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Campo JJ, Romeis E, Oberai A, Pablo JV, Hung C, Teng AA, Shandling AD, Phan A, Haynes AM, Giacani L. A novel pan-proteome array for high-throughput profiling of the humoral response to Treponema pallidum. iScience 2024; 27:110618. [PMID: 39262771 PMCID: PMC11387709 DOI: 10.1016/j.isci.2024.110618] [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: 04/24/2024] [Revised: 06/08/2024] [Accepted: 07/26/2024] [Indexed: 09/13/2024] Open
Abstract
Given the resurgence of syphilis, research endeavors to improve current assays for serological diagnosis and management of this disease are a priority. A proteome-scale platform for high-throughput profiling of the humoral response to Treponema pallidum (T. pallidum) proteins during infection could identify antigens suitable to ameliorate the performance and capabilities of treponemal tests for syphilis. Additionally, because infection-induced immunity is partially protective, profiling the response to T. pallidum outer membrane proteins (OMPs) could help select vaccine candidates. Therefore, we developed a pan-proteome array (PPA) based on the Nichols and SS14 strain complete proteomes and used it to define the immunoglobulin M (IgM) and IgG humoral response to T. pallidum proteins in sera collected longitudinally from long-term infected rabbits and from rabbits that were infected, treated, and re-infected. We identified antigens that could facilitate early diagnosis and immunity to a core set of OMP that could explain protection upon reinfection.
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Affiliation(s)
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Amber Phan
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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2
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. [Translated article] AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00651-3. [PMID: 39111574 DOI: 10.1016/j.ad.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 09/01/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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3
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Yount KS, Darville T. Immunity to Sexually Transmitted Bacterial Infections of the Female Genital Tract: Toward Effective Vaccines. Vaccines (Basel) 2024; 12:863. [PMID: 39203989 PMCID: PMC11359697 DOI: 10.3390/vaccines12080863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/19/2024] [Accepted: 07/27/2024] [Indexed: 09/03/2024] Open
Abstract
Sexually transmitted infections (STIs) caused by bacterial pathogens Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum present significant public health challenges. These infections profoundly impact reproductive health, leading to pelvic inflammatory disease, infertility, and increased susceptibility to other infections. Prevention measures, including antibiotic treatments, are limited by the often-asymptomatic nature of these infections, the need for repetitive and continual screening of sexually active persons, antibiotic resistance for gonorrhea, and shortages of penicillin for syphilis. While vaccines exist for viral STIs like human papillomavirus (HPV) and hepatitis B virus (HBV), there are no vaccines available for bacterial STIs. This review examines the immune responses in the female genital tract to these bacterial pathogens and the implications for developing effective vaccines against bacterial STIs.
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Affiliation(s)
| | - Toni Darville
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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4
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Reyes-Diaz M, Malca J, Konda KA, Vargas SK, Calvo GM, Caceres CF, Klausner JD. HIV Infection Modifies the Role of Prior Treponema pallidum Infection in the Clinical Presentation of Early Syphilis Among Adult Patients From Sexually Transmitted Infection Clinics in Peru. Sex Transm Dis 2024; 51:415-419. [PMID: 38372543 PMCID: PMC11131579 DOI: 10.1097/olq.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND We aimed to compare the clinical presentations (symptomatic vs. asymptomatic) with prior Treponema pallidum infection status (first infection vs. reinfection) among people with early syphilis. METHODS We used data from PICASSO, a cohort study in Peru that enrolled people with active syphilis from May 2019 to August 2021. Study participants had early syphilis and a prior syphilis serological test result within the prior 12 months to determine prior T. pallidum infection status. We calculated prevalence ratios (PRs) of symptomatic clinical presentation (primary or secondary syphilis) by prior T. pallidum infection status, stratified by HIV infection status. In addition, we explored the association of prior T. pallidum infection status and lesion presentation, stratified by primary and secondary syphilis cases, using the Fisher exact test. RESULTS We include 84 T. pallidum reinfection cases and 61 first infection cases. We found increased frequency of symptomatic clinical presentation among first-infection cases (39% vs. 20%; PR, 1.94; P = 0.014). This association was stronger among persons living without HIV infection (38% vs. 7%; adjusted PR, 6.63; P = 0.001) in comparison to those living with HIV infection (45% vs. 34%; adjusted PR, 1.38; P = 0.458). Among secondary syphilis cases, more participants from the reinfection group reported that their lesions improved 1 week after treatment (100% vs. 29%, P = 0.045) compared with those with a first infection. Among the primary syphilis cases, all participants reported that their lesions improved 1 week after treatment. CONCLUSIONS Prior syphilis was associated with a decreased prevalence of symptomatic reinfection, especially among persons not living with HIV infection.
