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Ahmed AS, Nivedita N, Sudharshan S, Manoharan A, Anand AR, Selvamuthu P, Biswas J. Ocular Syphilis - Clinical Features and Outcome in HIV Positive and HIV Negative Patients from a Tertiary Eye Center from India - A Comparative Study. Ocul Immunol Inflamm 2024:1-8. [PMID: 39145732 DOI: 10.1080/09273948.2024.2382347] [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: 04/05/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE To study and compare the clinical characteristics and outcome of ocular syphilis between HIV positive and HIV negative patients. METHODS Retrospective hospital-based case series from a tertiary eye care hospital in India. Patients with uveitis and positive syphilis serology were included. Demographics, clinical features, investigations, imaging and treatment modalities were noted. RESULTS Hundred and five (105) eyes of 66 patients were analyzed. Males were predominantly affected (n = 57/66, 86.4%). Secondary syphilis was the most common stage of presentation (n = 48/66, 72.7%). Two groups were identified: HIV positive (HIVP) patients (n = 39/66, 59%) and HIV negative (HIVN) patients (n = 27/66, 41%). 12/39 (30.8%) patients were newly diagnosed with HIV at the time of ocular presentation. Panuveitis was the most common presenting feature in both groups (n = 66/105 eyes, 62.8%). Diffuse necrotizing retinitis was more common in HIV patients (HIVP - 15 Vs HIVN - 5 eyes). Ocular co-infections were more common in HIV patients, ocular tuberculosis, the commonest in both groups. Intravenous penicillin and titrated dose of systemic steroids were the mainstay of treatment. Improvement in mean logMAR was noted from 1.415 to 0.828 with p-value < 0.001. At final follow-up, 71.8% patients showed visual improvement. Complete resolution of ocular inflammation was noted in 95.5% patients. CONCLUSION Ocular syphilis poses a diagnostic challenge considering the varied presentations and clinical course both in immunocompromised and immunocompetent groups. Clinical presentations are not always classical. High index of suspicion with supportive laboratory investigations and with characteristic OCT features helps diagnosis. All uveitis patients, especially with those suspected with infectious etiology, need to be tested for syphilis serology to prevent vision loss in this resurgent disease.
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Affiliation(s)
| | - Nair Nivedita
- Department of Ophthalmology, KIMS Health Hospital, Manama, Bahrain
| | | | | | | | - Poongulali Selvamuthu
- VHS Infectious Diseases Medical Center, Chennai Antiviral Research and Treatment (CART) Clinical Research Site (CRS), VHS, Chennai, India
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Goyal MK, Dhaliwal KK, Agrawal S. "Syphilitic Hepatitis": A Comprehensive Review of Clinical Features, Diagnostic Approaches, and Management Considerations. J Clin Gastroenterol 2024; 58:635-639. [PMID: 38896421 DOI: 10.1097/mcg.0000000000002035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Syphilitic hepatitis is a very rare presentation of syphilis infection, characterized by inflammation of the liver due to the invasion of hepatic tissue by the bacterium Treponema pallidum. This review article provides an in-depth analysis of the existing body of information pertaining to syphilitic hepatitis. The article primarily concentrates on key aspects such as the epidemiology, clinical manifestations, diagnostic methods, and therapeutic approaches associated with this condition. Despite its rarity, awareness of syphilitic hepatitis is vital for accurate diagnosis and appropriate intervention. The clinical presentations frequently exhibit similarities with many liver illnesses, hence presenting difficulties in making an accurate diagnosis. Common symptoms include fatigue, stomach pain, and jaundice. Diagnostic procedures encompass the use of serological assays, including rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS), in conjunction with imaging modalities to evaluate hepatic engagement. The primary therapeutic approach is the prompt initiation of antibiotic therapy, with a particular emphasis on penicillin, to eradicate the causative bacterial infection and facilitate the restoration of liver function. Failure to swiftly manage this condition may result in substantial morbidity. In summary, syphilitic hepatitis is a very uncommon but medically relevant manifestation of syphilis infection. The significance of increased clinical suspicion, precise diagnostic techniques, and prompt antibiotic administration is emphasized in this review since these are crucial in reducing the potentially severe outcomes associated with this illness.
