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PubMed1993

Surveillance for primary and secondary syphilis--United States, 1991.

PROBLEM/CONDITION: From 1986 through 1990, an epidemic of syphilis occurred throughout the United States. In 1991, the number of reported cases of primary and secondary (P&S) syphilis in the United States declined for the first time since 1985. REPORTING PERIOD COVERED: To examine how this decline reflected sex-specific, race/ethnicity-specific, and regional patterns of syphilis morbidity, we analyzed data for syphilis cases reported to CDC from 1984 through 1991. DESCRIPTION OF SYSTEM: Summary data for cases of syphilis reported to state health departments were sent quarterly and annually to CDC. The quarterly data from each state included total number of syphilis cases by sex, stage of disease (primary, secondary, early latent, and late latent), and source of report (public or private). The annual data from each state included total number of P&S syphilis cases by sex, racial/ethnic group (white, not of Hispanic origin; black, not of Hispanic origin; Hispanic; Asian/Pacific Islander; or American Indian/Alaskan Native), 5-year age group, and source of report. RESULTS: The decline in both the number and rate of reported syphilis cases in 1991 occurred in every racial group in the United States and in both sexes. This decline also occurred in every region of the United States except the Midwest, where the total P&S syphilis rate increased 37.3% from 1990 through 1991. Despite the increase in syphilis rates in the Midwest, the highest rates of P&S syphilis in 1991 were reported from the South. INTERPRETATION: The reasons for the decline in syphilis are unclear. No data exist to conclusively identify which STD control program activities affected the level of syphilis morbidity or to what extent those activities may have contributed to the decline. Changes in drug use and limited immunity to Treponema pallidum may have accounted for some of the decrease in syphilis incidence. Higher levels of poverty in the South and poor access to health-care services associated with poverty probably contributed to continued high levels of disease transmission in the South. ACTIONS TAKEN: Better evaluation of STD control program activities will be necessary to help determine the most effective strategies for preventing and controlling syphilis in different high-risk populations.

Female↗

PubMed2004

[Clinical analysis of 192 pregnant women infected by syphilis].

OBJECTIVE: To investigate the clinical characteristics of pregnant women with syphilis, their pregnant outcomes, perinatal and neonatal prognosis and the incidence of congenital syphilis. METHODS: One hundred and ninety-two pregnant women with syphilis by serological assays were divided into two groups, group A (n = 93): treated with a full course anti-syphilis therapy and group B (n = 99): untreated group. Meanwhile, they were divided into groups C and D according to maternal serum rapid plasma reagin (RPR) test: RPR titer < or = 1:8 (group C) and RPR titer > or = 1:16 (group D). The pregnant outcomes and congenital syphilis were compared between two groups. RESULTS: (1) Perinatal outcomes: Term delivery reached 93.6% (87/93) in group A and only 28.3% (28/99) in group B; the rate of premature birth and fetal intrauterine death were 5.4% (5/93) and 1.1% (1/93) in group A, obviously lower than 28.3% (28/99) and 32.3% (32/99) in group B (P < 0.005). No fetal intrauterine death and abortion occurred in the group A. Prognosis of neonates: Normal neonates were 63.0% (58/92) in group A, and only 23.2% (13/56) in group B; the rates of asphyxia neonates, low birth weight, congenital syphilis and neonatal death in group A were significantly lower than those in group B (P < 0.01). (2) The comparison between groups C and D: Term delivery rate in group C (78.1%, 89/114) was higher than that in group D (36.1%, 26/72); the rates of premature birth, congenital syphilis, perinatal death and neonatal death in group C were lower than those in group D (P < 0.01). (3) Gestational week and drug treatment: The earlier the treatment started during pregnancy, the lower the rate of congenital syphilis was (P < 0.01). The incidences of congenital syphilis were similar between penicillin and dibenzyl penicillin groups (P < 0.05). CONCLUSIONS: (1) Effective full-course anti-syphilis therapy is the key to improving the outcomes of pregnancy with syphilis, prognosis of neonates and reducing incidence of congenital syphilis. (2) Maternal serum RPR titer, the starting time of anti-syphilis treatment as well as the choice of therapeutical drugs are important influence factors on the outcomes of pregnancy with syphilis.

