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Sifuentes Rentería SE, Rodríguez Badillo P, Valdez González T. Multimodal Imaging Features of the Posterior Segment in Ocular Syphilis and HIV Co-Infection: A Single Center Case Series. Ocul Immunol Inflamm 2024; 32:1335-1341. [PMID: 37590885 DOI: 10.1080/09273948.2023.2244073] [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: 02/16/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To analyze the frequent multimodal imaging features in posterior syphilitic uveitis. PURPOSE Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection. METHODS All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy. RESULTS 18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement. CONCLUSION Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.
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Affiliation(s)
| | - Paulina Rodríguez Badillo
- Inflammatory Ocular Diseases Department, Foundation Hospital Nuestra Señora de la Luz (FHNSL), Mexico City, Mexico
- Ophthalmology Department, Clinica Especializada Condesa - Iztapalapa (CECI), Mexico City, Mexico
| | - Teresa Valdez González
- Inflammatory Ocular Diseases Department, Foundation Hospital Nuestra Señora de la Luz (FHNSL), Mexico City, Mexico
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Henriques BL, Vidal JE, Gamba C, Avelino-Silva VI. Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists. SAO PAULO MED J 2023; 141:20-29. [PMID: 36043668 PMCID: PMC9808987 DOI: 10.1590/1516-3180.2021.0744.r1.03032022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.
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Affiliation(s)
- Bárbara Labella Henriques
- MD. Doctoral Student, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Ernesto Vidal
- MD. PhD. Infectious Disease Specialist, Department of Neurology, Instituto de Infectologia Emilio Ribas, São Paulo (SP), Brazil; Infectious Disease Specialist, Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cristiano Gamba
- MD. Infectious Disease Specialist, Centro de Referência e Treinamento DST AIDS (CRT), São Paulo (SP), Brazil
| | - Vivian Iida Avelino-Silva
- MD, PhD. Infectious Disease Specialist, Department of Infectious Disease, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Behara SK, Bindu Satti SA. A cross-sectional descriptive study of clinical and serological prevalence of syphilis infection in people living with HIV and its effect on CD4+ T cells. Indian J Sex Transm Dis AIDS 2021; 42:106-110. [PMID: 34909613 PMCID: PMC8628088 DOI: 10.4103/ijstd.ijstd_68_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/04/2019] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
Context: The natural history of syphilis could be altered in the presence of HIV. It has been documented that syphilis infection increases the risk of HIV transmission by at least 3-fold. Aims: The aim of the study was (1) to study clinical presentation of syphilis in HIV individuals, (2) to estimate seroprevalence of syphilis in HIV individuals, and (3) to study the effect of syphilis infection on CD4+ T cells. Subjects and Methods: HIV-positive patients attending sexually transmitted infection clinic for a period of 1 year from June 2017 to May 2018 in the age group of 15–70 years were included in the study. A detailed history was taken; genital and dermatological examination was done. All patients were tested with VDRL and treponema pallidum hemagglutination assay (TPHA). Pearson's Chi-square test was used to compare categorical variables and Student's t-test was used to compare continuous variables. Results: Out of ninety study population, nine (10%) had clinical manifestations of syphilis. VDRL was positive with significant titers in all cases of syphilis. TPHA was positive in 88.9% of cases with clinical syphilis and 17.3% of cases without clinical manifestations of syphilis. Mean CD4 count was low among patients having syphilis infection compared to study population. Conclusion: This study shows high prevalence of syphilis in HIV and highlights the importance of preventing and promptly treating syphilis in people living with HIV, as the active infection is associated with fall in CD4 count, which leads to opportunistic infections.
