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Ciccarese G, Capello E, Varesano S, Giacani L, Capurro N, Drago F. Persistence of Treponema pallidum IgM antibodies in serum: What is their meaning? Diagn Microbiol Infect Dis 2024; 109:116341. [PMID: 38728874 DOI: 10.1016/j.diagmicrobio.2024.116341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024]
Abstract
We studied the detection of Treponema pallidum (TP)-IgM antibodies in the serum of 69 patients treated for syphilis. The persistence of TP-IgM antibodies in serum for more than 3 years was the only clue to suspect an active infection and, therefore, to investigate a central nervous system involvement.
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Affiliation(s)
- Giulia Ciccarese
- Section of Dermatology, Department of Medical and surgical sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy.
| | - Elisabetta Capello
- Clinica Neurologica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Serena Varesano
- Hygiene Section, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Niccolò Capurro
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
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2
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Yuan L, Xia D, Zhou Q, Xu W, Xu S, Yin Y. An evaluation of a multiplex PCR assay for the detection of Treponema pallidum, HSV-1, and HSV-2. Diagn Microbiol Infect Dis 2023; 106:115958. [PMID: 37172529 DOI: 10.1016/j.diagmicrobio.2023.115958] [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] [Received: 01/06/2023] [Revised: 03/13/2023] [Accepted: 04/16/2023] [Indexed: 05/15/2023]
Abstract
Multiplex PCR can utilize limited clinical material and is more cost-effective and expected to be used for the detection of Treponema pallidum, herpes simplex virus type 1 and 2 (HSV-1,2). We established a multiplex TP-HSV1-HSV2 Polymerase Chain Reaction (multiplex PCR) targeting the conserved regions of the PolA gene of TP and the UL42 gene of HSV1 and HSV2 to test skin lesions of 115 patients suspected of having TP and HSV1/2 infections. The laboratory sensitivities for all 3 pathogens were 300 copies/mL. The overall clinical sensitivity and specificity in secretion samples for TP were 91.7% and 100%, for HSV1 100% and 98%, and for HSV2 89.7% and 100%, respectively. The method appears superior in patients suspected of early TP infection but negative for nontreponemal antibody testing, and the method is also useful for the differential diagnosis of new skin lesions on genital, perianal, and oral sites of patients with a history of previous syphilis.
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Affiliation(s)
- Liufeng Yuan
- Department of Dermatology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Deju Xia
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; National Institute for Food and Drug Control, Beijing, China
| | - Qian Zhou
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Wenqi Xu
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Sihong Xu
- National Institute for Food and Drug Control, Beijing, China.
| | - Yueping Yin
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
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3
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Zhang Y, Goh SM, Mello MB, Baggaley RC, Wi T, Johnson CC, Asiedu KB, Marks M, Pham MD, Fairley CK, Chow EPF, Mitjà O, Toskin I, Ballard RC, Ong JJ. Improved rapid diagnostic tests to detect syphilis and yaws: a systematic review and meta-analysis. Sex Transm Infect 2022; 98:608-616. [PMID: 36180209 PMCID: PMC9685714 DOI: 10.1136/sextrans-2022-055546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws. METHODS We conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I2 statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence. RESULTS We included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively. CONCLUSIONS RDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment. PROSPERO REGISTRATION NUMBER CRD42021279587.
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Affiliation(s)
- Ying Zhang
- School of Public Health, The University of Sydney, Campertown, New South Wales, Australia
| | - Su Mei Goh
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Hospital for Tropical Diseases, University College London Hospital, London, UK,Division of Infection and Immunity, University College London, London, UK
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Catalonia, Spain
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ronald C Ballard
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Jason J Ong
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Shen Y, Dong X, Liu J, Lv H, Ge Y. Serum Interleukin-26 is a Potential Biomarker for the Differential Diagnosis of Neurosyphilis and Syphilis at Other Stages. Infect Drug Resist 2022; 15:3693-3702. [PMID: 35859909 PMCID: PMC9291666 DOI: 10.2147/idr.s366308] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Interleukin-26 (IL-26) is an atypical proinflammatory cytokine due to its binding to circulating double-stranded DNA and direct antibacterial activity. Although IL-26 has been confirmed to be involved in the pathophysiology of cancer, chronic inflammatory diseases and infections, the diagnostic and prognostic values of IL-26 levels in syphilis patients are not clear. This study aimed to investigate IL-26 levels in different stages of syphilis progression. Methods A total of 30 healthy controls and 166 patients with syphilis at different stages of disease progression were enrolled. Serum IL-26 levels were quantified in accordance with the protocols of RayBio® Human Interleukin-26 Enzyme Linked Immunosorbent Assay (ELISA) kits. Clinical laboratory diagnostic parameters and blood analysis data were detected and collected according to clinical medical laboratory standards. Results The levels of serum IL-26 were significantly higher in neurosyphilis patients than in healthy subjects (6.87 (4.36, 12.14) and 1.67 (0.09, 4.89) pg/μL, respectively; ****p < 0.0001), latent syphilis (1.48 (0.40, 2.05) pg/μL, ****p < 0.0001), seroresistant syphilis (0.81 (0.20, 2.91) pg/μL, ****p < 0.0001) and secondary syphilis (1.66 (0.41, 4.25) pg/μL, ****p < 0.0001) with data presented as the median with interquartile range. The concentration of serum IL-26 was most sensitive to serum low-density lipoprotein concentration (r = -0.438, **p = 0.004) in latent syphilis, urine epithelial cells (r = 0.459, **p = 0.003) in seroresistant syphilis, and serum creatinine levels (r = 0.463, **p = 0.004) and urea creatinine ratio levels (r = 0.500, **p = 0.008) in secondary syphilis patients. There was no significant correlation with the concentration of IL-26 and toluidine red unheated serum test (TRUST) titers in each type of syphilis patient. Conclusion Circulating IL-26 in serum displays diagnostic potential in the progression of neurosyphilis and warrants further evaluation in clinical trials.
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Affiliation(s)
- Yuhuan Shen
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China
| | - Xiaoyan Dong
- Department of Clinical Laboratory, Ningbo Blood Centers, Ningbo, Zhejiang, People's Republic of China
| | - Jinlin Liu
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China
| | - Huoyang Lv
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China
| | - Yumei Ge
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China.,Key Laboratory of Biomarkers and in vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
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Concurrent coronavirus disease 2019 and primary syphilis in a young man: A rare case report. J Infect Chemother 2022; 28:1552-1557. [PMID: 35868591 PMCID: PMC9295332 DOI: 10.1016/j.jiac.2022.07.008] [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: 05/11/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The global rise of syphilis infections and the ongoing coronavirus disease 2019 (COVID-19) pandemic are causes for concern. We herein report a rare case of concurrent primary syphilis and COVID-19. CASE REPORT A 29-year-old man was admitted with a diagnosis of COVID-19. Although COVID-19 pneumonia appeared during ciclesonide and favipiravir treatment, his symptoms improved without developing severe hypoxemia. A small, red ulcer on the left-side of his glans penis was noted and left inguinal lymph node swellings were detected on computed tomography (CT). He reported that his last engagement in sexual intercourse had been 3 months previously, and that his partner had subsequently been diagnosed with syphilis. Although both serum Treponema pallidum (TP) antibody and rapid plasma reagin (RPR) quantitative tests were negative on the day of admission, we clinically diagnosed a suspected case of primary syphilis and started treatment with amoxicillin (1500 mg/day). We subsequently learned that the TP antibody and RPR quantitative tests had been positive 4 days before starting syphilis treatment. Amoxicillin treatment was continued for 61 days, and the ulcer gradually improved. One year later, the RPR quantitative test was negative, and CT revealed a reduction in size of the inguinal lymph nodes and no residual signs of COVID-19 pneumonia. CONCLUSION The prevalence of syphilis has been increasing even during the COVID-19 pandemic, and the incidence of concurrent syphilis and COVID-19 might be higher than is recognized. Asking patients with COVID-19 about high-risk sexual behavior and genital lesions could help with early diagnosis of syphilis.