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Affiliation(s)
- Michael Reyes-Diaz
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Joselito Malca
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Kelika A. Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Silver K. Vargas
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
- Universidad Peruana Cayetano Heredia, Facultad de Salud Pública y Administración, Lima, Perú
| | - Gino M. Calvo
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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5
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00339-9. [PMID: 38663730 DOI: 10.1016/j.ad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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6
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Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med 2024; 13:1603. [PMID: 38541829 PMCID: PMC10971508 DOI: 10.3390/jcm13061603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 07/24/2024] Open
Abstract
Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.
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Affiliation(s)
- Giulia Ciccarese
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Mario Mastrolonardo
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Astrid Herzum
- Dermatology Unit, IRCCS Giannina Gaslini, 16147 Genova, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
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7
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Abstract
Dermatologists are familiar with the classic aspects of syphilis. Our objective in this update is to display novel features of sexually acquired syphilis, its pathophysiology, natural history, atypical clinical variants, skin of color, clinical pearls, and prospects. Textbook knowledge, congenital syphilis, epidemiology, and historical data are excluded.
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Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital Padre Hurtado, Santiago, Chile.
| | - Stephanie Saavedra-Portales
- Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital San Juan de Dios, Santiago, Chile
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8
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Foqué N, Van den Broeck S, Verschueren J, Meersman K, Van Esbroeck M, Van den Bossche D. Evaluation of the AIX1000 Automated Rapid Plasma Reagin Assay in a High-Prevalence Setting. Sex Transm Dis 2023; 50:446-451. [PMID: 36881435 DOI: 10.1097/olq.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Manually performed nontreponemal assays, such as rapid plasma reagin (RPR), are labor intensive and time consuming. Recently, commercial automated RPR assays gained attention. The aim of this study was to compare the qualitative and quantitative performance of the AIX1000 (RPR-A; Gold Standard Diagnostics) to a manual RPR test (RPR-M; Becton Dickinson Macrovue) within a high-prevalence setting. METHODS A retrospective panel of 223 samples was selected for comparison between RPR-A and RPR-M, including 24 samples from patients with known syphilis stages and 57 samples from 11 patients in follow-up. In addition, 127 samples obtained during routine syphilis diagnosis with RPR-M were analyzed prospectively with AIX1000. RESULTS Overall qualitative concordance (percent agreement) between both assays was 92.0% in the retrospective and 89.0% in the prospective panel. Of 32 discordances, 28 were explained by a treated syphilis infection still positive in one assay and already negative in the other. One sample was false positive with RPR-A, 1 infection remained undetected by RPR-M, and 2 remained undetected by RPR-A. A hook effect was apparent on the AIX1000 at RPR-A titers from 1:32 onward; however, no infections were missed. Accepting a ±1 titer difference, quantitative concordance between both assays reached 73.1% and 98.4% for the retrospective and prospective panels, respectively, with an upper limit of reactivity for RPR-A at 1:256. CONCLUSIONS The AIX1000 showed a similar performance to Macrovue RPR with the exception of a negative deviation for high-titer samples. Within the reverse algorithm used in our high-prevalence setting, AIX1000's main advantage is automation.
