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Thapa R, Pandey P, Parat MO, Gurung S, Parekh HS. Phase transforming in situ gels for sustained and controlled transmucosal drug delivery via the intravaginal route. Int J Pharm 2024; 655:124054. [PMID: 38548071 DOI: 10.1016/j.ijpharm.2024.124054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
Direct, reliable, controlled, and sustained drug delivery to female reproductive tract (FRT) remains elusive, with conventional dosage forms falling way short of the mark, leading to premature leakage, erratic drug delivery, and loss of compliance. Historically, the intravaginal route remains underserved by the pharmaceutical sector. To comprehensively address this, we turned our focus to phase-transforming sol-gels, using poloxamers, a thermosensitive polymer and, doxycycline (as hyclate salt, DOXH) as our model agent given its potential use in sexually transmitted infections (STIs). We further enhanced mucoadhesiveness through screening of differing viscosity grade hydroxypropyl methyl celluloses (HPMCs). The optimised sol-gels remained gelled at body temperature (<37 °C) and were prepared in buffer aligned to vaginal cavity pH and osmolality. Lead formulations were progressed based on their ability to retain key rheological properties, and acidic pH in the presence of simulated vaginal fluid (SVF). From a shelf-life perspective, DOXH stability, gelation temperature (Tsol-gel), and pH to three months (2-8 °C) was attained. In summary, the meticulously engineered, phase-transforming sol-gels provided sustained mucoretention despite dilution by vaginal fluid, paving the way for localised antimicrobial drug delivery at concentrations that potentially far exceed the minimum inhibitory concentration (MIC) for target STI-causing bacteria of the FRT.
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Affiliation(s)
- Ritu Thapa
- School of Pharamcy, The University of Queensland, 20 Cornwall St, Woollongabba, QLD 4102, Australia
| | - Preeti Pandey
- School of Pharamcy, The University of Queensland, 20 Cornwall St, Woollongabba, QLD 4102, Australia.
| | - Marie-Odile Parat
- School of Pharamcy, The University of Queensland, 20 Cornwall St, Woollongabba, QLD 4102, Australia
| | - Shila Gurung
- School of Health and Allied Sciences, Pokhara University, Pokhara-30, Kaski 33700, Nepal
| | - Harendra S Parekh
- School of Pharamcy, The University of Queensland, 20 Cornwall St, Woollongabba, QLD 4102, Australia.
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Ding D, Gao J, Zhang W, Xu D. The Diagnostic Performance of Laboratory Tests of Neurosyphilis: A Systematic Review and Network Meta-Analysis. Eur Neurol 2023; 86:418-429. [PMID: 37549649 DOI: 10.1159/000531341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/24/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The gold standard for diagnosing neurosyphilis (NS) is currently unavailable; various laboratory parameters in cerebrospinal fluid (CSF) and blood can assist in the diagnosis. METHODS PubMed, Embase, and the Cochrane Library were searched. Studies utilizing laboratory tests to assist in the diagnosis of NS were included. The pooled indicators for diagnostic performance and their respective 95% confidence intervals (CIs) were calculated. We used the superiority index to test the superiority of a diagnostic test. RESULTS Eleven citations were included in the study. Albumin quotient, CSF-TPHA, CSF-EIA, CSF-LDH, CSF-WBC, CSF-CXCL13, FTA-ABS, CSF-PCR, RPR, CSF-TPPA, TRUST, and CSF-venereal diseases research laboratory (VDRL) were assessed in the studies included. The pooled estimates of sensitivity, specificity, AUC of SROC and their respective 95% CIs for CSF-TPPA and CSF-VDRL were 0.97 (0.17, 1.00), 0.84 (0.62, 0.95), 0.93 (0.91, 0.95) and 0.74 (0.59, 0.85), 0.99 (0.93, 1.00), 0.94 (0.91, 0.96), respectively. CSF-TPHA demonstrated the highest relative sensitivity. CSF-VDRL manifested the highest specificity. CSF-TPHA, TRUST, CSF-VDRL, CSF-EIA, and RPR ranked in the top five laboratory tests with superiority index. CONCLUSION CSF-TPHA, TRUST, CSF-VDRL, CSF-EIA, and RPR indicate acceptable performance in detecting NS compared to other modalities. Comprehensive diagnostic strategies still play a significant role in the diagnosis of NS.
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Affiliation(s)
- Duyu Ding
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junhua Gao
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Center for Cognitive Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Neurology, Center for Cognitive Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory on Parkinson Disease, Beijing, China
| | - Dongmei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Terzi HA, Aydemir O, Karakece E, Hatipoglu H, Olmez M, Koroglu M, Altindis M. Investigation of the rapid immunochromatographic test performance in the diagnosis of syphilis; comparison of four serological methods. J LAB MED 2020. [DOI: 10.1515/labmed-2019-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
To test the performance of the newly available rapid test for syphilis, we compared it with Treponema pallidum hemagglutination assay (TPHA). Additionally, we investigated the performance of rapid plasma reagin (RPR) and chemiluminescence microparticle immunoassays (CMIA) at our laboratory using TPHA as a gold standard.
Methods
The serum samples of 595 patients with the pre-diagnosis of syphilis were studied by four serological methods. The sensitivity, specificity, and predictive values of RPR, CMIA, and syphilis rapid test were assessed by utilizing TPHA as a gold standard for the diagnosis of syphilis.