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Gong HZ, Li J, Zheng HY. The treatment outcome and predictors of serological response in syphilis in a sexually transmitted infections center, China. Int J STD AIDS 2022; 33:575-583. [PMID: 35384775 DOI: 10.1177/09564624221086471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Serology is the mainstay for syphilis treatment monitoring. Baseline rapid plasma reagin (RPR) titre, HIV status, and syphilis stage have been found to be associated with the time to serological response among syphilis patients. This study mainly aims to evaluate the time to serological response, and to identify factors affecting the serological outcome. Medical records of syphilis cases diagnosed in Peking Union Medical College Hospital (PUMCH) between 2008 and 2018 were retrospectively reviewed. Kaplan-Meier analysis was performed to evaluate the median time to serologic response and cumulative probability of serologic response over time according to different variables. Cox regression model was conducted to find factors associated with serological response. There were 984 patients diagnosed with primary, secondary, or latent syphilis cases and receiving injections of benzathine penicillin G (BPG) as initial treatment at the Peking Union Medical College Hospital (PUMCH) between 2008 and 2018. Finally, data on 571 patients, including 49 (8.6%) primary syphilis, 261 (45.7%) secondary syphilis, and 261 (45.7%) latent syphilis, were used for analysis. It took longer time to achieve serological response for subjects aged ≥45 years than younger individuals (89 days versus 58 days; p=0.008). Males achieved serological response more quickly than females (71 days versus 83 days; p = 0.011). There was a significant difference in the time to serological response according to different syphilis stages (p < 0.001), with 55 days (95% CI, 43-67 days) for primary, 57 days (95% CI, 51-63 days) for secondary, and 117 days for latent syphilis. In addition, patients with lower baseline RPR titre had longer period to achieve serological response (252 days [95% CI, 129-375 days] for RPR titre ≤1:8, 78 days [95% CI, 63-93 days] for RPR titres from 1:16 to 1:32, and 53 days [95% CI, 49-57 days] for RPR titres ≥1:64, respectively; p<0.001). However, no significant difference in time to serological response to treatment was found according to HIV coinfection status. The result of multivariate Cox regression analysis showed that being older than 45 years with latent syphilis, HIV coinfection, or with baseline RPR titre ≤1:8 was associated with slow response. Among patients followed for at least 1 year or seroreverted, 128 (36.9%) had seroreverted within a year, and 219 (63.1%) still had a positive RPR after 1 year. For multiple logistical regression, being female and HIV coinfection were significantly associated with the failure of seroreversion (OR, 0.42 [95% CI, 0.26-0.68]; p <0.001). This study revealed that younger age, higher initial RPR titre, early syphilis stage, and HIV-negative status were associated with faster serological cure. Female sex, individuals with HIV coinfection, and latent syphilis were significantly associated with the failure of seroreversion.
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Affiliation(s)
- Hui Zi Gong
- Department of Dermatology and Venereology, 34732Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China He Yi Zheng, and Jun Li contributed equally
| | - Jun Li
- Department of Dermatology and Venereology, 34732Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China He Yi Zheng, and Jun Li contributed equally
| | - He Yi Zheng
- Department of Dermatology and Venereology, 34732Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China He Yi Zheng, and Jun Li contributed equally
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7
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Scobie A, Brown CS, French P, Donati M, Muir P, Templeton K, Higgins SP, Patel H, Alexander S, Fifer H. The dark art of syphilis serology - an analysis of testing algorithms at a UK reference laboratory. J Med Microbiol 2022; 71. [PMID: 35451942 DOI: 10.1099/jmm.0.001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Due to the complex nature of treponemal serology interpretation, testing algorithms vary across the UK.Gap statement. There is currently no gold standard method for interpretation of discordant serology results.Aim. To analyse serological response in early infection and to determine the best approach for discordant total antibody EIA and TPPA samples.Methodology. National reference laboratory serology and PCR (genital ulcer swabs) results from 2010 to 2017 were extracted from an electronic laboratory database.Results. A total of 24149 sera underwent analysis. Of syphilis PCR positive cases with contemporaneous sera, 33% (17/52) were IgM positive/equivocal, whilst all were EIA and TPPA positive. No sera with isolated IgM positivity (0/90) demonstrated seroconversion consistent with early treponemal infection, in contrast to 17% (2/12) of sera with isolated TPPA positivity. Isolated EIA positivity was observed in 6.2% (1499/24149) samples with the same result on repeat testing in 73% (154/211). In 100 samples with discordant EIA/TPPA results, IgG Immunoblot was more commonly positive (12/41, 29%) or equivocal (24/41, 59%), in those with a higher EIA antibody index, compared to those with a low antibody index, of which none tested positive and 2/3 (67 %) were equivocal.Conclusion. Isolated IgM positivity was not helpful in identifying early infection; isolated total antibody EIA positivity is unlikely to be a significant finding. IgG immunoblot testing was unable to determine clear treponemal antibody status in nearly half of all EIA/TPPA discordant samples.
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Affiliation(s)
- Antonia Scobie
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Colin S Brown
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Patrick French
- The Mortimer Market Centre, Central and North West London NHS Trust, London WC1 6JB, UK
| | - Matthew Donati
- Bristol Public Health Laboratory, UK Health Security Agency, Bristol BS10 5NB, UK
| | - Peter Muir
- Bristol Public Health Laboratory, UK Health Security Agency, Bristol BS10 5NB, UK
| | - Kate Templeton
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, EH16 4TJ, UK
| | - Stephen P Higgins
- Department of Sexual Health and HIV, North Manchester General Hospital, Manchester, M5 8RB, UK
| | - Hemanti Patel
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Sarah Alexander
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
| | - Helen Fifer
- Reference Microbiology, UK Health Security Agency, 61, Colindale Avenue, NW9 5EQ, UK
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Konda K, Kojima N, Vargas SK, Calvo G, Reyes-Díaz M, Giacani L, Cáceres CF, Klausner JD. Syphilis naïve patients achieve treatment success more quickly: A comparison of time to syphilis treatment success in patients with repeat versus naïve infection. Clin Infect Dis 2021; 74:1887-1888. [PMID: 34596682 DOI: 10.1093/cid/ciab877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Konda
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - N Kojima
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - S K Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - G Calvo
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Reyes-Díaz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle WA, United States
| | - C F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle WA, United States.,Department of Preventive Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA, United States
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Mischler-Gornostaeva K, Glatz M, Fehr J, Bosshard PP. Clinical presentation and serological diagnosis of syphilis reinfection in men living with HIV: a retrospective cohort study. Sex Transm Infect 2021; 98:341-345. [PMID: 34475233 DOI: 10.1136/sextrans-2020-054923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Studies on the characteristics of syphilis reinfection are scarce despite increasing numbers and proportions of cases. We aimed to gain insights into the clinical and serological presentation of reinfected men living with HIV and to evaluate diagnostic criteria for syphilis reinfection. METHODS We conducted a retrospective cohort study of 259 HIV-positive men diagnosed with syphilis between January 1999 and September 2015 at the University Hospital Zurich. We compared patients with a single syphilis infection (n=109) to patients with reinfections (n=150). RESULTS The two groups matched in age, sexual orientation and numbers of other STIs. Reinfected patients more often presented with latent syphilis than patients with a single syphilis episode (41.9% vs 8.9%; p<0.001). Although generally high venereal diseases research laboratory (VDRL) or rapid plasma reagin (RPR) titres (median 1:32) were seen in reinfected patients, 19.4% had titres ≤1:8. Treponema pallidum passive particle agglutination (TPPA) titres were significantly higher (1:81 840 vs 1:10 240; p<0.001), while IgM values were significantly lower (1.27 vs 3.5; p<0.001) in syphilis reinfections than in first infections. The TPPA increased ≥fourfold in >92.3% of reinfected patients. CONCLUSIONS Our data highlight the paramount importance of regularly screening patients at risk as syphilis reinfections in men living with HIV are more likely to be latent infections, that is, without symptoms. As non-treponemal tests might be biologically false-positive (up to a titre of 1:8) due to various conditions, a ≥fourfold increase of the TPPA might be considered as optional criterion for the diagnosis of syphilis reinfections. This could be especially valuable for diagnosing reinfected latent stage patients.
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Affiliation(s)
| | - Martin Glatz
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Department of Public Health, University of Zurich, Zurich, Switzerland
| | - Philipp Peter Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients. Infect Dis Ther 2021; 10:1287-1298. [PMID: 33948910 PMCID: PMC8322187 DOI: 10.1007/s40121-021-00450-6] [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: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Poorer serologic responses of early syphilis to treatment have been inconsistently reported in HIV-positive patients compared with HIV-negative patients, but the interpretation of previous studies is limited by discrepant study designs. The present study aimed to evaluate the effect of HIV infection on the treatment response to a single dose of benzathine penicillin G (BPG) for early syphilis. Methods From January 2015 to March 2020, adult patients with early syphilis who received a single dose of BPG were enrolled and rapid plasma reagin (RPR) titers were periodically determined. The primary outcome was serologic response, defined as at least a fourfold decline of RPR titer at 12 months of BPG treatment compared with that at baseline, which was examined in the intention-to-treat (ITT) and per-protocol analyses. Treatment failure included lack of at least a fourfold decline in RPR titers and at least a fourfold increase in RPR titers. Results We prospectively enrolled 184 HIV-positive and 68 HIV-negative participants with early syphilis, who were all men who have sex with men, with a higher proportion of previous syphilis (70.1%) and early latent syphilis (64.1%) among HIV-positive participants. In the ITT with last-observation-carried-forward analysis, HIV-positive participants had a significantly lower serologic response rate at 12 months of treatment than HIV-negative participants (73.4% vs. 91.2%). Of HIV-positive participants, 12.5% failed to achieve at least fourfold decline in RPR titers and 14.1% had at least a fourfold increase in RPR titers. The factors associated with 12-month serologic response were HIV infection (adjusted odds ratio [AOR] 0.33; 95% confidence interval [CI] 0.13–0.81) and RPR titer (per 1-log2 increase, AOR 1.36; 95% CI 1.23–1.51). Conclusion HIV-positive patients with early syphilis had poorer serologic responses to BPG treatment than HIV-negative patients during a 12-month follow-up period. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00450-6.