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Affiliation(s)
- Manjeet Kumar Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Sangeeta Agrawal
- Medicine, Wright State University, Dayton VA Medical Center, Dayton, OH
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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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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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Gabster A, Fernández Díaz F, Zaldívar Y, Hernández M, Pascale JM, Orillac A, Moreno-Wynter S, Xavier Hall CD, Jhangimal M, Yu-Pon A, Rodríguez-Vargas C, Arjona-Miranda D, Fuentes B, Henestroza G, Araúz AB. Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study. Ther Adv Infect Dis 2024; 11:20499361241256290. [PMID: 38827952 PMCID: PMC11141218 DOI: 10.1177/20499361241256290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Background Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic. Methods A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis. Results In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14). Conclusion This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.
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Affiliation(s)
- Amanda Gabster
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Ave. Justo Arosemena y Calle 36, Panamá, Panamá 507-527-4952, Panama
- National Research System, National Secretariat of Science, Technology and Innovation, Panama City, Panama
- Center of Population Sciences for Health Equity, Faculty of Nursing, Florida State University, Tallahassee, FL, USA
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Yamitzel Zaldívar
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
- Facultad de Medicina, Universidad de Panamá, Transismica, Panama City, Panama
| | - Angelique Orillac
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | - Casey D. Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Mónica Jhangimal
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | - Anyi Yu-Pon
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | | | - Bárbara Fuentes
- Facultad de Medicina, Universidad Interamericana de Panamá, Panama City, Panama
| | - Germán Henestroza
- Division of Infectious Diseases, University of Alabama, Birmingham, AB, USA
| | - Ana Belén Araúz
- Hospital Santo Tomás, Panama City, Panama
- National Research System, National Secretariat of Science, Technology and Innovation, Panama City, Panama
- Facultad de Medicina, Universidad de Panamá, Transismica, Panama City, Panama
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Maharani RH, Nugraha T, Sutedja E, Ruchiatan K, Usman HA, Achdiat PA. Generalized Asymptomatic Nodulo-Ulcerative Lesions Without Systemic Symptoms in a Secondary Syphilis Patient Co-Infected with HIV. Clin Cosmet Investig Dermatol 2023; 16:3645-3650. [PMID: 38144158 PMCID: PMC10749176 DOI: 10.2147/ccid.s445155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Syphilis is a sexually-transmitted disease with various clinical stages. Secondary syphilis manifestations may mimic other skin lesions. Patient co-infected with Human Immunodeficiency Virus (HIV), with CD4 cell counts of 200-499 cells/mm3, often manifests an atypical cutaneous lesion, which may also occur as nodular or ulcerative lesions. Generalized nodulo-ulcerative lesions without systemic symptoms in secondary syphilis patients with HIV co-infection are rarely reported. A 22-year-old man presented with generalized asymptomatic multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs. His lesions spread progressively without the presence of any prodromal symptoms or adenopathy. He was previously diagnosed with HIV and is currently on antiretroviral medications, with a CD4 cell count of 388 cells/μL. His venereal disease research laboratories (VDRL) result was reactive (titer of 1:256). His Treponema pallidum hemagglutination assay (TPHA) result was also reactive (titer of 1:10,240). A skin biopsy was performed from the nodulo-ulcerative lesion on his back. Hematoxylin-eosin staining revealed a hyperplastic epidermis, a massive influx of plasma cells, and lymphocyte infiltration into the deep dermis, especially in the peri-adnexal, peri-vascular, and peri-muscular regions. The patient was diagnosed with secondary syphilis with HIV co-infection. He had no previous history of drug allergy. A single dose of 2.4 million units of benzathine penicillin G was administered. Almost all the lesions became hyperpigmented macules after two weeks and resolved completely after one month. His VDRL titer declined to 1:32 after three months. The various atypical lesions of secondary syphilis may lead to misdiagnosis and delayed treatment. The presence of multiple asymptomatic nodulo-ulcerative lesion without prodromal symptoms may indicate the presence of secondary syphilis, notably in patients co-infected with HIV. Therefore, knowledge of atypical cutaneous manifestations of secondary syphilis is warranted in order to treat patients accordingly.