Results
Of the patients, 6.2% (37/595) had positive RPR, 5.5% (33/595) had positive CMIA, 5.5% (33/595) had a positive rapid immunochromatographic method and 5% (30/595) had positive TPHA. When TPHA results were taken as the reference, the sensitivity of the rapid test for syphilis was 100%, the specificity was 99.5%, PPV was 90.9%, and NPV was 100.0%.
Conclusions
It was observed that the rapid test for syphilis used in the study was quite successful, its cost was appropriate, and the test was very fast and easy to apply. At the same time, the agreement between syphilis rapid test and TPHA was found to be excellent.
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Affiliation(s)
- Huseyin Agah Terzi
- Department of Microbiology , Sakarya University, Research/Training Hospital , Sakarya , Turkey
| | - Ozlem Aydemir
- Department of Microbiology , Sakarya University, Research/Training Hospital , Sakarya , Turkey
| | - Engin Karakece
- Department of Microbiology , Sakarya University, Research/Training Hospital , Sakarya , Turkey
| | - Huseyin Hatipoglu
- Department of Microbiology , School of Medicine, Sakarya University , Sakarya , Turkey
| | - Mehmet Olmez
- Department of Microbiology , School of Medicine, Sakarya University , Sakarya , Turkey
| | - Mehmet Koroglu
- Department of Microbiology , School of Medicine, Sakarya University , Sakarya , Turkey
| | - Mustafa Altindis
- Department of Microbiology , School of Medicine, Sakarya University , Sakarya , Turkey
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Ahn JY, Boettiger D, Kiertiburanakul S, Merati TP, Huy BV, Wong WW, Ditangco R, Lee MP, Oka S, Durier N, Choi JY. Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database. J Int AIDS Soc 2016; 19:20965. [PMID: 27774955 PMCID: PMC5075717 DOI: 10.7448/ias.19.1.20965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/29/2016] [Accepted: 09/14/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. METHODS Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. RESULTS We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. CONCLUSIONS We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.
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Affiliation(s)
- Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | | | | | - Tuti Parwati Merati
- Faculty of Medicine, Udayana University and Sanglah Hospital, Bali, Indonesia
| | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Shinichi Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Nicolas Durier
- TREAT Asia, Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea;
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Kararizou E, Mitsonis C, Dimopoulos N, Gkiatas K, Markou I, Kalfakis N. Psychosis or Simply a New Manifestation of Neurosyphilis? J Int Med Res 2016; 34:335-7. [PMID: 16866029 DOI: 10.1177/147323000603400314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. Neurosyphilis was diagnosed during the clinical evaluation. Blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal Disease Research Laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin G and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.
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Affiliation(s)
- E Kararizou
- Department of Neurology, Eginition Hospital, Athens National University, Athens, Greece.
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Kingston MA, Higgins SP. Audit of the Management of Early Syphilis at North Manchester General Hospital. Int J STD AIDS 2016; 15:352-4. [PMID: 15117508 DOI: 10.1177/095646240401500516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The city of Manchester has seen a sustained increase in reported cases of early (infectious) syphilis since the late 1990s. We audited the management of patients presenting with early syphilis to North Manchester General Hospital, with reference to the UK national guidelines. Between January 1999 and December 2001 72 cases of early syphilis were identified. Most (90%) occurred in men who have sex with men, 50% of whom were HIV-positive. Serology and polymerase chain reaction testing of lesions were useful diagnostic tests. Treatment regimens followed the national guidelines in 63% of cases, with adherence to the guidelines improving as the outbreak continued. The majority of patients were treated with intramuscular penicillin (78%), with only three discontinuing this treatment due to side effects. Only 4% of sexual contacts identified were traced and screened, an indication of high levels of both anonymous sex and partner change in this group.
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Affiliation(s)
- M A Kingston
- Department of Genitourinary Medicine, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB, UK
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7
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Rotanov SV, Ermatova FA. Using IgM methods in the diagnostics of syphilis. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-4-83-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors present the results of a questionnaire survey conducted in serological laboratories in 60 dermatovenerology enterprises in the subjects of the Russian Federation on the use of up-to-date methods for the determination of Class M antibodies for the diagnostics of early syphilis. It was revealed that treponemal specific Class M antibodies were determined in 86.67% of laboratories: the EIAIgM method was used in 86.67% of laboratories, IBIgM - in 18.33%, and PHTIgM - in 6.67% of laboratories only. The total number of IgM tests did not exceed 1.3% of the entire volume of immunochemical reactions conducted for the diagnostics of syphilis in laboratories in 2012; as for IgM methods, the use of EIAIgM prevailed - 97.27% while the frequency of using PHTIgM and IBIgM was 2.0 and 0.73%, respectively. In the authors’ opinion, such ratios were stipulated by the absence of production of kits made in Russia during the study period (in 2012) and allowed for use for methods such as PHTIgM and IBIgM while there was a wide choice of kits required for EIAIgM and laboratories had a long-term experience of using this method.
