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Sharma R, Salimi E, D’Assumpcao C, Valdez M, Chaudhry A, Heidari A, Kuran R, Bhandohal J. Catastrophic Case of West Nile Virus Rhombencephalitis in AIDS. J Investig Med High Impact Case Rep 2024; 12:23247096241267132. [PMID: 39077811 PMCID: PMC11289818 DOI: 10.1177/23247096241267132] [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: 11/23/2023] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/31/2024] Open
Abstract
West Nile Virus (WNV) belongs to the Flaviviridae family of viruses. It was first isolated and identified in 1937. Patients typically present with flu-like symptoms or are asymptomatic; however, neuroinvasive West Nile can lead to significant neurological impairment. Herein presented is a catastrophic case of WNV rhombencephalitis in a male patient newly diagnosed with AIDS. This report sheds light on the potential for severe neurological complications in co-infected patients and emphasizes the importance of early recognition.
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Affiliation(s)
- Rupam Sharma
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elika Salimi
- Western University of Health Sciences, Pomona, CA, USA
| | - Carlos D’Assumpcao
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael Valdez
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Akriti Chaudhry
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arash Heidari
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rasha Kuran
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Janpreet Bhandohal
- Kern Medical, Bakersfield, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Balaji S, Chakraborty R, Aggarwal S. Neurological Complications Caused by Human Immunodeficiency Virus (HIV) and Associated Opportunistic Co-infections: A Review on their Diagnosis and Therapeutic Insights. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:284-305. [PMID: 37005520 DOI: 10.2174/1871527322666230330083708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 01/25/2023] [Indexed: 04/04/2023]
Abstract
Neurocognitive disorders associated with human immunodeficiency virus (HIV) infected individuals increase the risk of mortality and morbidity that remain a prevalent clinical complication even in the antiretroviral therapy era. It is estimated that a considerable number of people in the HIV community are developing neurological complications at their early stages of infection. The daily lives of people with chronic HIV infections are greatly affected by cognitive declines such as loss of attention, learning, and executive functions, and other adverse conditions like neuronal injury and dementia. It has been found that the entry of HIV into the brain and subsequently crossing the blood-brain barrier (BBB) causes brain cell damage, which is the prerequisite for the development of neurocognitive disorders. Besides the HIV replication in the central nervous system and the adverse effects of antiretroviral therapy on the BBB, a range of opportunistic infections, including viral, bacterial, and parasitic agents, augment the neurological complications in people living with HIV (PLHIV). Given the immuno-compromised state of PLHIV, these co-infections can present a wide range of clinical syndromes with atypical manifestations that pose challenges in diagnosis and clinical management, representing a substantial burden for the public health system. Therefore, the present review narrates the neurological complications triggered by HIV and their diagnosis and treatment options. Moreover, coinfections that are known to cause neurological disorders in HIV infected individuals are highlighted.
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Affiliation(s)
- Sivaraman Balaji
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chakraborty
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Sumit Aggarwal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
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Fu Y, Yang L, Du J, Khan R, Liu D. Establishment of HIV-negative neurosyphilis risk score model based on logistic regression. Eur J Med Res 2023; 28:200. [PMID: 37381052 DOI: 10.1186/s40001-023-01177-5] [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: 12/05/2022] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE To establish the risk scoring model for HIV-negative neurosyphilis (NS) patients and to optimize the lumbar puncture strategy. METHODS From 2016 to 2021, clinical information on 319 syphilis patients was gathered. Multivariate logistic regression was used to examine the independent risk factors in NS patients who tested negative for human immunodeficiency virus (HIV). Receiver operating characteristic curves (ROC) were used to assess the risk scoring model's capacity for identification. According to scoring model, the timing of lumbar puncture was suggested. RESULTS There were statistically significant differences between HIV-negative NS and non-neurosyphilis (NNS) patients in the following factors. These included age, gender, neuropsychiatric symptoms (including visual abnormalities, hearing abnormalities, memory abnormalities, mental abnormalities, paresthesia, seizures, headache, dizziness), serum toluidine red unheated serum test (TRUST), cerebrospinal fluid Treponema pallidum particle agglutination test (CSF-TPPA), cerebrospinal fluid white blood cell count (CSF-WBC), and cerebrospinal fluid protein quantification (CSF-Pro) (P < 0.05). Logistic regression analysis of HIV-negative NS patients risk factors showed that age, gender, and serum TRUST were independent risk factors for HIV-negative NS (P = 0.000). The total risk score (- 1 ~ 11 points) was obtained by adding the weight scores of each risk factor. And the predicted probability of NS in HIV-negative syphilis patients (1.6 ~ 86.6%) was calculated under the corresponding rating. ROC calculation results showed that the score had good discrimination value for HIV-negative NS and NNS: area under the curve (AUC) was 0.80, the standard error was 0.026 and 95% CI was 74.9-85.1% (P = 0.000). CONCLUSION The risk scoring model in this study can classify the risk of neurosyphilis in syphilis patients, optimize the lumbar puncture strategy to a certain extent, and provide ideas for the clinical diagnosis and treatment of HIV-negative neurosyphilis.
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Affiliation(s)
- Yu Fu
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Ling Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Jie Du
- Department of Biostatistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Raqib Khan
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Donghua Liu
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China.
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4
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Human Immunodeficiency Virus and Uveitis. Viruses 2023; 15:v15020444. [PMID: 36851658 PMCID: PMC9962278 DOI: 10.3390/v15020444] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Uveitis is one of the most common ocular complications in people living with the Human immunodeficiency virus (HIV) and can be classified into HIV-induced uveitis, co-infection related uveitis, immune recovery uveitis, and drug-induced uveitis. The introduction of antiretroviral therapy has considerably changed the incidence, diagnosis, and treatment of different types of HIV-related uveitis. Furthermore, the specific immune condition of patients infected with HIV makes diagnosing HIV-related uveitis difficult. Recent studies have focused on the growing prevalence of syphilis/tuberculosis co-infection in uveitis. Simultaneously, more studies have demonstrated that HIV can directly contribute to the incidence of uveitis. However, the detailed mechanism has not been studied. Immune recovery uveitis is diagnosed by exclusion, and recent studies have addressed the role of biomarkers in its diagnosis. This review highlights recent updates on HIV-related uveitis. Furthermore, it aims to draw the attention of infectious disease physicians and ophthalmologists to the ocular health of patients infected with HIV.