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Affiliation(s)
- Nikki Foqué
- From the Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Tiecco G, Degli Antoni M, Storti S, Marchese V, Focà E, Torti C, Castelli F, Quiros-Roldan E. A 2021 Update on Syphilis: Taking Stock from Pathogenesis to Vaccines. Pathogens 2021; 10:1364. [PMID: 34832520 PMCID: PMC8620723 DOI: 10.3390/pathogens10111364] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
In 2021 the scientific community's efforts have been focused on solving the back-breaking challenge of the COVID-19 pandemic, but sexually transmitted infections (STI) are still one of the most common global health problems. Syphilis is a systemic disease caused by the spirochaete Treponema pallidum (TP) and is one of the oldest known diseases. Its incidence has increased in the last few years and syphilis still remains a contemporary plague that continues to afflict millions of people worldwide. Despite research improvements, syphilis pathogenesis is not completely clear; clinical presentation is very heterogeneous and the diagnosis can sometimes be difficult. Furthermore, few therapeutic options are available, and a vaccine has not been found yet. In this review, we describe the most recent evidence concerning the clinical manifestation, diagnosis, treatment and vaccine prospectives for this disease.
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Affiliation(s)
- Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Melania Degli Antoni
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Samuele Storti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Valentina Marchese
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
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10
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Mischler-Gornostaeva K, Glatz M, Fehr J, Bosshard PP. Clinical presentation and serological diagnosis of syphilis reinfection in men living with HIV: a retrospective cohort study. Sex Transm Infect 2021; 98:341-345. [PMID: 34475233 DOI: 10.1136/sextrans-2020-054923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Studies on the characteristics of syphilis reinfection are scarce despite increasing numbers and proportions of cases. We aimed to gain insights into the clinical and serological presentation of reinfected men living with HIV and to evaluate diagnostic criteria for syphilis reinfection. METHODS We conducted a retrospective cohort study of 259 HIV-positive men diagnosed with syphilis between January 1999 and September 2015 at the University Hospital Zurich. We compared patients with a single syphilis infection (n=109) to patients with reinfections (n=150). RESULTS The two groups matched in age, sexual orientation and numbers of other STIs. Reinfected patients more often presented with latent syphilis than patients with a single syphilis episode (41.9% vs 8.9%; p<0.001). Although generally high venereal diseases research laboratory (VDRL) or rapid plasma reagin (RPR) titres (median 1:32) were seen in reinfected patients, 19.4% had titres ≤1:8. Treponema pallidum passive particle agglutination (TPPA) titres were significantly higher (1:81 840 vs 1:10 240; p<0.001), while IgM values were significantly lower (1.27 vs 3.5; p<0.001) in syphilis reinfections than in first infections. The TPPA increased ≥fourfold in >92.3% of reinfected patients. CONCLUSIONS Our data highlight the paramount importance of regularly screening patients at risk as syphilis reinfections in men living with HIV are more likely to be latent infections, that is, without symptoms. As non-treponemal tests might be biologically false-positive (up to a titre of 1:8) due to various conditions, a ≥fourfold increase of the TPPA might be considered as optional criterion for the diagnosis of syphilis reinfections. This could be especially valuable for diagnosing reinfected latent stage patients.