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8
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Negasheva ES, Rotanov SV. Clinical and serological surveillance of patients treated for early syphilis forms. ACTA ACUST UNITED AC 2015. [DOI: 10.17116/klinderma201514442-49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Abstract
OBJECTIVE Neurosyphilis is caused by dissemination into the central nervous system of Treponema pallidum. Although the incidence of syphilis in the Netherlands has declined since the mid-1980s, syphilis has re-emerged, mainly in the urban centres. It is not known whether this also holds true for neurosyphilis. METHODS The epidemiology of neurosyphilis in Dutch general hospitals in the period 1999-2010 was studied in a retrospective cohort study. Data from the Dutch sexually transmitted infection (STI) clinics were used to analyse the number of patients diagnosed with syphilis in this period. RESULTS An incidence of neurosyphilis of 0.47 per 100 000 adults was calculated, corresponding with about 60 new cases per year. This incidence was higher in the western (urbanised) part of the Netherlands, as compared with the more rural areas (0.6 and 0.4, respectively). The number of patients diagnosed with syphilis in STI clinics increased from 150 to 700 cases in 2004 and decreased to 500 new cases in 2010. The sex ratio was in favour of men, yielding a percentage of 90% of the syphilis cases and of 75% of the neurosyphilitic cases. The incidence of neurosyphilis was highest in men aged 35-65 years, and in women aged 75 years and above. The most frequently reported clinical manifestation of neurosyphilis was tabes dorsalis. In this study, 15% of the patients were HIV seropositive. CONCLUSION The incidence of neurosyphilis in a mixed urban-rural community such as the Netherlands is comparable to that in other European countries. Most patients are young, urban and men, and given the frequent atypical manifestations of the disease reintroduction of screening for neurosyphilis has to be considered.
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Zhu K, Zhou Q, Han R, Cheng H. Acute monoarthritis in a delayed diagnosis of syphilis patient with persistent rupioid psoriasis-like lesions. BMC Infect Dis 2012; 12:338. [PMID: 23216913 PMCID: PMC3524466 DOI: 10.1186/1471-2334-12-338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of syphilis is increasing in many parts of the world. Clinicians may have limited experience in the diagnosis when the clinical appearance is unusual. If early diagnosis is not made and prompt treatment not given, then the disease may remain quiescent until more serious symptoms or systemic involvement develops. Case presentation We report the first case of a delayed diagnosis of syphilis with a ten-year history of persistent rupioid psoriasis-like lesions. Acute monoarthritis and high fever together with aggravation of skin lesions led to a careful clinical examination. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Standard treatment with benzathine penicillin brought a partial and transient improvement. A complete clinical and serological resolution of the disease was achieved by a prolonged and repeated penicillin treatment combined with methylprednisolone. A 7-year follow-up of the patient proved a full recovery. Conclusion Our case highlights the fact that clinical signs of syphilis can be diverse and complicated. Unusual clinical manifestations can happen in an immunocompetent individual. Treatment strategy may need to be adjusted in a difficult case.
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Affiliation(s)
- Kejian Zhu
- Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No, 3 Qingchun Road East, Hangzhou, Zhejiang, People's Republic of China
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Rodríguez-Cerdeira C, Silami-Lopes V. Congenital Syphilis in the 21st Century. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Rodríguez-Cerdeira C, Silami-Lopes VG. Congenital syphilis in the 21st century. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:679-93. [PMID: 22382200 DOI: 10.1016/j.ad.2011.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 10/28/2022] Open
Abstract
While the prevalence of congenital syphilis continues to be low throughout most of the developed world, there has been a slight resurgence of the disease in several European countries, including Spain. In this context, we need to become more familiar with the signs and symptoms of this disease and consider its diagnosis in patients with only mild clinical manifestations. A definitive diagnosis may be difficult or even impossible in patients whose diagnostic tests reveal low positive titers or inconsistent results. The cornerstone of congenital syphilis control is prenatal screening and the treatment of infected mothers with penicillin, an effective and economical intervention. Based on a review of the literature supplemented by data from our own clinical experience, this article provides a detailed description of the clinical manifestations of congenital syphilis as well as the various diagnostic methods and treatments available.
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Spornraft-Ragaller P, Abraham S, Lueck C, Meurer M. Response of HIV-infected patients with syphilis to therapy with penicillin or intravenous ceftriaxone. Eur J Med Res 2011; 16:47-51. [PMID: 21463980 PMCID: PMC3353420 DOI: 10.1186/2047-783x-16-2-47] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Ceftriaxone is commonly used as an alternative antibiotic drug in treating syphilis but clinical data on its efficacy are limited. Objective: To evaluate the response of HIV-infected patients with active syphilis to treatment with penicillin or ceftriaxone. Methods A retrospective study involving 24 consecutive patients with a positive Veneral Disease Research Laboratory test (VDRL) and at least one specific treponemal test. 12 patients were treated with different regimens of high-dose penicillin G for at least 2 weeks. Another 12 patients were treated with ceftriaxone 1-2 g per day intravenously for 10-21 days. Results After a median follow up of 18,3 months all patients of the penicillin-treated group and 11 of 12 ceftriaxone-treated patients showed a ≥ 4-fold decline in VDRL-titers; 91% of them already within 6 months after therapy. Conclusion Our serological data demonstrate a comparable efficacy of currently recommened penicillin and ceftriaxone treatment regimens for active syphilis in HIV-infected patients.
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Affiliation(s)
- Petra Spornraft-Ragaller
- Dept. of Dermatology, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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14
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Abstract
After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade.
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Farhi D, Dupin N. Origins of syphilis and management in the immunocompetent patient: Facts and controversies. Clin Dermatol 2010; 28:533-8. [DOI: 10.1016/j.clindermatol.2010.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Krüger C, Malleyeck I. Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries. World J Pediatr 2010; 6:125-31. [PMID: 20490768 DOI: 10.1007/s12519-010-0028-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 10/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND With 700,000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania. METHODS For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed. RESULTS Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin. CONCLUSIONS Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.