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Trujillo D, Arayasirikul S, Xie H, Sicro S, Meza J, Bella M, Daza E, Torres F, McFarland W, Wilson EC. Disparities in Sexually Transmitted Infection Testing and the Need to Strengthen Comprehensive Sexual Health Services for Trans Women. Transgend Health 2022; 7:230-236. [PMID: 36643058 PMCID: PMC9829146 DOI: 10.1089/trgh.2020.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Few studies have examined the importance of improving the sexual health delivery system beyond HIV among trans women. We assessed survey data from the National HIV Behavioral Surveillance Transgender Woman (NHBS-Trans) Study in San Francisco to characterize the utilization of sexual health services among HIV-negative trans women and to explore opportunities to improve sexual health services for trans women. Methods Trans women were recruited through respondent-driven sampling from July 2019 to February 2020. The analytic sample was restricted to 116 HIV-negative trans women. We identified trends in data using chi-squared tests to assess significance between sexual risk behavior and the use of preventative sexual health services and built logistic regression models to assess the relationships between sexual risk behaviors and sexually transmitted infection (STI) testing. Results The majority of sample was trans women of color with most identifying as Latinx (42.2%). Over half were low income (56%), and majority had been homeless in past 12 months (62.9%). The prevalence of condomless receptive anal sex was 52.6% with about two-thirds (62.1%) recently having an STI test. Participants who engaged in recent condomless receptive anal sex had more than fivefold greater odds of having a recent STI test compared to their counterparts who did not (adjusted odds ratio [aOR] 5.60, 95% confidence interval [CI] 1.83-17.11; p=0.003). We also found age- and education-related disparities in STI testing. Conclusion This study characterized the utilization of sexual health services among HIV-negative trans women and identified important disparities in STI testing. We discuss opportunities to strengthen sexual health care delivery systems.
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Affiliation(s)
- Dillon Trujillo
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Address correspondence to: Dillon Trujillo, MPH, Trans Research Unit for Equity (TRUE), San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA,
| | - Sean Arayasirikul
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,Department of Psychiatry and University of California San Francisco, San Francisco, California, USA
| | - Hui Xie
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Sofia Sicro
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Joaquin Meza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Mackie Bella
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Emperatriz Daza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Francisco Torres
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Erin C. Wilson
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
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van Ruitenbeek N, van Kasteren M, Bouma-de Krijger A. Neurosyphilis mimicking giant cell arteritis both clinically and microscopically. BMJ Case Rep 2022; 15:e247642. [PMID: 35641087 PMCID: PMC9157360 DOI: 10.1136/bcr-2021-247642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/03/2022] Open
Abstract
Temporal arteritis is usually caused by giant cell arteritis (GCA). However, inflammation of the temporal artery can also occur secondary to autoimmune diseases or infections.We present a remarkable case of a man in his 70s with biopsy proven temporal arteritis, who was later diagnosed with meningovascular neurosyphilis. The presentation of an acute onset monocular vision loss with inflammation of the temporal artery on biopsy appeared a GCA, misleading the physicians, as it turned out to be a manifestation of neurosyphilis.
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Affiliation(s)
| | - Marjo van Kasteren
- Internal Medicine, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
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Pomsoong C, Sukanjanapong S, Ratanapokasatit Y, Suchonwanit P. Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review. Front Med (Lausanne) 2022; 9:890206. [PMID: 35586075 PMCID: PMC9108265 DOI: 10.3389/fmed.2022.890206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSyphilitic alopecia (SA), which mimics other types of alopecia, is an uncommon manifestation of secondary syphilis. Trichoscopic features may facilitate its diagnosis. However, studies on SA and its trichoscopic characteristics remain limited.ObjectiveTo investigate the epidemiological, clinical, and trichoscopic findings and laboratory results, treatment, and outcomes of SA in Thai patients as well as to comprehensively summarize all trichoscopic features of SA through a systematic review.MethodsData on patients diagnosed with SA between December 2010 and December 2021 were obtained from their medical records and analyzed retrospectively. A systematic review of trichoscopic data, both from our institution and from studies registered in the PubMed, MEDLINE, and Embase databases, was conducted. A descriptive summarization was performed to comprehensively study the trichoscopic features of SA.ResultsOf the 205 patients with secondary syphilis, 23 patients with SA (symptomatic SA: 20, essential SA: 3) were included. The mean age was 27.6 ± 8.8 years, and male predominance was noted. The moth-eaten pattern was the most common SA presentation, and the parieto-occipital scalp was the most commonly affected area. All patients with SA achieved significant hair regrowth within 3 months of antibiotic therapy. Trichoscopic images were available for 20 patients with SA from our institute and were included in the systematic review. Fourteen articles provided information on 21 patients. Overall (N = 41), 26 (63.4%), 8 (19.5%), and 7 (17.1%) patients had moth-eaten alopecia, diffuse alopecia, and mixed alopecia, respectively. The most frequent trichoscopic finding was short regrowing hairs (78%), followed by decreased hair per follicular unit (75.6%), and empty follicles (51.2%). Unique features included flame hairs, bent tapering hairs, reddish-brown background, and brown rings around the perifollicular areas, each described in one case. However, the results were based only on case reports and small case series.ConclusionsGiven the progressively increasing frequency of SA, trichoscopic examination may be valuable when SA is suspected in patients with idiopathic alopecia; however, our findings are quite non-specific. The absence of exclamation mark hairs may help in the diagnosis of SA. Further comparative studies on other types of alopecia are required to determine the most useful diagnostic features.
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Aaron KJ, Brill I, Causey-Pruitt Z, Murphy K, Augenbraun M, Kassaye S, Milam JE, Seidman D, French AL, Gange SJ, Adimora AA, Sheth AN, Fischl MA, Van Der Pol B, Marrazzo J, Kempf MC, Dionne-Odom J. Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015). Sex Transm Infect 2022; 98:4-10. [PMID: 33408096 PMCID: PMC9099234 DOI: 10.1136/sextrans-2020-054674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions. METHODS The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis. RESULTS The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection. CONCLUSIONS Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.