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Affiliation(s)
- Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Tomi Nugraha
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kartika Ruchiatan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hermin Aminah Usman
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Turco M, Ruffo Di Calabria V, Rapaccini AL, Pisano L. Multiple chancres in HIV-negative patients: An atypical presentation? J Eur Acad Dermatol Venereol 2023; 37:e1333-e1335. [PMID: 37417361 DOI: 10.1111/jdv.19315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Affiliation(s)
- M Turco
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - V Ruffo Di Calabria
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - A L Rapaccini
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - L Pisano
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
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SHALEV N, CASTOR D, MORRISON E, QUIGEE D, HUANG S, ZUCKER J. Persistently Elevated Risk of Syphilis Among Human Immunodeficiency Virus-Positive Men Receiving Care in a Status-Neutral Setting: A Retrospective Analysis. Sex Transm Dis 2023; 50:150-156. [PMID: 36454554 PMCID: PMC9905295 DOI: 10.1097/olq.0000000000001749] [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: 12/03/2022]
Abstract
BACKGROUND Over the past decade, the incidence of primary and secondary syphilis has increased dramatically in the United States and Western Europe. Men living with human immunodeficiency virus (HIV) and those at risk of HIV infection experience disproportionately high rates of early syphilis (ES). We compared the odds of ES among HIV-positive and HIV-negative men participating in a status-neutral comprehensive HIV prevention and treatment program (CHP). METHODS We conducted a retrospective analysis of men aged 18 to 65 years with ≥ 1 CHP visit and ≥2 rapid plasma reagin (RPR) tests performed between January 1, 2018, and December 31, 2021. Early syphilis was defined as newly reactive RPR with a minimum titer of ≥1:4 or a ≥ 4-fold increase in the RPR titer. Multiple logistic regression analyses were performed to determine predictors of ES. RESULTS A total of 2490 men met the inclusion criteria, of whom 1426 (57.3%) were HIV-positive and 1064 (42.7%) were HIV-negative. Of the 393 men with ES, 284 (72.3%) were HIV-positive and 109 (27.7%) were HIV-negative. Human immunodeficiency virus-positive men had higher adjusted odds of ES (adjusted odds ratio, 2.86; 95% confidence interval, 2.45-3.27) than HIV-negative men did. Chlamydia or gonorrhea infection did not differ according to HIV status (adjusted odds ratio, 0.93; 95% confidence interval, 0.82-1.04). CONCLUSIONS In our status-neutral care setting, HIV-positive status was associated with significantly higher odds of ES, but not chlamydia or gonorrhea. Our findings emphasize the vulnerability of HIV-positive men to syphilis in an era of effective HIV biomedical prevention.