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Affiliation(s)
- Carsten Krüger
- Department of Pediatrics, St. Franziskus Hospital, Ahlen, Germany.
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MAVLYUTOVA GI, MINULLIN IK, BiLDYUK YEV, GUBAIDULLiN RM. A case of late diagnostics of tertiary syphilis. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article describes a case of late diagnostics of tertiary syphilis affecting the musculoskeletal system in a patient who was under long-term supervision with a district general practitioner and who was diagnosed with thrombophlebitis. The diagnosis was verified only after the autotomy of the right lower leg
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Farhi D, Benhaddou N, Grange P, Zizi N, Deleuze J, Morini JP, Gerhardt P, Krivine A, Avril MF, Dupin N. Clinical and serologic baseline and follow-up features of syphilis according to HIV status in the post-HAART era. Medicine (Baltimore) 2009; 88:331-340. [PMID: 19910747 DOI: 10.1097/md.0b013e3181c2af86] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.
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Affiliation(s)
- David Farhi
- From Department of Dermatology and Venereology (DF, NZ, JD, JPM, PG, MFA, ND), Hôpital Cochin-Pavillon Tarnier, AP-HP, Université Paris 5-René Descartes, Paris; Department of Bacteriology (NB), Hôpital Cochin, AP-HP, Université Paris 5, Paris; Laboratoire de Recherche en Dermatologie et Centre National de Référence de la Syphilis (PG, ND), UPRES EA 1833, Université Paris 5-René Descartes, Paris; Department of Virology (AK), Hôpital Saint-Vincent de Paul, AP-HP, Université Paris 5, Paris, France
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Chao YC, Chen CH, Chen YK, Chou CT. A large ulcer and cutaneous small‐vessel vasculitis associated with syphilis infection. Scand J Rheumatol 2009; 35:147-51. [PMID: 16641051 DOI: 10.1080/03009740500381229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cutaneous vasculitis (CV) is a condition with cutaneous manifestations and possible systemic involvement. The causative factors or associated diseases are usually drugs, infection, collagen vascular disease, or malignancy. Syphilis as a cause of cutaneous vasculitis is rare. We report the case of a large cutaneous ulcer and small-vessel vasculitis associated with syphilis infection. We suggest that in apparently idiopathic CV or a chronic ulcer refractory to treatment, screening should be performed to detect any underlying infection such as syphilis. It is important to have a rapid and accurate diagnosis because the lesions are very contagious, but may be rapidly and completely cured by early administration of antibiotic treatment.
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Affiliation(s)
- Y-C Chao
- Section of Allergy, Immunology and Rheumatology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
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20
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French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H. IUSTI: 2008 European Guidelines on the Management of Syphilis. Int J STD AIDS 2009; 20:300-9. [PMID: 19386965 DOI: 10.1258/ijsa.2008.008510] [Citation(s) in RCA: 189] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P French
- The Mortimer Market Centre, Camden Primary Care Trust and University College London, Mortimer Market, London WC1E 6JB, UK.
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21
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Kim J, Kim WH, Cho C, Kim J, Kim GY, Nam MH, Kim JS, Bae SY, Cho Y. [Evaluation of automated architect syphilis TP as a diagnostic laboratory screening test for syphilis]. Korean J Lab Med 2009; 28:475-82. [PMID: 19127113 DOI: 10.3343/kjlm.2008.28.6.475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.
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Affiliation(s)
- Jeeyong Kim
- Department of Laboratory Medicine, Korea University Hospital, Seoul, Korea
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Mazaira M, Almagro M, Fonseca E. Indicaciones de la punción lumbar en pacientes con sífilis precoz activa coinfectados por el VIH. Casuística en un hospital terciario de La Coruña (España) 2003-2006. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)76176-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wong T, Singh AE, De P. Primary syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin. Am J Med 2008; 121:903-8. [PMID: 18823862 DOI: 10.1016/j.amjmed.2008.04.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 04/02/2008] [Accepted: 04/21/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Benzathine penicillin G is the treatment of choice for infectious syphilis, but tetracycline and doxycycline are believed to be effective second-line treatments. The objective of this study was to assess the serological response from treatment of primary syphilis with benzathine penicillin compared with doxycycline or tetracycline. METHODS We examined rapid plasma reagin serological test results of all first-time primary syphilis patients in Alberta, Canada from 1980 to 2001 and compared treatment with single dose of penicillin with 14-day course of oral doxycycline (100 mg twice a day) or oral tetracycline (500 mg 4 times a day). Serological treatment success was defined as a minimum 4-fold decrease in baseline rapid plasma reagin test antibody titer within 6 months, or > or =8-fold decrease within 12 months, or > or =16-fold decrease by 24 months. The median time to successful response was estimated, and factors associated with treatment success were identified by unadjusted logistic regression. RESULTS Of the 445 primary syphilis cases with available treatment outcome data, 420 (94.4%) received penicillin and 25 (5.6%) received doxycycline/tetracycline. The serological treatment success rate was 97.4% in the penicillin group (409/420) and 100% in the doxycycline/tetracycline group (25/25), and not significantly different. The estimated median time to serological treatment success was 72.0 days (mean=101.7, range 10-603) in penicillin and 43.0 days (mean=78.6, range 15-334) in doxycycline/tetracycline-treated patients; however, this difference was not statistically significant (P=0.16). CONCLUSION Doxycycline/tetracycline had a similarly high serological treatment success rate when compared with penicillin in the treatment of primary syphilis.
