SEARCH · PubMed Health

Results for “Syphilis”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources

PubMed1990

Clinical survey of syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with special reference to the recent clinical manifestations and evaluation of IgM antibodies to Treponema pallidum.

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA + IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.

Adolescent↗

PubMed1998

Treatment of infants with reactive syphilis serology, New Jersey: 1992 to 1996.

BACKGROUND AND RATIONALE: Diagnosis of congenital syphilis is problematic: infants with congenital syphilis are often asymptomatic, and signs in symptomatic infants are frequently subtle and nonspecific. Furthermore, there are no readily available diagnostic tests that provide a definitive diagnosis. Previously, the diagnosis of congenital syphilis was based on a complex set of clinical and laboratory criteria, and only infants with clinically apparent illness or laboratory findings indicating congenital syphilis were classified as cases and reported to health departments and the Centers for Disease Control and Prevention (CDC). To systematize diagnosis and case-reporting, the CDC developed a standardized surveillance case definition in 1988. This case definition includes symptomatic infants as well as asymptomatic infants of mothers with untreated or inadequately treated syphilis during pregnancy. It is intended to be highly sensitive to better estimate the burden of disease in the community. Treatment guidelines for congenital syphilis are intentionally conservative and err on the side of overtreatment so that all potentially infected infants are treated. The congenital syphilis surveillance case definition is compatible with the American Academy of Pediatrics (AAP) and CDC treatment guidelines; thus, the number of infants identified and reported to state health departments and the CDC should reflect the number of infants treated. Hundreds of infants with reactive serologic tests for syphilis (STS) are reported each year to the New Jersey Department of Health and Senior Services (NJDHSS). The majority of these infants do not meet the case definition for congenital syphilis, and most are treated although treatment guidelines indicate that treatment is not necessary. OBJECTIVE: To determine whether infants with reactive STS in New Jersey are being treated according to the AAP treatment guidelines. METHODS: Medical records of newborns with reactive STS reported to NJDHSS between July 1, 1992, and June 30, 1996, were reviewed to determine status of infection and compliance with the AAP treatment guidelines. The 1995 NJDHSS Uniform Billing and Hospital Discharge Data was used to estimate the mean cost of hospitalization per day for infants with the diagnosis of congenital syphilis. Results. During the study period, 1669 newborns with reactive STS were reported to the NJDHSS Sexually Transmitted Disease Program. Medical record review was completed for 1480 infants (88%). Infants were classified by CDC surveillance criteria as follows: 0 confirmed cases; 515 (35%) presumptive cases; 16 (1%) syphilitic stillbirths; and 949 (64%) cases that did not meet the definition for congenital syphilis. Of the 512 presumptive cases that survived the immediate perinatal period, 478 (93%) were treated with antibiotics and 459 (90%) were treated according to the AAP treatment guidelines. Only 27 infants (6%) were treated with a single intramuscular dose of benzathine penicillin. Thirty-four infants (7%) were not treated; instead, their physicians chose to follow them clinically and serologically. All of those treated were asymptomatic, and most were born to mothers with a history of adequate treatment before or during pregnancy, but who were without serologic follow-up. Of the 949 infants that did not meet the case definition, 329 infants (35%) were not treated and 620 (65%) were treated with antibiotics. The 508 (82%) infants treated with antibiotics were treated with intravenous or intramuscular antibiotics for 10 days; only 62 (10%) were treated with a singular intramuscular dose of benzathine penicillin. According to NJDHSS Uniform Billing Hospital Discharge Data, 267 infants weighing >/= 2500 g were discharged with a diagnosis of congenital syphilis in 1995. The median number of hospital days for these infants was 10, and the mean cost of hospitalization per day was $1010. Sources of payment of hospital charges for most infants were public in

Anti-Bacterial Agents↗

PubMedDate not supplied

Prevalence, burden, and control of syphilis in Haiti's rural Artibonite region.

