiliation(s)
- Didier K Ekouevi
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo.,2Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.,3Programme PACCI - Site ANRS Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire.,4INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.,Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | | | - Fifonsi A Gbeasor-Komlanvi
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Yao R Konu
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo
| | - Essèboè K Sewu
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Mounerou Salou
- 6Laboratoire de Biologie Moléculaire, Département des Sciences Fondamentales, Université de Lomé, Lomé, Togo
| | - Claver A Dagnra
- 6Laboratoire de Biologie Moléculaire, Département des Sciences Fondamentales, Université de Lomé, Lomé, Togo.,Programme National de Lutte contre le VIH/Sida et les Infections Sexuellement Transmissibles (PNLS/IST), Lomé, Togo
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36
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Beale MA, Marks M, Sahi SK, Tantalo LC, Nori AV, French P, Lukehart SA, Marra CM, Thomson NR. Genomic epidemiology of syphilis reveals independent emergence of macrolide resistance across multiple circulating lineages. Nat Commun 2019; 10:3255. [PMID: 31332179 PMCID: PMC6646400 DOI: 10.1038/s41467-019-11216-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
Syphilis is a sexually transmitted infection caused by Treponema pallidum subspecies pallidum and may lead to severe complications. Recent years have seen striking increases in syphilis in many countries. Previous analyses have suggested one lineage of syphilis, SS14, may have expanded recently, indicating emergence of a single pandemic azithromycin-resistant cluster. Here we use direct sequencing of T. pallidum combined with phylogenomic analyses to show that both SS14- and Nichols-lineages are simultaneously circulating in clinically relevant populations in multiple countries. We correlate the appearance of genotypic macrolide resistance with multiple independently evolved SS14 sub-lineages and show that genotypically resistant and sensitive sub-lineages are spreading contemporaneously. These findings inform our understanding of the current syphilis epidemic by demonstrating how macrolide resistance evolves in Treponema subspecies and provide a warning on broader issues of antimicrobial resistance.
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Affiliation(s)
- Mathew A Beale
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK.
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Sharon K Sahi
- Department of Neurology, University of Washington, Seattle, WA, 98195, USA
| | - Lauren C Tantalo
- Department of Neurology, University of Washington, Seattle, WA, 98195, USA
| | | | - Patrick French
- The Mortimer Market Centre CNWL, Camden Provider Services, London, UK
| | - Sheila A Lukehart
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Christina M Marra
- Department of Neurology, University of Washington, Seattle, WA, 98195, USA
| | - Nicholas R Thomson
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, UK.
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Elmouden H, Louhab N, Kissani N. Medullary involvement in neurosyphilis: a report of 12 cases and a review of the literature. Spinal Cord Ser Cases 2019; 5:38. [PMID: 31632699 PMCID: PMC6786502 DOI: 10.1038/s41394-019-0185-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 01/18/2023] Open
Abstract
Study design Retrospective case series. Objectives To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco. Setting The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. Methods Twelve charts of persons with syphilitic myelitis over a period of 17 years were reviewed to determine demographics, presenting symptoms, clinical and radiological findings, biological features, treatment received and outcomes. Results There were 120 reports of neurosyphilis. Twelve patients (10%) had syphilitic myelitis. Eleven patients (92%) were male with mean age of 44 at presentation. Tabes dorsalis was the most common clinical form. Cerebrospinal fluid analysis showed lymphocytic meningitis in nine patients (75%). Spine MRI was abnormal in four patients (33%). All patients were treated with 30 million units of aqueous penicillin G IV per day for 10 days, every 3 months. In follow-up, two patients (17%) with clinical syphilitic meningomyelitis improved significantly, eight patients (66%) with tabes dorsalis and subacute transverse myelitis showed partial improvement but clinical status was stationary for two patients (17%) with Erb paraplegia. Conclusions All patients with myelopathy should undergo syphilitic serology because of nonspecific manifestations and curability of this disease.