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Affiliation(s)
- Tom Wong
- Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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25
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Castro R, Prieto ES, da Luz Martins Pereira F. Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) tests. J Clin Lab Anal 2008; 22:257-61. [PMID: 18623120 DOI: 10.1002/jcla.20254] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Venereal Disease Research Laboratory (VDRL) test has long been considered the best serological test for the diagnosis of neurosyphilis. The goal of this study was to find out if the Rapid Plasma Reagin (RPR) could be an alternative to the VDRL. Cerebrospinal fluid (CSF) and sera samples from patients in the following stages of syphilis were tested: 8 had symptomatic and 16 asymptomatic neurosyphilis, 4 were in the primary stage, 6 had secondary syphilis, and 92 were in the latent stage. We have also studied 61 samples from individuals with treated syphilis and 126 with other neurological diseases than neurosyphilis. All the CSF samples were studied with both RPR and VDRL tests. RPR and VDRL test results were mostly concordant. The specificity of these tests for current neurosyphilis was 99% for the VDRL and 99.3% for the RPR, whereas the sensitivity was 70.8 and 75%, respectively, for the VDRL and RPR. In view of these results it seems to us that the RPR could be an alternative to the VDRL in the diagnosis of neurosyphilis.
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Affiliation(s)
- Rita Castro
- Instituto de Higiene e Medicina Tropical, Unidade de Doenças Sexualmente Transmitidas, Lisboa, Portugal.
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Abstract
Cases of syphilis have been increasing in the UK and it remains an important public health problem. Here, we provide an overview of syphilis, its presentation, diagnosis and management.
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Affiliation(s)
- Kathryn Eccleston
- Department of Genito-Urinary Medicine, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, UK.
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Indications for Lumbar Puncture in Patients With Early Active Syphilis and Human Immunodeficiency Virus Coinfection: Experience in a Tertiary Level Hospital in La Coruña, Spain, 2003-2006. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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An Evaluation of the Relative Sensitivities of the Venereal Disease Research Laboratory Test and the Treponema pallidum Particle Agglutination Test Among Patients Diagnosed With Primary Syphilis. Sex Transm Dis 2007. [DOI: 10.1097/olq.0b013e3181124473] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Waugh M. Sexually transmitted infections-microbial infections, 2007 update. Skinmed 2007; 6:242-4. [PMID: 17786104 DOI: 10.1111/j.1540-9740.2007.06190.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human sexual behavior required for the continuation of humankind nevertheless has its downsides, among them sexually transmitted infections (STIs). The treatment of microbial STIs is challenging but not in itself essentially very difficult. Controlling STIs, on the other hand, is like the task of Sisyphus, a king in Greek mythology who was forced forever to roll a block of stone to the top of a steep hill, only to see it roll back to the valley, where he started the toilsome task again. This is how many a venereologist must view the day's practice, supervising patients with STIs. Yes, there are newcomers, many of them very young, but there are many others, the recidivists, whom the physician and health care staff know only too well. "You don't mind seeing me again, doc. You (collectively) were so good to me last time"--as though catching a chlamydial infection 3 or 4 times, gonorrhea 20 or 30 times, and syphilis on occasion were badges of virility or part of life's natural progression. This is the pattern of STIs in 2007.
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Gloyd S, Montoya P, Floriano F, Chadreque MC, Pfeiffer J, Gimbel-Sherr K. Scaling Up Antenatal Syphilis Screening in Mozambique: Transforming Policy to Action. Sex Transm Dis 2007; 34:S31-6. [PMID: 17592388 DOI: 10.1097/01.olq.0000264586.49616.72] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This paper examines the decade-long scale-up process of antenatal syphilis screening through Mozambique's National Health System. GOAL The primary goal is to provide lessons learned in the provision of integrated antenatal care resource-poor settings and identify key challenges to successful scale-up. STUDY DESIGN We documented health systems activities associated with improvements in the proportion of women tested, treated, and partners treated for syphilis. RESULTS The proportion of women in antenatal visit screened for syphilis in the two target provinces has risen from 5% in 1992 to between 60% and 95% consistently since 1999. This success required multiple levels of health system strengthening. CONCLUSIONS The Mozambique experience shows that key elements to effective antenatal syphilis screening include adequate workforce, facilities, coherent systems of care, community involvement, donor management, advocacy, and leadership.
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Affiliation(s)
- Stephen Gloyd
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
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Affiliation(s)
- Stefan Wöhrl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, A-1090 Vienna, Austria.
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Affiliation(s)
- D A Lewis
- STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa.
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Abstract
Clinical management of patients with syphilis is controversial. This article summarizes recent research on syphilis treatment efficacy and outcomes and is based on a comprehensive systematic review of published literature, relevant abstracts, conference proceedings, technical reports, and guidelines. Penicillin remains the drug of choice for the treatment of syphilis. Although several studies have suggested that azithromycin may have clinical efficacy, macrolide resistance has been widely documented among strains of Treponema pallidum, and treatment failures have been reported. Ceftriaxone is effective for the treatment of syphilis when used in multiple-dose regimens. Lumbar puncture should be performed for human immunodeficiency virus-infected patients with syphilis of >1 year's duration and a serum nontreponemal test titer > or =1 : 32, as well for other patients for whom the clinical suspicion of neurosyphilis is high. Newer laboratory tests for syphilis are undergoing extensive evaluation and may prove to be useful for future clinical care. American and European approaches to syphilis treatment are similar, but they vary across several parameters.
