1
|
Matthias J, Khan AM, Craze K, Karki S, Newman DR. Evaluation of Automated Processing of Electronically Reported Serological Tests for Syphilis Using Current and Historical Syphilis Results Compared With Traditional Reactor Grid Processing in Florida. Sex Transm Dis 2024; 51:420-424. [PMID: 38372524 PMCID: PMC11088518 DOI: 10.1097/olq.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Syphilis in Florida increased 49% from 2016 to 2020. Moreover, many serological tests for syphilis (STS) do not indicate current infection. Traditionally, syphilis surveillance systems used reactor grids, a method for prioritizing STS for investigation based on age, nontreponemal titer, and/or sex. In 2022, Florida's sexually transmitted disease surveillance system implemented an automated method for processing electronically reported STS (eSTS), expanding upon the reactor grid, using an individual's current STS (treponemal and nontreponemal), treatment history, and historical STS results aiming for more efficiently processing eSTS. We compared the new method of processing eSTS results against the reactor grid and determined potential value in time/cost savings of this change. METHODS All eSTSs (n = 4144) from January 2, 2023 to January 8, 2023, were compared by how the logic-based method processed test results versus how the reactor grid processed test results. Each method was compared using measurements of accuracy (e.g., sensitivity/specificity). Time and cost savings in eSTS processing were estimated. RESULTS Using the surveillance case definition as reference, the accuracy of the logic-based method for processing eSTS was nearly double (82.3% vs. 43.6%), had greater specificity (79.0% vs. 33.0%), and increased positive predictive value (47.5% vs. 22.0%) when compared with the reactor grid method. Sensitivity (99.5% vs. 98.6%) and negative predictive value (99.9% vs. 99.2%) remained similar. The logic-based method is estimated to save 7783 hours annually (~$185,000). CONCLUSIONS Processing eSTS based on current and historical STS results is significantly more accurate than using a reactor grid. Moreover, these improvements save time and resources that can be better allocated to other program prevention activities.
Collapse
Affiliation(s)
- James Matthias
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA
- Florida Department of Health, Division of Disease Control and Prevention, Tallahassee, FL
| | - Amir M. Khan
- Florida Department of Health, Division of Disease Control and Prevention, Tallahassee, FL
| | - Kristin Craze
- Florida Department of Health, Division of Disease Control and Prevention, Tallahassee, FL
| | - Saugat Karki
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA
| | - Daniel R. Newman
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA
| |
Collapse
|
2
|
Reyes-Diaz M, Malca J, Konda KA, Vargas SK, Calvo GM, Caceres CF, Klausner JD. HIV Infection Modifies the Role of Prior Treponema pallidum Infection in the Clinical Presentation of Early Syphilis Among Adult Patients From Sexually Transmitted Infection Clinics in Peru. Sex Transm Dis 2024; 51:415-419. [PMID: 38372543 PMCID: PMC11131579 DOI: 10.1097/olq.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND We aimed to compare the clinical presentations (symptomatic vs. asymptomatic) with prior Treponema pallidum infection status (first infection vs. reinfection) among people with early syphilis. METHODS We used data from PICASSO, a cohort study in Peru that enrolled people with active syphilis from May 2019 to August 2021. Study participants had early syphilis and a prior syphilis serological test result within the prior 12 months to determine prior T. pallidum infection status. We calculated prevalence ratios (PRs) of symptomatic clinical presentation (primary or secondary syphilis) by prior T. pallidum infection status, stratified by HIV infection status. In addition, we explored the association of prior T. pallidum infection status and lesion presentation, stratified by primary and secondary syphilis cases, using the Fisher exact test. RESULTS We include 84 T. pallidum reinfection cases and 61 first infection cases. We found increased frequency of symptomatic clinical presentation among first-infection cases (39% vs. 20%; PR, 1.94; P = 0.014). This association was stronger among persons living without HIV infection (38% vs. 7%; adjusted PR, 6.63; P = 0.001) in comparison to those living with HIV infection (45% vs. 34%; adjusted PR, 1.38; P = 0.458). Among secondary syphilis cases, more participants from the reinfection group reported that their lesions improved 1 week after treatment (100% vs. 29%, P = 0.045) compared with those with a first infection. Among the primary syphilis cases, all participants reported that their lesions improved 1 week after treatment. CONCLUSIONS Prior syphilis was associated with a decreased prevalence of symptomatic reinfection, especially among persons not living with HIV infection.