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Affiliation(s)
- Hafida Elmouden
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
| | - Nisserine Louhab
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
| | - Najib Kissani
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
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38
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol 2019; 82:1-14. [PMID: 30986477 DOI: 10.1016/j.jaad.2019.02.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
Syphilis is caused by infection with the spirochetal bacterium Treponema pallidum subsp. pallidum. It was first recognized in the late 15th century. Since 2000, the incidence of sexually acquired syphilis has increased substantially in the developed world, with men who have sex with men and persons living with HIV infection disproportionately affected. Clinical manifestations of syphilis are protean and often include mucocutaneous manifestations. The first article in this continuing medical education series reviews historical aspects, microbiology, epidemiology, and clinical manifestations of sexually acquired syphilis.
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Affiliation(s)
- Amy K Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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39
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Okuonghae D, Gumel AB, Ikhimwin BO, Iboi E. Mathematical Assessment of the Role of Early Latent Infections and Targeted Control Strategies on Syphilis Transmission Dynamics. Acta Biotheor 2019; 67:47-84. [PMID: 29971669 DOI: 10.1007/s10441-018-9336-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/28/2018] [Indexed: 11/25/2022]
Abstract
A new multi-stage deterministic model for the transmission dynamics of syphilis, which incorporates disease transmission by individuals in the early latent stage of syphilis infection and the reversions of early latent syphilis to the primary and secondary stages, is formulated and rigorously analysed. The model is used to assess the population-level impact of preventive (condom use) and therapeutic measures (treatment using antibiotics) against the spread of the disease in a community. It is shown that the disease-free equilibrium of the model is globally-asymptotically stable whenever the associated control reproduction number (denoted by [Formula: see text]) is less than unity. A special case of the model is shown to have a unique and globally-asymptotically stable endemic equilibrium whenever the associated reproduction number (denoted by [Formula: see text]) exceeds unity. Uncertainty and sensitivity analysis of the model, using parameter values and ranges relevant to syphilis transmission dynamics in Nigeria, show that the top three parameters that drive the syphilis infection (with respect to [Formula: see text]) are the disease transmission rate ([Formula: see text]), compliance in condom use (c) and efficacy of condom ([Formula: see text]). Numerical simulations of the model show that the targeted treatment of secondary syphilis cases is more effective than the targeted treatment of individuals in the primary or early latent stage of syphilis infection.
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Affiliation(s)
- D Okuonghae
- Department of Mathematics, University of Benin, Benin City, Nigeria.
| | - A B Gumel
- School of Mathematical and Statistical Sciences, Arizona State University, Arizona, USA
| | - B O Ikhimwin
- School of Mathematics and Statistics, The University of Sydney, Sydney, Australia
| | - E Iboi
- School of Mathematical and Statistical Sciences, Arizona State University, Arizona, USA
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40
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Aslam MV, Owusu-Edusei K, Kidd SE, Torrone EA, Dietz PM. Increasing Syphilis Diagnoses Among Females Giving Birth in US Hospitals, 2010-2014. Sex Transm Dis 2019; 46:147-152. [PMID: 30461596 PMCID: PMC10941208 DOI: 10.1097/olq.0000000000000945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND National trends in syphilis rates among females delivering newborns are not well characterized. We assessed 2010-2014 trends in syphilis diagnoses documented on discharge records and associated factors among females who have given birth in US hospitals. METHODS We calculated quarterly trends in syphilis rates (per 100,000 deliveries) by using International Classification of Diseases, Ninth Revision, Clinical Modification codes on delivery discharge records from the National Inpatient Sample. Changes in trends were determined by using Joinpoint software. We estimated relative risks (RR) to assess the association of syphilis diagnoses with race/ethnicity, age, insurance status, household income, and census region. RESULTS Overall, estimated syphilis rates decreased during 2010-2012 at 1.0% per quarter (P < 0.001) and increased afterward at 1.8% (P < 0.001). The syphilis rate increase was statistically significant across all sociodemographic groups and all US regions, with substantial increases identified among whites (35.2% per quarter; P < 0.001) and Medicaid recipients (15.1%; P < 0.001). In 2014, the risk of syphilis diagnosis was greater among blacks (RR, 13.02; 95% confidence interval [CI], 9.46-17.92) or Hispanics (RR, 4.53; 95% CI, 3.19-6.42), compared with whites; Medicaid recipients (RR, 4.63; 95% CI, 3.38-6.33) or uninsured persons (RR, 2.84; 95% CI, 1.74-4.63), compared with privately insured patients; females with the lowest household income (RR, 5.32; 95% CI, 3.55-7.97), compared with the highest income; and females in the South (RR, 2.42; 95% CI, 1.66-3.53), compared with the West. CONCLUSIONS Increasing syphilis rates among pregnant females of all backgrounds reinforce the importance of prenatal screening and treatment.
