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Xie JW, Wang M, Zheng YW, Lin Y, He Y, Lin LR. Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis. Front Public Health 2023; 11:1105847. [PMID: 36817920 PMCID: PMC9932918 DOI: 10.3389/fpubh.2023.1105847] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Nontreponemal and treponemal tests for analyzing cerebrospinal fluid to confirm the existence of neurosyphilis have been widely used, so we aim to evaluate and compare their performance on the cerebrospinal fluid in the diagnosis of neurosyphilis. Methods We conducted a systematic literature search on five databases and utilized a bivariate random-effects model to perform the quantitative synthesis. Results Nontreponemal tests demonstrated a pooled sensitivity of 0.77 (95% CI: 0.68-0.83), a pooled specificity of 0.99 (95% CI: 0.97-1.00), and a summary AUC of 0.97 (95% CI: 0.95-0.98). The pooled sensitivity, pooled specificity, and summary AUC of treponemal tests were 0.95 (95% CI: 0.90-0.98), 0.85 (95% CI: 0.67-0.94), and 0.97 (95% CI: 0.95-0.98), respectively. The pooled specificity of all nontreponemal tests varied minimally (ranging from 0.97 to 0.99), with TRUST (0.83) having a higher pooled sensitivity than VDRL (0.77) and RPR (0.73). Among all treponemal tests, EIA has outstanding diagnostic performance with a pooled sensitivity of 0.99 and a pooled specificity of 0.98. Conclusion Nontreponemal tests exhibited a higher pooled specificity, and treponemal tests exhibited a higher pooled sensitivity in diagnosing neurosyphilis on cerebrospinal fluid. TRUST may be a satisfactory substitute for VDRL. EIA is a prospective diagnostic tool that deserves further study in the future. Our study may be useful to clinical laboratories in selecting appropriate serological tests on the cerebrospinal fluid for the diagnosis of neurosyphilis.
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Affiliation(s)
- Jia-Wen Xie
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Mao Wang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Ya-Wen Zheng
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yun He
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China,*Correspondence: Li-Rong Lin ✉
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2
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Liu M, Fan Y, Chen J, Yang J, Gao L, Wu X, Xu X, Zhang Y, Yue P, Cao W, Ji Z, Su X, Wen S, Kong J, Zhou G, Li B, Dong Y, Liu A, Bao F. Efficacy and Safety of Treatments for Different Stages of Syphilis: a Systematic Review and Network Meta-Analysis of Randomized Controlled Trials and Observational Studies. Microbiol Spectr 2022; 10:e0297722. [PMID: 36377935 PMCID: PMC9769634 DOI: 10.1128/spectrum.02977-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Parenteral penicillin is the first-line regimen for treating syphilis. However, allergic reactions and poor drug tolerance still present challenging problems with respect to use of this antibiotic. This study aimed to evaluate the efficacy and safety of ceftriaxone, erythromycin, minocycline, tetracycline, and doxycycline for syphilis treatment, compared with penicillin, to determine which antibiotic could be a better substitute for penicillin. This study included 17 articles, comprising 3 randomized controlled trials (RCTs) and 14 observational studies and involving 4,485 syphilis patients. Estimated risk ratios (RRs) and 95% confidence interval (CIs) were used to compare the serological response rates. At the 6- and 12-month follow-ups, the serological response rates were compared by direct meta-analysis and network meta-analysis (NMA). Based on direct meta-analysis, the serological response rates at the 3- and 24-month follow-ups were compared. Our NMA showed a higher serological response rate for ceftriaxone than for penicillin at the 6-month follow-up (RR of 1.12, 95% CI of 1.02 to 1.23). Ceftriaxone was equally effective as penicillin for syphilis in terms of serological response rates, and it was a better substitute for penicillin than ceftriaxone, erythromycin, minocycline, tetracycline, or doxycycline. However, more large-scale, high-quality, double-blind trials are still needed to determine whether ceftriaxone can safely replace penicillin for the treatment of syphilis when necessary. IMPORTANCE Parenteral penicillin is the first-line regimen for syphilis treatment. However, allergic reactions and poor drug tolerance still present emerging threatening problems with respect to use of this antibiotic. Our results showed a higher serological response rate for ceftriaxone than for penicillin at the 6-month follow-up. Sufficient data are not available for demonstrating significant differences in the efficacy of the other four antibiotics (erythromycin, minocycline, tetracycline, and doxycycline) for treating syphilis. In the clinical treatment of syphilis in patients who are allergic to penicillin or for whom penicillin is not available, ceftriaxone appears to be a better alternative treatment. This meta-analysis provides a reference for clinical treatment of syphilis. Currently, a lack of sufficient evidence to guide antibiotic treatment of syphilis exists, and a need for more high-quality RCTs is still present. This network meta-analysis can lay a foundation for further research.