Adult↗

PubMed1999

New HIV cases attributable to syphilis in the USA: estimates from a simplified transmission model.

OBJECTIVE: Because syphilis can raise the likelihood of HIV transmission and acquisition, syphilis prevention in the USA has the potential benefit of reducing the number of new cases of HIV. We developed a simplified transmission model to estimate the annual number and cost of new, heterosexually-acquired HIV cases in the USA attributable to syphilis. DESIGN: We estimated the number of heterosexual, HIV serodiscordant partnerships in which syphilis was present in 1996. The model included the probability of transmission of HIV (with and without the presence of syphilis) and other parameters based on data from recent literature. Published direct costs (HIV treatment costs including antiretroviral therapy) and indirect costs (e.g., lost productivity) per case of HIV were used to estimate the annual cost of HIV cases attributable to syphilis. The potential savings in averted HIV costs related to syphilis were used to estimate the potential benefits of a syphilis elimination program. RESULTS: In 1996, an estimated 1082 new heterosexual cases of HIV in the USA could be attributed to syphilis. These cases represented direct costs of US$ 211 million and indirect costs of US$ 541 million; yielding US$ 752 million in total costs. Over 15 years, a syphilis elimination program could save over US$ 833 million (discounted at 3% annually) in averted direct medical costs of syphilis-related HIV infections. CONCLUSIONS: If the only benefit of syphilis elimination were to prevent new HIV cases attributable to syphilis, a national syphilis elimination program costing less than US$ 833 million would probably pay for itself.

Cost of Illness↗

PubMed2004

Congenital syphilis: identification of two distinct profiles of maternal characteristics associated with risk.

BACKGROUND: Behavioral and socioeconomic factors create considerable obstacles to the elimination of congenital syphilis. A clear understanding of maternal risk factors is important to define interventions in every community. GOAL: The goal of this study was to investigate maternal risk factors for congenital syphilis. STUDY DESIGN: We conducted a case-control and descriptive analysis of 3 groups of live born infants and their mothers consisting of: group I (cases of congenital syphilis), group II (neonates without congenital syphilis whose mothers had been adequately treated for syphilis), and group III (random sample of newborn infants whose mothers have not had syphilis). Data were prospectively collected from personal interview and antenatal records. RESULTS: In the case-control study, including groups I and III, the maternal characteristics independently associated with congenital syphilis in the logistic regression were monthly per capita income under 30 US dollars (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1-7.4), single status (OR, 2.8; 95% CI, 1.1-7.8), and less than 6 prenatal visits (OR, 3.2; 95% CI, 1.3-8.1). Comparison between groups I and II (only mothers who have had syphilis) showed a strong protective association of prenatal care with congenital syphilis (OR, 0.05; 95% CI, 0.00-0.39). Additional analysis identified 2 separate profiles of maternal characteristics, one consisting of low socioeconomic status and the other of risk behaviors. Some women who had syphilis before or during pregnancy received adequate prenatal care and delivered infants without congenital syphilis. Most of these women had high-risk behaviors but they were, in general, less poor, older, and more educated than mothers of infants with congenital syphilis. CONCLUSIONS: Risk behaviors and low socioeconomic characteristics constituted 2 separate maternal profiles associated with congenital syphilis. Socioeconomic risk factors interfered more with prenatal care. To become more effective, the strategies for prevention of congenital syphilis should be targeted to each maternal profile.

Adult↗

PubMed2005

Outcome of maternal syphilis at Rajavithi Hospital on offsprings.