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Affiliation(s)
- Maria V Aslam
- From the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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41
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Schuch LF, da Silva KD, de Arruda JAA, Etges A, Gomes APN, Mesquita RA, Vasconcelos ACU, Tarquinio SBC. Forty cases of acquired oral syphilis and a review of the literature. Int J Oral Maxillofac Surg 2018; 48:635-643. [PMID: 30459066 DOI: 10.1016/j.ijom.2018.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/20/2018] [Accepted: 10/31/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.
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Affiliation(s)
- L F Schuch
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - K D da Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - J A A de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - A Etges
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - A P N Gomes
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - R A Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A C U Vasconcelos
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - S B C Tarquinio
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Bembry W, Anderson M, Nelson S. Congenital Syphilis: The Great Pretender Strikes Back. A Case Report. Clin Pediatr (Phila) 2018; 57:992-996. [PMID: 29084433 DOI: 10.1177/0009922817738343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Whitney Bembry
- 1 Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Margot Anderson
- 1 Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Stephen Nelson
- 2 Deparment of Pediatrics and Neurology, Tulane University School of Medicine, New Orleans, LA, USA
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Tomori C, McFall AM, Solomon SS, Srikrishnan AK, Anand S, Balakrishnan P, Mehta SH, Celentano DD. Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Soc Sci Med 2018; 206:110-116. [PMID: 29615297 DOI: 10.1016/j.socscimed.2018.03.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - P Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
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Jahanbakhsh F, Bagheri Amiri F, Sedaghat A, Fahimfar N, Mostafavi E. Prevalence of HAV Ab, HEV (IgG), HSV2 IgG, and Syphilis Among Sheltered Homeless Adults in Tehran, 2012. Int J Health Policy Manag 2018. [PMID: 29524951 PMCID: PMC5890067 DOI: 10.15171/ijhpm.2017.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This study investigated the prevalence for hepatitis A virus (HAV), hepatitis E virus (HEV), herpes simplex virus type 2 (HSV2) and syphilis among homeless in the city of Tehran.
Methods: In this cross-sectional study, 596 homeless were recruited in Tehran. A researcher-designed questionnaire was used to study demographic data. Using enzyme-linked immunoassay, and rapid plasma reagin (RPR) test, we evaluated the seroprevalence of HAV anti-body, HEV IgG, herpes, HSV2 IgG, and syphilis among sheltered homeless in Tehran. The associations between the participant’s characteristics and infections were evaluated using logistic regression and chi-square.
Results: A total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from June to August 2012. Their age mean was 42 years and meantime of being homeless was 24 months. Seroprevalence of syphilis, HEV IgG, HSV2 IgG and HAV Ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. History of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. Among people who had intravenous drug abuse, 48.25% had history of syringe sharing.
Conclusion: The prevalence of HAV, HEV and HSV2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (STD). Our findings highlighted that significant healthcare needs of sheltered homeless people in Tehran are unmet and much more attention needs to be paid for the health of homeless people.