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Affiliation(s)
- Bradley P Stoner
- Department of Anthropology and Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO 63130, USA.
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Paraskevas GP, Kapaki E, Kararizou E, Mitsonis C, Sfagos C, Vassilopoulos D. Cerebrospinal Fluid Tau Protein Is Increased in Neurosyphilis: A Discrimination From Syphilis Without Nervous System Involvement? Sex Transm Dis 2007; 34:220-3. [PMID: 16906125 DOI: 10.1097/01.olq.0000233738.23278.4e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the levels of tau protein in neurosyphilis. STUDY DESIGN Total tau protein in the cerebrospinal fluid of 12 patients with neurosyphilis, 17 with syphilis without nervous system involvement, 14 controls, and 14 patients with Alzheimer disease of comparable age were analyzed. Double-sandwich enzyme-linked immunosorbent assay was used for measurements. RESULTS Increased levels of cerebrospinal fluid total tau were observed in neurosyphilis (median [25th-75th percentile]: 349 pg/mL [312-429]) and in Alzheimer disease (543 [441-1017]) as compared with the controls (189 [106-220]) and syphilis without nervous system involvement (190 [160-223]). Using a cutoff level of 300 pg/mL, increased tau discriminated cases of neurosyphilis from syphilis without nervous system involvement with a sensitivity and specificity of 83% and 94%, respectively. CONCLUSIONS These results indicate that increased total tau may be useful in the discrimination of neurosyphilis from syphilis without nervous system involvement.
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Affiliation(s)
- George P Paraskevas
- Athens National University, Medical School, Department of Neurology, Eginition Hospital, Greece
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Libois A, De Wit S, Poll B, Garcia F, Florence E, Del Rio A, Sanchez P, Negredo E, Vandenbruaene M, Gatell JM, Clumeck N. HIV and Syphilis: When to Perform a Lumbar Puncture. Sex Transm Dis 2007; 34:141-4. [PMID: 16865051 DOI: 10.1097/01.olq.0000230481.28936.e5] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to determine predictive factors for neurosyphilis in HIV-infected patients with syphilis and optimize the use of lumbar puncture. STUDY DESIGN The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood cells count > or =20/microL, and/or a reactive cerebrospinal fluid-Venereal Disease Research Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index. RESULTS Twenty-six of 112 had neurosyphilis. Neurologic manifestations and serum rapid plasma reagin (RPR) were associated with neurosyphilis (P = 0.036, P = 0.018, respectively). In multivariate analysis, log(2)RPR was still associated with neurosyphilis (P = 0.005). In patients without neurologic manifestations, the risk of neurosyphilis increases gradually with log(2)RPR. A serum RPR of 1/32 seems to be the best cutoff point to decide the performance or not of a lumbar puncture (sensitivity 100%, specificity 40%). CONCLUSION In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.
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Affiliation(s)
- Agnès Libois
- Service des maladies infectieuses, CHU Saint-Pierre, 322 rue haute, 1000 Brussels, Belgium.
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Castro R, Prieto ES, Aguas MJ, Manata MJ, Botas J, Araújo C, Borges F, Aldir I, Exposto FDL. Evaluation of the Treponema pallidum particle agglutination technique (TP.PA) in the diagnosis of neurosyphilis. J Clin Lab Anal 2007; 20:233-8. [PMID: 17115423 PMCID: PMC6807610 DOI: 10.1002/jcla.20147] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Treponema pallidum particle agglutination technique (TP.PA) was evaluated, in comparison with the Venereal Disease Research Laboratory (VDRL) test, microhemagglutination assay for Treponema pallidum antibodies (MHA-TP), and fluorescent treponemal antibody-ABS (FTA-Abs) test for the diagnosis of neurosyphilis. We have studied 198 cerebrospinal fluid (CSF) samples from patients with syphilis, including neurosyphilis, treated syphilis, and with other neurological manifestations than neurosyphilis. All tests were nonreactive in these last group of patients. In the neurosyphilis patients, sensitivity of the TP.PA was 100%. The performance of this test in CSF from patients with primary syphilis was as good as that of the other tests. In secondary and latent syphilis, the TP.PA results (27 reactive samples/73) were similar to those of the MHA-TP (25 reactive samples/73). In the individuals treated for syphilis, the TP.PA, FTA-Abs, and MHA-TP tests were found to be reactive in eight, six, and eight samples, respectively. In conclusion, it seems that the TP.PA can be used in CSF to diagnose neurosyphilis, although as for other serological tests, interpretation of results should be done in conjunction with other neurosyphilis parameters.
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Affiliation(s)
- Rita Castro
- Unidade de Doenças Sexualmente Transmitidas/Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Tridapalli E, Capretti MG, Sambri V, Marangoni A, Moroni A, D'Antuono A, Bacchi ML, Faldella G. Prenatal syphilis infection is a possible cause of preterm delivery among immigrant women from eastern Europe. Sex Transm Infect 2006; 83:102-5. [PMID: 17098768 PMCID: PMC2598605 DOI: 10.1136/sti.2006.021352] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE to evaluate the prevalence of maternal syphilis at delivery and neonatal syphilis infection in an Italian urban area, in connection with the increased flow of immigration. STUDY DESIGN A prospective surveillance study was carried out in Bologna, Italy, from November 2000 to March 2006. All pregnant women were screened for syphilis at delivery. Infants born to seropositive mothers were enrolled in a prospective follow-up. RESULTS During the study period 19,205 women gave birth to 19,548 infants. A total of 85 women were seropositive for syphilis at delivery. The overall syphilis seroprevalence in pregnant women was 0.44%, but it was 4.3% in women from eastern Europe and 5.8% in women from Central-South America. Ten women were first found positive at delivery, as they did not receive any prenatal care. Nine of these were from eastern Europe. All their infants were asymptomatic, but six had both reactive immunoglobulin (Ig)M western blot and rapid plasma reagin tests and were considered prenatally infected. Three of six were preterm (gestational age <37 weeks). CONCLUSIONS In Italy, congenital syphilis infection is strictly related to immigration from eastern Europe. Although it is asymptomatic, it could cause premature delivery. Therefore, it is necessary to perform serological tests during the third trimester in mothers coming from endemic areas to adequately treat syphilis in pregnancy and prevent congenital infection. If the mother's test results are not available at delivery, it is necessary to investigate the newborn, especially if it is born prematurely.