BACKGROUND: Syphilis remains an important sexually transmitted disease and continues to be an important problem in Thailand. Despite the clinical efficiency of penicillin in the treatment of pregnant patients with syphilis, infants with congenital syphilis are still encountered. Congenital syphilis poses significant challenges for the clinician because infants may be asymptomatic at birth or present with a highly variable clinical picture. OBJECTIVES: To evaluate the outcomes of neonates born to syphilitic mothers, the efficacy of antepartum treatment in the prevention of congenital syphilis and treatment for congenital syphilis after delivery. MATERIAL AND METHOD: The surveillance conducted from September 1st, 2002 to December 31st, 2003, involved 63 mothers who were diagnosed with syphilis and their offsprings at Rajavithi Hospital, Bangkok, Thailand. Sixty-four infants had complete physical examination, growth, development and laboratory evaluation at Queen Sirikit National Institute of Child Health at the time of delivery and at the ages of 1, 2, 4 and 6 months. RESULTS: There were 63 mothers and 64 infants recruited in the present study. Fifty-three mothers had prenatal care (84.13%). The VDRL was positive in the first prenatal care visit in 42 mothers (66.67%) and 11 mothers (17.46%) had seroconversion later on. Maternal treatment for syphilis included adequate penicillin 23 cases (36.51%), inadequate penicillin 5 cases (7.94%), erythromycin 9 cases (14.29%) and 26 mothers (41.27%) received no treatment at all. The mean maternal age, mean gestation age at treatment for syphilis and at delivery were 30.31 +/- 5.60 years, 32.75 +/- 6. 73 weeks and 38.60 +/- 1.57 weeks respectively. Failure rate in the adequate penicillin group was 8.7%. The mean birth weight of the 64 infants was 3034 +/- 495 grams, no syphilitic stillbirth occurred. Nine infants (14.06%) were identified with presumptive congenital syphilis. The manifestation include hepatomegaly (55.56%), desquamation of palms and soles (44.44%), radiological changes (33.33%) and abnormal cerebrospinal fluid (25%). The fluorescent treponemal antibody absorption immunoglobulin M (FTA-ABS IgM) tests of the infants were positive in 2 out of 9 cases (22.22%). The range of maternal and neonatal VDRL titer were between weakly reactive to 1.32 and nonreactive to 1:32 respectively. Fifty infants (78.13%) including 9 presumptive cases were followed-up, all had normal growth. Thirty-four infants (68%) who had re-evaluation for VDRL titers, were seronegative. CONCLUSION: Penicillin is the effective treatment of pregnant patients with syphilis and infants with congenital syphilis. The high risk of congenital syphilis correlates with untreated mothers and inadequate maternal syphilis treatment.

Adult↗

PubMed1994

Epidemic syphilis: maternal factors associated with congenital infection.

OBJECTIVE: Little is known about which cases of maternal syphilis will affect the newborn. Because of the current epidemic of syphilis in pregnancy in our city, we sought to identify risk factors during pregnancy associated with congenital infection. STUDY DESIGN: We reviewed 253 cases of maternal syphilis prospectively identified over a 1-year period. On the basis of neonatal diagnosis, these data were divided into two groups, those without evidence of presumptive congenital syphilis and those with evidence of presumptive congenital syphilis. Presumptive congenital syphilis was defined according to the Centers for Disease Control and Prevention surveillance case definition. Cases with bloody spinal taps and cases of suspected congenital syphilis that did not meet these criteria were excluded. Venereal Disease Research Laboratory titers are given as the inverse of the geometric mean. RESULTS: Venereal Disease Research Laboratory titer at time of diagnosis and unknown duration of disease were risk factors for congenital syphilis. There was a significantly decreased rate of congenital syphilis with single-dose therapy if disease length was < 1 year (p < 0.005). Unknown duration of disease was associated with 67.9% and 48.6% rates of congenital syphilis with one- and three-dose therapy respectively. There was a 28% incidence of preterm birth. CONCLUSION: Our study suggests an alarming rate of failure of current therapy to prevent congenital syphilis. Venereal Disease Research Laboratory titer at time of diagnosis and unknown duration of disease are risk factors for congenital syphilis. The high rate of presumptive congenital syphilis in the unknown duration group indicates that identification before or earlier in pregnancy will be necessary to prevent devastating consequences for the neonate.

Adult↗

PubMed1999

Syphilis serology and HIV infection in Harare, Zimbabwe.