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Affiliation(s)
| | - Fahimeh Bagheri Amiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Sedaghat
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.,Center for Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Noushin Fahimfar
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Choudhri Y, Miller J, Sandhu J, Leon A, Aho J. Infectious and congenital syphilis in Canada, 2010-2015. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2018; 44:43-48. [PMID: 29770098 PMCID: PMC5864261 DOI: 10.14745/ccdr.v44i02a02] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001. OBJECTIVE To summarize trends observed in syphilis rates for 2010 to 2015 in Canada. METHODS Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated. RESULTS From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases. CONCLUSION Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.
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Affiliation(s)
- Y Choudhri
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - J Miller
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - J Sandhu
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - A Leon
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - J Aho
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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Cabello A, Górgolas M. Syphilis. Status of a current epidemic. Med Clin (Barc) 2017; 149:540-541. [PMID: 28865919 DOI: 10.1016/j.medcli.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Alfonso Cabello
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
| | - Miguel Górgolas
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
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Abstract
BACKGROUND After reaching an all-time low in 2000, syphilis incidence in the United States has increased as the burden shifted from heterosexuals to men who have sex with men (MSM). Houston, Texas, experienced 2 outbreaks of syphilis during this transformation in trends. Further evaluation is necessary to determine if these outbreaks occurred among the same subpopulations. METHODS Surveillance data collected on all reported infectious syphilis cases in Houston from 1971 to 2013 were analyzed. Trends in incidence among MSM and human immunodeficiency virus-positive Houston residents were examined. Peak syphilis years subsequent to 1999, years 2007 and 2012, were compared to determine if outbreaks arose in distinctive subpopulations. Categorical variables between these years were compared using chi-square and Fisher's exact tests, whereas further associations between the years were evaluated using multivariable logistic regression. RESULTS Incidence among MSM was 20.9 to 32.1 times higher than other men from 2005 to 2013. After adjusting for covariates, cases in 2012 were significantly more likely to be Hispanic (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [95% CI], 1.03-2.53), reported meeting partners via the Internet (AOR, 1.74; 95% CI, 1.18-2.58), and engaged in anonymous sex (AOR, 1.92; 95% CI, 1.40-2.63) in comparison to cases in 2007. CONCLUSIONS We found marked disparities of syphilis by subpopulation in Houston. Herein, we present evidence that outbreaks have been distinct in a major southern city with a high burden of syphilis.
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Putot A, Rozé B, Pierre-François S, Pircher M, Vilain R, Miossec C, Desbois N, Hochedez P, Guitteaud K, Laudarin I, Abel S, Cabié A. New Surge of Syphilis among Patients Living with Human Immunodeficiency Virus in Martinique in 2015. Am J Trop Med Hyg 2017; 97:923-926. [PMID: 28820696 DOI: 10.4269/ajtmh.16-0760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had sex with men (MSM) and who were living with human immunodeficiency virus (HIV). The outbreak subsequently affected all groups at risk, leading to a first epidemic peak in 2008. After an initial decrease, the outbreak started growing again in 2014 among patients living with HIV with unprecedented incidence among MSM. Herein, we describe the change in medical and social parameters of the outbreak since 2005.