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Affiliation(s)
- Noga SHALEV
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
| | - Delivette CASTOR
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, United States of America
| | - Ellen MORRISON
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, United States of America
| | - Daniela QUIGEE
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
| | - Simian HUANG
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
| | - Jason ZUCKER
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States of America
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Meseli SE, Pelit S. Syphilis and dentists: The data about knowledge and awareness of clinicians in Turkey. Int J STD AIDS 2023; 34:408-415. [PMID: 36821515 DOI: 10.1177/09564624231155678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Syphilis may give pathognomonic signs in oral cavity. In order to emerge an awareness about dentists' role in syphilis management, it was aimed to obtain the data from them about their knowledge.Methods: This survey-based, cross-sectional study was conducted with 709 dentists practicing in Turkey. Participants answered 16 statements about syphilis "Transmission Routes," "Extra-oral Clinical Features," "Oral Findings," and "Diagnosis & Treatment" with options yes/no/I do not know. Moreover, they responded to two 5-point Likert type questions about their comfort level and frequency of taking sexual anamnesis. The statistical significance was set at p ≤ .05.Results: The mean age (years) and female/male ratio of the participants were 35.7 ± 10.2 and 449/260, respectively. The average of the correct answers in the survey was 10.38 ± 3.3. "Transmission Routes" had the highest ratio (50.6%) in terms of all questions in a single category that were answered correctly among groups. Dentists practicing at faculties had the highest number of correct answers (p = .003). The total number of correct answers and the number of correct answers in each category were positively related to both the level of comfort and the frequency of taking patient's sexual anamnesis (Oral Findings p = .002; others p ≤ .001).Conclusions: The results of this study indicate that dentists practicing in Turkey lack a significant level of knowledge about syphilis. This highlights the need for further training and education programs for dentists in Turkey.
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Affiliation(s)
- Suleyman E Meseli
- Faculty of Dentistry, Periodontology Department, 187981Istanbul Aydin University, Istanbul, Turkey
| | - Suleyman Pelit
- Sisli Hamidiye Etfal Training and Research Hospital, Medical Microbiology Department, 448249University of Health Sciences, Istanbul, Turkey
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Aung ET, Fairley CK, Ong JJ, Chen MY, Phillips TR, Tran J, Samra R, Chow EPF. Incidence and Risk Factors for Early Syphilis Among Men Who Have Sex With Men in Australia, 2013-2019: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad017. [PMID: 36751651 PMCID: PMC9898878 DOI: 10.1093/ofid/ofad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Background We aimed to examine the incidence of syphilis in men who have sex with men (MSM) and identify subgroups of MSM at a higher risk of syphilis infection. Methods We conducted a retrospective cohort study of MSM attending a sexual health clinic in Australia, during 2013-2019, who had at least 2 syphilis serological tests during the study period. The incidence of syphilis was expressed as per 100 person-years. A cox regression analysis was conducted to identify risk factors for syphilis. Results A total of 24 391 individual MSM (75 086 consultations) were included. A total of 1404 new syphilis cases were diagnosed with an incidence of 3.7/100 person-years (95% confidence interval, 3.5-3.9). Syphilis incidence was higher in MSM with human immunodeficiency virus ([HIV] 9.3/100 person-years) than in MSM taking HIV pre-exposure prophylaxis (PrEP) (6.9/100 person-years) or HIV-negative MSM not taking PrEP (2.2/100 person-years). Risk factors associated with high incidence of syphilis included the following: MSM with HIV (adjusted hazard ratio [aHR] 2.7), MSM taking HIV PrEP (aHR 2.1), past history of syphilis infection (aHR 2.4), injecting drug use (aHR 2.7), condomless anal sex (aHR 1.7), >4 sexual partners in the last 12 months (aHR 1.2), and concurrent sexually transmitted infection (chlamydia and gonorrhoea) (aHR 1.6). Conclusions The incidence of syphilis remains high among MSM, particularly in subgroups with associated risk factors for syphilis infections. These data highlight the need for biomedical and behavioral interventions to be targeted to subgroups of MSM at the highest risk of syphilis infection.