OBJECTIVES: A study was conducted to determine the prevalence and health consequences of syphilis and to evaluate existing control measures in a Haitian rural district of 200,000 people served by 12 community dispensaries and Hospital Albert Schweitzer. METHODS: Syphilis seroprevalence among consecutive women receiving antenatal services was assessed using rapid plasma reagin (RPR) screening and fluorescent treponemal antibody absorption (FTA-ABS) confirmatory testing. Hospital and dispensary records were used to review genital ulcer disease and syphilis cases seen during 1995. RESULTS: Of 811 pregnant women attending prenatal clinics during a 3-month period in 1996, 46 (5.7%) were RPR reactive. Syphilis seroreactivity was confirmed in 45 (97.8%) of 46 samples by FTA-ABS. Of 649 women attending dispensaries in the valley 41 (6.3%) were syphilis seroreactive compared with 4 (2.5%) of 162 women attending dispensaries in the mountains (OR = 2.66; P = 0.056). In 1995, 620 cases of genital ulcer disease were seen at the community dispensaries. At the central hospital, 257 new diagnoses of syphilis were made in 1995, including 30 cases of primary and secondary syphilis, 168 cases of latent disease, 17 cases of recurrent infection, 9 cases of tertiary disease, and 33 cases of congenital syphilis. CONCLUSIONS: The 33 cases of congenital syphilis, a rate of 550 cases for 100,000 live births, clearly demonstrated a failure of local control measures. Decentralized prenatal screening for syphilis, same-day treatment of seroreactors, and strengthened partner treatment were initiated. Further studies to improve primary prevention of syphilis in rural populations have been started. Other strategies, including mass treatment of high-risk groups, should be investigated.

Cost of Illness↗

PubMed2003

Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease.

Analysis of Variance↗

PubMedDate not supplied

[Positive serology for syphilis in neonatal period: prevalence in secondary level maternity. Association with maternal risk factors and with positive serology for HIV-1].

To study neonatal Syphilis seropositivity incidence, its association with HIV-1 seropositivity and the impact of Congenital Syphilis CDC case definition, cord blood VDRL and Indirect Hemagglutination (IHA) for Syphilis were performed in 3,664 newborns from Dec/91-July/92. A positive group was formed by those with positive VDRL and IHA or just positive IHA. The control group consisted of 200 VDRL and IHA negative neonates. Among the 3,664 neonates 5.6% were seropositive for Syphilis. A significant association was noted (p < or = 0.05) between neonatal seropositivity for Syphilis and mothers older than 20 years, single, with sexual promiscuity, drug use, no pre-natal care, multiparity and previous still-births. All positive neonates fitted in the Presumptive Congenital Syphilis CDC definition. In 50 seropositive for Syphilis neonates ELISA for HIV-1 was performed and 6/50 were positive. Congenital Syphilis is of concern, specially in neonates of mothers with risk factors for Syphilis acquisition. HIV-1 should be considered in seropositive for Syphilis neonates. Adoption of Congenital Syphilis new CDC case definition is advised, particularly in countries where prenatal care is deficient.

AIDS Serodiagnosis↗

PubMed1993

[Analysis of 1983-1991 Leipzig University Dermatology Clinic observed cases of syphilis].

A total of 1380 patients with syphilis were diagnosed and treated from January 1983 to December 1991 at the Department of Dermatology and Venereology at Leipzig University in West Saxon, Federal Republic of Germany where the population is 1.4 million. The incidence of syphilis increased gradually from 1983 to 1989 and then decreased again. The number of recent cases of syphilis was almost twice as high as latent syphilis cases (63:37%). The vast majority of cases suffered from early syphilis. In almost half the source of infection was casual contacts (44%); in one-third it was a stable partners (30%); about 6% were homosexuals and about 4% were prostitutes. Among the primary syphilis cases multiple chancres were seen in 16%. In 31% of cases, the ulcus durum was extragenital. Among the secondary syphilis cases macular and maculopapular exanthema were the commonest features (51%), followed by palmoplantar syphilis (5%), condylomata lata (5%), angina specifica (3%) and papular exanthema (3%). However, in 30% of the cases multiple skin features were observed. Secondary syphilis with persistent chancres were seen in 12%. Five percent of the patients were suffering from the second to the fifth reinfection in their life, and again 5% of the syphilis cases were detected during pregnancy. Only two patients had an HIV infection, 10% suffered from gonorrhea and 10% from trichomoniasis, 12% from chlamydial infection, 4% from genital warts and 8% from herpes simplex genitalis at the same time. The therapy of choice was penicillin. In 0.3% an allergy to penicillin was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2001

Antibiotics for syphilis diagnosed during pregnancy.