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11
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Ortiz DA, Shukla MR, Loeffelholz MJ. The Traditional or Reverse Algorithm for Diagnosis of Syphilis: Pros and Cons. Clin Infect Dis 2021; 71:S43-S51. [PMID: 32578864 PMCID: PMC7312234 DOI: 10.1093/cid/ciaa307] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We reviewed relevant syphilis diagnostic literature to address the question “What diagnostic considerations should be taken into account when screening for syphilis using the traditional or reverse algorithm?” Improved laboratory diagnosis of syphilis is an important element of the effort to reduce syphilis rates. Screening for syphilis is performed using either a nontreponemal or treponemal test (part of the traditional or reverse algorithm, respectively). Both syphilis algorithms are used by laboratories. However, there are limited data on the performance and cost-effectiveness of the algorithms. An expert panel generated “key questions” in the laboratory diagnosis of syphilis. This paper pertains to the key factors that should be considered when deciding whether to screen for syphilis using either the traditional or the reverse algorithm. A systematic literature review was performed, and tables of evidence were created to address this question.
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Affiliation(s)
- Daniel A Ortiz
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mayur R Shukla
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Time to Serological Cure and Associated Factors Among Syphilis Patients With and Without HIV in a Sexually Transmitted Infections Center, Thailand. Sex Transm Dis 2021; 47:283-289. [PMID: 32149964 DOI: 10.1097/olq.0000000000001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Together with clinical correlation, nontreponemal titers are used to monitor treatment outcomes. Syphilis patients with HIV and without HIV coinfection were found to have different serological responses after treatment. This study aims to determine time to serological cure for treatment of syphilis and factors associated with it in patients with and without HIV. METHOD A descriptive study of syphilis patients who visited Bangrak STIs Center between January 1, 2007, and December 31, 2016. Univariate analysis was done to determine factors associated with serological outcomes. Survival curve analysis and multivariate Cox regression analysis were applied to compare time to serological cure between patients with various characteristics. RESULTS Of 497 syphilis patients, 62.1% had serological cure, 2.2% had nonresponse, 4.6% had treatment failure or reinfection, 9.9% had serofast status, and 21.2% were undetermined because of loss to follow-up. The time to serological cure was 110 days (95% confidence interval [CI], 59-163 days) and 102 days (95% CI, 94-110 days) among patients with HIV and without HIV, respectively (P = 0.162). Time to serological cure was significantly faster in early syphilis and baseline titer ≥1:32. After adjustment with the Cox regression model, patients with early syphilis were associated with serological cure with a hazard ratio of 1.75 (95% CI, 1.32-2.32). Time to serological cure among early syphilis patients was significantly longer in HIV-positive than HIV-negative patients (P = 0.002), whereas no difference was observed in late syphilis (P = 0.104). CONCLUSION Early syphilis was associated with faster time to serological cure. HIV patients with early syphilis took longer time to reach serological cure than did HIV-negative patients, whereas no such a difference was observed in late syphilis.
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Abstract
PURPOSE OF REVIEW Neurosyphilis (NS) and Lyme neuroborreliosis (LNB) are spirochetal diseases with distinct clinical manifestations. The diagnosis of NS remains challenging due to imperfect diagnostic criteria and testing modalities. With LNB, misconceptions about diagnosis and treatment lead to considerable morbidity and drug related adverse effects. RECENT FINDINGS Although studies continue investigating alternate approaches and new diagnostic tests for NS, few data exist to change current approaches to diagnosis, management or follow up. In the diagnosis of LNB, the chemokine CXCL13 shows promising diagnostic accuracy. A systematic review discourages the use of cell-based assays when investigating Lyme disease. Clinical studies show no benefit from extended antibiotic treatment for patients with unspecific symptoms labelled as having Lyme disease. SUMMARY The diagnosis of NS may be delayed due to a lack of specificity of findings, low suspicion for syphilis, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis is required provide timely diagnosis and management of NS. Fortunately, penicillin remains the treatment of choice. Overdiagnosis and overtreatment in patients labelled as having Lyme disease can be avoided by an evidence-based approach towards diagnosis and treatment.
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Nieuwenburg SA, Sprenger RJ, Schim van der Loeff MF, de Vries HJC. Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses. Sex Transm Infect 2021; 98:95-100. [PMID: 33608479 DOI: 10.1136/sextrans-2020-054887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored. METHODS This retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3-6 months. We included data of participants with ≥1 syphilis diagnosis in 2014-2019. Pearson's χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses. RESULTS We included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032). CONCLUSIONS In repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.
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Affiliation(s)
- Silvia Achia Nieuwenburg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ricardo Jamie Sprenger
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Franciscus Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands.,Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands .,Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam UMC location Academic Medical Centre, Amsterdam, The Netherlands
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15
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Paparizos V, Tsimpidakis A, Nicolaidou E, Daskalakis E, Paparizou E, Vasalou V, Vrioni G, Rigopoulos D. Duration of anti-treponemal immunoglobulin M seroreversion after successful syphilis treatment in HIV-positive and -negative patients. Int J STD AIDS 2021; 32:523-527. [PMID: 33533297 DOI: 10.1177/0956462420980927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treponemal immunoglobulin M (IgM) antibody detection is currently among serologic tests used for syphilis diagnosis. However, the exact role of these antibodies is unclear. In this retrospective study of 326 (198 HIV positive and 128 negative) patients with early syphilis and positive IgM serology, data were analysed to investigate the time of IgM seroreversion after treatment and correlation with covariate factors. Median time of IgM seroreversion in the study population was 9 months (range 3-84, interquartile range 5-12). No statistically significant difference was observed between HIV-positive and -negative patients. At 12 months, 80.1% of the patients had a negative IgM test. At 6 months, 100% of HIV-positive patients had a fourfold decrease or greater in Venereal Disease Research Laboratory titres, but only 35.4% had a negative treponemal IgM. Secondary and early latent stage patients had a slower seroreversion of IgM (Hazard Ratio (HR) = 0.73, p = 0.064 and HR = 0.60, p = 0.023, respectively) than those with primary syphilis. A very strong association was observed of time to seroreversion of treponemal IgM with baseline VDRL titre (p < 0.001). Treponemal IgM antibody detection often cannot distinguish between active and successfully treated syphilis. Treponemal IgM may only be useful in the cases recommended in the guidelines, and in cases of untreated syphilis, it could support but not confirm the diagnosis.
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Affiliation(s)
- Vasilios Paparizos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Electra Nicolaidou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Evangelos Daskalakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Eleni Paparizou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Varvara Vasalou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Georgia Vrioni
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Dimitris Rigopoulos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
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Luo Z, Ding Y, Yuan J, Tian L, Zhang L, Wu Q, Mou J. Predictors of serological cure after penicillin therapy in HIV-negative patients with early syphilis in Shenzhen, China. PLoS One 2021; 16:e0245812. [PMID: 33508015 PMCID: PMC7842941 DOI: 10.1371/journal.pone.0245812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Syphilis is a common infectious disease worldwide. Serological monitoring is important for syphilis management. We currently know little about the characteristics of this seronegative response. The aim of this study was to explore the factors associated with serological cure after treatment of early syphilis. METHODS A retrospective cohort study was conducted and the data of patients with early syphilis in a clinic in Shenzhen from 2011 to 2019 were retrieved. Univariable and multiple Cox proportional hazard regression models were utilized to identify factors associated with a serological cure state among syphilis patients with early syphilis two years after treatment. RESULTS A total of 346 (85.9%) syphilis patients achieved serological cure. The multivariate analysis results revealed that having a baseline TRUST titer >1:8 was associated with an increased probability of serological cure, compared with having a baseline TRUST titer ≤1:8 (HR = 1.43, 95% CI = 1.10-1.85, P<0.01); primary syphilis was positively associated with serological cure, compared with participants with latent early syphilis (HR = 1.72, 95% CI = 1.27-2.33, P<0.001). CONCLUSIONS Two years after treatment, a higher percentage of early syphilis patients achieved serological cure. The study indicated that the syphilis stage and baseline serum titer were crucial factors associated with serological cure.
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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
| | - Lishan Tian
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Qiuhong Wu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jinsong Mou
- Shenzhen Pingshan Maternal and Child Health Hospital, Shenzhen, China
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17
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Wu H, Qi M, Wang H, Liu Q, Liu Y. Efficacy of minocycline in the treatment of early syphilis. Int J STD AIDS 2021; 32:648-653. [PMID: 33496202 DOI: 10.1177/0956462420984695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Syphilis is the third prevalent infectious disease in China, caused by the spirochete bacterium Treponema pallidum. Minocycline is a derivative of tetracycline used as an alternative treatment for syphilis, but there are few studies in this field. In this research, we compared the efficacy of benzathine penicillin and minocycline in the treatment of early syphilis patients and analyzed some of the factors affecting the efficacy of minocycline. A total of 276 eligible patients treated between January 2011 and December 2017 were retrospectively analyzed, and 158 patients received 100 mg of minocycline orally, twice daily for 28 days, while 118 patients received benzathine penicillin, 2.4 million units intramuscular injections, once a week, 1-2 times in all. All patients accepted rapid plasma regain (RPR) serological tests and followed up for 24 months to evaluate serological treatment responses. After comparison, the serological cure rate of the minocycline treatment group (85.44%) was similar to the benzathine penicillin treatment group (88.14%). Besides, patients in the minocycline treatment group with higher initial RPR titer (≥1:32) exhibited better treatment effect. In addition, during the 24-month follow-up, the serological cure rate of primary syphilis patients after minocycline treatment was significantly higher than that of secondary and early latent syphilis patients. Therefore, minocycline may be an effective alternative treatment to early syphilis when benzathine penicillin is not available.