OBJECTIVE: To determine the reliability of serological tests in detecting syphilis in a factory worker cohort and examine the impact of concurrent HIV infection on serological tests for syphilis. METHOD: Reactions to non-treponemal and treponemal antigens were tested using sera from a cohort of 3401 factory workers in Harare, Zimbabwe. The participants consented to regular testing for syphilis, by VDRL, and HIV using two ELISAs. All sera from men who were VDRL positive, and a random sample of VDRL negative sera, were tested by RPR, TPHA, and where appropriate FTA-Abs. From the results, men were defined as having no syphilis, active syphilis, incident syphilis, historic syphilis, or giving biological false positive reactions. RESULTS: 709 sera were examined from 580 men. There were 78 cases of active syphilis in the cohort, giving a prevalence of 2.3%, and the seroincidence was 0.25 per 100 person years of follow up. The prevalence of HIV in the cohort was 19.8%. There was a strong association between syphilis, whether active, incident or historic, and HIV seropositivity. With both HIV positive and negative sera the negative predictive values of VDRL and RPR were > 99.9% while the positive predictive value for VDRL (30%) was lower than for RPR (39%). Biological false positive reactions were detected in 0.5% of the cohort, with in most cases a transient rise in VDRL titres up to < 1/16. Higher false positive titres occurred in five men, each of whom was HIV positive. CONCLUSIONS: The VDRL is reliable in detecting possible cases of syphilis even in a community with a high prevalence of heterosexually transmitted HIV. There is need, however, for confirmatory tests. The prevalence of syphilis in this cohort is very low in comparison with other countries in southern Africa, but is consistent with recent data from Harare. Despite a strong association between syphilis and HIV it was clear that syphilis could not be counted as a major factor fueling the HIV epidemic in Zimbabwe.

Cohort Studies↗

PubMed2000

Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County, 1994-6.

OBJECTIVES: To describe HIV prevalence and the association between syphilis incidence and sexual and drug injection risk behaviours in a cohort of street recruited injecting drug users (IDUs) in Los Angeles County, between 1994 and 1996. METHODS: During the study period, 513 street recruited African-American and Latino IDUs were screened for syphilis and antibodies to HIV. Subjects were administered a risk behaviour survey at baseline and followed up at 6 month intervals for 18 months with repeated interviews and serological screening. Rate ratios were used to examine associations between syphilis incidence and demographic characteristics and risk behaviours. A proportional hazard model was used to identify predictors of syphilis incidence independent of demographic characteristics. RESULTS: 74% of the sample were male, 70% African-American, 30% Latino; and the median age was 43 years. Overall baseline serological prevalence of HIV was 2.5% and of syphilis 5.7%. None of the participants were co-infected for HIV and syphilis at baseline or at any of the 6 month follow ups. Among 390 eligible IDUs retained for analysis of incidence data, the overall syphilis incidence was 26.0 per 1000 person years. Higher syphilis incidence was found for women compared with men (RR = 2.70; 95% CI 1.60, 4.55), and for those 44 years of age or younger compared with those 45 years of age and older (RR = 2.26; 95% CI 1.25, 4.08). African-Americans were more likely to be syphilis incident cases when compared with Latinos, although the difference did not reach statistical significance (RR = 1.27; 95% CI 0.72, 2.23). In bivariate analysis, risk behaviours significantly associated with higher syphilis incidence included injection of cocaine, "speedball" and heroin, "crack" smoking, recency of first injection event, backloading of syringes, injecting with others, exchanging drugs or money for sex, multiple sex partners, and non-heterosexual sexual preference. Variables that significantly predicted syphilis infection at follow up in the multivariate analysis included multiple sex partners (RR = 7.8; 95% CI 2.4, 25.0), exchanging money for sex (RR = 3.0; 95% CI 0.9, 9.6), and recent initiation to injection drug use (RR = 4.6; 95% CI 1.1, 18.8). CONCLUSION: Syphilis transmission among IDUs in Los Angeles County remains a serious public health concern, particularly among IDUs who engage in trading of sex for money or drugs. Although low, the prevalence of HIV observed in this study constitutes a serious concern because of the potential for expanded HIV transmission in this susceptible population of IDUs with high syphilis incidence. Enhanced case finding screening efforts and prevention of transmission of sexually transmitted infections should specifically target hard to reach IDUs and their sexual partners.