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Affiliation(s)
- Ei T Aung
- Correspondence: Ei Thu Aung, MBChB, FAChSHM, 580 Swanston Street, Carlton, VIC 3053, Australia ( or ). A/Pro Eric Chow ()
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Ranjit Samra
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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Gupta M, Verma GK, Sharma R, Sankhyan M, Rattan R, Negi AK. The Changing Trend of Syphilis: Is It a Sign of Impending Epidemic? Indian J Dermatol 2023; 68:15-24. [PMID: 37151273 PMCID: PMC10162747 DOI: 10.4103/ijd.ijd_788_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Syphilis is a treatable bacterial infection caused by Treponema pallidum. There has been a change in incidence of syphilis in various nations over the years. Aim To study the epidemiological trends, demographic profile, high-risk behaviour, clinical pattern, and stage of syphilis over the last ten years in patients presenting to an STD clinic in a tertiary care hospital. Material and Methods This was a retrospective observational study over ten years. Records of all confirmed syphilis cases were analysed in relation to demography and clinical profile. Results There were a total of 3,110 STD patients among whom 31 cases (accounting for 0.99%) of confirmed syphilis were seen. There was a significant increase in cases in the last five years of study, especially in the last year. An increase in primary (PS) and secondary syphilis (SS) was observed. Males outnumbered females (3:1). Mean age of patients was 35.0 ± 11.53 years. Professionals were most common (22.6%) having syphilis followed by farmers (19.35%). A significant proportion (45.1%) of our patients were at least graduates. Unprotected sex was seen in all the patients followed by extramarital/premarital sex (71.35%). There were 16.12% of cases who had a history of paid sex and 9.7% were homosexuals. SS and latent syphilis were more common (38.7% each) than PS (19.35%). In PS single chancre and in SS truncal asymptomatic rash was the commonest clinical presentation. Limitation: Single-centre study, including only self-reported patients leading to a small sample size, is the major limitation of the study. Conclusion The increased trend of primary and secondary syphilis in recent years highlights that there is a risk of an impending epidemic.
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Affiliation(s)
- Mudita Gupta
- From the Department of Dermatology, Venereology and Leprosy, IGMC Shimla, Himachal Pradesh, India
| | - Ghanshyam K. Verma
- From the Department of Dermatology, Venereology and Leprosy, IGMC Shimla, Himachal Pradesh, India
| | - Rajni Sharma
- From the Department of Dermatology, Venereology and Leprosy, IGMC Shimla, Himachal Pradesh, India
| | - Manish Sankhyan
- Department of Dermatology, Sundernagar, Himachal Pradesh, India
| | - Renu Rattan
- From the Department of Dermatology, Venereology and Leprosy, IGMC Shimla, Himachal Pradesh, India
| | - Ajeet Kumar Negi
- From the Department of Dermatology, Venereology and Leprosy, IGMC Shimla, Himachal Pradesh, India
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12
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Nieuwenburg SA, Hoornenborg E, Davidovich U, de Vries HJC, Schim van der Loeff M. Developing a symptoms-based risk score for infectious syphilis among men who have sex with men. Sex Transm Infect 2022:sextrans-2022-055550. [PMID: 36400527 DOI: 10.1136/sextrans-2022-055550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundSyphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.MethodsWe included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018–2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre’s routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.ResultsWe included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27–45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.ConclusionSymptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.
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Affiliation(s)
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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13
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D'Avanzo PA, LoSchiavo CE, Krause KD, Karr A, Halkitis PN. Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study. AIDS Patient Care STDS 2022; 36:416-424. [PMID: 36367994 PMCID: PMC9700354 DOI: 10.1089/apc.2022.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.
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Affiliation(s)
- Paul A. D'Avanzo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Caleb E. LoSchiavo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
| | - Anita Karr
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
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14
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Li G, Ali K, Gao X, Lu S, Xu W, Zhu X. Impact of Asymptomatic Neurosyphilis on Patients Quality of Life and Social Stigma. Psychol Res Behav Manag 2022; 15:2683-2689. [PMID: 36160273 PMCID: PMC9505332 DOI: 10.2147/prbm.s382100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background/Objectives Neurosyphilis is a disease caused by Treponema pallidum when it invades the central nervous system. Asymptomatic neurosyphilis (ANS) is one of the most common types of neurosyphilis, however it is often misdiagnosed. This study aimed to explore the impact of ANS on patient's quality of life and social stigma. Methods A total of 159 ANS patients were diagnosed by their serology and cerebrospinal fluid. These patients' stigma and quality of life were assessed separately through the Social Impact Scale (SIS) and the Easy Response Questionnaire. Results The average age was 36.25±8.36 years old, and 114 patients were males (71.69%). The serum syphilis test of 159 selected patients was positive, and the indicators of nucleus cells, protein quantification, and syphilis antibodies in the cerebrospinal fluid met the criteria for ANS. The total stigma score was (40.23 ±10.12), with the scores of the different entries being clearly differentiated, with the highest being the 15th entry (I feel I need to keep my illness a secret), with an average score of 3.15/4. Conclusion Patients with asymptomatic neurosyphilis may feel social stigma and are more negative when facing their disease. Health-care workers should be aware of the particular aspects of their condition and pay special attention to the need for patient privacy.