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Affiliation(s)
- Kristal J Aaron
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ilene Brill
- Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA
| | - Zenoria Causey-Pruitt
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kerry Murphy
- Department of Medicine/Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Augenbraun
- Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine/Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Joel E Milam
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, and Bixby Center for Global Reproductive Health, San Francisco, California, USA
| | - Audrey L French
- Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, Illinois, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anandi N Sheth
- Department of Medicine/Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Barbara Van Der Pol
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeanne Marrazzo
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mirjam-Colette Kempf
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA,Department of Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Qi Y, Li RL, Wang YY, Wang W, Liu XZ, Liu J, Li X, Zhang XD, Yu W, Liu JJ, Guo YF, Rao B, Li HJ. Characteristics of Brain White Matter Microstructure in HIV Male Patients With Primary Syphilis Co-Infection. Front Neurol 2022; 12:776818. [PMID: 35115993 PMCID: PMC8805514 DOI: 10.3389/fneur.2021.776818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: To investigate the effect of syphilis infection on the microstructure of white matter (WM) in HIV-infected male patients using diffusion tensor imaging (DTI). Methods: Twenty-seven HIV-infected male patients with current syphilis or a history of syphilis (HIV +/syphilis +), twenty-nine HIV-infected male patients without syphilis co-infection (HIV +/syphilis–), and twenty-nine healthy controls (HC) were enrolled. All participants received DTI, and all patients received comprehensive neuropsychological assessment. Tract-based spatial statistics (TBSS) was adopted to analyze the DTI measures: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Correlation analysis was conducted to investigate the relationships between DTI measures and cognitive performance. Results: There were no significant differences in DTI measures between HIV+/syphilis– and HC. Compared with HC, lower FA was found in body of corpus callosum (BCC), splenium of corpus callosum (SCC), genu of corpus callosum (GCC), the bilateral anterior corona radiata (ACR), superior corona radiata (SCR), posterior corona radiata (PCR), and posterior thalamic radiation (PTR) in HIV+/syphilis+ (p < 0.05). Higher RD was found in BCC and SCC (p < 0.05). Compared with HIV+/syphilis–, lower scores were found in complex motor skills (CMS) in HIV+/syphilis+, lower FA was found in BCC, SCC, GCC, the bilateral ACR, SCR, PCR, PTR, cingulate gyrus (CGC), the right inferior fronto-occipital fasciculus (IFO), the retrolenticular part of internal capsule (RLIC), sagittal stratum (SS), external capsule (EC) in HIV+/syphilis+ (p < 0.01). Correlation analysis uncorrected for multiple comparisons showed there was a positive correlation between FA in GCC and CMS, FA in BCC, and CMS in HIV+/syphilis+. Conclusions: Syphilis co-infection can have an additive or synergistic effect on the brain WM in HIV-infected subjects. HIV-infected patients without syphilis should be actively treated to avoid syphilis infection.
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Affiliation(s)
- Yu Qi
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Rui-Li Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuan-Yuan Wang
- Department of Radiology, The Second Hospital of Beijing, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xu-Ze Liu
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Jing Liu
- Department of Radiology, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Xing Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Zhang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Wen Yu
- Geriatric Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiao-Jiao Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yi-Fan Guo
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
- *Correspondence: Yi-Fan Guo
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Bo Rao
| | - Hong-Jun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Hong-Jun Li
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10
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Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV. Case Rep Infect Dis 2021; 2021:1124033. [PMID: 34820142 PMCID: PMC8608535 DOI: 10.1155/2021/1124033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.
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Yu J, Shi J, Wan H, Li J, Shao Y, Ye J, Dai L, Wang X, Liu A. Clinical characteristics, diagnosis, and predictors of neurosyphilis patients with human immunodeficiency virus co-infection: A retrospective study at infectious diseases hospitals in two cities of China. Medicine (Baltimore) 2021; 100:e27430. [PMID: 34678871 PMCID: PMC8542171 DOI: 10.1097/md.0000000000027430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT This study aimed to compare between the clinical and laboratory characteristics of neurosyphilis and those of syphilis in human immunodeficiency virus (HIV) positive and explore the risk factors associated with the occurrence of neurosyphilis in the HIV infected.In-patients diagnosed with HIV and syphilis co-infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination were divided into neurosyphilis group and syphilis group. The demographic characteristics, symptoms and signs, and laboratory tests of the 2 groups were comparatively analyzed. Logistic regression analysis was used to explore the risk factors associated with the occurrence of neurosyphilis.Among 81 patients, 33 patients were assigned to the neurosyphilis group, and 48 to the syphilis group. There were no significant differences in the age, gender, marital status, acquired immunodeficiency syndrome course, opportunistic infections, serum HIV viral load, and history of syphilis treatment. The difference in HIV transmission route between the 2 groups was statistically significant (P = .010), and the patients from the neurosyphilis group were mainly infected via heterosexual contact. The proportion of serum toludine red unheated serum test (TRUST) titer ≥1:16 in the neurosyphilis group were 78.8%, which was significantly higher compared to the syphilis group (48.9%). The level of CSF white blood cell count, CSF protein, and CSF HIV viral load in the neurosyphilis group were significantly higher than those of the syphilis group. The proportion of patients with neurological symptoms and signs in the neurosyphilis group was significantly higher compared to the syphilis group (P < .001). Multivariate logistic regression analysis showed that heterosexual contact transmission route, not received antiretroviral therapy, lower CD4 cell count and higher serum TRUST titer, untreated with syphilis, and neurological symptoms and signs were risk factors associated with the occurrence of neurosyphilis.The serum TRUST titer, CSF white blood cell count, CSF protein level, CSF HIV viral load, and the percentage of neurological symptoms and signs in the neurosyphilis group were higher. Heterosexual transmission route, not received antiretroviral therapy, and untreated with syphilis prompted the possibility of neurosyphilis occurrence.
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Affiliation(s)
- Jianhua Yu
- Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - JinChuan Shi
- Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Hu Wan
- Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Jianwei Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ying Shao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiangzhu Ye
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lili Dai
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiwen Wang
- Peking University 302 Clinical Medical School, Beijing, China
| | - An Liu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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12
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Abstract
Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.
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Affiliation(s)
- Lynn K Gordon
- Department of Ophthalmology Stein Eye Institute, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA
| | - Helen Danesh-Meyer
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
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13
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Mercurio L, Taylor LE, Jarman AF. Neurosyphilis: Old Disease, New Implications for Emergency Physicians. Clin Pract Cases Emerg Med 2019; 4:46-50. [PMID: 32064424 PMCID: PMC7012537 DOI: 10.5811/cpcem.2019.9.43871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/28/2019] [Accepted: 09/26/2019] [Indexed: 11/11/2022] Open
Abstract
Recent epidemiologic data demonstrate increasing rates of neurosyphilis, particularly among those in the community of men who have sex with men and those coinfected with the human immunodeficiency virus (HIV). Here we discuss a case of early neurosyphilis and new HIV diagnosis in a 27-year-old previously-healthy trans woman presenting for the second time with progressive, ascending weakness and cranial nerve VI palsy. Emergency physicians should consider this rare but highly morbid diagnosis, given the rising prevalence of neurosyphilis among at-risk patients and those with new neurologic deficits.