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Affiliation(s)
- Meixiao Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jiaru Yang
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Li Gao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xinya Wu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xin Xu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yu Zhang
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Peng Yue
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xuan Su
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jing Kong
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Guozhong Zhou
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Bingxue Li
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yan Dong
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Aihua Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
| | - Fukai Bao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
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Berger JI, Vernon K, Abdo F, Gulati S, Hariharan R. Looks Like Neurosyphilis, Feels Like Guillain-Barre: At the Confluence of Infection and Immunology. Cureus 2022; 14:e26318. [PMID: 35911366 PMCID: PMC9314239 DOI: 10.7759/cureus.26318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
We present a 51-year-old male, with a past medical history of type 2 insulin-dependent diabetes mellitus (T2IDDM) without neuropathy, coronavirus disease 2019 (COVID-19) in April 2020 without residual symptoms, Raynaud's, and recent occupational outdoor exposure to insects as a construction manager who came to the emergency room complaining of a three-week history of bilateral progressive numbness and weakness beginning in his lower extremities and ascending toward his pelvis. Notably, he received the second dose of his Moderna COVID-19 vaccine one week prior to symptom onset and four weeks prior to admission. He also reported a recent appearance of a maculopapular rash on his upper extremities and flanks. Physical exam was remarkable for bilateral distal motor weakness in the upper and lower extremities with associated paresthesia and decreased reflexes in the lower extremities. The patient had slight ataxia and difficulty with heel walk and toe walk. Notably, the cranial nerve exam was normal, and the patient was afebrile. Intravenous immune globulin (IVIG) was started empirically for the treatment of Guillain-Barre syndrome (GBS), and doxycycline 100mg intravenous twice a day and ceftriaxone 2g intravenous daily were started for possible tick-borne disease. Subsequently, rapid plasma reagin (RPR) returned reactive at 1:64, and cerebral spinal fluid (CSF) venereal disease research laboratory (VDRL) test was reactive at 1:2 with markedly elevated protein and pleocytosis. Human immunodeficiency virus (HIV) testing was negative. Lyme disease testing was negative. Nerve conduction studies (NCS) and electromyography (EMG) showed a sensorimotor polyneuropathy with mixed demyelinating and axonal features. IVIG was continued for a total of five days, and antibiotics were changed to penicillin G (PCN G) for a total of 14 days for definitive treatment of early neurosyphilis (NS). While both clinical and laboratory findings confirm a positive diagnosis of NS, the patient’s CSF composition showed very elevated total protein levels and pleocytosis. Additionally, his early peripheral neuropathy and EMG findings are not characteristics of a single disease and, instead, suggested a mixed pathology. We postulate that this patient had confirmed secondary syphilis with early NS associated with, and possibly correlated with, a simultaneous episode of acute inflammatory demyelinating polyneuropathy (AIDP) and/or a vaccine-related phenomenon.
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Niimura M, Imai H. Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report. NMC Case Rep J 2022; 8:637-643. [PMID: 35079528 PMCID: PMC8769426 DOI: 10.2176/nmccrj.cr.2021-0098] [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: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Neurosyphilis is an infection of the central nervous system by Treponema pallidum. Gummatous neurosyphilis, especially spinal syphilitic gumma, is an exceedingly rare manifestation and may be misdiagnosed as other tumors due to its rarity. A 42-year-old man with a medical history of treatment for syphilis presented with rapidly progressive leg paralysis, leg sensory disturbance, and bladder and rectal disturbance. Spinal MRI demonstrated an intradural extramedullary lesion strongly compressing the spinal cord at the T6/7 level, which was accompanied with dural tail sign and perilesional meningeal thickening at the T6–T8 levels. Small intradural extramedullary lesions were also detected at the T1 and T8 levels. Serological and cerebrospinal fluid examinations for syphilis were both positive. In the treatment of spinal syphilitic gumma, the decompression of the spinal cord by lesionectomy followed by postoperative antibiotic treatment is considered to be an optimal procedure in patients with rapid progression of neurological deterioration. In the present case, the symptomatic main lesion that was compressing the thoracic cord was excised by surgery and analyzed by histopathological examination, and another small asymptomatic lesion was resolved by postoperative antibiotic treatment. Spinal syphilitic gumma was diagnosed using both histopathological findings of the surgically resected lesion and another residual lesion that was resolved by postoperative antibiotic treatment.