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Affiliation(s)
- Haoqing Wu
- Department of Dermatovenereology, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Manli Qi
- Department of Dermatovenereology, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Huiping Wang
- Department of Dermatovenereology, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Quanzhong Liu
- Department of Dermatovenereology, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Yuanjun Liu
- Department of Dermatovenereology, 117865Tianjin Medical University General Hospital, Tianjin, China
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18
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Abstract
OBJECTIVE To examine syphilis serology after treatment in people living with HIV. No unanimous guidelines exist in the era of increasing coinfection. DESIGN Retrospective review using a tertiary care clinic in Toronto from 2000 to 2017. METHODS The 2015 Centers for Diseases Control and Prevention syphilis guidelines were used to define an adequate serologic response. Cumulative distribution estimates and proportional hazards models accounting for interval censoring estimated the time to serologic response and seroreversion. Multistate models were used to investigate extended periods of serofast serology. RESULTS A total of 171 patients with syphilis met our inclusion criteria (16 primary, 53 secondary, 26 early latent, 46 late latent, 30 neurosyphilis). Serologic response was achieved by 12 months for 65 (94%) patients and by 12-18 months for four (6%) patients with primary/secondary syphilis. For latent and neurosyphilis, 94 (92%) achieved serologic response by 24 months and one (1%) at 24.1 months. 84 (49%) patients achieved seroreversion with a median (95% confidence interval) time of 2 (1.44, 2.68) years. Latent syphilis was associated with a lower likelihood of achieving serologic response [hazard ratio (HR) = 0.52, P = 0.05] and seroreversion (HR = 0.27, P < 0.001) compared with primary/secondary syphilis. The probability of moving from a new infection state to a serofast state within 1 year was high (0.65) but the 1-year probability of transitioning from a serofast state to seroreversion was low (0.27). CONCLUSION The majority of people living with HIV infected with syphilis will achieve an adequate serologic response as per the Centers for Diseases Control and Prevention guidelines. Seroreversion was observed in about half but can take years to occur.
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19
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Paul G, Wesselmann J, Adzic D, Malin JJ, Suarez I, Priesner V, Kümmerle T, Wyen C, Jung N, van Bremen K, Schlabe S, Wasmuth JC, Boesecke C, Fätkenheuer G, Rockstroh J, Schwarze-Zander C, Lehmann C. Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med 2020; 22:165-171. [PMID: 33128333 DOI: 10.1111/hiv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/25/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. METHODS From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. RESULTS In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. CONCLUSION Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
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Affiliation(s)
- G Paul
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - J Wesselmann
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - D Adzic
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - I Suarez
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - T Kümmerle
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K van Bremen
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J-C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - G Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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20
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Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2020; 35:574-588. [PMID: 33094521 DOI: 10.1111/jdv.16946] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.
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Affiliation(s)
- M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - N Dupin
- Syphilis National Reference Center, Hôpital Tarnier-Cochin, AP-HP, Paris, France
| | - G S Tiplica
- 2nd Dermatological Clinic, Carol Davila University, Colentina Clinical Hospital, Bucharest, Romania
| | - M Potočnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - R Patel
- Department of Genitourinary Medicine, the Royal South Hants Hospital, Southampton, UK
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21
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Arando M, Caballero E, Curran A, Armengol P, Barberá M, Vall-Mayans M. The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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22
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Arando M, Caballero E, Curran A, Armengol P, Barberá MJ, Vall-Mayans M. The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:841-849. [PMID: 31587806 DOI: 10.1016/j.ad.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. METHODS Retrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. RESULTS A total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. CONCLUSION The epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment.
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Affiliation(s)
- M Arando
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
| | - E Caballero
- Departamento de Microbiología, Hospital Vall d'Hebron, Barcelona, España
| | - A Curran
- Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - P Armengol
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - M J Barberá
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
| | - M Vall-Mayans
- Unidad de ITS de Vall d'Hebron-Drassanes, Departamento de Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España
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23
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Centers for Disease Control and Prevention Syphilis Summit-Diagnostics and Laboratory Issues. Sex Transm Dis 2019; 45:S13-S16. [PMID: 30102681 DOI: 10.1097/olq.0000000000000843] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Syphilis, caused by the bacterium Treponema pallidum, is on the rise in the United States particularly among men who have sex with men. The disease is complex with varied clinical manifestations and challenges remain in the laboratory diagnostic setting because T. pallidum is noncultivable and no single test can accurately diagnose all stages of the disease. There are missed opportunities for the use of direct detection tests in primary and secondary syphilis. The increasing use of different reverse sequence algorithms for serology testing without validation in populations with varying risks for syphilis makes the interpretation of test results difficult; this has led to concerns about diagnostic errors or overtreatment. On the other hand, the traditional algorithm may miss some early primary syphilis cases, which is of concern in high-risk populations. The potential utility of rapid syphilis serology tests in different settings or populations remains to be determined. The implementation of better tests and appropriate testing algorithms together with laboratory guidelines for test use in general will lead to better diagnostic options for syphilis.
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24
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Noda AA, Rodríguez I, Grillová L, Bosshard PP, Lienhard R. Accuracy of PCR and serological testing for the diagnosis of primary syphilis: Both tests are necessary. Int J STD AIDS 2019; 30:1087-1094. [PMID: 31551003 DOI: 10.1177/0956462419859764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Syphilis, caused by the spirochete Treponema pallidum subspecies pallidum, is a rising global public health concern and laboratory diagnostics remain challenging. Especially during early disease, rapid and accurate diagnosis is crucial to ensure patients and their contacts receive timely treatment to eradicate infection and prevent further transmission. In this prospective observational study, we evaluated the performance of polymerase chain reaction (PCR) and serological testing for the diagnosis of primary syphilis by evaluating anogenital swabs and sera from 178 Cuban patients presenting with ulcers. Three different PCR assays were evaluated targeting polA, tpp47 and 16S rDNA loci. Sera were evaluated with venereal disease research laboratory (VDRL) and T. pallidum hemagglutination (TPHA) assays. Assuming both methods were confirmatory, our data showed that PCR and serology did not correlate well (agreement = 52.3%, kappa 0.0512, 95% CI −0.0928–0.1951, p = 0.496). The sensitivities, specificities, positive and negative predictive values of the PCR assays were 76.1%, 100%, 100% and 57.9%, respectively, while the values for serology were 62.5%, 100%, 100% and 45.2%, respectively. The combination of PCR and serology can offer valuable information for the diagnosis of syphilis in patients presenting with anogenital ulceration avoiding further clinical complications and disease transmission.
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Affiliation(s)
- Angel A Noda
- Department of Mycology-Bacteriology, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba
| | - Islay Rodríguez
- Department of Mycology-Bacteriology, Institute of Tropical Medicine "Pedro Kourí", Havana, Cuba
| | - Linda Grillová
- Department of Biology, Masaryk University, Brno, Czech Republic.,Department of Microbiology, Institut Pasteur, Paris, France
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Lienhard
- Department of Serology, ADMED Microbiologie, La Chaux-de-Fonds, Switzerland
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Abstract
PURPOSE OF REVIEW This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system. SUMMARY Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.
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26
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Motswaledi HM. Common dermatological conditions in the HIV patient. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1610234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- HM Motswaledi
- Department of Dermatology, Sefako Makgatho Health Sciences University
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Laboratory diagnosis, management, and prevention. J Am Acad Dermatol 2019; 82:17-28. [PMID: 30986474 DOI: 10.1016/j.jaad.2019.02.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
Abstract
The methods used for the laboratory diagnosis of syphilis include direct detection of Treponema pallidum subspecies pallidum and serologic testing. Serologic testing relies on both nontreponemal and treponemal tests. In newly developed reverse-sequence screening algorithms, treponemal tests are performed before nontreponemal tests. The management of syphilis requires appropriate staging, treatment, and follow-up of patients along with the prompt reporting of infections to public health authorities to assist with prevention and control efforts. Benzathine penicillin G remains the treatment of choice for all stages of syphilis. Screening of populations at higher risk for syphilis is recommended by the US Centers for Disease Control and Prevention, the US Preventive Services Task Force, and the World Health Organization. The second article in this continuing medical education series reviews the testing for and the management 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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28
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Santos AMG, Souza Júnior VRD, Melo FLD, Aquino AECDA, Ramos MOA, Araújo LM, Lira CRD, Sobral PM, Figueiroa F, Melo HRLD, Araújo PSRD. Prevalence and risk factors of syphilis and human immunodeficiency virus co-infection at a university hospital in Brazil. Rev Soc Bras Med Trop 2019; 51:813-818. [PMID: 30517536 DOI: 10.1590/0037-8682-0097-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The incidence of syphilis has increased since the 1970s. METHODS This was a descriptive and analytical cross-sectional study with a non-probabilistic sample. RESULTS Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10-20 years, and 40.3% received antiretroviral therapy for 10-20 years. CONCLUSIONS The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures.