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Affiliation(s)
- Guiping Li
- Mental Health Center Affiliated Hangzhou Seventh People's Hospital Zhejiang University School of Medicine, Hangzhou, 310013, People's Republic of China
| | - Kamran Ali
- Department of Dermatology, International Education College of Zhejiang Chinese Medical University, Hangzhou, 310006, People's Republic of China
| | - Xiujun Gao
- Mental Health Center Affiliated Hangzhou Seventh People's Hospital Zhejiang University School of Medicine, Hangzhou, 310013, People's Republic of China
| | - Sha Lu
- Mental Health Center Affiliated Hangzhou Seventh People's Hospital Zhejiang University School of Medicine, Hangzhou, 310013, People's Republic of China
| | - Weiqin Xu
- Mental Health Center Affiliated Hangzhou Seventh People's Hospital Zhejiang University School of Medicine, Hangzhou, 310013, People's Republic of China
| | - Xiaoying Zhu
- Mental Health Center Affiliated Hangzhou Seventh People's Hospital Zhejiang University School of Medicine, Hangzhou, 310013, People's Republic of China
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15
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de Brito Pinto TK, da Cunha-Oliveira ACGDP, Sales-Moioli AIL, Dantas JF, da Costa RMM, Silva Moura JP, Gómez-Cantarino S, Valentim RADM. Clinical Protocols and Treatment Guidelines for the Management of Maternal and Congenital Syphilis in Brazil and Portugal: Analysis and Comparisons: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10513. [PMID: 36078229 PMCID: PMC9518460 DOI: 10.3390/ijerph191710513] [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: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 05/18/2023]
Abstract
(1) Background: Maternal syphilis (MS) and congenital syphilis (CS) are serious public health problems worldwide due to their high morbidity and mortality rates. (2) Objective: Evaluating the applicability of Clinical Protocols and Treatment Guidelines on case incidence trends in Brazil and Portugal. (3) Methods: The review was done through bibliographic research in two public databases and government websites from both countries, published between 2007 and 2022. All guidelines that contained CS and MS were selected. (4) Results and discussion: After evaluation, we found that Brazil and Portugal have adequate protocols for screening and treating congenital and maternal syphilis. (5) Conclusion: The results suggest that CS and MS incidence are notably higher in Brazil than in Portugal due to economic, cultural, and social disparities and the differences in territory size. Therefore, these demographic and socioeconomic factors could strongly influence efforts to fight against syphilis and thus control the infection.
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Affiliation(s)
- Talita Katiane de Brito Pinto
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
| | - Aliete Cristina Gomes Dias Pedrosa da Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | | | - Jane Francinete Dantas
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | - Rosângela Maria Morais da Costa
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
- Municipal Health Department, Natal City Hall, Natal 59014-030, Brazil
| | - José Paulo Silva Moura
- Doctor Daniel de Matos Maternity, Coimbra Hospital and University Center, 3000-157 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
| | - Sagrario Gómez-Cantarino
- Faculty of Physiotherapy and Nursing, Toledo Campus, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Ricardo Alexsandro de Medeiros Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
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16
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Yap EWY. Rash, red eyes, lip erosions and genital ulcer - What is the diagnosis? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:99-102. [PMID: 35440965 PMCID: PMC9004432 DOI: 10.51866/tyk1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Maculopapular eruptions are frequently described as large areas of rash characterised by red, small, confluent bumps. They are frequently puzzling for the attending clinician due to the multiple possible aetiologies. Accurate diagnosis is important because treatment varies depending on the aetiology, and some rashes can be life-threatening if not treated promptly. Common aetiologies implicated include drug allergies, infection-related (for example: viral exanthems, scarlet fever) and autoimmune conditions (for example: Still's disease). We report a case of maculopapular eruption associated with mucocutaneous involvement and systemic symptoms. The possible differential diagnoses and approach to the management of this patient are discussed.