BACKGROUND: Congenital syphilis is an increasing problem in many developing countries and in the transitional economies of Eastern Europe and the former Soviet Union. In several countries this increase has been aggravated by HIV/AIDS. While the effectiveness of penicillin in the treatment of syphilis in pregnant women and the prevention of congenital syphilis was established shortly after the introduction of penicillin in the 1940s, there is uncertainty about the optimal treatment regimens. OBJECTIVES: To identify the most effective antibiotic treatment regimen (in terms of dose, length of course and mode of administration) of syphilis with and without concomitant infection with HIV for pregnant women infected with syphilis. SEARCH STRATEGY: MEDLINE 1966 to March 2000; EMBASE 1974 to March 2000, the Cochrane Controlled Trials Register (last searched March 2001), the Cochrane Pregnancy and Childbirth group trials register (last searched March 2001) and the references of traditional reviews were searched. Experts in specialist units were contacted. SELECTION CRITERIA: It was planned that any trial in which an attempt is made to allocate treatment for syphilis during pregnancy by a random or quasi-random method would be included in this review. DATA COLLECTION AND ANALYSIS: Information was extracted using a data extraction sheet and this included entry criteria, the source of controls, and whether the authors stratified by the stage of pregnancy when the diagnosis of syphilis was made. MAIN RESULTS: Twenty six studies met the criteria for detailed scrutiny. However, none of these met the pre-determined criteria for comparative groups and none included comparisons between randomly allocated groups of pregnant women. REVIEWER'S CONCLUSIONS: While there is no doubt that penicillin is effective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis, uncertainty remains about what are the optimal treatment regimens. Further studies are needed to evaluate treatment failure cases with currently recommended regimens and this should include an assessment of the role of HIV infection in cases of prenatal syphilis treatment failure. The effectiveness of various antibiotic regimens for the treatment of primary and secondary syphilis in pregnant women need to be assessed using randomised controlled trials which compare them with existing recommendations.

Anti-Bacterial Agents↗

PubMed1989

Time series analysis of syphilis surveillance data.

To manage a public health programme effectively it is necessary to set objectives and priorities according to the resources available. To utilize available resources optimally in a disease control programme we should both estimate the present and predict the future magnitude of the health problem. The CDC has an effective programme to control syphilis, a sexually transmitted disease. To keep track of control activities, CDC receives the number of syphilis cases from all states every three months. Primary and secondary syphilis cases declined from an all time high of 106,539 cases in 1947 to 6399 cases in 1956. Since then, syphilis cases increased to 27,921 in 1986. Congenital syphilis cases declined from 17,600 in 1941 to 239 in 1983, but increased to 408 in 1986. We built time series models for primary and secondary syphilis cases in men and women and congenital syphilis cases in children under one year of age. These models were used to forecast syphilis cases in all three categories. This analysis suggests that no change in the trend of male syphilis cases has occurred, but syphilis cases in women and congenital syphilis cases in children under one year of age during 1987 have increased.

Data Interpretation, Statistical↗

PubMed1995

Poor correlation between reactive syphilis serology and human immunodeficiency virus testing among potential cornea donors.