Adolescent↗

PubMed1999

The use of Western blotting as the confirmatory test for syphilis in patients with rheumatic disease.

OBJECTIVE: As a direct or indirect result of antiphospholipid antibody production, subjective laboratory interpretation, and false positive results, the common serologic tests for syphilis have been inherently inaccurate diagnostic tests in patients with systemic lupus erythematosus (SLE) and other autoimmune diseases. We assessed the diagnostic accuracy of syphilis testing in patients with SLE and other autoimmune diseases using the treponemal Western blot (TWB) as the gold standard. METHODS: A prospective cohort study carried out at a tertiary care medical center. We studied 107 patients with autoimmune disease, 50 with at least one positive serologic test for syphilis and 57 disease matched controls. Prior to enrollment all eligible patients underwent a clinical assessment performed by at least 2 rheumatologists to confirm a diagnosis of rheumatic disease. All subjects underwent serologic testing, in blinded fashion, for syphilis using the rapid plasma reagin test (RPR), Venereal Disease Research Laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA-ABS), and the TWB. RESULTS: Eighty-seven percent of the patients studied were female, the mean age was 46.5 years, and the most common diagnosis at the time of enrollment was SLE. Using the TWB as the gold standard diagnostic test for syphilis, the sensitivity, specificity, and positive predictive values for each syphilis test were calculated. The sensitivity and specificity for the RPR in patients with rheumatic disease was 62.5% (95% confidence interval 24.5 to 91.5%) and 91.9% (95% CI 84.2 to 96.2%), respectively. The sensitivity and specificity for the VDRL were 37.5% (95% CI 8.5 to 75.5%) and 89.9% (95% CI 81.8 to 94.8%), respectively. Confirmatory syphilis testing using the FTA-ABS showed a sensitivity of 100% (95% CI 68.6 to 100%) and a specificity of 67.7% (95% CI 57.4 to 76.5%). Eight patients tested positive for syphilis by Western blotting. For the FTA-ABS test, there was a significantly higher number of false positive results (n = 32) compared to false negative results (n = 0), p < 0.0005. CONCLUSION: The FTA-ABS is not an accurate confirmatory test for syphilis in patients with SLE and other autoimmune diseases. While a negative FTA-ABS may exclude syphilis infection in the majority of cases, a positive FTA-ABS test result cannot assuredly confirm syphilis infection in this population. Western blotting is an accurate confirmatory test for syphilis and may be necessary to unequivocally discern the immunological response of syphilis from that of an underlying autoimmune disease.

Blotting, Western↗

PubMed2001

[Syphilis in pregnancy women].

OBJECTIVE: To investigate obstetric treatment and pregnancy outcomes of syphilis infection during pregnancy. METHODS: 64 pregnant women diagnosed with syphilis by serological assays were divided into treated group and untreated group according to whether they accepted full-dose treatment against syphilis or not. Patients in the treated group accepted benzathine penicillin(2.4 million units once per week) intramuscular injection for three weeks. The outcome of pregnan after treatment was observed and compared between the two groups. RESULTS: There were 5 cases of primary syphilis (7.8%), 29 cases of secondary syphilis (45.3%), and 30 cases of latent syphilis (46.9%) among the 64 cases. The occurrences of premature birth, fetal intrauterine death, and stillbirth were 0, and 3 cases of congenital syphilis in total 13 cases who carried pregnancy to term in the treated group; while 4, 11, 3, and 10 in the untreated group respectively. In treated group, the 3 babies with congenital syphilis were born from 10 mothers received treatment after 24 gestational weeks, while no congenital syphilis in the 3 women started treatment before 24 weeks. CONCLUSIONS: Pregnant syphilis is prone to be misdiagnosed because of its slight symptom, so it is especially important to screen syphilis as a routine among high risk pregnant women. Premature, fetal death and congenital syphilis can be well controlled through regular and early treatment during pregnancy, yet congenital syphilis can not be avoided completely.