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Affiliation(s)
| | | | - Fábio Lopes de Melo
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | | | - Lucas Marinho Araújo
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | - Patrícia Maria Sobral
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | | | - Paulo Sérgio Ramos de Araújo
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil.,Instituto Aggeu Magalhaes, Fundação Oswaldo Cruz, Recife, PE, Brasil
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29
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Spagnuolo V, Poli A, Galli L, Nozza S, Bossolasco S, Cernuschi M, Maillard M, Hasson H, Gianotti N, Guffanti M, Lazzarin A, Castagna A. Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV. Open Forum Infect Dis 2018; 6:ofy324. [PMID: 30631790 PMCID: PMC6324658 DOI: 10.1093/ofid/ofy324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/17/2018] [Accepted: 11/28/2018] [Indexed: 01/06/2023] Open
Abstract
Background Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). Methods This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. Results A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P = .009), secondary syphilis (AHR, 1.29; P = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P = .027), for episodes that occurred in more recent years (AHR, 1.62; P = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P = .002). TR was not associated with the type of treatment regimen in early and late syphilis. Conclusions Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.
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Affiliation(s)
- Vincenzo Spagnuolo
- Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Andrea Poli
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Laura Galli
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Silvia Nozza
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Simona Bossolasco
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Massimo Cernuschi
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Myriam Maillard
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Hamid Hasson
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Nicola Gianotti
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Monica Guffanti
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Adriano Lazzarin
- IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Clinic of Infectious Diseases, Milan, Italy
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30
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Pastuszczak M, Sitko M, Bociaga-Jasik M, Kucharz J, Wojas-Pelc A. Lack of antiretroviral therapy is associated with higher risk of neurosyphilis among HIV-infected patients who remain serofast after therapy for early syphilis. Medicine (Baltimore) 2018; 97:e13171. [PMID: 30407349 PMCID: PMC6250445 DOI: 10.1097/md.0000000000013171] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Resolution of clinical symptoms and at least 4-fold decline in nontreponemal antibody titers after treatment of syphilis is regarded as "proof of cure." However, a substantial proportion of patients demonstrates <4-fold reduction of titers after recommended therapy (serofast state). It remains unclear whether the serofast state is indicative of persistence of bacteria or only a residual immune response.The aim of the present study was to determine the association between the serofast state and the risk of neurosyphilis in human immunodeficiency virus (HIV)-infected individuals and to identify potential predictors of neurosyphilis.Thirty-three patients with early syphilis and HIV co-infection were included. One year after the recommended treatment of syphilis, all patients who did not achieve proper serologic response underwent lumbar puncture and cerebrospinal fluid (CSF) examination.Twelve months after completing therapy for syphilis, the proportion of patients with serofast state after syphilis therapy was 36.4% (n = 12). Among them, 5 (41.7%) had neurosyphilis. Individuals who remained serofast and had neurosyphilis (n = 5) when compared to those without neurosyphilis (n = 7) were characterized by significantly lower CD4+ cell count and higher HIV RNA levels (P < .05). Moreover, a significantly higher proportion of patients with neurosyphilis was not receiving antiretroviral therapy (ART). The nonreceipt of ART independently increased the risk of neurosyphilis in the analyzed group of serofast HIV-infected patients (odds ratio = 4.5; 95% confidence interval 1.5-13.59, P = .003).Patients co-infected with HIV require careful serologic and clinical follow-up after therapy for syphilis. In all of the patients who do not respond serologically after treatment for syphilis, especially in those who are not receiving ART, lumbar puncture and CSF examination should be considered.
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Affiliation(s)
| | - Marek Sitko
- Department of Infectious Diseases, Jagiellonian University Medical College, Cracow
| | - Monika Bociaga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Cracow
| | - Jakub Kucharz
- Department of Uro-Oncology, Institute of Oncology, Warsaw, Poland
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31
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Pastuszczak M, Jakiela B, Wojas-Pelc A. Association of interleukin-10 promoter polymorphisms with serofast state after syphilis treatment. Sex Transm Infect 2018; 95:163-168. [PMID: 30341234 DOI: 10.1136/sextrans-2018-053753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Recent studies suggested that upregulation of anti-inflammatory immune response during early syphilis may be associated with persistence of Treponema pallidum infection despite adequate treatment, resulting in a serofast state. The objective of this study was to determine whether enhanced interleukin (IL)-10-related response during early T. pallidum infection increased the risk of serofast syphilis. METHODS Two IL10 gene promoter polymorphisms affecting IL-10 production (-1082A>G [rs1800896], -592C>A [rs1800872]) and serum levels of IL-10 were measured in 80 patients with early syphilis before and 6 months after penicillin treatment and in 24 healthy volunteers (control group). RESULTS After 6 months, patients were stratified based on serological response into two groups: (1) serofast state (n = 28) and (2) serologically cured (n = 52). Pretreatment and post-treatment serum IL-10 levels were significantly higher in patients who remained serofast compared with those who had a serological cure (p<0.001). The GG genotype of the -1082A>G (rs1800896) polymorphism and the CC genotype of the -592C>A (rs1800872) polymorphism were significantly correlated with higher serum IL-10 levels. Moreover, the OR for remaining serofast for carriers of these genotypes was 16.2 (95% CI: 4.1 to 65.0, p<0.0001) and 2.9 (95% CI: 1.4 to 5.9, p=0.002), respectively. CONCLUSIONS We showed that a pronounced anti-inflammatory immune response may be an important predictor for the serofast state. Additionally, host-related factors such as polymorphisms of immune regulatory genes may influence the risk of remaining serofast after syphilis therapy.
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Affiliation(s)
- Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
| | - Bogdan Jakiela
- Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
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32
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Pereira LE, McCormick J, Dorji T, Kang J, Sun Y, Shukla M, Hopkins A, Deutsch J, Kersh EN, Bernstein K, Fakile YF. Laboratory Evaluation of a Commercially Available Rapid Syphilis Test. J Clin Microbiol 2018; 56:e00832-18. [PMID: 30021825 PMCID: PMC6156315 DOI: 10.1128/jcm.00832-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/15/2018] [Indexed: 11/20/2022] Open
Abstract
Serological diagnosis of syphilis depends on assays that detect treponemal and nontreponemal antibodies. Laboratory certification and trained personnel are needed to perform most of these tests, while high costs and long turnaround time can hinder treatment initiation or linkage to care. A rapid treponemal syphilis test (RST) that is simple to perform, accessible, and inexpensive would be ideal. The Syphilis Health Check (SHC) assay is the only Food and Drug Administration (FDA)-cleared and Clinical Laboratory Improvement Amendments (CLIA)-waived RST in the United States. In this study, 1,406 archived human serum samples were tested using SHC and traditional treponemal and nontreponemal assays. Rapid test results were compared with treponemal data alone and with a laboratory test panel consensus defined as being reactive by both treponemal and nontreponemal assays for a given specimen, or nonreactive by both types of assays. The sensitivity and specificity of the SHC assay compared with treponemal tests alone were 88.7% (95% confidence interval [CI], 86.2 to 90.0%) and 93.1% (95% CI, 90.0 to 94.9%), respectively, while comparison with the laboratory test panel consensus showed 95.7% (95% CI, 93.6 to 97.2%) sensitivity and 93.2% (95% CI, 91.0 to 95.1%) specificity. The data were further stratified based on age, sex, pregnancy, and HIV status. The sensitivity and specificity of the SHC assay ranged from 66.7% (95% CI, 46.0 to 83.5%) to 91.7% (95% CI, 87.7 to 94.7%) and 88% (95% CI, 68.8 to 97.5%) to 100% (95% CI, 47.8 to 100%), respectively, across groups compared to traditional treponemal assays, generally increasing for all groups except the HIV-positive (HIV+) population when factoring in the laboratory test panel consensus. These data contribute to current knowledge of the SHC assay performance for distinct populations and may guide use in various settings.
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Affiliation(s)
- Lara E Pereira
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua McCormick
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Tandin Dorji
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Kang
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yongcheng Sun
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mayur Shukla
- Atlanta Research and Education Foundation, Inc., Decatur, Georgia, USA
| | - Andre Hopkins
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Deutsch
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kyle Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yetunde F Fakile
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Serological evolution in early syphilis. Enferm Infecc Microbiol Clin 2018; 37:183-186. [PMID: 30145037 DOI: 10.1016/j.eimc.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The evolution of syphilis after treatment could be affected by different factors, for example HIV. In consequence, HIV positive patients are sometimes treated with more doses of penicillin (PBG). The aim of the study is to describe and compare the serological evolution by different factors in patients with early syphilis in Barcelona. METHODS The serological control was made over the following year. A time analysis was performed through the study of Kaplan- Meier curves. RESULTS The serological control was made in 208 patients, 42.5% of whom were HIV-positive. In a Kaplan-Meier curve the median of days needed to observe the cure was 99 [97-105] without differences depending on HIV, previous syphilis, stage or RPR titters. A better evolution was observed in patients treated with doxycycline P=.02. CONCLUSIONS The serological evolution is similar in HIV-negative and HIV-positive patients treated according to current recommendations, observing the cure at 3 month after treatment.
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34
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Stone RB, Chung Y, Ansa BE. Syphilis Trends in the Central Savannah River Area (CSRA) of Georgia and South Carolina, USA. J Clin Med 2018; 7:jcm7080190. [PMID: 30065154 PMCID: PMC6112017 DOI: 10.3390/jcm7080190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022] Open
Abstract
There has been an alarming resurgence of early syphilis since 2000, especially in the southeast region, which has one of the highest rates of primary and secondary syphilis in the United States of America (USA). Although the Central Savannah River Area (CSRA) is the second most populous area in Georgia with a large presence of health care facilities, its counties have one of the lowest overall rankings in health outcomes. This study examined the syphilis rates and trends in the CSRA. Data from the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention’s AtlasPlus was used. Cases of primary and secondary syphilis diagnosed during 2010–2015 were analyzed to describe reported syphilis among CSRA residents. In the CSRA, between 2010 and 2015, the incidence rate of primary and secondary syphilis increased from 5.9 to 9.4 cases per 100,000 population. The lowest rate of syphilis was observed in 2011 (2.7 cases per 100,000) and the highest rate in 2015. In 2015, the highest syphilis rates were observed among males (15.9 per 100,000), non-Hispanic blacks (16.9 per 100,000), and persons between the ages 20–24 years (34.5 per 100,000). The relevance of preventive measures has been widely communicated, yet it is clear that risk-taking sexual behavior is on the rise. Greater effort is warranted to reduce risky behaviors that promote the transmission of syphilis, including areas outside of major metropolitan areas.