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Affiliation(s)
- Laura Mercurio
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island
| | - Lynn E Taylor
- University of Rhode Island Providence Campus, CODAC Behavioral Health, Providence, Rhode Island
| | - Angela F Jarman
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
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14
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Shover CL, DeVost MA, Beymer MR, Gorbach PM, Flynn RP, Bolan RK. Using Sexual Orientation and Gender Identity to Monitor Disparities in HIV, Sexually Transmitted Infections, and Viral Hepatitis. Am J Public Health 2019; 108:S277-S283. [PMID: 30383431 DOI: 10.2105/ajph.2018.304751] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify sexual orientation and gender identity (SOGI) disparities in incidence of HIV, other sexually transmitted infections (STIs), and viral hepatitis. METHODS We performed a records-based study of 19 933 patients visiting a federally qualified health center in Los Angeles, California, between November 2016 and October 2017 that examined HIV, STIs, and viral hepatitis incidence proportions. We created multivariable logistic regression models to examine the association between incidence proportions and SOGI among people living with HIV and HIV-negative patients. RESULTS Among those who were HIV-negative at baseline (n = 16 757), 29% tested positive for any STI during the study period, compared with 38% of people living with HIV. Stratified by birth sex, STI positivity was 32% among men and 11% among women. By SOGI, STI positivity was 35% among gay and bisexual cisgender men, 15% among heterosexual cisgender men, 11% among cisgender women, 25% among transgender women, 13% among gay and bisexual transgender men, 3% among heterosexual transgender men, and 26% among nonbinary people. CONCLUSIONS Stratifying by SOGI highlighted disparities that are obscured when stratifying by birth sex. Public Health Implications. To monitor and reduce disparities, health jurisdictions should include SOGI data with infectious disease reporting.
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Affiliation(s)
- Chelsea L Shover
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Michelle A DeVost
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Matthew R Beymer
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Pamina M Gorbach
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Risa P Flynn
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Robert K Bolan
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
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15
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Hobbs E, Vera JH, Marks M, Barritt AW, Ridha BH, Lawrence D. Neurosyphilis in patients with HIV. Pract Neurol 2018; 18:211-218. [PMID: 29478035 DOI: 10.1136/practneurol-2017-001754] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 01/26/2023]
Abstract
Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.
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Affiliation(s)
- Emily Hobbs
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Jaime H Vera
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Lawson Unit, Royal Sussex County Hospital, Brighton, UK
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew William Barritt
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Hurstwood Park Neurological Centre, Haywards Heath, UK
| | - Basil H Ridha
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Hurstwood Park Neurological Centre, Haywards Heath, UK
| | - David Lawrence
- Lawson Unit, Royal Sussex County Hospital, Brighton, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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16
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Point-of-Care Sexually Transmitted Infection Diagnostics: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting. Sex Transm Dis 2017; 44:211-218. [PMID: 28282646 PMCID: PMC5347466 DOI: 10.1097/olq.0000000000000572] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The STAR STI-CTG programmatic meeting reviewed point-of-care sexually transmitted infection diagnostics including current and emerging technologies, clinical and public health benefits, international applications, regulatory considerations, and future developments. The goal of the point-of-care (POC) sexually transmitted infection (STI) Diagnostics meeting was to review the state-of-the-art research and develop recommendations for the use of POC STI diagnostics. Experts from academia, government, nonprofit, and industry discussed POC diagnostics for STIs such as Chlamydia trachomatis, human papillomavirus, Neisseria gonorrhoeae, Trichomonas vaginalis, and Treponema pallidum. Key objectives included a review of current and emerging technologies, clinical and public health benefits, POC STI diagnostics in developing countries, regulatory considerations, and future areas of development. Key points of the meeting are as follows: (i) although some rapid point-of-care tests are affordable, sensitive, specific, easy to perform, and deliverable to those who need them for select sexually transmitted infections, implementation barriers exist at the device, patient, provider, and health system levels; (ii) further investment in research and development of point-of-care tests for sexually transmitted infections is needed, and new technologies can be used to improve diagnostic testing, test uptake, and treatment; (iii) efficient deployment of self-testing in supervised (ie, pharmacies, clinics, and so on) and/or unsupervised (ie, home, offices, and so on) settings could facilitate more screening and diagnosis that will reduce the burden of sexually transmitted infections; (iv) development of novel diagnostic technologies has outpaced the generation of guidance tools and documents issued by regulatory agencies; and (v) questions regarding quality management are emerging including the mechanism by which poor-performing diagnostics are removed from the market and quality assurance of self-testing is ensured.
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17
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Lam CR, Holtz TH, Leelawiwat W, Mock PA, Chonwattana W, Wimonsate W, Varangrat A, Thienkrua W, Rose C, Chitwarakorn A, Curlin ME. Subtypes and Risk Behaviors Among Incident HIV Cases in the Bangkok Men Who Have Sex with Men Cohort Study, Thailand, 2006-2014. AIDS Res Hum Retroviruses 2017; 33:1004-1012. [PMID: 28019101 DOI: 10.1089/aid.2016.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 incidence and prevalence remain high among men who have sex with men (MSM), and transgender women (TGW), in Thailand. To examine the link between epidemiologic factors and HIV-1 subtype transmission among Thai MSM, we compared covariates of infection with HIV CRF01_AE and other HIV strains among participants in the Bangkok MSM Cohort Study (BMCS). The BMCS was an observational cohort study of Thai MSM and TGW with up to 60 months of follow-up at 4 monthly intervals. Participants underwent HIV/sexually transmitted infections testing and provided behavioral data at each visit. Infecting viral strain was characterized by gene sequencing and/or multiregion hybridization assay. We correlated behavioral/clinical variables with infecting strain using Cox proportional hazards. Among a total of 1372 HIV seronegative enrolled participants with 4,192 person-years of follow-up, we identified 215 seroconverters between April 2006 and December 2014, with 177 infected with CRF01_AE and 38 with non-CRF01_AE subtype. Age 18-21 years (adjusted hazard ratio [AHR] 2.2, 95% confidence interval [CI]: 1.4-3.5), age 22-29 (AHR 1.6, 95% CI: 1.1-2.3), living alone (AHR 1.5, 95% CI: 1.1-2.1), drug use (AHR 2.2, 95% CI: 1.4-3.5), intermittent condom use (AHR 1.7, 95% CI: 1.3-2.3), any receptive anal intercourse (AHR 1.7, 95% CI: 1.2-2.4), group sex (AHR 1.5, 95% CI: 1.1-2.2), anti-herpes simplex virus type 1 (AHR 1.5, 95% CI: 1.1-2.1), and Treponema pallidum antibody positivity (AHR 2.5, 95% CI: 1.4-4.4) were associated with CRF01_AE infection. Age 18-21 years (AHR 5.1, 95% CI: 1.6-16.5), age 22-29 (AHR 3.6, 95% CI: 1.3-10.4), drug use (AHR 3.1, 95% CI: 1.3-7.5), group sex (AHR 2.4, 95% CI: 1.1-5.0), and hepatitis B virus surface antigen (AHR 3.6, 95% CI: 1.3-10.2) were associated with non-CRF01_AE infection. We observed several significant biological and behavioral correlates of infection with CRF01_AE and other HIV strains among Thai MSM. Divergence in correlates by strain may indicate differences in HIV transmission epidemiology between CRF01_AE and other strains. These differences could reflect founder effects, transmission within networks distinguished by specific risk factors, and possibly biological differences between HIV strains.