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Affiliation(s)
- Suresh Kumar Behara
- Department of DVL, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
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Neto PLF, Fonseca RRDS, Avelino MEDS, Vilhena EM, Barbosa MDADAP, Lopes CAF, Gomes STM, Sequeira BJ, Laurentino RV, Freitas FB, Oliveira-Filho AB, Machado LFA. Prevalence and Factors Associated With Syphilis in People Living With HIV/AIDS in the State of Pará, Northern Brazil. Front Public Health 2021; 9:646663. [PMID: 34434909 PMCID: PMC8381150 DOI: 10.3389/fpubh.2021.646663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
Syphilis continues to be a public health problem worldwide and its incidence has increased in people living with HIV/AIDS in recent years. This study determined the prevalence and factors associated with syphilis in people living with HIV/AIDS in the city of Belém, northern Brazil. A cross-sectional study was conducted from June to November 2018. A total of 500 people living with HIV/AIDS attended at a specialized unit of the public health network of the State of Pará were studied. Questionnaires were used to collect socio-demographic data and potential risk factors for syphilis. Blood samples were collected from all subjects and screened for syphilis using VDRL, and the seropositive were confirmed using FTA-abs. Logistic regressions were used to identify the factors associated with syphilis. Most subjects were male (56.8%), had more than 40 years (54.0%), single (63.0%), had finished high school (54.2%), had monthly income ≤1 minimum wage (72.4%), and had been born to the city of Belém (59.8%). Prevalence of syphilis was 6.4%. Eight characteristics/behaviors associated with syphilis: male, young adults, single, studied at least high school, monthly income >1 minimum wage, homosexual/bisexual, does not use or sporadically use condoms during sexual intercourse, and have had more than one sexual partner in the last three months. The prevalence of syphilis in people living with HIV/AIDS in Belém is low when compared to other Brazilian states. However, there is a need for public policies and actions to monitor, control and prevent these two sexually transmitted infections.
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Affiliation(s)
- Pedro Leão Fontes Neto
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil
| | - Ricardo Roberto de Souza Fonseca
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | - Maria Eduarda de Sousa Avelino
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | | | | | | | | | - Bianca Jorge Sequeira
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | | | | | - Aldemir Branco Oliveira-Filho
- Study and Research Group on Vulnerable Populations, Institute for Coastal Studies, Federal University of Pará, Bragança, Brazil
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
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Machado LFA, Fonseca RRDS, Queiroz MAF, Oliveira-Filho AB, Cayres-Vallinoto IMV, Vallinoto ACR, Ishak MDOG, Ishak R. The Epidemiological Impact of STIs among General and Vulnerable Populations of the Amazon Region of Brazil: 30 years of Surveillance. Viruses 2021; 13:v13050855. [PMID: 34067165 PMCID: PMC8151421 DOI: 10.3390/v13050855] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
Sexually transmitted infections (STIs) represent a worldwide public health problem and, although many of them are curable, they continue to be neglected, especially in areas with a low human development index, such as in the northern region of Brazil. This review describes the results of 30 years of studies at the Virus Laboratory at the Federal University of Pará, including the prevalence and molecular epidemiology of HIV-1, HTLV-1/2, HPV, HBV, Treponema pallidum and Chlamydia trachomatis among urban and non-urban populations, and also in vulnerable groups in the Brazilian Amazon. Control strategies and challenges in preventing STIs are discussed considering this immense geographic region, where essential health services are unable to reach the entire population, especially the most vulnerable, such as female sex workers, people who use illicit drugs, remnants of quilombolos and indigenous communities.
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Affiliation(s)
- Luiz Fernando Almeida Machado
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
- Correspondence:
| | - Ricardo Roberto de Souza Fonseca
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Maria Alice Freitas Queiroz
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Aldemir Branco Oliveira-Filho
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68.600-000, Brazil;
| | - Izaura Maria Vieira Cayres-Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Antonio Carlos Rosário Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Marluísa de Oliveira Guimarães Ishak
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