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Affiliation(s)
- Rebecca B Stone
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Yunmi Chung
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
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Kularatne RS, Muller EE, Maseko DV, Kufa-Chakezha T, Lewis DA. Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007-2015. PLoS One 2018; 13:e0194125. [PMID: 29617372 PMCID: PMC5884493 DOI: 10.1371/journal.pone.0194125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background In South Africa, treatment of genital ulcer disease (GUD) occurs in the context of syndromic management. GUD aetiological studies have been conducted in Johannesburg since 2007. We report on GUD pathogen prevalence, sero-prevalence of STI co-infections and aetiological trends among GUD patients presenting to a community-based primary healthcare facility in Johannesburg over a 9-year period. Methods and findings GUD surveys were conducted from January to April each year. Consecutive genital ulcers were sampled from consenting adults. Swab-extracted DNA was tested by multiplex real-time PCR assays for herpes simplex virus (HSV), Treponema pallidum (TP), Haemophilus ducreyi (HD) and Chlamydia trachomatis (CT). HSV-positive DNA extracts were further subtyped into HSV-1 and HSV-2 using a commercial PCR assay; CT-positive extracts were tested with an in-house PCR assay specific for serovars L1-L3 (lymphogranuloma venereum). Sera were tested for HIV, HSV-2, and syphilis co-infections. Giemsa-stained ulcer smears were screened for Klebsiella granulomatis by microscopy. Data were analysed with STATATM version 14. Of 771 GUD specimens, 503 (65.2%) had a detectable pathogen: HSV 468 (60.7%); TP 30 (3.9%); CT L1-3 7 (0.9%); HD 4 (0.5%). No aetiological agents were detected in 270 (34.8%) ulcer specimens. Seroprevalence rates were as follows: HIV 61.7%; HSV-2 80.2% and syphilis 5.8%. There was a strong association between GUD pathogen detection and HIV seropositivity (p < 0.001); 68% of cases caused by HSV were co-infected with HIV. There was a significant decline in the relative prevalence of ulcer-derived HSV over time, predominantly from 2013–2015 (p-value for trend = 0.023); and a trend towards a decrease in the HIV seropositivity rate (p-value for trend = 0.209). Conclusions HSV remains the leading cause of pathogen-detectable GUD in South Africa. The prevalence of HIV co-infection among GUD patients is high, underlining the importance of linkage to universal HIV testing and treatment in primary healthcare settings.
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Affiliation(s)
- Ranmini S. Kularatne
- Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Etienne E. Muller
- Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Dumisile V. Maseko
- Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tendesayi Kufa-Chakezha
- Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - David A. Lewis
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
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Jiang Y, Weng R, Zhang Y, Fan R, Liu Y, Chen Z, Peng F, Chen Y, Chen X. The performance of rapid plasma reagin (RPR) titer in HIV-negative general paresis after neurosyphilis therapy. BMC Infect Dis 2018; 18:144. [PMID: 29606102 PMCID: PMC5879544 DOI: 10.1186/s12879-018-3062-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 03/25/2018] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Repeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response. However, it is unknown whether serum rapid plasma reagin (RPR) titer can serve as a surrogate for determining the efficacy of treatment in general paresis (GP) remains unknown. METHODS We retrospectively reviewed data from 105 GP patients, who were divided into two groups (62 CSF RPR+ patients and 43 CSF RPR- patients) according to reactive RPR test status in CSF. Clinical assessment included the Mini-Mental State Examination (MMSE) scores, CSF examinations (WBC count, protein concentration and RPR titer), and serum tests (RPR titer and TPPA). Among the 105 GP patients, 13 CSF RPR+ patients and 6 CSF RPR- patients had a 12 months follow-up of CSF, serum measures and MMSE. RESULTS The median serum RPR titer was significantly higher in CSF RPR+ patients than that in CSF RPR- GP patients, 1:8 [IQR 1:4-1:32] vs. 1:4 [IQR 1:4-1:8] (P < 0.001). The number of CSF RPR+ patients with serum RPR titer≥1:32 was significantly higher when compared with CSF RPR- patients (P = 0.001). For CSF RPR+ patients, the MMSE scores improved or remained constantly after penicillin treatment. For CSF RPR+ patients, the CSF RPR titer declined four-fold in 85% (11/13) of the patients, whereas the serum RPR titer declined four-fold in only 46% (6/13) of the patients, the odds ratio is 6.4 (95% confidence interval 1.0-41.2). CONCLUSIONS A four-fold decline in CSF RPR titer is a good predictor for treatment efficacy in CSF RPR+ GP patients within 12 months after the completion of therapy.
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Affiliation(s)
- Ying Jiang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Ruihui Weng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yuefeng Zhang
- Department of Neurology, Guangzhou Brain Hospital, Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong, 510370, People's Republic of China
| | - Rong Fan
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yulun Liu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhigang Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Xiaohong Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
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The Significance of Isolated Reactive Treponemal Enzyme Immunoassay in the Diagnosis of Early Syphilis. Sex Transm Dis 2017; 43:365-8. [PMID: 27196257 DOI: 10.1097/olq.0000000000000446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Treponemal test algorithm for syphilis screening is widely used. A diagnostic challenge between identifying early syphilis versus a false positive signal occurs in cases where the treponemal enzyme immunoassay (EIA) is reactive and confirmatory T. pallidum particle agglutination assay is negative. We investigated the diagnostic outcome of isolated reactive EIA in patients attending a sexual health clinic. METHODS Results of syphilis serology tests carried out at Birmingham Whittall Street Clinic between August 10, 2010, and November 31, 2014, were reviewed. Cases with isolated EIA were routinely invited for repeat syphilis serology. Outcomes of patients with isolated EIA were reviewed and the proportion with confirmed positive syphilis serology on their repeat test identified. The number of isolated EIA cases needed to retest to identify 1 case of early syphilis was calculated. RESULTS A total of 121,724 syphilis screening tests were performed. Among the 1561 individual patients with reactive EIA sera, 316 (20% of total reactive tests) had isolated reactive EIA. Repeat syphilis serology results of 163 patients were reviewed; 106 patients remained with isolated reactive EIA, 50 had negative EIA test and 7 (4.3%) had confirmed reactive EIA. Of the 7 patients, 2 had evidence of early syphilis infection. The number of isolated EIA needed to retest to identify 1 case of early syphilis was 81.5 (95% confidence interval, 22.9-671.4). CONCLUSIONS Routine recall of patients with isolated EIA sera is not warranted. Risk of acquisition or presence of early syphilis should be assessed independently and irrespective of a negative syphilis screening test or isolated EIA.
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Kim JI, Park JH, Choi JY, Lee GY, Kim WS. Serologic Response to Treatment in Human Immunodeficiency Virus-Negative Syphilis Patients Using Automated Serological Tests: Proposals for New Guidelines. Ann Dermatol 2017; 29:768-775. [PMID: 29200767 PMCID: PMC5705360 DOI: 10.5021/ad.2017.29.6.768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Automated analyzer-based nontreponemal serological tests for syphilis (STS) have been used for several decades. Objective In this study, we evaluated serological responses to treatment and proposed clinical guidelines for automated STS. Methods This retrospective cohort study analyzed human immunodeficiency virus-negative syphilis patients who were diagnosed with automated rapid plasma reagin (auto RPR) tests as a nontreponemal STS, and who also received the fluorescent treponemal antibody-absorption test as a confirmatory test. The ratio of auto RPR values after treatment against those at baseline was defined as the auto RPR ratio for the analysis of the serological response to treatment. The cutoff value for reliable seroreversion prediction was assessed with receiver-operating-characteristic curves. Results Overall, 89.7% of participants (78/87) seroreverted and 10.3% of participants (9/87) remained serofast during the two-year follow-up period. We were unable to describe trends in the changes among auto RPR values within six months after treatment because of high variation. All of the patients who had an auto RPR ratio ≥1.0 after six months continuously had positive serologic results during their 24-month follow-up and were classified as a serofast group. The receiver-operating-characteristic curves revealed a 25% reduction in auto RPR values nine months after treatment and predicted seroreversion with a sensitivity of 96.2% and a specificity of 100%. Conclusion The most important primary checkpoint for syphilis treatment response is an increase in automated nontreponemal STS six months after treatment. Thus, we recommend monitoring the treatment response with an auto RPR.