Collapse
Affiliation(s)
- Michael Reyes-Diaz
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Joselito Malca
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Kelika A. Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Silver K. Vargas
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
- Universidad Peruana Cayetano Heredia, Facultad de Salud Pública y Administración, Lima, Perú
| | - Gino M. Calvo
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad - CIISSS, Lima – Perú
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Hu YT, Wu JB, Zhuang MH, Zhao YY, Lin Y, Jiang XY, Liu LL. A 4-fold or greater decrease in TPPA titers may indicate effective BPG treatment in primary syphilis. Int Immunopharmacol 2024; 127:111333. [PMID: 38091829 DOI: 10.1016/j.intimp.2023.111333] [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: 09/06/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND In the majority of clinical environments, the treponema pallidum particle agglutination (TPPA) test is known for its higher specificity compared to the rapid plasma reagin (RPR) test and is commonly employed for the diagnosis of syphilis, but their use for serological monitoring after syphilis therapy is controversial. OBJECTIVES We aim to evaluate whether the TPPA titers is suitable for monitoring syphilis treatment efficacy. METHODS At first, 232 patients with primary syphilis were recruited. Serological testing was performed at baseline (initial visit) and at 6 months (±1 month) after benzathine penicillin G (BPG) treatment. Second, New Zealand white male rabbits were infected with Treponema pallidum (T. pallidum) to evaluate the changes in TPPA titers after BPG therapy. Finally, we compared the TPPA titers in the culture supernatant of rabbit splenocytes stimulated with T. pallidum with or without BPG. RESULTS After 6 months of treatment, 150 (64.7%) of 232 primary syphilis patients achieved serological cure, and 82 (35.3%) had adverse outcomes. Among 110 patients with TPPA titers decreased by more than fourfold, 109 of them were serological cure patients (≥4-fold decrease in RPR titers) (P < 0.0001). In the rabbit model of syphilis, the TPPA titers was significantly decreased in the treatment subgroup (P = 0.016) and remained constant (±2-fold) or increased (≥4-fold) in the nontreatment subgroup. In addition, T. pallidum resulted in a positive TPPA titers in the culture supernatant of splenocytes (median titers was 1: 80), while BPG could directly reduce the TPPA titers in the culture supernatant (median titers was 1: 40) (P = 0.032). CONCLUSIONS A 4-fold or greater decrease in TPPA titers may indicate effective treatment in primary syphilis. Combining TPPA titers with RPR titers results may potentially aid in the early diagnosis of syphilis.
Collapse
Affiliation(s)
- Yun-Ting Hu
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Jia-Bin Wu
- Laboratory of Basic Medicine, Fuzong Clinical College (The 900th Hospital), Fujian Medical University, Fuzhou, Fujian Province, China
| | - Miao-Hui Zhuang
- Xiamen International Travel Health Care Center, Xiamen, Fujian Province, China
| | - Yuan-Yi Zhao
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Yu Lin
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Xiao-Yong Jiang
- Department of Dermatology, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, China.
| | - Li-Li Liu
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China; Xiamen Clinical Laboratory Quality Control Center, Xiamen, Fujian Province, China.
| |
Collapse
|
4
|
Raccagni AR, Ranzenigo M, Bruzzesi E, Maci C, Castagna A, Nozza S. Neisseria gonorrhoeae Antimicrobial Resistance: The Future of Antibiotic Therapy. J Clin Med 2023; 12:7767. [PMID: 38137836 PMCID: PMC10744250 DOI: 10.3390/jcm12247767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/25/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
The growing threat of antibiotic-resistant Neisseria gonorrhoeae, which causes gonorrhea, presents a current public health challenge. Over the years, the pathogen has developed resistance to different antibiotics, leaving few effective treatment options. High-level resistance to key drugs, including ceftriaxone, has become a concerning reality. This article primarily focuses on the treatment of gonorrhea and the current clinical trials aimed at providing new antibiotic treatment options. We explore ongoing efforts to assess new antibiotics, including zoliflodacin, and gepotidacin. These drugs offer new effective treatment options, but their rapid availability remains uncertain. We delve into two ongoing clinical trials: one evaluating the efficacy and safety of gepotidacin compared to the standard ceftriaxone-azithromycin combination and the other assessing the non-inferiority of zoliflodacin versus the combination therapy of ceftriaxone-azithromycin. These trials represent crucial steps in the search for alternative treatments for uncomplicated gonorrhea. Notably, gonorrhea has been included in the "WHO Priority Pathogens List for Research and Development of New Antibiotics". In conclusion, the urgent need for innovative treatment strategies is underscored by the rising threat of antibiotic resistance in N. gonorrhoeae; collaboration among researchers, industries, and healthcare authorities is therefore essential.
