Availability of benzathine penicillin G for syphilis treatment in Shandong Province, Eastern China

Benzathine Penicillin G Shortage and Secondary Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. This disease is characterized by four different stages, each presenting with a variety of manifestations or asymptomatic disease. These stages can be further broken down into early-stage syphilis, which includes primary and secondary syphilis, and late-stage syphilis, which includes tertiary syphilis. It is crucial to recognize and treat syphilis early because the later stages of the disease are marked by irreversible damage to the central nervous system (CNS) and cardiovascular system, and can even increase mortality risk. The primary recommended treatment for early-stage syphilis is intramuscular (IM) benzathine penicillin G (BPG). In this case report, we present a patient with secondary syphilis who exhibited red papules and nonspecific skin eruptions. Due to the unavailability of BPG, the patient initially received doxycycline as an alternative treatment. After eight days of searching multiple facilities and pharmacies, a dose of BPG was finally located and administered to the patient. We highlight crucial information about the BPG shortage, including supply and demand challenges, infrastructure issues, and the broader impact on numerous other antimicrobials. We emphasize the importance of recognizing this issue and provide alternatives for managing the disease in resource-limited settings.

Evaluating the effect of the plan of national syphilis control in controlling the syphilis epidemic in Jiangsu, China 2010-2020

Background

Starting in 2010, the Chinese government initiated a 10-year syphilis control plan, called the national syphilis control plan (NSCP), to address the emerging threat of syphilis. We aimed to evaluate the effect of the NSCP plan on syphilis control in Jiangsu, China.

Methods

The temporal trends of syphilis incidence, prevalence and rate of condom use were estimated by Joinpoint regression with average annual percent change (APC) and average annual percentage (APPC). A Chi-square test was conducted to analyze the outcomes in different subgroups. ArcGIS was used to analyze the spatiotemporal distribution of syphilis incidence.

Results

Geographically, early and congenital syphilis incidence decreased significantly in all areas of the province during the period of NSCP. Early syphilis incidence decreased from 21.1 to 8.8 (APC: -7.5, 95%CI: -8.6, -6.5, p < 0.001) per 100,000 people, and congenital syphilis decreased from 63.6 to 4.1 (APC: -14.8, 95%CI: -20.8, -8.4, p < 0.01) per 100,000 newborns from 2010 to 2020. Also, syphilis prevalence reduced from 13.4 to 3.8% (APC: -8.7, 95%CI: -12.1, -5.0, p = 0.001) among men who have sex with men, from 5.3 to 1.7% (APC: -7.9, 95%CI: -11.7, -3.8, p = 0.002) among female sex workers and remained under 1.0% with slight variations among pregnant women (APC: 0.3, 95%CI: -4.3, 5.1, p = 0.877) from 2010 to 2020. 0.2% (2,436) of pregnant women who received free syphilis testing during pregnancy were diagnosed with current syphilis infection, and 97.0% (2,555) of newborns in the province were delivered to women diagnosed with syphilis. 91.8% (2,346) of live babies and about 90% of diagnosed patients received complete standard syphilis diagnosis and treatment services.

Conclusion

Trends of early syphilis incidence and syphilis prevalence show a considerable decreasing trend among almost all the key populations after implementing NSCP. Congenital syphilis has significantly decreased as well and hence, the NSCP program should be sustained and strengthened to control the syphilis epidemic in China further.

Research of Combined ES-BP Model in Predicting Syphilis Incidence 1982-2020 in Mainland China

Background

Syphilis remains a major public health concern in China. We aimed to construct an optimum model to forecast syphilis epidemic trends and provide effective precautionary measures for prevention and control.

Methods

Data on the incidence of syphilis between 1982 and 2020 were obtained from the China Health Statistics Yearbook. An exponential smoothing model (ES model) and a BP neural network model were constructed, and on this basis, the ES-BP combination model was created. The prediction performance was assessed to compare the MAE (Mean Absolute Error), MSE (Mean Squared Error), MAPE (Mean Absolute Percentage Error), and RMSE (Root Mean Square Error).