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Kengne-Nde C, de Dieu Anoubissi J, Loni-Ekali G, Nguefeu-Nkenfou C, Moussa Y, Messeh A, Fokam J, Zeh-Meka A, Snayeul-Wawo D, Tseuko D, Ngo-Nemb M, Kob D, Billong SC, Bonono L, Elat JB. Highlighting a population-based re-emergence of Syphilis infection and assessing associated risk factors among pregnant women in Cameroon: Evidence from the 2009, 2012 and 2017 national sentinel surveillance surveys of HIV and syphilis. PLoS One 2020; 15:e0241999. [PMID: 33186360 PMCID: PMC7665812 DOI: 10.1371/journal.pone.0241999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Syphilis and HIV can be transmitted from pregnant women to their children and they remain a public health problem in Africa. Our study aimed to determine the trends of seroprevalence of HIV/syphilis co-infection and syphilis infection overtime through the national surveillance system in Cameroon and to explore associated risk factors. Methods We conducted cross-sectional studies of HIV and syphilis, targeting each year 7000 first antenatal care (ANC-1) attendees at the same sites during the 2009, 2012 and 2017 sentinel surveillance surveys. Pregnant women were enrolled at their ANC-1, sociodemographic and clinical information were collected. HIV and Syphilis test were performed by serial algorithm as per the national guidelines. Trends were assessed for HIV, syphilis and HIV/syphilis by estimating seroprevalence from cross-sectional studies. Associated risk factors were explored using multinomial logistic regression with 4 outcomes: HIV/syphilis co-infection, HIV infection only, syphilis infection only and no infection. Results Overall, 6 632, 6 521 and 6 859 pregnant women were enrolled in 2009, 2012 and 2017 respectively. In 2017, a total of 3 901 pregnant women enrolled were tested for syphilis. Almost half of them (47.9%) were living in urban area and were aged less than 25 years (44.7%). While HIV epidemic was on a decline (from 7.6% (95% CI: 6.99–8.28) in 2009 to 5.7% (95% CI: 4.93–6.4) in 2017), a huge significant increase of syphilis prevalence was observed (from 0.6% (95% CI:0.40–0.80) in 2009 to 5.7% (95% CI:4.93–6.40) in 2017). Pregnant women residing in rural areas were more likely to be infected with syphilis than those living in the urban area (aOR = 1.8 [95% CI: 1.3–2.4]). Unmarried pregnant women were three time more likely to be infected by HIV/Syphilis Co-infection than married, cohabiting, widow or divorced pregnant women (aOR = 2.8 [95% CI: 1.3–2.4]). Furthermore; living in Northern region was associated with a lower risk of being infected with HIV (aOR = 0.6 [95% CI: 0.5–0.9]) and Syphilis infection (aOR = 0.6 [95% CI: 0.4–0.9]). Conclusion The epidemiological dynamics of syphilis suggests a growing burden of syphilis infection in the general population of Cameroon. Our findings support the fact that while emphasizing strategies to fight HIV, huge efforts should also be made for strategies to prevent and fight syphilis infection especially among HIV positive women, in rural area, and southern regions.
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Affiliation(s)
- Cyprien Kengne-Nde
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | | | - Gabriel Loni-Ekali
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Celine Nguefeu-Nkenfou
- Chantal BIYA International Reference Centre (CBIRC) for research on HIV/AIDS prevention and management, Yaounde, Cameroon.,Higher Teachers' Training College, University of Yaounde I, Yaounde, Cameroon
| | - Yasmine Moussa
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Arlette Messeh
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Joseph Fokam
- Chantal BIYA International Reference Centre (CBIRC) for research on HIV/AIDS prevention and management, Yaounde, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaounde 1, Yaounde, Cameroon.,National HIV Drug Resistance Surveillance and Prevention Working Group, National AIDS Control Committee, Yaoundé, Cameroon
| | - Albert Zeh-Meka
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Denis Snayeul-Wawo
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Dorine Tseuko
- National Laboratory of Public Health, Yaounde, Cameroon
| | - Marinette Ngo-Nemb
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | | | - Serge-Clotaire Billong
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaounde 1, Yaounde, Cameroon.,National HIV Drug Resistance Surveillance and Prevention Working Group, National AIDS Control Committee, Yaoundé, Cameroon
| | - Leonard Bonono
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon
| | - Jean-Bosco Elat
- Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon.,National HIV Drug Resistance Surveillance and Prevention Working Group, National AIDS Control Committee, Yaoundé, Cameroon
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Florencio KBV, Costa ADD, Viana TCDM, Gomes DCDA, Gouveia PADC. Secondary syphilis with pulmonary involvement mimicking lymphoma: a case report. Rev Soc Bras Med Trop 2019; 52:e20190044. [DOI: 10.1590/0037-8682-0044-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/08/2019] [Indexed: 11/22/2022] Open
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Oliveira LDS, Caixeta LM, Martins JLR, Segati KD, Moura RS, Daher MC, Pinto EMH. Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State. Rev Soc Bras Med Trop 2018; 51:436-444. [PMID: 30133625 DOI: 10.1590/0037-8682-0467-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/04/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.