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Affiliation(s)
- Alain Putot
- Service de Médecine Gériatrique, Hôpital de Champmaillot, Centre Hospitalier Universitaire de Dijon, Dijon, France.,Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Benoît Rozé
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Sandrine Pierre-François
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Mathilde Pircher
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Rosalie Vilain
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Charline Miossec
- Service de Parasitologie, Mycologie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Nicole Desbois
- Service de Parasitologie, Mycologie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Patrick Hochedez
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Karine Guitteaud
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Ingrid Laudarin
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - Sylvie Abel
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - André Cabié
- INSERM CIC1425, Centre Hospitalier Universitaire de Martinique, Fort de France, France.,Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort de France, France
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Hoogewoud F, Frumholtz L, Loubet P, Charlier C, Blanche P, Lebeaux D, Benhaddou N, Sedira N, Coutte L, Vanhaecke C, Launay O, Le Jeunne C, Héron E, Monnet D, Lortholary O, Sahel JA, Dupin N, Brézin A, Errera MH, Salah S, Groh M. Prognostic Factors in Syphilitic Uveitis. Ophthalmology 2017; 124:1808-1816. [PMID: 28779905 DOI: 10.1016/j.ophtha.2017.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To identify predictors of treatment success in syphilitic uveitis (SU). DESIGN Retrospective multicentric analysis of patients treated for SU. PARTICIPANTS A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed. METHODS Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions. MAIN OUTCOME MEASURES Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month. RESULTS Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes. CONCLUSIONS Early improvement is the strongest predictor of ophthalmological recovery in SU.
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Affiliation(s)
- Florence Hoogewoud
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Laure Frumholtz
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Paul Loubet
- IAME, UMR 1137, INSERM, Hôpital Bichat, Paris, France; Department of Infectious Diseases, Hôpital Bichat-Claude Bernard, Paris, France
| | - Caroline Charlier
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | - David Lebeaux
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - Nadjet Benhaddou
- National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France
| | - Neila Sedira
- Department of Internal Medicine, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Laetitia Coutte
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | | | - Odile Launay
- Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Dominique Monnet
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Olivier Lortholary
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - José-Alain Sahel
- Department of Ophthalmology IV, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Nicolas Dupin
- National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France; Department of Dermatology, Hôpital Cochin, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Marie-Hélène Errera
- Department of Ophthalmology IV, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Sawsen Salah
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Present address: Department of Internal Medicine, Hôpital St. Louis, Paris, France.
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Almeida VCD, Donalisio MR, Cordeiro R. Factors associated with reinfection of syphilis in reference centers for sexually transmitted infections. Rev Saude Publica 2017; 51:64. [PMID: 28678903 PMCID: PMC5477707 DOI: 10.1590/s1518-8787.2017051006432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/25/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aim to analyze trend of syphilis and factors associated with recurrent episodes of syphilis among adults and adolescents attended in a STI/AIDS reference centers in Campinas, state of São Paulo, 2004 to 2012. METHODS Medical records, pharmacy data, and notification database were accessed to analyze trends of syphilis and sociodemographic, epidemiological and clinical variables associated with reinfection of syphilis. After univariate analysis, a hierarchical logistic regression model was adjusted to analyze variables associated with more than one episode of syphilis (dependent variable). First step (sex, age, and years of schooling) were tested and in the second, epidemiological and clinical variables. RESULTS A total of 1,009 episodes of syphilis were identified among 860 adolescents and adults, 117 individuals (13.6%) presented with more than one episode of syphilis. Factors associated with more than one episode of syphilis were sex (male) (OR = 4.28; 95%CI 1.31–14.0), age (OR = 1.02; 95%CI 1.00–1.04), homosexual/bisexual orientation (OR = 2.29; 95%CI 1.22–4.32), HIV coinfection (OR = 3.54; 95%CI 2.22–5.63), and absence of STI symptoms at the time of syphilis diagnostic (OR = 1.70; 95%CI 1.03–2.80). CONCLUSIONS The number of cases of syphilis and proportion in relation to STI increased in recent years in a specific population attended in a STI/AIDS reference centers in Campinas. Association with HIV, homosexual/bisexual orientation and the silent clinical characteristic of cases confirm the necessity to implement more aggressive strategies to prevent the occurrence of syphilis and other STI in specific populations with higher disease risk.
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Affiliation(s)
- Valéria Correa de Almeida
- Faculdade de Medicina São Leopoldo Mandic.,Secretaria Municipal de Saúde de Campinas. Campinas, SP, Brasil
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas da Unicamp. Campinas, SP, Brasil
| | - Ricardo Cordeiro
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas da Unicamp. Campinas, SP, Brasil
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