Collapse
Affiliation(s)
- Angelo Roberto Raccagni
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
| | - Martina Ranzenigo
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
| | - Chiara Maci
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.R.); (E.B.); (C.M.); (A.C.); (S.N.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| |
Collapse
|
5
|
Ikeuchi K, Fukushima K, Tanaka M, Yajima K, Saito M, Imamura A. Changes in rapid plasma reagin titers in patients with syphilis before and after treatment: A retrospective cohort study in an HIV/AIDS referral hospital in Tokyo. PLoS One 2023; 18:e0292044. [PMID: 37768989 PMCID: PMC10538775 DOI: 10.1371/journal.pone.0292044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Although the rapid plasma reagin (RPR) test is used to determine treatment efficacy for syphilis, animal studies show that it decreases gradually after an initial increase even without treatment. Pre-treatment changes in RPR titer in humans and its relationship with post-treatment changes in RPR titer are not well known. METHODS We retrospectively analyzed the clinical records of syphilitic patients who underwent automated RPR (Mediace) testing twice before treatment (i.e., at diagnosis and treatment initiation) within 1-3 months at an HIV/AIDS referral hospital in Japan between 2006 and 2018. The RPR values were expressed as the ratio to the value at treatment initiation. The mean monthly relative change in the RPR after treatment was calculated on the log2 scale for each patient and analyzed by multivariable linear regression. RESULTS Sixty-eight patients were identified. The median age was 45 (interquartile range [IQR], 38-50), 98.5% (67/68) were men, and 97.1% (66/68) had HIV. The median RPR titer ratio at treatment initiation/diagnosis was 0.87 (IQR, 0.48-1.30). The RPR titer decreased more than twofold in 26.5% (18/68) and more than fourfold in 10.3% (7/68) before treatment. In the multivariable analysis, higher age (predicted monthly RPR relative change on the log2 scale 0.23/10 years [95% confidence interval [CI], 0.090-0.37]), history of syphilis (0.36 [95% CI, 0.07-0.65]), and a lower ratio of RPR at treatment initiation/diagnosis (-0.52/every 10-fold increase [95% CI, -0.81 to -0.22]) were associated with a slower RPR decrease after treatment. CONCLUSIONS In a mostly HIV patient population, RPR titer can show more than four-fold spontaneous increase or decrease within 1-3 months. Pre-treatment spontaneous decrease of RPR titer was associated with a slower decrease in post-treatment RPR titer.
Collapse
Affiliation(s)
- Kazuhiko Ikeuchi
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Kazuaki Fukushima
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masaru Tanaka
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Keishiro Yajima
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
6
|
Avelino MEDS, da Silva AS, de Figueiredo LGCP, Fonseca RRDS, Menezes CR, Lima SS, Mendes AL, da Silva CHB, dos Reis IVS, Nunes HBDF, Sequeira BJ, Machado LFA. Exposure to Treponema pallidum Infection among Adolescent and Young Adult Women in Roraima, Amazon Region of Brazil. Microorganisms 2023; 11:2382. [PMID: 37894040 PMCID: PMC10609070 DOI: 10.3390/microorganisms11102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Syphilis is a chronic infectious disease, and its prevalence has been described since the 15th century. Because of the high prevalence of this infection in Brazil, this study aimed to evaluate the prevalence of syphilis and its associated factors among adolescent and young women living in the city of Boa Vista, Roraima, Brazil. METHODS The present study was cross-sectional, descriptive, analytical and quantitative. It involved 200 young and adolescent women. Laboratory tests were performed to diagnose syphilis, and a sociodemographic and epidemiological questionnaire was employed. RESULTS In the studied sample, 10 women had a positive result for syphilis, characterizing a prevalence of 5% for infection with Treponema pallidum. There was a statistically significant association between a monthly family income of less than 1 minimum wage and syphilis (p = 0.0449) and between illicit drug use and syphilis (p = 0.0234). CONCLUSIONS These results indicate the need for public health interventions, action plans, and the implementation of risk reduction strategies focused on this population.
Collapse
Affiliation(s)
- Maria Eduarda de Sousa Avelino
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (M.E.d.S.A.); (R.R.d.S.F.); (C.R.M.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| | - Andrio Silva da Silva
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| | | | - Ricardo Roberto de Souza Fonseca
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (M.E.d.S.A.); (R.R.d.S.F.); (C.R.M.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| | - Cláudia Ribeiro Menezes
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (M.E.d.S.A.); (R.R.d.S.F.); (C.R.M.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| | - Sandra Souza Lima
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| | - Ana Luísa Mendes
- Health Research Center, School of Medicine, Federal University of Roraima, Boa Vista 69317-810, RR, Brazil; (A.L.M.); (C.H.B.d.S.); (I.V.S.d.R.); (H.B.d.F.N.); (B.J.S.)
| | - Carla Hart Borges da Silva
- Health Research Center, School of Medicine, Federal University of Roraima, Boa Vista 69317-810, RR, Brazil; (A.L.M.); (C.H.B.d.S.); (I.V.S.d.R.); (H.B.d.F.N.); (B.J.S.)
| | - Isabela Vanessa Sampaio dos Reis
- Health Research Center, School of Medicine, Federal University of Roraima, Boa Vista 69317-810, RR, Brazil; (A.L.M.); (C.H.B.d.S.); (I.V.S.d.R.); (H.B.d.F.N.); (B.J.S.)
| | - Huendel Batista de Figueiredo Nunes
- Health Research Center, School of Medicine, Federal University of Roraima, Boa Vista 69317-810, RR, Brazil; (A.L.M.); (C.H.B.d.S.); (I.V.S.d.R.); (H.B.d.F.N.); (B.J.S.)
| | - Bianca Jorge Sequeira
- Health Research Center, School of Medicine, Federal University of Roraima, Boa Vista 69317-810, RR, Brazil; (A.L.M.); (C.H.B.d.S.); (I.V.S.d.R.); (H.B.d.F.N.); (B.J.S.)
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (M.E.d.S.A.); (R.R.d.S.F.); (C.R.M.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.S.d.S.); (L.G.C.P.d.F.); (S.S.L.)
| |
Collapse
|