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Affiliation(s)
- Jung-In Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Yeon Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Serk Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Xiao Y, Tong ML, Lin LR, Liu LL, Gao K, Chen MJ, Zhang HL, Zheng WH, Li SL, Lin HL, Lin ZF, Yang TC, Niu JJ. Serological Response Predicts Normalization of Cerebrospinal Fluid Abnormalities at Six Months after Treatment in HIV-Negative Neurosyphilis Patients. Sci Rep 2017; 7:9911. [PMID: 28855625 PMCID: PMC5577126 DOI: 10.1038/s41598-017-10387-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/07/2017] [Indexed: 12/09/2022] Open
Abstract
This study aimed to determine whether a serological response could predict the normalization of cerebrospinal fluid (CSF) abnormalities at 6 months after treatment in human immunodeficiency virus (HIV)-negative neurosyphilis patients. A total of 123 neurosyphilis patients were recruited at baseline, 58 of these patients undergoing treatment, repeated CSF examinations and serological tests for syphilis at 6 months after treatment were included in the follow-up study. Before treatment, the CSF rapid plasma reagin (RPR) titer, CSF Treponema pallidum particle agglutination (TPPA) titer, CSF leukocyte count, and CSF protein concentration were correlated with both serum RPR and TPPA titers. At 6 months after treatment, 28 and nine patients achieved serological responses of RPR and TPPA tests, respectively. The sensitivities of the serological response of RPR and TPPA tests for identifying the normalization of CSF abnormalities were 60.0∼83.3% and 17.1~22.2%, respectively; and 75.0∼91.3% of patients showing serological response of RPR test also achieved CSF normalization, suggesting that the serological response could predict CSF normalization to some degree. Particularly, in patients with ≥8-fold decreases in the serum RPR titer, the CSF RPR, CSF leukocyte count, and CSF protein concentration had normalized, and follow-up lumbar puncture could be reduced considering the resolution of neurological symptoms.
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Affiliation(s)
- Yao Xiao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian Province, China.,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, Fujian Province, China
| | - Man-Li Tong
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Li-Rong Lin
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Li-Li Liu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Kun Gao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Mei-Jun Chen
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Hui-Lin Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Wei-Hong Zheng
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Shu-Lian Li
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Hui-Ling Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Zhi-Feng Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Tian-Ci Yang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China.
| | - Jian-Jun Niu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, Fujian Province, China.
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Abstract
Similarly to the general population, genitourinary tract infections are common conditions in theimmunocompromised host. They can be furthermore divided into infections of the urinary tract and genital tract infections. Transplant recipients are more likely to have infections of the urinary tract infections while persons with human immunodeficiency virus (HIV) are at higher risk for the second group of infections, especially sexually transmitted infections (STIs). Manifestations of these diseases can be associated with more complications and can be more severe. We provide an overview of manifestations, diagnosis, and management of these disorders.
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Xiao Y, Tong ML, Liu LL, Lin LR, Chen MJ, Zhang HL, Zheng WH, Li SL, Lin HL, Lin ZF, Xing HQ, Niu JJ, Yang TC. Novel predictors of neurosyphilis among HIV-negative syphilis patients with neurological symptoms: an observational study. BMC Infect Dis 2017; 17:310. [PMID: 28446129 PMCID: PMC5406894 DOI: 10.1186/s12879-017-2339-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Known predictors of neurosyphilis were mainly drawn from human immunodeficiency virus (HIV)-infected syphilis patients, which may not be applicable to HIV-negative populations as they have different characteristics, particularly those with neurological symptoms. This study aimed to identify novel predictors of HIV-negative symptomatic neurosyphilis (S-NS). Methods From June 2005 to June 2015, 370 HIV-negative syphilis patients with neurological symptoms were recruited, consisting of 191 S-NS patients (including 123 confirmed neurosyphilis and 68 probable neurosyphilis patients) and 179 syphilis/non-neurosyphilis (N-NS) patients. Clinical and laboratory characteristics of S-NS were compared with N-NS to identify factors predictive of S-NS. Serum rapid plasma reagin (RPR), Treponema pallidum particle agglutination (TPPA), and their parallel testing format for screening S-NS were evaluated. Results The likelihood of S-NS was positively associated with the serum RPR and TPPA titers. The serum TPPA titers performed better than the serum RPR titers in screening S-NS. The optimal cut-off points to recognize S-NS were serum RPR titer ≥1:4 and serum TPPA titer ≥1:2560 respectively. A parallel testing format of a serum RPR titer ≥1:2 and serum TPPA titer ≥1:1280 screened out 95.8% of S-NS and all confirmed cases of neurosyphilis. S-NS was independently associated with male sex, serum RPR titer ≥1:4, serum TPPA titer ≥1:2560, and elevated serum creatine kinase. Concurrence of these factors increased the likelihood of S-NS. Conclusions Quantitation of serum TPPA is worthwhile and performs better than serum RPR in screening S-NS. Serum RPR, serum TPPA, male sex, and serum creatine kinase can predict S-NS. Moreover, patients with both a serum RPR titer <1:2 and a serum TPPA titer <1:1280 have a low probability of S-NS, suggesting that it is reasonable to reduce lumbar punctures in such individuals.
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Affiliation(s)
- Yao Xiao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China.,Xiamen Hospital of Traditional Chinese Medicine, Xiamen, 361009, China.,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, 361004, China
| | - Man-Li Tong
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Li-Li Liu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Li-Rong Lin
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Mei-Jun Chen
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Hui-Lin Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Wei-Hong Zheng
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Shu-Lian Li
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Hui-Ling Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Zhi-Feng Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Hui-Qin Xing
- Institute of Neuroscience, Medical College of Xiamen University, Xiamen, 361005, China
| | - Jian-Jun Niu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China. .,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, 361004, China.
| | - Tian-Ci Yang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China.
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Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. Minocycline, a representative tetracycline derivative, has the greatest antimicrobial activity among all tetracyclines. There are few reports about treating syphilis with minocycline because there is a lack of efficacy data from controlled trials. We compared the rates of serological cure in patients with early syphilis who were treated with minocycline or benzathine penicillin G (BPG).During the study period, a total of 40 syphilis patients received the BPG treatment, which was a single intramuscular dose of 2.4 million units of BPG, and 156 patients were treated with minocycline; 77 patients were placed in the 2-week, standard minocycline therapy group and received 100 mg of minocycline orally, twice daily for 14 days, and 79 patients were placed in the 4-week, lengthened minocycline therapy group and received 100 mg of minocycline orally, twice daily for 28 days. The outcome of interest was the rate of serological cure in these patients.At the end of the 2-year follow-up, the serological cure rate of the 4-week, lengthened minocycline therapy group (87.34%) was higher than that of both the 2-week, standard minocycline therapy group (72.73%) and the BPG treatment group (77.50%). In addition, the curative effect of the 4-week, lengthened minocycline therapy was significantly greater than that of the 2-week, standard minocycline therapy in patients who were aged >40 years; exhibited an initial rapid plasma reagin titer ≥1: 32; or exhibited secondary syphilis (P = 0.000, 0.008, 0.000; <0.05).Minocycline appears to be an effective agent for treating early syphilis, especially when applied as a 4-week, lengthened therapy.
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Pastuszczak M, Gozdzialska A, Jakiela B, Obtulowicz A, Jaskiewicz J, Wojas-Pelc A. Robust pro-inflammatory immune response is associated with serological cure in patients with syphilis: an observational study. Sex Transm Infect 2016; 93:11-14. [PMID: 27356549 DOI: 10.1136/sextrans-2016-052681] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Approximately 15% of adequately treated patients with early syphilis remain serofast. Pathogenesis and clinical significance of this phenomenon is unclear. The objective of this study was to determine whether there is any association between host immune response and treatment outcome (serofast state or proper serological response). METHODS Forty-four patients with secondary syphilis were enrolled to this study. Levels of pro-inflammatory cytokines such as interferon-γ, tumour necrosis factor-α and interleukin-6 were measured before treatment and 8 hours after injection of antibiotic. RESULTS After 1 year, based on the serological response patients were stratified into two groups: (1) proper serological response (n=31) and (2) serofast state (n=9). The serological cure rate was 77.5% at 12 months after treatment. Patients with proper serological response had significantly higher levels of analysed cytokines (at baseline and 8 hours after treatment) compared with the serofast state group (p<0.05). CONCLUSIONS We showed that robust host pro-inflammatory immune response to infection may be the predictive factor of serological cure. The treatment outcome may be also associated with the magnitude of immune reaction occurring during the treatment.
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Affiliation(s)
- Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
| | | | - Bogdan Jakiela
- Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland
| | - Aleksander Obtulowicz
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
| | | | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
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Costa-Silva M, Azevedo C, Azevedo F, Lisboa C. Early syphilis treatment in HIV-infected patients: single dose vs. three doses of benzathine penicillin G. J Eur Acad Dermatol Venereol 2016; 30:1805-1809. [PMID: 27329618 DOI: 10.1111/jdv.13766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current treatment guidelines for early stages of syphilis are the same regardless of HIV serostatus. There is still controversy about the best treatment for syphilis in HIV patients and the current recommendations are based on limited data. OBJECTIVE The primary goal of this study was to compare the serological response rates to a single dose vs. three weekly doses of benzathine penicillin G (BPG) in HIV-infected patients with early syphilis and to assess the adequacy of current recommendations. METHODS Clinical and laboratory data of HIV patients with early syphilis treated in Sexually Transmitted Disease Clinic between January 2000 and December 2014 were recorded. A good serological response was defined as a ≥4-fold decline in Venereal Disease Research Laboratory (VDRL) titre within 12 months after treatment. Serological failure was defined as a lack of at least fourfold decrease in VDRL titres within 12 months after treatment. RESULTS After applying inclusion and exclusion criteria, 60 patients were enrolled in the study. Seventeen (28.3%) patients were treated with a single dose of BPG, while in 43 (71.7%) patients, three weekly doses were used. Fifty eight (96.7%) had a good serological response at 12 months and seroconversion was confirmed in 29 (48.3%) patients. There was no statistically significant difference between the two treatment groups regarding serological response, seroconversion rate and the time needed to obtain a good serological response. Furthermore, treatment response was not affected by the number of CD4 cells. CONCLUSIONS The results of our study support the current international treatment guidelines, recommending early syphilis treatment with a single dose of BPG in HIV patients.