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Affiliation(s)
- Caitlin R. Lam
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Timothy H. Holtz
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanna Leelawiwat
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Philip A. Mock
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wannee Chonwattana
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wipas Wimonsate
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Varangrat
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Warunee Thienkrua
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Charles Rose
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anupong Chitwarakorn
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Marcel E. Curlin
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association. Case Rep Dermatol Med 2017; 2017:3843174. [PMID: 29225977 PMCID: PMC5684593 DOI: 10.1155/2017/3843174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.
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20
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Li D, Yang X, Zhang Z, Wang Z, Qi X, Ruan Y, Zhou Y, Li C, Luo F, Lau JTF. Incidence of Co-Infections of HIV, Herpes Simplex Virus Type 2 and Syphilis in a Large Cohort of Men Who Have Sex with Men in Beijing, China. PLoS One 2016; 11:e0147422. [PMID: 26820145 PMCID: PMC4731205 DOI: 10.1371/journal.pone.0147422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The HIV-epidemic among MSM in China has worsened. In this key population, prevalence of HSV-2 and syphilis infection and co-infection with HIV is high. METHODS A longitudinal study was conducted (n = 962) in Beijing, China, with three overlapping cohorts (n = 857, 757 and 760) consisting of MSM that were free from pairs of infections of concern (i.e. HIV-HSV-2, HIV-syphilis, HSV-2-syphilis) at baseline to estimate incidence of HIV, HSV-2, syphilis, and those of co-infection. RESULTS The incidence of HIV, HSV-2 and syphilis in the overall cohort was 3.90 (95% CI = 2.37, 5.43), 7.87 (95% CI = 5.74, 10.00) and 6.06 (95% CI = 4.18, 7.94) cases per 100 person-years (PYs), respectively. The incidence of HIV-HSV-2, HIV-Syphilis and HSV-2-Syphilis co-infections was 0.30 (95% CI = 0.29, 0.88), 1.02 (95% CI = 0.13, 2.17) and 1.41 (95% CI: 0.04, 2.78) cases per 100 PYs, respectively, in the three sub-cohorts constructed for this study. CONCLUSIONS The incidence of HIV, HSV-2 and syphilis was very high and those of their co-infections were relatively high. Such co-infections have negative impacts on the HIV/STI epidemics. Prevention practices need to take such co-infections into account.
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Affiliation(s)
- Dongliang Li
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Xueying Yang
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Zheng Zhang
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Zixin Wang
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Xiao Qi
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yunhua Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Soochow University, Suzhou, Jiangsu, China
| | - Chunrong Li
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Fengji Luo
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
- * E-mail: (JTFL); (FJL)
| | - Joseph T. F. Lau
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
- * E-mail: (JTFL); (FJL)
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21
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The Great Imitator Strikes Again: Syphilis Presenting as "Tongue Changing Colors". Case Rep Emerg Med 2016; 2016:1607583. [PMID: 26904314 PMCID: PMC4745935 DOI: 10.1155/2016/1607583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/29/2015] [Indexed: 11/17/2022] Open
Abstract
Syphilis is known as the great imitator, making its diagnosis in the emergency department difficult. A 29-year-old male presented with the chief complaint of “my tongue is changing colors.” A syphilis rapid plasma reagin (RPR) test resulted as positive. In primary syphilis, the chancre is the characteristic lesion. While chancres are frequently found on the external genitalia or anus, extragenital chancres arise in 2% of patients. With oral involvement, the chancre is commonly found on the lip or tongue. The patient was treated for secondary syphilis with 2.4 million units of long acting penicillin intramuscularly. On follow-up a month later, the patient's symptoms had resolved.
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Aronowitz R, Deener A, Keene D, Schnittker J, Tach L. Cultural reflexivity in health research and practice. Am J Public Health 2015; 105 Suppl 3:S403-8. [PMID: 25905833 DOI: 10.2105/ajph.2015.302551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent public health movements have invoked cultural change to improve health and reduce health disparities. We argue that these cultural discourses have sometimes justified and maintained health inequalities when those with power and authority designated their own social practices as legitimate and healthy while labeling the practices of marginalized groups as illegitimate or unhealthy. This "misrecognition," which creates seemingly objective knowledge without understanding historical and social conditions, sustains unequal power dynamics and obscures the fact that what is deemed legitimate and healthy can be temporally, geographically, and socially relative. We use examples from research across multiple disciplines to illustrate the potential consequences of cultural misrecognition, highlight instances in which culture was invoked in ways that overcame misrecognition, and discuss how cultural reflexivity can be used to improve health research and practice.
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Affiliation(s)
- Robert Aronowitz
- Robert Aronowitz is with the Department of History and Sociology of Science, University of Pennsylvania, Philadelphia. Andrew Deener is with the Department of Sociology, University of Connecticut, Hartford. Danya Keene is with the Division of Social and Behavioral Sciences, Yale School of Public Health, Yale University, Hartford. Jason Schnittker is with the Department of Sociology, University of Pennsylvania. Laura Tach is with the Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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23
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Ho EL, Spudich SS. Neurosyphilis and the impact of HIV infection. Sex Health 2015; 12:148-54. [DOI: 10.1071/sh14195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/18/2015] [Indexed: 11/23/2022]
Abstract
Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.
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Hepatic Lesions with Secondary Syphilis in an HIV-Infected Patient. Case Rep Med 2014; 2014:604794. [PMID: 25349616 PMCID: PMC4202275 DOI: 10.1155/2014/604794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Syphilis among HIV-infected patients continues to be a public health concern, especially in men who have sex with men. The clinical manifestations of syphilis are protean; syphilitic hepatitis is an unusual complication that can occur at any stage of the disease. We report a case of an HIV-infected male who presented with systemic symptoms and liver lesions highly suggestive of lymphoma and was proven to have syphilitic hepatitis by liver biopsy. Our case reinforces the importance of recognizing syphilis as a possible cause of unexplained abnormal liver enzymes and/or hepatic lesions in HIV-infected patients.
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Triple Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a0ea85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mathur P, Zurlo J, Albright P, Crook T, Whitener C, Du P. Rising Syphilis Infection among Rural HIV-Infected Men who Routinely Received Risk-Reduction Counseling: New Challenges to HIV Prevention in Clinical Care. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 5. [PMID: 26366322 DOI: 10.4172/2155-6113.1000333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Syphilis incidence has been steadily increasing among HIV-infected men in the United States, representing an important public health challenge to HIV prevention. Clinic-based HIV prevention interventions are available but may need to be revisited in response to syphilis epidemic. We wanted to better understand the current epidemiology of syphilis in rural HIV-infected men who routinely received HIV risk-reduction counseling in order to plan more effective HIV prevention strategies in clinical care. METHODS We conducted a retrospective cohort study to examine factors associated with syphilis infections in rural HIV-infected men who received sexually transmitted disease screening and HIV risk-reduction counseling during HIV primary care from January 2008 to June 2013. We assessed patients' demographic, clinical, behavioral and psychosocial characteristics and performed a multivariable exact logistic regression to identify factors related to syphilis. RESULTS Despite routine risk screening and HIV risk-reduction counseling, a total of 51 syphilis infections were diagnosed among 702 HIV-infected men (5 patients were diagnosed ≥ 2 episodes). The majority of the study participants was sexually active and reported at least one unsafe sexual behavior, mainly inconsistent condom use. Younger age (<35 years, adjusted odds ratio (aOR)=3.09), higher educational attainment (some college or above, aOR=3.72), and perception that the partner may have sex with other people (aOR=3.10) were significantly associated with syphilis infection. Non-injection drug use was related to syphilis in HIV-infected men who have sex with men (aOR=2.86). DISCUSSION Some HIV-infected men, especially young, educated men, or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that increase their own risks of acquiring syphilis and may also facilitate HIV transmission. New strategies need to be developed for HIV primary care providers to help HIV-infected patients maintain safer sex practices.