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Pinto VM, Tancredi MV, Buchalla CM, Miranda AE. History of syphilis in women living with AIDS and associated risk factors in São Paulo, Brazil. Rev Assoc Med Bras (1992) 2015; 60:342-8. [PMID: 25211418 DOI: 10.1590/1806-9282.60.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 01/13/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the epidemiological profile, risk behaviors, frequency of prior history of syphilis in women living with AIDS and to investigate associated factors. METHODS a cross-sectional study conducted with women living with HIV attending at Reference Center for AIDS in São Paulo. Demographic, behavioral, and clinical data were analyzed based on medical records. RESULTS a total of 598 women were included in the study and the prevalence of previous syphilis was 6.2% (95% CI 4,3-8,1). Seventy-three percent of women were less than 40 years of age when diagnosed with AIDS and 49.6% had more than eight years of formal education. 67.2% were white and 65.9% were not married or living with a partner, 53.2% reported that their first sexual intercourse aged more than 15 years, 56.5% reported having only one partner in the last year and 13% reported drug use. Regarding laboratory data, 83.8% had CD4+ <500 cells/ mm3 upon diagnosis of AIDS. Previous syphilis was associated with the use of crack cocaine [AOR = 6.8 (95% CI 1.7 - 27.5)], >1 sexual partner in the last year [AOR = 6.6 (95% CI 1.2 - 37.1)], CD4 + <500 cells/mm3 [AOR = 3.8 (women 1.1 - 13.6)], HIV diagnosis > 8 years [AOR = 2.4 (95% CI 1.0 - 5.8)]. CONCLUSION a high prevalence of previous syphilis was found in the population studied, and crack use was identified among the main associated risk factors. Interventions to reduce the risk of sexual transmission of HIV and syphilis must be strengthened, with the implementation of control actions, screening strategies, early diagnosis and treatment, preventing complications, reducing morbidity and improving sexual and reproductive health.
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Affiliation(s)
- Valdir Monteiro Pinto
- State STD and AIDS program of São Paulo, São Paulo State Health Department, STD/AIDS Reference and Training Center, São Paulo, Brazil
| | - Mariza Vono Tancredi
- State STD and AIDS program of São Paulo, São Paulo State Health Department, STD/AIDS Reference and Training Center, São Paulo, Brazil
| | | | - Angelica Espinosa Miranda
- Department of Social Medicine, Infectious Disease Center, Federal University of Espírito Santo, Vitória, ES, Brazil
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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PATIENTS WITH ACUTE SYPHILITIC POSTERIOR PLACOID CHORIORETINOPATHY. Retina 2014; 34:373-84. [DOI: 10.1097/iae.0b013e3182993f11] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Syphilis and HIV co-infection in patients who attend an AIDS outpatient clinic in Vitoria, Brazil. AIDS Behav 2014; 18 Suppl 1:S104-9. [PMID: 23732958 DOI: 10.1007/s10461-013-0533-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Our goal was to determine the prevalence of, and risk factors associated with, syphilis in HIV-infected patients who attend an AIDS outpatient clinic in Vitoria, Brazil. We conducted a cross-sectional study-including interviews for demographic, behavioral, and clinical characteristics-and blood collection (venipuncture and fingerstick) for VDRL and treponemal tests (rapid test) in a total of 438 patients. The mean age was 43.0 years (SD = 11), and mean years of school was 8.1 (SD = 4.2). The prevalence of syphilis was 5.3 % (95 % CI 3.3-7.3). The treponemal test was positive in 18.9 % of participants. In multivariate analysis, prevalent syphilis infection was independently associated with male gender (AOR 4.6, 95 % CI 1.1-20.0), a history of male-male sex (AOR 1.8, 95 % CI 1.6-4.1), current use of antiretroviral therapy (AOR 5.5, 95 % CI 1.7-16.7), and history of treated syphilis infection (AOR 5.5, 95 % CI 2.0-15.8). Syphilis prevalence was high in patients living with HIV/AIDS who attend an AIDS clinic; therefore, routine sexually transmitted infections counseling and screening should be included in their care.