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Affiliation(s)
- M Costa-Silva
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE, Porto, Portugal.
| | - C Azevedo
- Department of Infectious Diseases, Centro Hospitalar São João, EPE, Porto, Portugal
| | - F Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - C Lisboa
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE, Porto, Portugal.,Department of Microbiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Benzathine penicillin G for the management of early syphilis among HIV co-infected persons: A systematic review. ACTA ACUST UNITED AC 2016; 42:30-36. [PMID: 29770001 DOI: 10.14745/ccdr.v42i02a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The optimal treatment for syphilis in people who are human immunodeficiency virus (HIV) positive is controversial. Objective To assess the efficacy of three doses versus a single dose of long acting Benzathine Penicillin G (BP-G) for the effective management of early syphilis among HIV co-infected populations. Methods A systematic search of the published literature was conducted using MEDLINE and EMBASE databases to identify clinical and observational studies published between January 2010 and May 2015. Inclusion criteria were: publication in English or French, populations co-infected with HIV and early syphilis, treatment with BP-G and outcomes related to syphilis treatment. All articles underwent a risk of bias assessment and data extraction was completed on all included studies. Results Seven studies were eligible for final inclusion, data extraction and analysis. The evidence from the final included studies were from non-randomized controlled trials. In general, no significant differences were found between groups treated with one versus two or more doses of BP-G; but there was a trend toward longer time to treatment failure with three doses. Differences in methodology limit the ability to draw any firm conclusions on the relative efficacy between these two treatment regimens. Conclusion Insufficient data exist to ascertain whether or not there is an added benefit from additional doses of BP-G for the treatment of early syphilis with HIV co-infection. A high-quality, randomized controlled trial is needed to definitively nswer this question.
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Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1. Clin Infect Dis 2015; 61 Suppl 8:S818-36. [DOI: 10.1093/cid/civ714] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Seña AC, Zhang XH, Li T, Zheng HP, Yang B, Yang LG, Salazar JC, Cohen MS, Moody MA, Radolf JD, Tucker JD. A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infect Dis 2015; 15:479. [PMID: 26511465 PMCID: PMC4625448 DOI: 10.1186/s12879-015-1209-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/12/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Syphilis remains a global public health threat and can lead to severe complications. In addition to resolution of clinical manifestations, a reduction in nontreponemal antibody titers after treatment is regarded as "proof of cure." However, some patients manifest < 4-fold decline ("serological non-response") or persistently positive nontreponemal titers despite an appropriate decline ("serofast") that may represent treatment failure, reinfection, or a benign immune response. To delineate these treatment phenomena, we conducted a systematic review of the literature regarding serological outcomes and associated factors among HIV-infected and -uninfected subjects. METHODS Six databases (PubMed, Embase, CINAHL, Web of Science, Scopus, and BIOSIS) were searched with no date restrictions. Relevant articles that evaluated serological treatment responses and correlates of serological cure (≥ four-fold decline in nontreponemal titers) were included. RESULTS We identified 1693 reports in the literature, of which 20 studies met selection criteria. The median proportion of patients who had serological non-response was 12.1% overall (interquartile range, 4.9-25.6), but varied depending on the time points after therapy. The serofast proportion could only be estimated from 2 studies, which ranged from 35.2-44.4%. Serological cure was primarily associated with younger age, higher baseline nontreponemal titers, and earlier syphilis stage. The relationship between serological cure and HIV status was inconsistent; among HIV-infected patients, CD4 count and HIV viral load was not associated with serological cure. CONCLUSIONS Serological non-response and the serofast state are common syphilis treatment outcomes, highlighting the importance of determining the immunological and clinical significance of persistent nontreponemal antibody titers after therapy.
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Affiliation(s)
- Arlene C Seña
- Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Xiao-Hui Zhang
- Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China.
| | - Trudy Li
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - He-Ping Zheng
- Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China.
| | - Bin Yang
- Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China.
| | - Li-Gang Yang
- Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China.
| | - Juan C Salazar
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Connecticut and Connecticut Children's Medical Center, Farmington, Connecticut, USA.
| | - Myron S Cohen
- Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - M Anthony Moody
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA.
- Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA.
| | - Justin D Radolf
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Connecticut and Connecticut Children's Medical Center, Farmington, Connecticut, USA.
- Department of Medicine, UConn Health, Farmington, Connecticut, USA.
| | - Joseph D Tucker
- Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Amelot F, Picot E, Meusy A, Rousseau C, Brun M, Guillot B. [Syphilis in Montpellier, France, from 2002 to 2011: Survey in a free hospital screening centre for venereal disease and in the dermatology unit of a regional public hospital]. Ann Dermatol Venereol 2015; 142:742-50. [PMID: 26362133 DOI: 10.1016/j.annder.2015.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 04/15/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In a context of resurgent syphilis in France since 2000, we conducted a retrospective study in two different centres in Montpellier, France: the dermatology department of a public hospital and an anonymous and free centre for provision of information, diagnosis and treatment of venereal diseases (CDAG-CIDDIST). PATIENTS AND METHODS All patients with syphilis seen from January 2002 to December 2011 were included with the collaboration of the National Health Institute (InVS) and the Bacteriology Department of the public hospital. Epidemiology, clinical presentation, serological data, and treatment and monitoring data for up to 2 years were recorded. RESULTS One hundred and seventy-five cases of syphilis were diagnosed: 154 at the CDAG and 21 at the dermatology unit. Ninety-six percent of cases concerned men with a median age of 36 years. Eighty-two percent of these cases involved men having sex with men (MSM). Forty-nine percent of cases were diagnosed in the secondary stage, 22% in the primary stage and 28% in the latent stage. The treatment administered in the majority of cases (73%) was benzathine-penicillin G. The numbers of patients showing incomplete follow-up were equal at both centres, with 31 patients (17.7%) failing to attend the follow-up visit. A decrease of at least 2 dilutions in VDRL score occurred in the year following treatment for 93 of 103 patients (90%). Patients managed at the dermatology department were older than their counterparts managed at the CDAG and exhibited more frequent cutaneous eruptions (58% vs. 3%, P<0.0001) but were less frequently bisexual. However, no significant differences were seen concerning sex and associated infections (hepatitis, gonococcal infection, HPV or herpes). DISCUSSION Syphilis is on the rise, especially in the MSM population. The epidemiological characteristics of our cohort were consistent with those of other Western European countries. Although the reasons for consultation differed between CDAG/CIDDIST and the dermatology department, the two centres are complementary. Benzathine-penicillin G was the most commonly used treatment, in accordance with the recommendations. Measures must be introduced to improve patient monitoring without compromising anonymity.
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Affiliation(s)
- F Amelot
- Département de dermatologie, CHU, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
| | - E Picot
- CDAG/CIDDIST de Montpellier, département de dermatologie, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - A Meusy
- Département de l'information médicale, hôpital La-Colombière, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France
| | - C Rousseau
- Cellule de l'InVS en région languedoc-roussillon (CIRE), département coordination des alertes et des régions, institut de veille sanitaire, ARS LR - 28 Parc-Club du Millénaire, 1025, rue Henri-Becquerel, CS3000, 34067 Montpellier cedex 2, France
| | - M Brun
- Laboratoire de bactériologie, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - B Guillot
- Département de dermatologie, CHU, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34000 Montpellier, France
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Abstract
PURPOSE OF REVIEW Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians. RECENT FINDINGS Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern. SUMMARY Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.
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Tuddenham S, Ghanem KG. Emerging trends and persistent challenges in the management of adult syphilis. BMC Infect Dis 2015; 15:351. [PMID: 26286439 PMCID: PMC4545322 DOI: 10.1186/s12879-015-1028-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/15/2015] [Indexed: 01/13/2023] Open
Abstract
There are an estimated 10.6 million incident cases of syphilis worldwide each year. We highlight some persistent challenges and emerging trends in the clinical management of syphilis with a particular focus on therapy, serology, diagnostics, and prevention. Decades after the introduction of penicillin, the optimal management of early syphilis continues to be a controversial topic, particularly in the setting of HIV co-infection. Similarly, the need for routine lumbar puncture in HIV co-infected asymptomatic persons is an unanswered question. Despite advances in both automation and point-of-care diagnostics, we continue to rely on indirect measures of disease activity to manage this infection. As syphilis rates in some populations continue to rise, novel and effective prevention strategies are needed.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Center Tower #378, Baltimore, MD, 21224, USA. .,Division of Infectious Diseases, 1830 E. Monument Street, Room 442, Baltimore, MD, 21287, USA.
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Center Tower #378, Baltimore, MD, 21224, USA. .,Division of Infectious Diseases, 1830 E. Monument Street, Room 442, Baltimore, MD, 21287, USA.
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