PURPOSE: The current practice in which eye banks screen cornea donors for syphilis is based mainly on the potential utility of positive syphilis serology as a surrogate marker for human immunodeficiency virus-1 (HIV-1) infection. We examined the correlation between positive syphilis and HIV-1 serologies within the potential cornea donor population. METHODS: We distributed a questionnaire to 94 eye banks in the United States regarding their rates of positive serology for syphilis and HIV-1 between Feb. 1 and July 30, 1992. We subsequently used the polymerase chain reaction for HIV-1 to further evaluate the whole blood of 21 rapid plasma reagin and fluorescent treponemal antibody-positive, HIV-1 enzyme-linked immunosorbent assay (ELISA)-negative cornea donors to determine whether these donors were infected with HIV-1 but were within a seronegative window for HIV-1 antibodies at their time of death. RESULTS: Of 8,932 donors screened, 103 (1.15%) had reactive screening for syphilis serology and 35 (0.39%) were HIV-1 seropositive. No donor with positive syphilis serology was also HIV-1 seropositive. Twelve of 31 donors who originally tested seropositive for syphilis by nontreponemal screening tests (Venereal Disease Research Laboratory or rapid plasma reagin tests) proved seronegative for syphilis when further tested with a treponemal test (FTA-ABS or microhemagglutination-Treponema pallidum), suggesting a high (38.7%) false-positive rate for the syphilis screening tests. Additionally, all 21 rapid plasma reagin and fluorescent-treponemal antibody-positive, HIV-1 ELISA-negative donors further tested were also negative for HIV-1 by the polymerase chain reaction. CONCLUSIONS: Among potential cornea donors, a population prescreened for identifiable HIV-1 risk factors, positive syphilis serology appears to be a poor marker for HIV-1 infection. The role of syphilis screening of potential cornea donors may need to be reevaluated.

AIDS Serodiagnosis↗

PubMed1990

Congenital syphilis presenting in infants after the newborn period.

BACKGROUND AND METHODS: There has been a recent, dramatic increase in the incidence of congenital syphilis, particularly in urban areas. We describe seven infants seen during one year who were first given a diagnosis of congenital syphilis at 3 to 14 weeks of age, when symptoms developed. We reviewed these infants' charts in order to ascertain the reasons for the failure to diagnose syphilis at birth and to identify the signs and symptoms of congenital syphilis in this group of infants. RESULTS: At delivery, four of the infants and their mothers had negative qualitative rapid-plasma-reagin tests for syphilis. The other three mothers had been seronegative during the pregnancy and were therefore not tested at delivery; two of their infants were seronegative at birth, and one was not tested. When the infants became symptomatic between 3 and 14 weeks of age and were admitted to the hospital, all seven infants and the five mothers available for testing were found to be seropositive for syphilis. Four infants presented with a characteristic diffuse rash; the other three presented with fever and were found on admission to have aseptic meningitis. All these infants had multisystem disease, as evidenced by hepatomegaly, increased aminotransferase and alkaline phosphatase levels, anemia, and monocytosis. In all the infants syphilis responded to parenteral penicillin. CONCLUSIONS: Congenital syphilis may be missed if serologic tests are not performed for both the mother and her infant at the time of delivery. Even when these tests are performed, some infants are not identified as having syphilis, probably because the infection is very recent and there has been insufficient time for an antibody response to develop. Some infants with congenital syphilis of later onset do not present with a typical rash; therefore, at least in areas where the disease is prevalent, serologic tests for syphilis should be included in the evaluation of all febrile infants, even those with negative results on serologic testing at birth.

Age Factors↗

PubMed1993

Diagnosis of congenital syphilis by combining Treponema pallidum-specific IgM detection with immunofluorescent antigen detection for T. pallidum.

Most infants at risk for congenital syphilis can be identified easily by a positive maternal serologic test for syphilis. However, a diagnosis of congenital syphilis can be difficult to make in an individual infant. Seven infants with delayed-onset congenital syphilis and 101 newborns at risk for congenital syphilis were evaluated for characteristic physical findings and laboratory-detectable abnormalities of congenital syphilis. By using a combination of Western blot for T. pallidum-specific IgM detection and immunofluorescent antigen detection for the identification of T. pallidum, a diagnosis of congenital syphilis was made in all 7 infants with delayed-onset congenital syphilis and 24 of the 101 newborns at risk for congenital syphilis. However, T. pallidum-specific IgM was negative in 6 of the 24 newborns with congenital syphilis. T. pallidum-specific IgM detection alone is inadequate for the diagnosis of congenital syphilis.