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Affiliation(s)
- Manabu Niimura
- Department of Neurosurgery, Shinagawa Shisyokai Hospital, Tokyo, Japan.,Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
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5
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Rival G, Okorji O, Kern R, Patel P, Fradeneck K, Cullen D. Bilateral Cranial Nerve VI Palsies in Cryptococcal Meningitis, HIV, and Syphilis: A Case Report. Clin Pract Cases Emerg Med 2021; 5:515-518. [PMID: 34813461 PMCID: PMC8610467 DOI: 10.5811/cpcem.2021.8.53347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/21/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Cranial nerve (CN) VI palsy is a common complaint seen in the emergency department (ED) and has a wide range of causes. Bilateral CN VI palsies are uncommon and appear to be associated with more severe complications. CASE REPORT A 29-year-old male presented to the ED from an ophthalmology office for diplopia, headache, and strabismus. He was found to have bilateral CN VI palsies and new-onset seizure in the ED. A lumbar puncture revealed cryptococcal meningitis. Additional tests revealed a new diagnosis of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and syphilis. CONCLUSION Cryptococcal meningitis remains a life-threatening complication of HIV/AIDS. Coinfections with HIV, particularly syphilis, further complicate a patient's prognosis as both can lead to devastating neurological sequelae. In cryptococcal meningitis, elevated intracranial pressure is a complication that can manifest as seizures, altered mental status, and cranial nerve palsies.
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Affiliation(s)
- Germaine Rival
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Onyi Okorji
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Rachael Kern
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Preya Patel
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Kate Fradeneck
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Darragh Cullen
- Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania
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6
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Boog GHP, Lopes JVZ, Mahler JV, Solti M, Kawahara LT, Teng AK, Munhoz JVT, Levin AS. Diagnostic tools for neurosyphilis: a systematic review. BMC Infect Dis 2021; 21:568. [PMID: 34126948 PMCID: PMC8201870 DOI: 10.1186/s12879-021-06264-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/01/2021] [Indexed: 01/29/2023] Open
Abstract
Purpose Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods. Methods We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Information was synthesized in tables. The risk of bias was examined using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy recommendations. Results Fourteen studies were included. The main finding was a remarkable diversity of tests, which had varied purposes, techniques, and evaluation methodologies. There was no uniform criterion or gold standard to define neurosyphilis. The current basis for its diagnosis is clinical suspicion and cerebrospinal fluid analysis. There are new promising tests such as PCR tests and chemokine measurement assays. Conclusions The diagnosis of neurosyphilis is still a challenge, despite the variety of existing and developing tests. We believe that the multiplicity of reference standards adopted as criteria for diagnosis reveals the imprecision of the current definitions of neurosyphilis. An important next step for the scientific community is to create a universally accepted diagnostic definition for this disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06264-8.