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Affiliation(s)
- E Tridapalli
- Department of Preventive Paediatrics and Neonatology; St Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy.
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Tong SYC, Haqqani H, Street AC. A pox on the heart: five cases of cardiovascular syphilis. Med J Aust 2006; 184:241-3. [PMID: 16515437 DOI: 10.5694/j.1326-5377.2006.tb00214.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Accepted: 01/11/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Steven Y C Tong
- Victorian Infectious Diseases Service, Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
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Long CM, Klausner JD, Leon S, Jones FR, Giron M, Cuadros J, Pajuelo J, Caceres C, Coates TJ. Syphilis Treatment and HIV Infection in a Population-Based Study of Persons at High Risk for Sexually Transmitted Disease/HIV Infection in Lima, Peru. Sex Transm Dis 2006; 33:151-5. [PMID: 16508525 DOI: 10.1097/01.olq.0000204506.06551.5f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to characterize syphilis epidemiology and the relationship of HIV status and initial rapid plasma reagin (RPR) titer to syphilis treatment in Lima, Peru. STUDY DESIGN We screened 1,261 individuals at high risk for sexually transmitted diseases for syphilis and HIV infection. Syphilis was treated with penicillin injection or doxycycline; treatment was repeated in unresponsive cases. RESULTS : The prevalence of syphilis was 7.7%, 1-year incidence rate was 4.7%, and reinfection rate was 42.7%. The treatment success rate was 93.4% (71 of 76); those with initial RPR titers <or=1:8 were less often treated successfully (86.8% vs. 100%, P = 0.054) and required additional treatment more often (26.2% vs. 7.7%, P = 0.028) than those >or=1:16. HIV infection was associated with syphilis, prevalent in 15.6% and 3.7% of those with and without syphilis, respectively (P < 0.001), but did not affect treatment success (90.9% vs. 93.8%). CONCLUSIONS Syphilis was common, associated with HIV infection, and less responsive to therapy in those with initial RPR titers <or=1:8. HIV infection did not affect syphilis treatment success rates.
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Smith GT, Goldmeier D, Migdal C. Neurosyphilis with optic neuritis: an update. Postgrad Med J 2006; 82:36-9. [PMID: 16397078 PMCID: PMC2563717 DOI: 10.1136/pgmj.2004.020875] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 03/15/2005] [Indexed: 11/03/2022]
Affiliation(s)
- G T Smith
- Western Eye Hospital, Marylebone Road, London NW1 5QH, England.
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Vall-Mayans M, Casals M, Vives A, Loureiro E, Armengol P, Sanz B. Reemergencia de la sífilis infecciosa en varones homosexuales y coinfección por el virus de la inmunodeficiencia humana en Barcelona, 2002-2003. Med Clin (Barc) 2006; 126:94-6. [PMID: 16472482 DOI: 10.1157/13083877] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES An increase in syphilis infections since the mid 1990s has been documented, especially in homosexual men, in different European and North American cities. We intended to describe the characteristics of newly diagnosed cases of syphilis at the Sexually Transmitted Infections Unit of Barcelona in 2002 and 2003. PATIENTS AND METHOD Descriptive analysis of cases with infectious syphilis and multivariate analysis of factors associated with HIV coinfection. RESULTS 102 cases were diagnosed with infectious syphilis, 98 males (88 homosexual men). HIV coinfection was present in 34% of cases. Predictive factors of HIV coinfection were age > 30 years (p = 0.003) and having a HIV positive partner (p = 0.044). Clinically, there were no differences between cases coinfected or not with HIV. CONCLUSIONS There has been a recent increase of syphilis in Barcelona, especially among some core groups of homosexual men with high rates of HIV coinfection.
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Affiliation(s)
- Martí Vall-Mayans
- Unidad de Enfermedades de Transmisión Sexual, CAP Drassanes, Institut Català de la Salut, Barcelona, Spain.
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43
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Abstract
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
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Affiliation(s)
- B T Goh
- The Ambrose King Centre, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
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44
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Abstract
When bile duct obstruction is ruled out newly developed icterus is mainly caused by infection with hepatotropic viruses, autoimmune hepatitis or drug induced hepatopathy. We report on a 30 year old previously healthy patient with cholestatic hepatitis which was caused by infection with Treponema pallidum. Cholestatic hepatitis resolved after administration of penicillin without recurrence.