Antibodies, Bacterial↗

PubMed1994

Syphilis in pregnancy: experience from a rural aboriginal community.

Syphilis in pregnancy is seldom encountered in urban Australia. This retrospective study reports on the high prevalence of syphilis and its associated complications in a group of pregnant Aboriginal women attending the Dareton Community Health Centre for antenatal care between September, 1989 and September, 1991. During this time, the centre provided antenatal care for 71 Aboriginal pregnancies and maternal syphilis was found in 20 (28%). The mean age of the women was 21.3 years (range of 14-33 years). The perinatal mortality rate was 48 per 1,000 births. All stillbirths were associated with maternal syphilis. The relative risk of stillbirth in the presence of syphilis was 4 (95% CI 2.56-6.25, p = 0.022). Prematurity was associated with maternal syphilis. The odds ratio for premature delivery was 21.5 (95% CI 2.26-2.05, p = 0.003). There was no statistical difference between the mean birth-weight and mean placental weight of term infants born to women with syphilis and women without syphilis (p = 0.35 and p = 0.31 respectively). When the placental:birth-weight ratios were considered, an apparent larger placenta was seen in association with syphilis but this was secondary to the lower birth-weights in association with prematurity. Late and poor attendance for antenatal care was a feature of all women attending this centre and not a feature associated with syphilis. The treatment and follow-up of syphilis were hindered by poor compliance.

Adolescent↗

PubMed1998

Syphilis in pregnant women and their children in the United Kingdom: results from national clinician reporting surveys 1994-7.

OBJECTIVE: To measure the incidence of syphilis detected in pregnancy and congenital syphilis in the United Kingdom. DESIGN: Surveys through consultants in genitourinary medicine and paediatricians with active surveillance. SETTING: United Kingdom, 1994-7. SUBJECTS: Women treated for syphilis in pregnancy, and children with early congenital syphilis born in the United Kingdom. RESULTS: Over 3 years 139 women were diagnosed with and treated for syphilis in pregnancy; 121 were detected through antenatal screening. Thirty one had confirmed or probable congenitally transmissible syphilis, putting their pregnancies at risk. These were minimum figures but are compatible with the 90 to 100 women newly diagnosed annually as having infectious or early latent syphilis. A universal screening policy would require 18 600 and 55 700 women (maximum numbers) to be screened, respectively, to detect one woman needing treatment and to prevent one case of congenital syphilis. Nine presumptive cases of children with congenital syphilis born in the United Kingdom were reported. Mothers requiring treatment for syphilis were found in almost every health region but were more prevalent in London and the south east. Being born abroad and belonging to an ethnic minority group were strong risk factors, but 14% (19 of 121) of cases treated and six of 31 definite or probably transmissible cases occurred in white women born in the United Kingdom. CONCLUSIONS: Congenitally transmissible syphilis continues to occur among pregnant women in the United Kingdom. Cases would be missed and stillbirths and congenitally infected babies would occur if antenatal screening was abandoned.

Emigration and Immigration↗

PubMed2000

Enzywell recombinant enzyme immunoassay for the serological diagnosis of syphilis.

The aim of this study was to evaluate Enzywell TP, a new rapid enzyme immunoassay (EIA) that uses 2 recombinant Treponema pallidum antigens for the serological diagnosis of syphilis. Specificity was evaluated by screening 1055 unselected bloods requesting serological tests for syphilis in parallel with Enzywell TP and the Syphilis ICE EIA which is our standard screening test for syphilis. Sensitivity was evaluated using a panel of 159 known treponemal sera representing various stages of syphilis and 5 treponemal sera detected on screening. The specificity of Enzywell TP on initial and repeat testing (99.6% and 99.7% respectively) was similar to that of the Syphilis ICE test (99.8% and 99.9% respectively). The sensitivity of Enzywell TP (100%) was similar to that of Syphilis ICE (99.4%): both tests were significantly more sensitive (P=0.01) than the fluorescent antibody absorbed test (94.5%) but not the T. pallidum particle agglutination (TPPA) assay (99.4%). Both Enzywell TP and Syphilis ICE were positive with sera from 16 known HIV-infected patients who had been treated for syphilis many years previously (mean 9.4 years) confirming the value of these tests in excluding previous syphilis in HIV-infected individuals. We conclude that the Enzywell recombinant EIA is simple, rapid, highly sensitive and specific, and is a welcome addition to the range of currently available diagnostic tests for syphilis.