Adolescent↗

PubMed1996

Serologic response to treatment of syphilis in patients with HIV infection.

BACKGROUND: Much controversy exists concerning the manifestations, therapy, and response to treatment of syphilis in patients coinfected with the human immunodeficiency virus (HIV). OBJECTIVE: To assess the effect of HIV infection on the serologic response to treatment of patients with syphilis. METHODS: Sixty-four HIV-seropositive patients with syphilis were matched with 64 patients with syphilis who were HIV negative. Matching criteria included age (+/- 5 years), sex, race, initial rapid plasma reagin (RPR) titer (+/- 1 dilution), and stage of syphilis at entry. There were 26 matched patients with early syphilis, 26 matched patients with late syphilis, and 12 matched patients with biological false-positive RPR. The HIV-positive patients with early syphilis received three doses of penicillin G benzathine. All other patients received treatment as recommended by the Centers for Disease Control and Prevention, Atlanta, Ga. Our study's major end points were clinical and serologic response to treatment. RESULTS: All 16 patients with symptomatic syphilis were cured. No patient developed clinical signs of neurosyphilis during the 12-month follow-up period. Twenty-nine (56%) of 52 HIV-positive patients with early or late syphilis did not have a fourfold decrease in RPR titer 6 months after treatment compared with 20 (38%) of 52 matched controls (P = .06). No unique characteristics identifying patients who did not respond serologically could be established. The HIV-positive patients with initial RPR less than 1:32 experienced a significantly slower decrease in RPR at 12 months than did the controls (P < .001). CONCLUSIONS: Patients with syphilis who are HIV positive are less likely to experience serologic improvement after recommended therapy than are patients with syphilis who are HIV negative. Patients with HIV infection who contract syphilis should receive intensive and prolonged follow-up, and consideration should be given to designing alternative regimens.

Adult↗

PubMed2005

Estimating prenatal syphilis and HIV screening rates for commercially insured women.

OBJECTIVE: Although routine serologic testing for syphilis and human immunodeficiency virus (HIV) for all pregnant women is recommended by the Centers for Disease Control and Prevention and many health professional organizations, little is known about the extent of prenatal syphilis and HIV screening rates among commercially insured pregnant women. METHODS: A claims database for a large commercially insured population was analyzed to estimate syphilis and HIV screening rates for pregnant women who were continuously enrolled in the same health insurance plan during 1998 and 1999 in 13 U.S. states. Diagnostic and procedural services were used to determine pregnancy status, receipt of prenatal care, and syphilis and HIV testing during pregnancy. RESULTS: Of 13,250 identified pregnancies, 12,156 (92%) were among women who had prenatal visits; 8368 (63%) included claims for syphilis testing; and 4411 (33%) included claims for HIV testing. Of the 8368 pregnancies with syphilis testing, 6326 (76%) included syphilis tests that were performed during the initial prenatal visit. Of the 4411 pregnancies with HIV testing, 3168 (72%) included HIV testing on the initial prenatal visit. Of 4249 pregnancies with syphilis and HIV testing, 3146 (74%) included HIV testing and syphilis testing on the initial prenatal visit. CONCLUSIONS: Most HIV and syphilis tests had been provided during initial prenatal visits among women who had HIV and syphilis testing. Prenatal screening rates for syphilis and HIV identified through claims were lower than expected. This may be due to deficiencies in documentation of syphilis and HIV screening in administrative databases or actual screening rates. Further investigation is needed to determine how accurately claims data can measure actual screening practices.

Age Distribution↗

PubMedDate not supplied

The syphilis epidemic in Connecticut: relationship to drug use and prostitution.

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.

Connecticut↗

PubMed2005

Control of syphilis outbreaks in men who have sex with men: the role of screening in nonmedical settings.