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Affiliation(s)
- Evelyn Wen Yee Yap
- MBBS (IMU), MRCP (UK), Department of Dermatology, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia,
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17
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Rosana Y, Yasmon A, Indriatmi W, Effendi I, Kusumawati RL, Rowawi R, Sudigdoadi S, Pradini GW, Wiraguna AAGP, Puspawati NMD, Kusumawaty M, Massi MN. Detection A2058G and A2059G on the 23S rRNA Gene by Multiplex Nested PCR to Identify Treponema pallidum Resistance to Azithromycin in Indonesia. Jpn J Infect Dis 2021; 75:355-360. [PMID: 34980709 DOI: 10.7883/yoken.jjid.2021.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Azithromycin is one of the antibiotics used to treat syphilis, especially in the context of penicillin allergy. Resistance to azithromycin is widely reported associated with one and/or two point mutations on the 23S rRNA gene but has yet to be described in Indonesia. Specimens were collected from 220 patients diagnosed with secondary syphilis. A multiplex nested PCR testing system using the 23S rRNA target gene of Treponema pallidum was designed using three pairs of primers. The first step used PCR pairs of primers to detect T. pallidum. In the second step of PCR using 2 pairs of primers were achieved to identify azithromycin resistant T. pallidum based on A2058G and A2059G point mutations. There was no T.pallidum identified resistant to azithromycin in Jakarta and Bandung. T. pallidum resistance to azithromycin were found in Makassar, Medan, and Bali. The majority of azithromycin resistance was found among heterosexual males and in patients living with HIV. This study has demonstrated T. pallidum resistance to azithromycin in Indonesia appears to be a novel variant of resistance, containing both the A2058G and A2059G mutations that was found in Medan and Makassar.
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Affiliation(s)
- Yeva Rosana
- Department of Microbiology Medical Faculty Universitas Indonesia - Ciptomangunkusumo Hospital, Indonesia
| | - Andi Yasmon
- Department of Microbiology Medical Faculty Universitas Indonesia - Ciptomangunkusumo Hospital, Indonesia
| | - Wresti Indriatmi
- Department of Dermato-Venereology, Medical Faculty Universitas Indonesia - Ciptomangunkusumo Hospital, Indonesia
| | - Ida Effendi
- Clinical Microbiologist Program, Faculty of Medicine, Universitas Indonesia, Indonesia.,Department of Microbiology, Faculty of Medicine, Trisakti University, Indonesia
| | - Raden Lia Kusumawati
- Department of Microbiology, Medical Faculty University of Sumatera Utara, Indonesia
| | - Rasmia Rowawi
- Department of Dermato-Venereology, Hasan Sadikin Hospital, Universitas Padjadjaran, Indonesia
| | - Sunarjati Sudigdoadi
- Microbiology Division, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Indonesia
| | - Gita Widya Pradini
- Microbiology Division, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Indonesia
| | | | - Ni Made Dwi Puspawati
- Department of Dermato-Venereology, Medical Faculty University of Udayana-Sanglah Hospital, Indonesia
| | - Maryam Kusumawaty
- Department of Dermato-Venereology Medical Faculty University of Hasanuddin, Indonesia
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18
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Fernández-Naval C, Arando M, Espasa M, Antón A, Fernández-Huerta M, Silgado A, Pinatar C, Zarzuela F, González-López JJ, Serra-Pladevall J, Sulleiro E, Pumarola T, Vall-Mayans M, Esperalba J. Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona. Future Microbiol 2021; 16:967-976. [PMID: 34414771 DOI: 10.2217/fmb-2021-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.