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Affiliation(s)
| | | | | | - Marina Solti
- Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Anna S Levin
- Infection Control Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Tuddenham S, Katz SS, Ghanem KG. Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests. Clin Infect Dis 2021; 71:S21-S42. [PMID: 32578862 PMCID: PMC7312285 DOI: 10.1093/cid/ciaa306] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960–2017, and for data related to the venereal disease research laboratory test from 1940–1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha S Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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8
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Li Y, Jiang G. Azithromycin vs penicillin G benzathine for early syphilis: A meta-analysis of randomized controlled trials. Dermatol Ther 2020; 33:e14025. [PMID: 32677163 DOI: 10.1111/dth.14025] [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: 05/29/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
Syphilis is a very serious infection that causes acute cutaneous manifestations. Penicillin is the gold standard for treating syphilis. This meta-analysis was conducted based on self-published randomized controlled trials (RCTs) data to compare the efficacy of azithromycin with penicillin for treating syphilis. RCTs on azithromycin vs penicillin for the treatment of syphilis were retrieved from the Cochrane Library, MEDLINE, EBSCO, Embase, Ovid, and other databases, and the estimated risk ratio (RR) and 95% confidence interval (CI) were used to study the following outcome indicators: 3-month response rate, 6-month response rate, 12-month response rate, recurrence rate, serum fixation rate, and failure rate. This meta-analysis included seven RCTs involving 639 subjects (of whom 335 were treated with azithromycin and 304 were treated with penicillin). There was no significant difference in the 3-month response rate (RR = 0.97, 95% CI: 0.79-1.19), 6-month response rate (RR = 1.01, 95% CI: 0.85-1.20), 12-month response rate (RR = 1.02, 95% CI: 0.97-1.09), serum fixation rate (RR = 0.71, 95% CI: 0.24-2.12), and failure rate (RR = 0.62, 95% CI: 0.33-1.16). In summary, there is no evidence in the literature that azithromycin is less effective than penicillin for treating syphilis.
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Affiliation(s)
- Yizhi Li
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Dermatology, Xuzhou Medical University, Xuzhou, China
| | - Guan Jiang
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Dermatology, Xuzhou Medical University, Xuzhou, China
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9
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Morris JE, Ivos M, Axe D. Recurrent ocular syphilis in a patient living with HIV. Int J STD AIDS 2020; 31:1114-1116. [PMID: 32829675 DOI: 10.1177/0956462420906923] [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: 11/15/2022]
Abstract
A 26-year-old male living with human immunodeficiency virus (HIV) and who had previously been treated for ocular syphilis presented to the Emergency Department with progressive vision loss and uveitis. The efficacy of standard management for neurosyphilis in HIV and recurrence was examined.
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Affiliation(s)
- James E Morris
- Department of Surgery, Division of Emergency Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Mia Ivos
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - David Axe
- Department of Ophthalmology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
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Abstract
Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.
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Affiliation(s)
- Lynn K Gordon
- Department of Ophthalmology Stein Eye Institute, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA
| | - Helen Danesh-Meyer
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
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11
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Lu Y, Ke W, Yang L, Wang Z, Lv P, Gu J, Hao C, Li J, Cai Y, Gu M, Liu H, Chen W, Zhang X, Wang L, Liu Y, Yang B, Zou H, Zheng H. Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study. BMC Infect Dis 2019; 19:1017. [PMID: 31791265 PMCID: PMC6886180 DOI: 10.1186/s12879-019-4582-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.
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Affiliation(s)
- Yong Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Ping Lv
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yumao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Mei Gu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Hongfang Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Wenjing Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Xiaohui Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Liuyuan Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Yahui Liu
- Qingyuan Chronic Disease Prevention Hospital, Qingyuan, 511500, Guangdong, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China. .,Kirby Institute, The University of New South Wales, Sydney, Australia.
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.
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Ceccarelli G, Borrazzo C, Lazzaro A, Innocenti GP, Celani L, Cavallari EN, Pinacchio C, Santinelli L, Mastroianni CM, d'Ettorre G. Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study. Brain Sci 2019; 9:brainsci9100278. [PMID: 31627294 PMCID: PMC6826495 DOI: 10.3390/brainsci9100278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in cases of (1) late syphilis (acquired >2 years previously), (2) CD4+ cells ≤ 350/mm3 and/or a serum Venereal Disease Research Laboratory/Rapid Plasma Reagin (VDRL/RPR) title > 1:32, (3) “serological failure” after syphilis therapy, and (4) the use of alternative treatment for syphilis. In the present study, we aimed to verify the accuracy of the guideline’s criteria for the indication of LP in the suspicion of ANS in a cohort of PLWH. Methods: This retrospective study was carried out in a cohort of PLWH referred at a single medical center of a large academic hospital in Italy. Clinical and laboratory data of patients diagnosed with late syphilis were extracted from the cohort and analyzed. The European Guidelines of syphilis were adopted for patient management. Results: Out of a cohort of 713 PLWH, only 51 (7%) had a diagnosis of late syphilis and were therefore included in the study. Thirty-one subjects (61%) met one or more diagnostic criteria to perform LP: 39% (12/31) of patients undergoing LP had a diagnosis of ANS. The accuracy of predictive criteria for ANS, suggested by the guidelines, was 62% for RPR > 1:32 and 74% for CD4+ ≤ 350 cc/µL. The simultaneous occurrence of both criteria (RPR > 1:32 plus CD4+ ≤ 350 cc/µL) achieved a diagnostic accuracy of 59%. Interestingly, only 17% of patients who underwent LP for serological failure were eventually diagnosed positive for ANS. Conclusion: Asymptomatic neurosyphilis represents a challenging, but not uncommon, diagnosis. Therefore, it requires a careful investigation. Low CD4+ cell count and RPR > 1:32 remain excellent predictors of neurosyphilis, but have become the only acceptable predictors of ANS in PLWH. “Serologic failure” should be regarded with caution as a criterion to perform LP in order to investigate possible ANS in HIV-syphilis coinfected patients asymptomatic for neurological disorders. The retrospective nature of this single-site study may represent a limit to the interpretation of the data. Thus, larger clinical studies on the topic are warranted.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy.