OBJECTIVE: To quantify the scope and yield of targeted syphilis screening in nonmedical settings in 7 US cities affected by recent syphilis outbreaks among men who have sex with men (MSM). METHODS: Data were collected from syphilis screening activities targeting MSM between 1999 and 2004, conducted in bathhouses or other commercial sex venues, MSM-oriented bars, mobile vans, and other nonmedical settings by the public health departments of Chicago, Houston, Miami/Fort Lauderdale, Los Angeles, NY, and San Francisco. RESULTS: Of 14,143 syphilis screening tests (STS) conducted during community outreach campaigns at a variety of MSM oriented venues, 132 (0.9%) new cases of syphilis were identified. One hundred five (0.8%) new cases of early syphilis were found, including 23 cases of symptomatic syphilis. Screening in jails produced the highest prevalence of early syphilis (1.3%, 51 cases/3853 STS), followed by sex venues, including bathhouses (1.2%, 29 cases/2511 STS). CONCLUSIONS: These data suggest that even nontraditional, highly targeted screening programs conducted during outbreak situations do not detect many persons with syphilis, even though many of the screening venues were locations where men with syphilis met their sex partners. The low prevalence of infectious syphilis identified during these screening events suggests that the direct impact of these programs on decreasing syphilis transmission may be negligible. However, the secondary benefits, such as increasing awareness of syphilis and prompting earlier treatment due to symptom recognition, may be substantial.

Cities↗

PubMed2001

Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction.

PURPOSE: Between 4-15% of pregnant women are believed to be infected with syphilis in sub-Saharan Africa. Active infection with syphilis in pregnant women results in foetal or infant death or disability for 50-80% of affected pregnancies, and is a major cause of adult morbidity as well. Antenatal syphilis screening is cheap and effective; however, it is often poorly implemented in countries with high syphilis risk. This study sought to estimate the missed opportunities for antenatal syphilis screening in sub-Saharan Africa. METHODS: Survey data were collected from 22 ministries of health in sub-Saharan Africa, complemented by data from published sources and key informants. Informants described their country's policies and experience with antenatal syphilis screening and estimated their national syphilis screening rates. FINDINGS: Seventy-three percent of women are reported by WHO to receive antenatal care in the study countries. Of women in antenatal care, 38% were estimated by survey respondents to be screened for syphilis. Costs and the organization of services were the principal reported obstacles to screening. With syphilis seroprevalence estimated at 8.3%, approximately 1 640 000 pregnant women with syphilis are undetected annually, including 1 030 000 women who attend antenatal care. DISCUSSION: Syphilis testing and treatment is a cost-effective intervention that deserves much greater attention, particularly in sub-Saharan Africa and other countries where syphilis infection is high.

Africa South of the Sahara↗

PubMed1989

Enzyme-linked immunosorbent assays for detection of immunoglobulin M to nontreponemal and treponemal antigens for the diagnosis of congenital syphilis.

Sera from newborn infants born of mothers with a high risk of syphilis were examined for immunoglobulin M (IgM) antibodies in two different enzyme-linked immunosorbent assays (ELISAs), using either purified flagella from Treponema phagedenis biotype Reiter or the Venereal Disease Research Laboratory (VDRL) antigen as the antigen. All sera were also examined by the fluorescent treponemal antibody absorption (FTA-ABS) test for IgM. Three different groups of patients were studied. Group 1 consisted of 84 women and their newborn infants from a high-risk population for syphilis. Congenital syphilis was diagnosed in one child who had an IgM-positive cord blood specimen in both the ELISA and the FTA-ABS test. Group 2 consisted of 10 mothers and their newborn children. All mothers had positive syphilis-screening tests, and all children had signs of congenital syphilis. All but one child had positive IgM tests. Group 3 consisted of 15 mothers and their newborn children. These mothers had been treated for syphilis late in pregnancy, and all had a positive screening test at delivery. Two of the children had positive IgM tests, probably caused by reactivity after late intrauterine treatment of congenital syphilis. The specificities of the IgM tests were high when evaluated with sera from newborn children without signs of congenital syphilis. Even though IgM rheumatoid factor was found in all of the children tested with definite congenital syphilis, the rheumatoid factor did not cause false-positive results in either the VDRL ELISA or the flagellum ELISA. No significant IgG-IgM competition was noticed in the ELISAs. This study also confirmed that IgA antibodies do not cross the placenta; most newborn children with congenital syphilis were positive in the VDRL ELISA for IgA. Both the VDRL ELISA and the flagellum ELISA are very useful in the diagnosis of congenital syphilis and may be substitute for the FTA-ABS test. The VDRL ELISA for IgM will be especially useful in developing countries with a high incidence of congenital syphilis.