Results

The optimum ES model was Brown's linear trend model, which had the lowest MAE and MAPE values, and its residual was a white noise sequence (P=0.359). The optimum BP neural network model had three layers with the number of nodes in the input, hidden, and output layers set to 5, 11, and 1, and the mean values of MAE, MSE, and RMSE by five-fold cross-validation were 1.519, 6.894, and 1.969, respectively. The ES-BP combination model had three layers, with model nodes 1, 4, and 1. The lowest mean values of MAE, MSE, and RMSE obtained by five-fold cross-validation were 1.265, 5.739, and 2.105, respectively.

Conclusion

The ES, BP neural network, and ES-BP combination models can be used to predict syphilis incidence, but the prediction performance of the ES-BP combination model is better than that of a basic ES model and a basic BP neural network model.

The Clinical Characteristics and Serological Outcomes of Infants With Confirmed or Suspected Congenital Syphilis in Shanghai, China: A Hospital-Based Study

BACKGROUND

Congenital syphilis (CS) is the infection of an infant or fetus with Treponema pallidum. The aim of this study was to investigate the clinical features and outcomes of serology reversion in infants diagnosed with confirmed or suspected congenital syphilis (CS).

METHODS

Infants admitted to the neonatal department of Children's Hospital of Fudan University from 2013 to 2016 who met the case definition of CS or suspected CS were included in this study. Follow-up was performed in an outpatient clinic until reversion to non-reactivity of both toluidine red unheated serum test (TRUST) and Treponemal pallidum particle agglutination (TPPA). Follow-up data were collected until up to the end of 2019, when the last infant with CS reached 3 years of age.

RESULTS

In total, 682 infants were enrolled in this study, including 63 in the CS group and 619 in the suspected CS group. Forty-seven infants (74.6%) in the CS group had symptoms, and 57 (90.5%) had abnormal laboratory and/or long bone X-ray findings. By 6 months of age, TRUST results were negative in 53.3% of the infants with CS and in 100% of the infants with suspected CS. All the infants in the CS group returned to TRUST non-reactivity by 18 months of age. The TPPA results at 18 months of age showed that only 10.0% (3/30) of the patients in the CS group returned to non-reactivity, while a 99.6% (548/550) non-reactivity rate was observed in the suspected CS group. All the infants in the CS group returned to 19S-IgM-TPPA non-reactivity by 6 months of age.

CONCLUSIONS

Although CS is an burdensome disease that may cause fetal and neonatal death, CS responds well to treatment when diagnosed and treated promptly, even when symptoms or lab/X-ray findings are present at birth.

The challenge of diagnosis and treatment of neurosyphilis in China: results from a nationwide survey

Background The uncertainty of how neurosyphilis is diagnosed and treated in clinical settings led us to investigate whether this serious manifestation of syphilis infection is properly managed in China.

METHODS

This national cross-sectional study of the diagnosis and treatment of neurosyphilis included 1392 clinicians at 398 hospitals located in 116 cities in China.

RESULTS

Of 398 hospitals, 244 (61.3%) failed to perform diagnostic laboratory tests and 181 (45.5%) failed to provide recommended treatment for neurosyphilis. Of 1392 clinicians, 536 (38.5%) had previously diagnosed patients with neurosyphilis, but 419 (78.2%) of the latter provided diagnoses that did not meet the criteria set by national guidelines. Of the 485 clinicians who had previously treated patients with neurosyphilis, 280 (57.7%) failed to follow national guidelines for treatment. Analysis indicated that clinicians working in North China (adjusted odds ratio (aOR), 4.24; 95% confidence interval (CI), 1.65-10.88), tertiary hospitals (aOR, 3.23; 95% CI, 1.63-6.41), and hospitals specialising in sexually transmitted infections (aOR, 2.49; 95% CI, 1.24-4.99) were more likely to follow national guidelines for neurosyphilis treatment.

CONCLUSION

Lack of knowledge in disease management poses a great obstacle to prevent the serious consequences of neurosyphilis in Chinese patients. More effective measures are urgently needed to improve this suboptimal situation.

New screening approach to detecting congenital syphilis in China: a retrospective cohort study

BACKGROUND

Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS.

METHODS

Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women.

RESULTS

Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively.

CONCLUSIONS

An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.