| | - Giuseppe Pietro Innocenti
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Eugenio Nelson Cavallari
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.
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Süße M, Hannich MJ, Holbe C, Ruhnau J, Sarnowski B, Dressel A. Intrathecal inflammation in young stroke. Acta Neurol Scand 2019; 140:9-16. [PMID: 30939222 DOI: 10.1111/ane.13094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients. MATERIALS AND METHODS Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. A total of 122 were classified as young stroke (≤55 years), and 156 were classified as older stroke patients; lumbar puncture in this cohort was indicated due to atypical clinical presentation. RESULTS An infectious etiology was detected in 2.5% of young stroke patients (n = 3: vasculitis due to opportunistic infection, vasculitis due to neuroborreliosis, secondary vasospasm after viral meningitis) and in 1.9% (n = 3) in the older stroke cohort (vasculitis due to neurotuberculosis, septic embolic ischemia, vasculitis post-haemophilus influenza meningoencephalitis). Isolated vasculitis was evident in one patient of the older stroke cohort (0.6%). Non-specific alterations in CSF included increased cell count in 10% in young and in 9.3% in the older stroke cohort. Intrathecal Ig synthesis was present in 3.4% of the younger and in 4% of the older stroke cohort. CONCLUSIONS The prevalence of an infectious etiology in young stroke is modest but slightly higher in comparison with older stroke patients. As brain imaging is not always sufficient for suspecting vasculitis, we recommend implementation of lumbar puncture in young cryptogenic stroke patients. If an infectious disease is present in ischemic stroke, it is of high therapeutic relevance.
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Affiliation(s)
- Marie Süße
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Malte Johannes Hannich
- Institute of Clinical Chemistry and Laboratory Medicine University Medicine Greifswald Greifswald Germany
| | - Christine Holbe
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Johanna Ruhnau
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Bettina Sarnowski
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Alexander Dressel
- Departement of Neurology University Medicine Greifswald Greifswald Germany
- Departement of Neurology Carl‐Thiem Klinikum Cottbus Cottbus Germany
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Consider Syphilis in Case of Lymphopenia in HIV-Infected Men Who Have Sex with Men (MSM): A Single-center, Retrospective Study. Infect Dis Ther 2018; 7:485-494. [PMID: 30377976 PMCID: PMC6249181 DOI: 10.1007/s40121-018-0219-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction The way syphilis affects the immunologic and virologic parameters of a human immunodeficiency virus (HIV) infection remains controversial. The aim of this study was to investigate the impact of syphilis infection on lymphocyte and lymphocyte subset counts as well as viral load in HIV-infected patients. Methods All HIV-infected patients attending the outpatient clinic for infectious diseases of Hannover Medical University Hospital diagnosed with syphilis between 2009 and 2016 were retrospectively evaluated for changes in total lymphocyte, B cell, CD3+ T cell, CD4+ and CD8+ T cell counts as well as in HIV viral load. These parameters were assessed at three different time points, i.e., 3–6 months before, at diagnosis and 3–6 months after treatment of syphilis. Results Eighty-four HIV-infected patients, all with early syphilis, were identified. The vast majority were men who have sex with men (MSM), and 80% were receiving antiretroviral therapy (ART). Syphilis was associated with a significant reduction in the total lymphocyte count and counts of all studied lymphocyte subsets, including CD4+ T cells, whose percentage among lymphocytes did not change. No significant changes in HIV viral load were observed at any of the studied time points. Further, antibiotic treatment of syphilis restored lymphocyte counts back to pretreatment levels. Conclusion Syphilis induces a relative non-CD4+ T cell-specific lymphopenia in HIV-infected patients. Our data suggest that serologic testing for syphilis should be considered in HIV-infected MSM in case of an otherwise unexplained drop in total lymphocyte count. Electronic supplementary material The online version of this article (10.1007/s40121-018-0219-9) contains supplementary material, which is available to authorized users.