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Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature. Retina 2013; 32:1915-41. [PMID: 22863970 DOI: 10.1097/iae.0b013e31825f3851] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe the clinical and angiographic features of a series of patients with acute syphilitic posterior placoid chorioretinitis (ASPPC) in the context of previously published cases. METHODS A retrospective, noncomparative, multicenter chart review was performed on 16 patients with active ASPPC. Positive serologic tests supported the diagnosis in all patients. Color and red-free photographs as well as fluorescein angiography were obtained in each case. Indocyanine green angiography, optical coherence tomography, and fundus autofluorescence were performed on selected patients. A total of 44 previously published cases of ASPPC were identified using both a Medline Search and references listed in articles identified. RESULTS Ocular involvement was bilateral in 9 of our 16 patients (56.3%). The mean and median ages at presentation were 40 and 38 years, respectively (range 28-57 years). Nine patients (56.3%) were human immunodeficiency virus positive, with most recent CD4 cell counts ranging from 160 cells/μL to 450 cells/μL and a median CD4 cell count of 250 cells/μL. Seven of 16 patients (43.8%) had a history of mucocutaneous manifestations of secondary syphilis, whereas 4 (25.0%) had evidence of neurosyphilis. Anterior chamber and/or vitreous inflammation was evident in 13 patients (81.3%). Fifteen of 16 patients had positive venereal disease research laboratory or rapid plasma regain titers, and 13 of 13 tested patients had a positive serum fluorescent treponemal antibody absorption. The initial vision in the 25 affected eyes ranged from 20/20 to counting fingers, with a median of 20/80. In all patients, posterior segment examination in the involved eyes revealed a large, yellowish, placoid, outer retinal lesion. Fluorescein angiography showed progressive hyperfluorescence in the area of the lesion, often with scattered focal hypofluorescence, or leopard spotting. Inflammation subsided, the yellowish lesions resolved, and vision improved shortly after antibiotic therapy in 20 of 25 affected eyes. Visual acuity at last visit ranged from 20/20 to 20/150, with a median final vision of 20/25. A review of the literature revealed 44 previously reported cases of ASPPC. Shared demographic, clinical, and angiographic features were summarized. CONCLUSION Acute syphilitic posterior placoid chorioretinitis is an uncommon but clinically and angiographically distinct manifestation of ocular syphilis. All patients with characteristic clinical and angiographic findings of ASPPC should be tested for both neurosyphilis and human immunodeficiency virus coinfection. Vision recovery typically followed completion of appropriate antibiotic therapy.
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Adolf R, Bercht F, Aronis ML, Lunardi LW, Schechter M, Sprinz E. Prevalence and risk factors associated with syphilis in a cohort of HIV positive individuals in Brazil. AIDS Care 2011; 24:252-8. [PMID: 21780954 DOI: 10.1080/09540121.2011.597706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals with syphilis have higher chance of having HIV, and syphilis' genital ulcers increases HIV transmission rate. Nevertheless, there are few well-documented studies about HIV and syphilis co-infection and its risk factors. The study was based on 2262 HIV infected individuals from South Brazilian HIV cohort, which began in 1991, and this analysis included individuals who were included in the cohort until November 2008. Inclusion criteria were having CD4 + T cell count and viral load at baseline, and syphilis serology tests (venereal disease research laboratory [VDRL] > 1:64 or a positive VDRL plus a positive treponemal test). A total of 1012 patients were included; 580 were men (57%); mean age at HIV diagnosis was 33 years; 591 (58%) had previous diagnosis of AIDS; most of the individuals acquired HIV from sexual contact (47.9% heterosexual and 31.7% men who had sex with men [MSM]); and 759 (75%) were on antiretroviral therapy. The prevalence of syphilis was 20.5% (208). After multivariate analysis, being male (2.01; 95% CI, 1.23-3.27; p = 0.005) and MSM (1.91; 95% CI, 1.25-2.90; p = 0.002) were significantly associated to HIV and syphilis co-infection. Males and MSM were associated with higher risk of this co-infection. Our findings may reflect that this particular population is still engaging in unprotected sexual intercourse, and efforts should be made to better target this specific group as they might perpetuate these infections.
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Affiliation(s)
- Rafael Adolf
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Oliveira VMD, Verdasca IC, Monteiro MC. [Syphilis detection using ELISA and VDRL tests on blood donors at the blood center of Guarapuava, State of Paraná]. Rev Soc Bras Med Trop 2009; 41:428-30. [PMID: 18853023 DOI: 10.1590/s0037-86822008000400023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 07/15/2008] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to evaluate the syphilis seroprevalence among 5,752 blood donors who were attended at the blood center of Guarapuava, State of Paraná, in 2006. The seropositivity rates were 2.1% for enzyme Linked Immuno Sorbent Assay and 0.2% for Veneral Disease Research Laboratory, thus showing low prevalence of syphilis among the individuals who came to this blood bank.
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