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Affiliation(s)
- Poonam Mathur
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
| | - John Zurlo
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
| | - Patsi Albright
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
| | - Tonya Crook
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
| | - Cynthia Whitener
- Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
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Yasuda S, Imoto K, Uchida K, Kawaguchi S, Yokoi Y, Shigematsu H, Masuda M. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:862-6. [PMID: 23774613 DOI: 10.5761/atcs.cr.12.02211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients.
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Affiliation(s)
- Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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Marra CM, Deutsch R, Collier AC, Morgello S, Letendre S, Clifford D, Gelman B, McArthur J, McCutchan JA, Simpson DM, Duarte NA, Heaton RK, Grant I. Neurocognitive impairment in HIV-infected individuals with previous syphilis. Int J STD AIDS 2013; 24:351-5. [PMID: 23970701 DOI: 10.1177/0956462412472827] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.
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Affiliation(s)
- C M Marra
- Department of Neurology, University of Washington, Seattle, WA, USA.
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Leuci S, Martina S, Adamo D, Ruoppo E, Santarelli A, Sorrentino R, Favia G, Mignogna M. Oral Syphilis: a retrospective analysis of 12 cases and a review of the literature. Oral Dis 2013; 19:738-46. [PMID: 23294141 DOI: 10.1111/odi.12058] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/28/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To present a retrospective analysis of multicentre case series of oral syphilis and a review of relevant literature. SUBJECTS AND METHODS A PUBMED search was carried out from 1950 to 2011. Clinical records of patients with exclusive/prevalent oral manifestations of syphilis were collected and examined in three independent hospitals. RESULTS Of 23 reports describing 34 patients were detected through the review (35% primary, 56% secondary, and 9% tertiary disease), describing unspecific ulcers (59%), mucosal patches (23%), keratosis (6%), pseudomembranes (3%), and gumma (9%). Multicentre case series revealed 12 patients with oral syphilis, of which 17%, 58%, and 25% with, respectively, primary, secondary, and tertiary lesions. Clinically, patients showed white patches (17%), blistering mucositis (8%), chronic unspecific ulcers with/without skin lesions (50%), gumma (17%), and necrosis of the dorsum of the tongue (8%). Oral bullae and tongue necrosis are never described in the current review. CONCLUSIONS Diagnosis of syphilis remains a challenge because of the multiform and polymorphous clinical pattern at onset and its ability to imitate different diseases. It is mandatory to include syphilis in the differential diagnosis of unusual oral lesions. Diagnosis of oral lesions of syphilis is often difficult, and biopsy is required in controversial cases.
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Affiliation(s)
- S Leuci
- Department of Odontostomatological and Maxillo Facial Sciences, Oral Medicine Unit, Federico II University of Naples, Naples, Italy
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Nokhodian Z, Yazdani MR, Yaran M, Shoaei P, Mirian M, Ataei B, Babak A, Ataie M. Prevalence and Risk Factors of HIV, Syphilis, Hepatitis B and C Among Female Prisoners in Isfahan, Iran. HEPATITIS MONTHLY 2012; 12:442-7. [PMID: 23008724 PMCID: PMC3437455 DOI: 10.5812/hepatmon.6144] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 05/18/2012] [Accepted: 05/31/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran. OBJECTIVES The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures. PATIENTS AND METHODS In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method. After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases. RESULTS The mean age of the participants in the study was 34.54 ± 11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected. CONCLUSIONS A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied.
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Affiliation(s)
- Zary Nokhodian
- Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mohammad Reza Yazdani
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Majid Yaran
- Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Parisa Shoaei
- Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mina Mirian
- Isfahan Pharmaceutical Sciences Research Center, Isfahan, IR Iran
| | - Behrooz Ataei
- Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding author: Behrooz Ataei, Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel.: +98-3113359359, Fax: +98-3113373735, E-mail:
| | - Anahita Babak
- Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mehdi Ataie
- School of Medicine, Najafabad Branch, Islamic Azad University, Isfahan, IR Iran
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Bowleg L, Raj A. Shared communities, structural contexts, and HIV risk: prioritizing the HIV risk and prevention needs of Black heterosexual men. Am J Public Health 2012; 102 Suppl 2:S173-7. [PMID: 22401513 DOI: 10.2105/ajph.2011.300342] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Black heterosexual men (BHM) are seldom mentioned in HIV prevention research, policy, and interventions, despite evidence that heterosexual contact is becoming the leading exposure category for BHM. The disparate effect of HIV/AIDS on BHM; the debunked "down low" myth; the contexts of BHM's lives in terms of disproportionate poverty, unemployment, and incarceration; and a growing empirical base linking these factors to increased HIV risk, underscore the need to prioritize HIV risk and prevention initiatives for BHM. We highlighted the structural contexts of HIV risk for BHM, and four community-based approaches to address HIV risk and prevention for BHM: (1) men's health programs; (2) workforce and postincarceration release programs; (3) linkages to women's prevention programs; and (4) faith-based initiatives.
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Affiliation(s)
- Lisa Bowleg
- Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, PA 19102, USA.
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Ho EL, Lukehart SA. Syphilis: using modern approaches to understand an old disease. J Clin Invest 2011; 121:4584-92. [PMID: 22133883 DOI: 10.1172/jci57173] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Syphilis is a fascinating and perplexing infection, with protean clinical manifestations and both diagnostic and management ambiguities. Treponema pallidum subsp. pallidum, the agent of syphilis, is challenging to study in part because it cannot be cultured or genetically manipulated. Here, we review recent progress in the application of modern molecular techniques to understanding the biological basis of this multistage disease and to the development of new tools for diagnosis, for predicting efficacy of treatment with alternative antibiotics, and for studying the transmission of infection through population networks.
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Affiliation(s)
- Emily L Ho
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Impact of Age, Gender, and Pregnancy on Syphilis Screening Using the Captia Syphilis-G Assay. Sex Transm Dis 2011; 38:1126-30. [DOI: 10.1097/olq.0b013e31822e60e1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade.