Adult↗

PubMed1990

Evaluation of the Captia enzyme immunoassays for detection of immunoglobulins G and M to Treponema pallidum in syphilis.

Two new enzyme-linked immunosorbent assays (ELISA), one for the measurement of immunoglobulin G (IgG) (Captia Syphilis-G) and one for the measurement of IgM (Captia Syphilis-M), were evaluated for detecting antibodies to Treponema pallidum. Serum samples from 169 patients, 96 with various stages of untreated syphilis, 63 with treated syphilis, and 10 who were noninfected, were investigated. All sera were also examined by traditional treponemal and cardiolipin tests and by the fluorescent treponemal antibody absorption (FTA-ABS) test for 19S(IgM). The overall sensitivity of Captia Syphilis-G was 98.3%. The IgG ELISA was very sensitive (100%) in all stages of untreated syphilis, except in primary syphilis (82%). In all diagnostic groups of syphilis, the reactivity of Captia Syphilis-M was similar to that of the 19S(IgM) FTA-ABS test, except in reinfections, in which the IgM capture ELISA was less sensitive. False-positive IgM capture ELISA results were not found in the 10 neonates born to mothers adequately treated for syphilis. However, of six serum samples containing rheumatoid factor, two were reactive in the Captia Syphilis-M test but not in the 19S(IgM) FTA-ABS test. This indicated that the specificity of the IgM capture ELISA was not absolute. All serum samples from treated patients were reactive in the IgG ELISA, but only 15 samples were reactive in the IgM capture ELISA, which appeared to be as effective as the 19S(IgM) FTA-ABS test in monitoring the effect of treatment. Simultaneous measurement of IgG and IgM antibodies for T. pallidum by the Captia immunoassays appears to be an efficient and simple method for confirming the diagnosis of syphilis as well as for indicating whether active disease is present.

Antibodies, Bacterial↗

PubMed2002

Epidemics due to imported syphilis in Finland.

BACKGROUND: Russia and other states of the former Soviet Union experienced a huge increase in syphilis beginning in the early 1990s. At first these epidemics were not well known in neighboring countries such as Finland. STUDY DESIGN: In 1995 the incidence of syphilis in Finland doubled to 3.3/100,000 and a local cluster of 18 cases was detected in the city of Tampere. The reasons for this epidemic were analyzed and the occurrence of syphilis was carefully monitored up to 2001. RESULTS: The main reason for the increased incidence in Finland was the import of syphilis from Russia; only a few cases were acquired from Estonia or elsewhere. The source partners of Finnish men who contracted syphilis abroad were mostly sex workers or other casual partners. Mobile prostitution to Finland was not involved in the transmission. Most syphilis cases were found sporadically in southern Finland, in areas where foreign travel is frequent. Secondary transmission in Finland was usually limited to one or two partners. The only isolated cluster was further away and developed due to unawareness of the risk of syphilis by the cases and local healthcare providers. From 1995 onward, syphilis was carefully monitored by national reporting and a special sexually transmitted disease (STD) surveillance network, and the incidence remained at a constant level even though travel to and from Russia more than tripled. Nationwide serologic surveillance in STD and maternity clinics and among blood donors showed no major changes in the prevalence of syphilis. CONCLUSION: An epidemic of syphilis imported mainly by heterosexual men from Russia caused one sporadic cluster in Finland in 1995. Thereafter, general awareness by the public and healthcare providers about the risks of contracting syphilis from abroad, in addition to effective use of national surveillance and notification systems, was needed to protect the country from further spread of syphilis to an endemic infection.

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