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Affiliation(s)
| | - Martin Glatz
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Department of Public Health, University of Zurich, Zurich, Switzerland
| | - Philipp Peter Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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Marra CM, Maxwell CL, Sahi SK, Tantalo LC, Dunaway SB, Lukehart SA. Previous Syphilis Alters the Course of Subsequent Episodes of Syphilis. Clin Infect Dis 2021; 74:e1-e5. [PMID: 33999990 DOI: 10.1093/cid/ciab287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The influence of previous syphilis on the course of a subsequent episode is unknown. METHODS Individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were allowed to enroll in the study again with subsequent syphilis. For each participant, the index episode was defined as the most recent syphilis episode for which the study entry visit was performed within 30 days of the syphilis diagnosis date. Venipuncture and lumbar puncture (LP) were performed. Total number of syphilis episodes was determined by review of medical and public health records. T. pallidum DNA in blood and rRNA in CSF were detected by polymerase chain reaction (PCR) and reverse transcriptase PCR. Odds ratios (ORs) with 95% confidence intervals (95% CI) were determined by logistic regression. RESULTS 651 individuals had one (n = 482), two (n = 121) or three or more (n = 48) episodes of syphilis. The proportion of individuals whose index episode was early latent stage was significantly higher in those with ≥3 syphilis episodes; this relationship was reduced to a trend when rate of testing was taken into account. Adjusted odds (aOR) of detection of T. pallidum DNA in blood or rRNA in CSF at the index episode were significantly lower in those with previous syphilis (0.17 [95% CI, 0.09-0.31] and 0.15 [95% CI, 0.07-0.35]). The aOR for neurosyphilis at the index episode was also significantly lower in individuals with previous syphilis (0.54 [95% CI, 0.34-0.87]). CONCLUSIONS Previous syphilis attenuates the manifestations of subsequent infection with T. pallidum.
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Affiliation(s)
- Christina M Marra
- University of Washington School of Medicine, Department of Neurology, Seattle, WA, USA.,Medicine (Infectious Diseases), Seattle, WA, USA
| | - Clare L Maxwell
- University of Washington School of Medicine, Department of Neurology, Seattle, WA, USA
| | - Sharon K Sahi
- University of Washington School of Medicine, Department of Neurology, Seattle, WA, USA
| | - Lauren C Tantalo
- University of Washington School of Medicine, Department of Neurology, Seattle, WA, USA
| | | | - Sheila A Lukehart
- Medicine (Infectious Diseases), Seattle, WA, USA.,Global Health, Seattle, WA, USA
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Nieuwenburg SA, Sprenger RJ, Schim van der Loeff MF, de Vries HJC. Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses. Sex Transm Infect 2021; 98:95-100. [PMID: 33608479 DOI: 10.1136/sextrans-2020-054887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored. METHODS This retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3-6 months. We included data of participants with ≥1 syphilis diagnosis in 2014-2019. Pearson's χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses. RESULTS We included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032). CONCLUSIONS In repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.
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Affiliation(s)
- Silvia Achia Nieuwenburg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ricardo Jamie Sprenger
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Franciscus Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands.,Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands .,Amsterdam institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam UMC location Academic Medical Centre, Amsterdam, The Netherlands
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13
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Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2020; 35:574-588. [PMID: 33094521 DOI: 10.1111/jdv.16946] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.