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Abstract
RATIONALE We report a rare case of syphilitic meningomyelitis presenting with visceral crisis and possessing characteristic imaging findings. PATIENT CONCERNS The patient, a 50-year-old woman, complained of pain in the upper abdomen and back. She then developed numbness in both lower extremities and weakness in the left lower limb. DIAGNOSIS Magnetic resonance imaging (MRI) of the spinal cord revealed the candle guttering sign and irregular enhancement at the T6 level. Rapid plasma reagin test of the cerebrospinal fluid yielded a titer of 1:8. Thus, the patient was diagnosed with syphilitic meningomyelitis. INTERVENTIONS She was treated with ceftriaxone and dexamethasone after the failure of penicillin treatment. OUTCOMES She could perform the activities of daily living, and her pain completely disappeared. LESSONS A patient with syphilitic meningomyelitis can present with visceral crisis caused by the involvement of the posterior nerve roots or the posterior horn, which usually occurs in patients with tabes dorsalis. Considering the non-specific symptoms and MRI features, we should be aware that abdominal pain may be a symptom of myelopathy, and syphilitic meningomyelitis ought to be taken into account in a patient with longitudinally extensive myelitis.
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Affiliation(s)
- Li Sun
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun
| | - Nannan Zheng
- Department of Neurology, Taiyuan Central Hospital, 5th lane of east Jiefang Road, Taiyuan, P.R China
| | - Yu Yang
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun
| | - Hai-Ning Zhang
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun
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Incidence of asymptomatic neurosyphilis in serofast Chinese syphilis patients. Sci Rep 2017; 7:15456. [PMID: 29133821 PMCID: PMC5684362 DOI: 10.1038/s41598-017-15641-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/31/2017] [Indexed: 11/20/2022] Open
Abstract
More new diagnosed syphilis cases were reported in china, the incidence and relevant factors of asymptomatic neurosyphilis (ANS) in serofast syphilis patients were unclear. Clinical and laboratory data of 402 Human Immunodeficiency Virus (HIV) negative, serofast syphilis patients, who underwent lumbar puncture at the Peking University Ditan Teaching Hospital between September 2008 and August 2016, were collected. Incidence of ANS was verified and the relevant factors were further analyzed. According to the ANS criteria, 139 (34.6%) patients had ANS. Of these, 40 (28.8%) had reactive cerebrospinal fluid (CSF), rapid plasma reagin (RPR) positive, 115 (82.7%) had CSF white blood cell (WBC) count > 5 × 106/L, 28 (20.1%) had CSF protein concentration > 45 mg/dL (without other neurological diseases). Patients aged 51–60 years, of non-Han ethnicity, with serum RPR titer 1:32 and ≥ 1:64 were 2.28-fold, 9.11-fold, 5.12-fold and 5.69-fold, respectively, more likely to have ANS. The incidence of ANS was 34.6% among Chinese serofast syphilis patients. Age, ethnicity and serum RPR titer were associated with high risk of ANS.
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Perez Barragán E, Urdez Hernández E, Pérez Orozco B, Sánchez González M. Meningovascular neurosyphilis with basilar artery thrombosis in HIV patient. J Infect Public Health 2017; 11:439-441. [PMID: 28993174 DOI: 10.1016/j.jiph.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/16/2017] [Accepted: 09/09/2017] [Indexed: 12/01/2022] Open
Abstract
Currently, neurosyphilis is an uncommon disease and may occur at any stage of syphilis. Co-infection of syphilis with HIV can affect the clinical course. We report a case of meningovascular neurosyphilis in a patient with HIV in whom basilar artery thrombosis and reactive VDRL in CSF were detected. Treatment with penicillin was instituted with adequate response showing clinical improvement. Neurosyphilis is a differential diagnosis in young patients with cerebral infarction, especially in HIV patients.