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Affiliation(s)
- A Bühl
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH
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45
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Bösel J, Klingebiel R, Schielke E. HIV–associated neurosyphilis mimicking acoustic neurinoma. J Neurol 2005; 253:250-2. [PMID: 16047112 DOI: 10.1007/s00415-005-0927-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 04/29/2005] [Accepted: 05/04/2005] [Indexed: 11/28/2022]
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46
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Abstract
Guidelines are an important instrument for improving the quality of medical care. In 2001, the German STD Society (DSTDG) published guidelines for syphilis diagnostics and treatment. For two reasons, these guidelines had to be reviewed urgently: Firstly, there is an obvious "renaissance" of syphilis among men having sex with men, which is complicated by a frequent comorbidity with HIV infection. Secondly, the standard drug for syphilis treatment in Germany, clemizole penicillin, has no longer been available since July 2003. In this article, the new German guidelines for syphilis treatment 2004, published by the DSTDG, are compared with other syphilis guidelines, which are valid for the European countries, i.e., the CDC, UK, Russian, and European guidelines 2002.
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Affiliation(s)
- H Schöfer
- Zentrum der Dermatologie und Venerologie, Johann Wolfgang Goethe-Universität Frankfurt/Main.
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47
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Vázquez F, Otero L, Ordás J, Junquera ML, Varela JA. [Up to date in sexually transmitted infections: epidemiology, diagnostic approaches and treatments]. Enferm Infecc Microbiol Clin 2004; 22:392-411. [PMID: 15355770 DOI: 10.1016/s0213-005x(04)73123-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last years, there have been important advances in sexually transmitted infections such as genome sequencing of Treponema pallidum, Chlamydia trachomatis or Mycoplasma genitalium; the new taxonomic position of Calymmatobacterium granulomatis; commercial diagnostic systems based on nucleic acid amplification; the emergence of quinolone resistance in Neisseria gonorrhoeae; new therapeutic approaches in vulvovaginal candidiasis that include boric acid; the demonstration that valacyclovir reduces the risk of transmission of genital herpes or the availability of immune-response modifier in the treatment of genital warts, and that are questions in the goal of this review. Viral hepatitis and HIV were no reviewed by space reasons.
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Affiliation(s)
- Fernando Vázquez
- Servicio de Microbiología, Hospital Monte Naranco, Departamento de Biología Funcional, Area de Microbiología, Facultad de Medicina, Universidad de Oviedo, Asturias, Spain.
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48
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Körber A, Dissemond J, Lehnen M, Franckson T, Grabbe S, Esser S. Syphilis bei HIV-Koinfektion. Syphilis with HIV coinfection. J Dtsch Dermatol Ges 2004; 2:833-40. [PMID: 16281586 DOI: 10.1046/j.1439-0353.2004.04071.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years a rising incidence of syphilis has been observed, especially in the population of homosexual men. Because of altered sexual behavior in terms of increased promiscuity paralleled by decreased use of condoms and the fact that a syphilis infection increases the susceptibility to HIV coinfection, the incidence of HIV is also rising once again in this population. In patients with HIV coinfection, the course of syphilis is often atypical or dramatic. Stage-specific features suggesting coinfection include prolonged primary ulcers persisting well into the secondary stage, numerous atypical cutaneous findings in the second stage and a rapid progression from stage to stage. The diagnosis of syphilis may be more difficult because of false positive or false negative serological findings in patients with HIV coinfection. Whether or not the CNS is more often involved is this patient group has not been established by prospective studies and remains controversial. However, WHO and CDC recommendations include evaluation of the CSF in HIV-infected patients with either late syphilis or when the time course is unknown period. There is worldwide agreement on the therapy of syphilis in patients with HIV coinfection. Patients with early syphilis should be treated with 2.4 benzathine penicillin i.m. once or twice; patients with late syphilis, twice or three times. Patients presenting with clinical or serological signs of neurosyphilis require 18-24 million IU penicillin i.v. daily for at least 2 weeks.
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Affiliation(s)
- Andreas Körber
- Klinik und Poliklinik für Dermatologie und Venerologie, STD-Kompetenzzentrum Nordrhein, Universitätsklinikum Essen
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49
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Chan DJ, Michelmore HM, Gold J. A diagnosis unmasked by an unusual reaction to ceftriaxone therapy for gonorrhoeal infection. Med J Aust 2003; 178:404-5. [PMID: 12697015 DOI: 10.5694/j.1326-5377.2003.tb05261.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2002] [Accepted: 03/11/2003] [Indexed: 11/17/2022]
Affiliation(s)
- Derek J Chan
- Department of HIV Medicine, Albion Street Centre, 150-154 Albion Street, Sydney, NSW 2010, Australia.
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50
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Schneede P, Hofstetter AG, Naber KG, Vahlensieck W, Ludwig M, Bach D, Bauer HW, Beyaert G, Blenk H, Bootz T, Friesen A, Geiges G, Himstedt HW, Hochreiter W, Keller HJ, Knopf HJ, Lenk S, Liedl B, Michaelis R, Neubauer L, Piechota H, Rassler J, Riedasch G, Rothenberger KH, Rüdiger K, Schmitz HJ, Stadie G, Thiel U, Truss MC, Wagenlehner FME, Weidner W, Westenfelder M, Göckel-Beining B, Heidenreich A, Rübben H, Schalkhäuser K, Thon W, Thüroff JW, Weidner W. [European Association of Urology guidelines on urinary and male genital tract infections]. Urologe A 2003; 42:104-12. [PMID: 12577160 DOI: 10.1007/s00120-002-0262-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.
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Affiliation(s)
- P Schneede
- Klinikum der Universität München-Grosshadern, Munich.
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