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Affiliation(s)
- M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - N Dupin
- Syphilis National Reference Center, Hôpital Tarnier-Cochin, AP-HP, Paris, France
| | - G S Tiplica
- 2nd Dermatological Clinic, Carol Davila University, Colentina Clinical Hospital, Bucharest, Romania
| | - M Potočnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - R Patel
- Department of Genitourinary Medicine, the Royal South Hants Hospital, Southampton, UK
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Osbak KK, Tsoumanis A, De Baetselier I, Van Esbroek M, Smet H, Kenyon CR, Crucitti T. Role of IgM testing in the diagnosis and post-treatment follow-up of syphilis: a prospective cohort study. BMJ Open 2020; 10:e035838. [PMID: 32958482 PMCID: PMC7507855 DOI: 10.1136/bmjopen-2019-035838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The diagnosis of repeat syphilis and its follow-up remains challenging. We aimed to investigate if IgM testing may assist in the diagnosis of syphilis reinfection/relapse and its treatment follow-up. METHODS This substudy was conducted in the context of a syphilis biomarker discovery study (ClinicalTrials.gov Nr: NCT02059525). Sera were collected from 120 individuals with a new diagnosis of syphilis (72 with repeat infections) and 30 syphilis negative controls during a cohort study investigating syphilis biomarkers conducted at a sexually transmitted infection/HIV clinic in Antwerp, Belgium. Syphilis was diagnosed based on a simultaneous positive treponemal and non-treponemal assay result and/or positive serum PCR targeting polA. Specimens collected at visit of diagnosis, and 3 and 6 months post-treatment were tested by two enzyme immunoassays (EIAs), recomWell (Mikrogen; MI) and Euroimmun (EU), to detect anti-treponemal IgM. Baseline specimens were also tested for anti-treponemal IgM using a line immunoassay (LIA) recomLine (MI). Quantitative kinetic decay curves were constructed from the longitudinal quantitative EIA results. RESULTS An overall sensitivity for the diagnosis of syphilis of 59.8% (95% CI: 50.3%-68.7%), 75.0% (95% CI: 66.1%-82.3%) and 63.3% (95% CI: 54.8%-72.6%) was obtained for the EU, MI EIAs and MI LIA, respectively. When only considering repeat syphilis, the diagnostic sensitivity decreased to 45.7% (95% CI: 33.9%-58.0%), 63.9% (95% CI: 51.7%-74.6%) and 47.2% (95% CI: 35.5%-59.3%), respectively. IgM seroreverted in most cases 6 months after treatment. Post-treatment IgM concentrations decreased almost 30% faster for initial syphilis compared with repeat infection. The IgM EIAs and IgM LIA agreed from fairly to moderately (Cohen's kappa (κ): 0.36 (EU EIA); κ: 0.53 (MI EIA); κ: 0.40 (MI LIA)) with the diagnosis of syphilis. CONCLUSIONS IgM detection was not a sensitive method to diagnose syphilis and was even poorer in the diagnosis of syphilis repeat infections.
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Affiliation(s)
- Kara K Osbak
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroek
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hilde Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris R Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medicine, Groote Schuur Hospital, Observatory, South Africa
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Marra CM, Maxwell CL, Sahi SK, Tantalo LC, Dunaway SB, Lukehart SA. Previous Syphilis Alters the Course of Subsequent Episodes of Syphilis. Clin Infect Dis 2020; 71:1243-1247. [PMID: 31560366 PMCID: PMC7442847 DOI: 10.1093/cid/ciz943] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Individuals with previous syphilis may be more likely to be asymptomatic when they are reinfected with Treponema pallidum. METHODS Individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were allowed to enroll in the study again with subsequent syphilis. For each participant, the index episode was defined as the most recent syphilis episode for which the study entry visit was performed within 30 days of the syphilis diagnosis date. Venipuncture and lumbar puncture were performed. The total number of syphilis episodes was determined by review of medical and public health records. Treponema pallidum DNA in blood and rRNA in CSF were detected using polymerase chain reaction (PCR) and reverse transcriptase PCR. Odds ratios (ORs) with 95% confidence intervals (CIs) were determined using logistic regression. RESULTS 701 individuals had 1 (n = 478), 2 (n = 155), or ≥3 (n = 68) episodes of syphilis. The proportion of individuals whose index episode was asymptomatic significantly increased with increased number of syphilis episodes (P < .001). This difference was not explained by frequency of serological tests. Adjusted ORs (aORs) of detection of T. pallidum DNA in blood or rRNA in CSF at the index episode were significantly lower in those with previous syphilis (0.13; 95% CI, .08-.23, and 0.06, 95% CI, .02-.17). The aOR of neurosyphilis at the index episode was also significantly lower in individuals with previous syphilis (0.43; 95% CI, .27-.68). CONCLUSIONS Previous syphilis attenuates clinical and laboratory manifestations of infection with T. pallidum.