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Affiliation(s)
- Edgar Perez Barragán
- Infectious Diseases Department, Infectious Diseases Hospital, National Medical Center "La Raza", IMSS, Ciudad de Mexico, Mexico.
| | - Elena Urdez Hernández
- Infectious Diseases Department, Infectious Diseases Hospital, National Medical Center "La Raza", IMSS, Ciudad de Mexico, Mexico
| | - Bernardo Pérez Orozco
- Infectious Diseases Department, Infectious Diseases Hospital, National Medical Center "La Raza", IMSS, Ciudad de Mexico, Mexico
| | - Mariela Sánchez González
- Radiology Department, Specialty Hospital, National Medical Center "La Raza", IMSS, Ciudad de Mexico, Mexico
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Liu HY, Han Y, Chen XS, Bai L, Guo SP, Li L, Wu P, Yin YP. Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies. PLoS One 2017; 12:e0180001. [PMID: 28658325 PMCID: PMC5489196 DOI: 10.1371/journal.pone.0180001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/07/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Parenteral penicillin is the first-line regimen for treating syphilis, but unsuitable for some patients due to penicillin allergy and lacking health resources. Unfortunately, the efficacy of penicillin alternatives remains poorly understood. This study aimed to assess the efficacy of ceftriaxone and doxycycline/tetracycline in treating early syphilis relative to that of penicillin, and thereby to determine which antibiotic is a better replacement for penicillin. METHOD By searching literature from PubMed, Cochrane Central Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov and systematically screening relevant studies, eligible randomized controlled trials (RCTs) and observational studies on treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and combined in this systematic review. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were utilized to compare their serological response and treatment failure rates. At 12-month follow up, serological response rates were compared by a direct meta-analysis and network meta-analysis (NMA), while treatment failure rates were compared with a direct meta-analysis. RESULT Three RCTs and seven cohort studies were included in this research. The results of NMA demonstrated that no significant differences existed in serological response rate at 12-month follow-up between any two of the three treatments (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs. doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89). CONCLUSION Ceftriaxone is as effective as penicillin in treating early syphilis with regard to serological response and treatment failure rate. Compared with doxycycline/tetracycline, ceftriaxone appears to be a better choice as the substitution of penicillin.
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Affiliation(s)
- Hong-ye Liu
- Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Han
- Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Xiang-sheng Chen
- Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Li Bai
- Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Shu-ping Guo
- Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Li Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Peng Wu
- Health Statistics Teaching and Research Section, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yue-ping Yin
- Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- * E-mail:
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Yang C, Li G, Fang J, Liu H, Yang B, Xu Y. Spinal Intramedullary Syphilitic Gumma: An Unusual Presentation of Neurosyphilis. World Neurosurg 2016; 95:622.e17-622.e23. [DOI: 10.1016/j.wneu.2016.07.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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Roberts CP, Klausner JD. Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men. Expert Rev Anti Infect Ther 2016; 14:1037-1046. [PMID: 27626361 DOI: 10.1080/14787210.2016.1236683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Syphilis and human immunodeficiency virus (HIV) coinfection disproportionately affects men who have sex with men (MSM), and the rate of coinfection has been increasing over the last decade. HIV and syphilis coinfection is particularly challenging because the infections interact synergistically thereby increasing the risk of acquisition and transmission as well as accelerating disease progression. Areas covered: This paper reviews and summarizes the epidemiology, pathogenesis, diagnosis, clinical management and prevention of HIV and syphilis coinfection among MSM. Expert commentary: Research does not support a different syphilis treatment for coinfected individuals; however, coinfection may warrant a recommendation for antiretroviral therapy. In order to reverse the epidemic of syphilis and HIV coinfection, there needs to be greater awareness, improved cultural sensitivity among health care providers, improved access to preventative services and increased screening for syphilis and HIV.
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Affiliation(s)
- Chelsea P Roberts
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA
| | - Jeffrey D Klausner
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Division of Infectious Diseases, Department of Medicine , University of California, Los Angeles , Los Angeles , CA , USA
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