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Affiliation(s)
- Candela Fernández-Naval
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Maider Arando
- Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain
| | - Mateu Espasa
- Microbiology Department, Corporació Sanitària Parc Taulí, Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
| | - Andrés Antón
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Miguel Fernández-Huerta
- Microbiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Aroa Silgado
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Cristina Pinatar
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Francesc Zarzuela
- Sexually Transmitted Infections Unit Vall d'Hebron-Drassanes, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain
| | - Juan José González-López
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Judit Serra-Pladevall
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Tomàs Pumarola
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Martí Vall-Mayans
- Microbiology Department, Hospital Germans Trias i Pujol, Carretera de Canyet, 08916, Badalona, Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Hospital Univeristari Vall d'Hebron - Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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19
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Navarrete J, Buchroithner C, Benedetto J, Bunker CB. Concomitant Follmann balanitis and secondary syphilis. BMJ Case Rep 2021; 14:e244079. [PMID: 34376420 PMCID: PMC8356155 DOI: 10.1136/bcr-2021-244079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Hospital Padre Hurtado, Santiago, Chile
| | | | - Juana Benedetto
- Department of Dermatology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Christopher B Bunker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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20
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High Lifetime Prevalence of Syphilis in Men Who Have Sex With Men and Transgender Women Versus Low Lifetime Prevalence in Female Sex Workers in Lima, Peru. Sex Transm Dis 2021; 47:549-555. [PMID: 32541611 PMCID: PMC7357539 DOI: 10.1097/olq.0000000000001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A study of men who have sex with men, transwomen, and female sex workers in Lima, Peru found that lifetime prevalence of syphilis was substantially lower in female sex workers compared with other groups. The syphilis epidemic continues to cause substantial morbidity worldwide and is worsening despite ongoing control efforts. Syphilis remains an important public health problem among 3 key populations: men who have sex with men (MSM), transgender women, and female sex workers.
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21
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Paul G, Wesselmann J, Adzic D, Malin JJ, Suarez I, Priesner V, Kümmerle T, Wyen C, Jung N, van Bremen K, Schlabe S, Wasmuth JC, Boesecke C, Fätkenheuer G, Rockstroh J, Schwarze-Zander C, Lehmann C. Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med 2020; 22:165-171. [PMID: 33128333 DOI: 10.1111/hiv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/25/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. METHODS From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. RESULTS In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. CONCLUSION Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
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Affiliation(s)
- G Paul
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - J Wesselmann
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - D Adzic
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - I Suarez
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - T Kümmerle
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K van Bremen
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J-C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - G Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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A nonspecific ulcer on upper lip presented as the first and sole sign of syphilis. J Infect Chemother 2020; 26:1309-1312. [PMID: 32768339 DOI: 10.1016/j.jiac.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/04/2020] [Accepted: 07/20/2020] [Indexed: 01/25/2023]
Abstract
Syphilis, a sexually transmitted disease, can be categorized as acquired syphilis and congenital syphilis, manifesting diverse lesions involving multiple sites. Oral manifestations at the primary stage of acquired syphilis are usually characterized by its short period and non-specific varied presentations. And oral ulcers as initial and the only presentation of syphilis oral lesions are infrequent and occur in less than 2% of patients. Because of its transient nature and variable manifestations which could mimic other oral ulcerative lesions, oral syphilis presenting as sole ulceration at early stage can be easily neglected and rather difficult to diagnose. Herein, we report a 35-year-old female patient manifested a sole atypical ulceration on her upper lip for approximately 1 month. We highlighted the importance of early and accurate diagnosis, focused on the characteristics of oral chancre, and gave an insight to the differential diagnoses, which would be enlightening and useful in clinical practice.
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Diagnosis and Management of Syphilis in Patients With HIV Co-infection. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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