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Affiliation(s)
- Christina M Marra
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Medicine–Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Clare L Maxwell
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sharon K Sahi
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren C Tantalo
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shelia B Dunaway
- Department of Medicine–Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sheila A Lukehart
- Department of Medicine–Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Global Health, University of Washington School of Medicine, Seattle, Washington, USA
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16
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Lee NY, Chen YC, Liu HY, Li CY, Li CW, Ko WC, Ko NY. Increased repeat syphilis among HIV-infected patients: A nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 2020; 99:e21132. [PMID: 32664143 PMCID: PMC7360277 DOI: 10.1097/md.0000000000021132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Abstract
Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (β = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61-0.98; P < .001) were associated with a reduced risk of repeat syphilis.The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.
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Affiliation(s)
- Nan-Yao Lee
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Ying Liu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Nai-Ying Ko
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Pham MD, Wise A, Garcia ML, Van H, Zheng S, Mohamed Y, Han Y, Wei WH, Yin YP, Chen XS, Dimech W, Braniff S, Technau KG, Luchters S, Anderson DA. Improving the coverage and accuracy of syphilis testing: The development of a novel rapid, point-of-care test for confirmatory testing of active syphilis infection and its early evaluation in China and South Africa. EClinicalMedicine 2020; 24:100440. [PMID: 32637904 PMCID: PMC7327895 DOI: 10.1016/j.eclinm.2020.100440] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis. METHODS The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO TPP), and 503 venous blood samples collected from pregnant/postpartum women in South Africa (sub-study two, addressing potential clinical utility). Performance of the index test was assessed against standard laboratory-based serology using a combination of treponemal (TPHA) and non-treponemal (rapid plasma reagin [RPR]) tests. FINDINGS In sub-study one, the index test demonstrated 96·1% (95%CI=91·7%-98·5%) sensitivity and 84·7% (95%CI=80·15-88·6%) specificity for identification of active syphilis (TPHA positive, RPR positive). It correctly identified 71% (107/150) samples of past-treated syphilis (TPHA positive, RPR negative). In sub-study two, the index test achieved 100% (95%CI=59%-100%) sensitivity for active syphilis and correctly identified all nine women with past syphilis. INTERPRETATION The TP-IgA POCT has met the WHO TPP for a POCT for diagnosis of active syphilis and demonstrated its potential utility in a clinical setting. Future studies are warranted to evaluate field performance of the final manufactured test. FUNDING Saving Lives at Birth: Grand Challenge for Development, Thrasher Research Fund, and the Victorian Government Operational Infrastructure Scheme.
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Affiliation(s)
- Minh D. Pham
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Wise
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mary L. Garcia
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Huy Van
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Shuning Zheng
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Yasmin Mohamed
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yan Han
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Wan-Hui Wei
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Yue-Ping Yin
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Xiang-Sheng Chen
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Wayne Dimech
- National Serology Reference Laboratory, Melbourne, Australia
| | - Susie Braniff
- National Serology Reference Laboratory, Melbourne, Australia
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - David A. Anderson
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Nanjing BioPoint Diagnostic Technology, Nanjing, PR China
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Enhancing the Control of Syphilis Among Men Who Have Sex With Men by Focusing on Acute Infectious Primary Syphilis and Core Transmission Groups. Sex Transm Dis 2020; 46:629-636. [PMID: 31356529 PMCID: PMC6887624 DOI: 10.1097/olq.0000000000001039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The syphilis epidemic among men who have sex with men (MSM) has been increasing steadily. Many syphilis control programs focus on assuring treatment of all persons diagnosed with early syphilis without prioritizing acute primary syphilis or specific subgroups. Acute primary syphilis is highly infectious and contributes to a high proportion of new cases. Surveillance data show that among MSM with incident syphilis (primary or secondary) only about 35% are identified in the primary stage, indicating that most primary cases are missed and untreated. Patients with primary syphilis and large numbers of sex partners may play a major role in maintaining syphilis transmission. Considering those issues, sexually transmitted disease (STD) programs should consider increasing their focus on primary syphilis by assigning primary cases the highest priority, expanding client and clinician health education, and increasing the detection of primary syphilis through increased serologic screening frequency among high-risk MSM. Furthermore, syphilis control programs should implement steps to identify asymptomatic high-probable occult primary cases based on low titer (≤1:8) and recent seroconversion. Finally, to address core transmission groups, programs should implement periodic risk assessment to identify persons with a high number of sex partners and offer these individuals risk-reduction counseling, case management, and selective syphilis preexposure or postexposure doxycycline chemoprophylaxis. Although reprioritizing prevention efforts might be challenging, the Centers for Disease Control and Prevention, community advocacy groups, university STD research centers, and national STD prevention training centers can assist by providing support for consensus discussions and direction in developing operational guidance, some of which may be best delivered through STD and human immunodeficiency virus program partnerships.