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García-García L, Ariza Megía MC, Álvaro A, Gil de Miguel Á, Gil-Prieto R. Epidemiology of hospitalizations due to Syphilis in large urban areas in Spain between 1997 and 2006. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 1:123-7. [DOI: 10.1016/j.srhc.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/23/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
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Farhi D, Benhaddou N, Grange P, Zizi N, Deleuze J, Morini JP, Gerhardt P, Krivine A, Avril MF, Dupin N. Clinical and serologic baseline and follow-up features of syphilis according to HIV status in the post-HAART era. Medicine (Baltimore) 2009; 88:331-340. [PMID: 19910747 DOI: 10.1097/md.0b013e3181c2af86] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.
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Affiliation(s)
- David Farhi
- From Department of Dermatology and Venereology (DF, NZ, JD, JPM, PG, MFA, ND), Hôpital Cochin-Pavillon Tarnier, AP-HP, Université Paris 5-René Descartes, Paris; Department of Bacteriology (NB), Hôpital Cochin, AP-HP, Université Paris 5, Paris; Laboratoire de Recherche en Dermatologie et Centre National de Référence de la Syphilis (PG, ND), UPRES EA 1833, Université Paris 5-René Descartes, Paris; Department of Virology (AK), Hôpital Saint-Vincent de Paul, AP-HP, Université Paris 5, Paris, France
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Nag VL, Dash NR, Pathak A, Agarwal SK. Need for syphilis screening and counselling in HIV counselling and testing centres: a curtain raiser study from north India. Aust J Rural Health 2009; 17:102-6. [PMID: 19335601 DOI: 10.1111/j.1440-1584.2009.01045.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Voluntary counselling and testing centres (VCTC) are important HIV screening points for the population with suspicion or apprehension for HIV, because of high-risk exposures. Theoretically, these are also at the risk of having co-infections, commonest being syphilis. The present short-term study was aimed at knowing the sero-reactivity of syphilis among a study cohort attending the VCTC in King George's Medical University, Lucknow, India. METHOD During a 2.5-month period, 49 HIV-positive and 171 HIV-negative sera were tested for venereal disease research laboratory (VDRL). The positive sera were further tested for treponema pallidum haemagglutination (TPHA). RESULT Eleven (22.4%) HIV-positive sera and 104 (60.8%) HIV-negative sera were VDRL-reactive (>or=1:8 dilutions). Of these, TPHA was reactive in three (27.3%) and four (3.9%), respectively. CONCLUSION The result might suggest the need for routine screening and counselling for syphilis at VCTC. Studies from other centres on larger population are required.
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Affiliation(s)
- Vijaya Lakshmi Nag
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Abstract
Syphilis is an important public health issue and continues to occur at high rates among HIV-infected patients. Although abnormal liver function tests are common among HIV-infected persons, the incidence of syphilitic hepatitis in this population is currently unknown. We present two cases of syphilitic hepatitis and performed a retrospective study to determine the incidence of hepatitis during early syphilis infections among HIV-infected persons. Our study showed that syphilitic hepatitis is common, occurring in 38% (12/32) of HIV-positive patients with early stages of syphilis infection. Most cases occurred during secondary syphilis, with the most common finding being a maculopapular rash. Syphilis should be included in the differential diagnosis of HIV patients presenting with liver test abnormalities, rash and/or sexual risk factors.
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Abstract
BACKGROUND Recently, the incidence of syphilis has risen, mainly among men having sex with men (MSM), many of whom are coinfected with HIV. Current guidelines recommend at least yearly syphilis testing in this group. In this study, we assessed the yield of routine syphilis screening in outpatient HIV-patients. METHODS From March through June 2003, syphilis serology was routinely performed in HIV-infected patients visiting our outpatient clinic. Serology was repeated six months later. Positive test results of the first episode were compared to historical test results (retrospective analysis). Test results of the second episode were compared to test results from the first episode (prospective analysis). Case records of all patients with a new infection were reviewed for symptomatic disease or testing because of syphilis contacts, versus asymptomatic disease. RESULTS In the retrospective analysis, 1,105 patients were included. In 68 patients, 81 syphilis infections were identified, of which 33% asymptomatic. 77/81 infections were acquired between 2000 and 2003, resulting in a total incidence of 2.7/100 person years (PY) of follow-up, and 0.9/100 PY for asymptomatic disease. In MSM, the incidence rate was 4.6/100 and 1.5/100 PY respectively. In the prospective analysis, 1,010 patients were included. Seventeen patients, all MSM, had a new or recurrent syphilis infection, of whom 4 asymptomatic, accounting for a total event rate of 3.5/100 PY. In MSM, the event rate was 6.2/100 PY, with an incidence of asymptomatic disease of 1.4/100 PY. CONCLUSION Routine screening for syphilis identifies significant numbers of asymptomatic syphilis infection in HIV-infected MSM.
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Seña AC, Torrone EA, Leone PA, Foust E, Hightow-Weidman L. Endemic early syphilis among young newly diagnosed HIV-positive men in a southeastern U.S. state. AIDS Patient Care STDS 2008; 22:955-63. [PMID: 19072102 DOI: 10.1089/apc.2008.0077] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An epidemic of HIV infections among college students who are primarily men who have sex with men (MSM) have been reported from North Carolina, a state with one of the highest syphilis rates in the southeastern United States. We assessed the proportion of early syphilis coinfections among young HIV-infected individuals statewide and associated risk factors. From January 2002 to July 2006, chart abstractions were performed from North Carolina surveillance records for newly diagnosed HIV-positive men 18-30 years of age reported between 2000-2005, and a subset of women in the same age group. Bivariable and multivariable analyses were conducted to assess early syphilis risk factors among HIV-infected persons. During the 6-year period, there were 1460 HIV-positive men aged 18-30 years reported in North Carolina; 90 (6.2%) were coinfected with early syphilis without a significant change over time. Data were available for 551 HIV-positive women diagnosed from 2002-2005; only 6 (1.1%) were coinfected. Fifty-five percent of coinfected men were diagnosed with both infections on the same date of evaluation. Young HIV-infected men who are black (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI], 1.3, 4.1), MSM (aOR 3.8; 95% CI, 1.8, 7.8), or reported sex with both genders (aOR 5.1; 95% CI, 2.2, 11.5), or anonymous sex (aOR 2.1; 95% CI, 1.3, 3.3) were more likely to have early syphilis. Although male coinfections have not increased over time, early syphilis has become endemic among young HIV-positive men statewide, emphasizing the need to provide screening for both infections among high-risk individuals.
