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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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Eguiluz M, Qquellon J, Vargas SK, Reyes-Diaz M, Konda KA, Caceres CF, Klausner JD. Molecular Characterization of Genital and Extragenital Lesions With the PlexPCR VHS Assay in Patients Diagnosed With Syphilis. Open Forum Infect Dis 2023; 10:ofad483. [PMID: 37869408 PMCID: PMC10588620 DOI: 10.1093/ofid/ofad483] [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: 04/14/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Syphilis diagnosis relies on immunologic markers and clinical protocols. However, syphilitic lesions can be confused with other genital ulcer diseases. Methods Using a PlexPCR VHS assay, we analyzed lesion DNA samples from 87 individuals who were clinically diagnosed with early syphilis infection and had at least 1 positive serologic test result. DNA was detected by the PlexPCR VHS multiplex assay and β-globin genes. Results Among the participants, 99% (86/87) had a positive rapid treponemal test result. DNA was successfully detected in 91% (79/87) of the lesion samples. PlexPCR VHS identified 5 herpes simplex virus (HSV)/Treponema pallidum coinfections (2 HSV-1 and 3 HSV-2), only T pallidum DNA in 62% (49/79), and only HSV-2 in 12.7% (10/79). While 19% (15/79) were negative for all pathogens, none were varicella zoster virus positive. The PlexPCR VHS had 68.4% agreement with the clinical diagnosis. Conclusions Since the PlexPCR VHS detects multiple organisms simultaneously, it can help to confirm actual syphilis and identify other pathogen coinfections or the pathogen causing the ulcer.
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Affiliation(s)
- Maria Eguiluz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jazmin Qquellon
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Reyes-Diaz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Scurtu LG, Jinga V, Simionescu O. Fascinating Molecular and Immune Escape Mechanisms in the Treatment of STIs (Syphilis, Gonorrhea, Chlamydia, and Herpes Simplex). Int J Mol Sci 2022; 23:ijms23073550. [PMID: 35408911 PMCID: PMC8998805 DOI: 10.3390/ijms23073550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
The incidence of syphilis, gonorrhea, chlamydia, and herpes simplex has increased over the last decade, despite the numerous prevention strategies. Worldwide scientists report a surge in drug-resistant infections, particularly in immunocompromised patients. Antigenic variations in syphilis enable long-term infection, but benzathine penicillin G maintains its efficiency, whereas macrolides should be recommended with caution. Mupirocin and zoliflodacin were recently introduced as therapies against ceftriaxone-resistant gonococcus, which poses a larger global threat. The gastrointestinal and prostatic potential reservoirs of Chlamydia trachomatis may represent the key towards complete eradication. Similar to syphilis, macrolides resistance has to be considered in genital chlamydiosis. Acyclovir-resistant HSV may respond to the novel helicase-primase inhibitors and topical imiquimod, particularly in HIV-positive patients. Novel drugs can overcome these challenges while nanocarriers enhance their potency, particularly in mucosal areas. This review summarizes the most recent and valuable discoveries regarding the immunopathogenic mechanisms of these sexually transmitted infections and discusses the challenges and opportunities of the novel molecules and nanomaterials.
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Affiliation(s)
- Lucian G. Scurtu
- Department of Dermatology I, Colentina Clinical Hospital, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020125 Bucharest, Romania;
| | - Viorel Jinga
- Department of Urology, Clinical Hospital Prof. Dr. Th. Burghele, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Olga Simionescu
- Department of Dermatology I, Colentina Clinical Hospital, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020125 Bucharest, Romania;
- Correspondence:
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Konda K, Kojima N, Vargas SK, Calvo G, Reyes-Díaz M, Giacani L, Cáceres CF, Klausner JD. Syphilis naïve patients achieve treatment success more quickly: A comparison of time to syphilis treatment success in patients with repeat versus naïve infection. Clin Infect Dis 2021; 74:1887-1888. [PMID: 34596682 DOI: 10.1093/cid/ciab877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Konda
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - N Kojima
- Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - S K Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - G Calvo
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Reyes-Díaz
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle WA, United States
| | - C F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle WA, United States.,Department of Preventive Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA, United States
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Paparizos V, Tsimpidakis A, Nicolaidou E, Daskalakis E, Paparizou E, Vasalou V, Vrioni G, Rigopoulos D. Duration of anti-treponemal immunoglobulin M seroreversion after successful syphilis treatment in HIV-positive and -negative patients. Int J STD AIDS 2021; 32:523-527. [PMID: 33533297 DOI: 10.1177/0956462420980927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treponemal immunoglobulin M (IgM) antibody detection is currently among serologic tests used for syphilis diagnosis. However, the exact role of these antibodies is unclear. In this retrospective study of 326 (198 HIV positive and 128 negative) patients with early syphilis and positive IgM serology, data were analysed to investigate the time of IgM seroreversion after treatment and correlation with covariate factors. Median time of IgM seroreversion in the study population was 9 months (range 3-84, interquartile range 5-12). No statistically significant difference was observed between HIV-positive and -negative patients. At 12 months, 80.1% of the patients had a negative IgM test. At 6 months, 100% of HIV-positive patients had a fourfold decrease or greater in Venereal Disease Research Laboratory titres, but only 35.4% had a negative treponemal IgM. Secondary and early latent stage patients had a slower seroreversion of IgM (Hazard Ratio (HR) = 0.73, p = 0.064 and HR = 0.60, p = 0.023, respectively) than those with primary syphilis. A very strong association was observed of time to seroreversion of treponemal IgM with baseline VDRL titre (p < 0.001). Treponemal IgM antibody detection often cannot distinguish between active and successfully treated syphilis. Treponemal IgM may only be useful in the cases recommended in the guidelines, and in cases of untreated syphilis, it could support but not confirm the diagnosis.
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Affiliation(s)
- Vasilios Paparizos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Electra Nicolaidou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Evangelos Daskalakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Eleni Paparizou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Varvara Vasalou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Georgia Vrioni
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Dimitris Rigopoulos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
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