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Kenyon C, Osbak KK, Crucitti T, Kestens L. Syphilis reinfection is associated with an attenuated immune profile in the same individual: a prospective observational cohort study. BMC Infect Dis 2018; 18:479. [PMID: 30253745 PMCID: PMC6156855 DOI: 10.1186/s12879-018-3399-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/20/2018] [Indexed: 01/02/2023] Open
Abstract
Background Ascertaining if the clinical and immunological response to repeat syphilis differs from that in initial syphilis may assist in designing optimal syphilis screening strategies and vaccine design. Methods We prospectively recruited 120 patients with a new diagnosis of (baseline) syphilis. During a 24-month follow-up period, 11 of these patients had a further diagnosis of (repeat) syphilis. We conducted a paired comparison of their plasma cyto-chemokines at baseline and repeat syphilis. Results Comparing to their baseline infection, paired analyses of the 11 individuals with repeat infections during follow-up revealed that these reinfections had lower concentrations of Interferon (IFN)α (0.8 [Interquartile range (IQR) 0.8–0.8 vs. 12.2 [IQR 1.6–24.2], P = 0.004) and Chemokine (C-C motif) ligand (CCL) 4 (0.9 [IQR 0.9–12.2 vs. 17.5 [IQR 4.9–32.8], P = 0.022]. Conclusion In this small study of 11 individuals, repeat syphilis was found to present with an attenuated immune response. The relevance of these findings to the design of optimal syphilis screening programs is discussed.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. .,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7700, South Africa.
| | | | - Tania Crucitti
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luc Kestens
- Immunology Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Cassell JA. Highlights from this issue. Br J Vener Dis 2018. [DOI: 10.1136/sextrans-2018-053638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kenyon C, Osbak KK, Apers L. Repeat Syphilis Is More Likely to Be Asymptomatic in HIV-Infected Individuals: A Retrospective Cohort Analysis With Important Implications for Screening. Open Forum Infect Dis 2018; 5:ofy096. [PMID: 29977956 PMCID: PMC6016412 DOI: 10.1093/ofid/ofy096] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
There is conflicting evidence as to whether repeat syphilis is more likely to present asymptomatically than initial syphilis. If it is, then this would motivate more frequent and long-term syphilis screening in persons with a history of multiple episodes of syphilis. We conducted detailed folder reviews of all individuals with 4 or more diagnoses of syphilis between 2000 and 2017 at the Institute of Tropical Medicine, Antwerp, and assessed if there was a difference in the proportion presenting with symptomatic (primary and secondary) vs asymptomatic (latent) syphilis in initial vs repeat syphilis. Forty-five clients with 4 or more episodes of syphilis were included in the study. All were HIV-infected. Repeat episodes of syphilis were less likely to be symptomatic than initial episodes (35/160 [21.9%] vs 28/45 [62.2%]; P < .001). Frequent screening in those with HIV infection may be the only way to diagnose repeat episodes of syphilis. Care providers can use this information to motivate persons with multiple episodes of syphilis to be screened every 3 to 6 months.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Ludwig Apers
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
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