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Affiliation(s)
- Arlene C. Seña
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth A. Torrone
- School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Peter A. Leone
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- HIV/STD Control Branch, North Carolina Division of Public Health, Raleigh, North Carolina
| | - Evelyn Foust
- HIV/STD Control Branch, North Carolina Division of Public Health, Raleigh, North Carolina
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Mishra S, Walmsley SL, Loutfy MR, Kaul R, Logue KJ, Gold WL. Otosyphilis in HIV-coinfected individuals: a case series from Toronto, Canada. AIDS Patient Care STDS 2008; 22:213-9. [PMID: 18290755 DOI: 10.1089/apc.2007.0019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We sought to identify and review the clinical features and treatment outcomes of eight recent cases of otosyphilis in HIV-positive patients seen in Toronto. All patients reported tinnitus, and seven (87.5%) reported subjective hearing loss. Not taking auditory findings into consideration, four patients would be classified as having secondary syphilis, three patients as having early latent syphilis, and one patient as having latent syphilis of unknown duration. The median CD4 cell count was 370 x 10(6)/L. All patients were treated with intravenous aqueous penicillin G with regimens recommended for the treatment of neurosyphilis; four patients received adjunctive steroids. All eight patients experienced improvement in tinnitus and four of the seven (57.1%) patients with symptomatic hearing loss also experienced improvement. Otosyphilis can occur in HIV-positive individuals despite high CD4 cell counts, and is potentially reversible. Increased awareness of uncommon manifestations of syphilis in high-risk individuals is warranted to prompt appropriate investigation and treatment.
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Affiliation(s)
- Sharmistha Mishra
- Division of Infectious Diseases, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Canada
| | - Sharon Lynn Walmsley
- Division of Infectious Diseases, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Canada
| | - Mona Rafik Loutfy
- Department of Medicine, University of Toronto, Canada
- Maple Leaf Clinic, Toronto, Canada
| | - Rupert Kaul
- Division of Infectious Diseases, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Canada
| | - Kenneth John Logue
- Division of Infectious Diseases, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Canada
| | - Wayne Lawrence Gold
- Division of Infectious Diseases, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Canada
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Decreases in AIDS Mortality and Increases in Primary and Secondary Syphilis in Men Who Have Sex With Men in the United States. J Acquir Immune Defic Syndr 2008; 27:640-3. [DOI: 10.1097/qai.0b013e31815e4062] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dougan S, Evans BG, Elford J. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis 2008; 34:783-90. [PMID: 17495592 DOI: 10.1097/01.olq.0000260919.34598.5b] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since 1996, there has been a resurgence in sexually transmitted infections (STIs) among men who have sex with men (MSM) in Western Europe. This has coincided with a significant decrease in HIV-associated mortality following the introduction of highly active antiretroviral therapies (HAART) and a corresponding increase in the number of MSM living with HIV. Levels of unprotected anal intercourse have also increased. In this article, we use STI surveillance data from a number of Western European countries to better understand the contribution of HIV-positive MSM to the recent increase in STIs. METHODS Published literature, surveillance reports, and ad hoc publications relating to HIV prevalence trends and STIs among HIV-positive MSM in Western Europe were reviewed. RESULTS Post-HAART, HIV prevalence among community samples of MSM ranged from 5% to 18%. HIV prevalence among MSM diagnosed with an STI was substantially higher. On average, HIV prevalence among MSM diagnosed with syphilis in 11 countries was 42% (range 14%-59%). Most HIV-positive MSM with syphilis were aware of their HIV status. In England and Wales, 32% of MSM with gonorrhea were HIV-positive in 2004. Outbreaks of lymphogranuloma venereum have been documented in 9 countries; HIV-positive MSM accounted for 75% of cases on average (range 0%-92%). Cases of sexually transmitted hepatitis C have been predominantly identified among HIV-positive MSM in Rotterdam, Paris, Amsterdam, and the United Kingdom. CONCLUSIONS In Western Europe, STIs have been disproportionately diagnosed among HIV-positive MSM post-HAART. Improved survival coupled with serosorting among HIV-positive MSM appears to explain the high prevalence of HIV among MSM with STIs. STI transmission among HIV-positive men will have contributed substantially to increasing STI trends seen among MSM in Western Europe, since 1996. These findings highlight the need for routine STI testing among HIV-positive MSM as well as safer sex messages highlighting the implications of STI coinfection.
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Affiliation(s)
- Sarah Dougan
- City University, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, London, United Kingdom.
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Signorini DJHP, Monteiro MCM, de Sá CAM, Sion FS, Leitão Neto HG, Lima DP, Machado JDDC. Prevalência da co-infecção HIV-sífilis em um hospital universitário da cidade do Rio de Janeiro no ano de 2005. Rev Soc Bras Med Trop 2007; 40:282-5. [PMID: 17653461 DOI: 10.1590/s0037-86822007000300006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 04/26/2007] [Indexed: 11/21/2022] Open
Abstract
Estudo de prevalência da co-infecção HIV-sífilis realizado com 830 pacientes em acompanhamento ambulatorial para HIV/aids entre janeiro e maio de 2005 no Hospital na cidade do Rio de Janeiro. Os participantes realizaram exames de VDRL (veneral disease research laboratory), contagens de células CD4+/CD8+ e de carga viral e responderam perguntas sobre características sócio-demográficas e história prévia de sífilis. A prevalência da sífilis foi de 2,7% (22), a relação entre homens e mulheres co-infectados foi de 4:1, aproximadamente. Homossexuais masculinos foram os mais acometidos e não encontramos associação entre co-infecção e idade, escolaridade e parâmetros laboratoriais testados. Do total de casos com sífilis, 73% (16) relataram tratamento prévio; destes, 14 (88%) pacientes foram re-infectados, enquanto 2 (12%) pacientes realizaram tratamento inapropriado. A presença de co-infecção HIV-sífilis em pacientes em acompanhamento rotineiro alerta-nos para necessidade de aconselhá-los a adotar práticas sexuais seguras durante os seus atendimentos ambulatoriais.
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Affiliation(s)
- Dario José Hart Pontes Signorini
- Departamento de Clínica Médica, Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Singer MC, Erickson PI, Badiane L, Diaz R, Ortiz D, Abraham T, Nicolaysen AM. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med 2006; 63:2010-21. [PMID: 16782250 PMCID: PMC7131051 DOI: 10.1016/j.socscimed.2006.05.012] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Indexed: 01/16/2023]
Abstract
This paper employs syndemics theory to explain high rates of sexually transmitted disease among inner city African American and Puerto Rican heterosexual young adults in Hartford, CT, USA. Syndemic theory helps to elucidate the tendency for multiple co-terminus and interacting epidemics to develop under conditions of health and social disparity. Based on enhanced focus group and in-depth interview data, the paper argues that respondents employed a cultural logic of risk assessment which put them at high risk for STD infection. This cultural logic was shaped by their experiences of growing up in the inner city which included: coming of age in an impoverished family, living in a broken home, experiencing domestic violence, limited expectations of the future, limited exposure to positive role models, lack of expectation of the dependency of others, and fear of intimacy.
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