Antibodies, Bacterial↗

PubMed2003

Diagnosis and management of syphilis.

Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. Primary syphilis typically presents as a solitary, painless chancre, whereas secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum. In latent syphilis, all clinical manifestations subside, and infection is apparent only on serologic testing. Late or tertiary syphilis can manifest years after infection as gummatous disease, cardiovascular disease, or central nervous system involvement. Neurosyphilis can develop in any stage of syphilis. The diagnosis of syphilis may involve dark-field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of syphilis. Alternative regimens for nonpregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. In pregnant women and patients with neurosyphilis, penicillin remains the only effective treatment option; if these patients are allergic to penicillin, desensitization is required before treatment is initiated. Once the diagnosis of syphilis is confirmed, quantitative nontreponemal test titers should be obtained. These titers should decline fourfold within six months after treatment of primary or secondary syphilis and within 12 to 24 months after treatment of latent or late syphilis. Serial cerebrospinal fluid examinations are necessary to ensure adequate treatment of neurosyphilis.

Diagnosis, Differential↗

PubMed1998

Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection.

OBJECTIVES: To identify risk factors for vertical HIV transmission that may provide opportunities for the prevention of future pediatric HIV infection. STUDY DESIGN: A prospective cohort of 44 pregnant HIV(+) women and their 53 offspring was followed between July 1989 and July 1996. RESULTS: Secondary and latent maternal syphilis infection was diagnosed in four pregnancies with VDRL titers > or = 1:128. Concurrent maternal syphilis infection was associated with 100% vertical HIV transmission (4/4), compared to 21% (3/14) deliveries that occurred in 13 women with only a history of treated sypillis (P = 0.01) and 14% (5/35) deliveries in women with no history of syphilis (P = 0.0015). Among non-Zidovudine exposed pregnancies, 100% (3/3) patients with concurrent syphilis transmitted HIV to their infants vs. 0% (0/8) patients with only a history of syphilis (P = 0.006). A history of treated syphilis did not increase subsequent transmission risk compared to women with no history of syphilis (3/14 vs. 5/35, P = 0.41). One patient delivered twice during the study and received Zidovudine prophylaxis during both pregnancies. Her first pregnancy VDRL titer was > or = 1:128, during which she delivered an HIV infected child. Following successful treatment for syphilis (VDRL titer, 1:1), she conceived again and delivered an uninfected infant 11 months later. Additional risk factors significantly associated with vertical HIV transmission were prematurity and low birth weight. Variables studied but not statistically-related to HIV transmission included: other sexually transmitted diseases, maternal age, race, intravenous drug or cocaine use, prenatal care, route of delivery, duration of HIV(+) status, and CD4 count. CONCLUSION: Among HIV(+) women, concurrent syphilis infection, but not a history of syphilis, is significantly associated with vertical perinatal HIV transmission. Frequent screening and prompt treatment of syphilis in non-pregnant HIV(+) women may help prevent subsequent HIV infected pregnancies.

Adult↗

PubMedDate not supplied

High syphilis rates among cocaine abusers identified in an emergency department.

The recent syphilis epidemic in the United States has been linked to cocaine abuse. The goal of this study was to estimate the prevalence of newly diagnosed latent syphilis, as well as previously treated syphilis, in emergency department patients giving a history of cocaine use. Charity Hospital emergency department patients without symptoms of sexually transmitted disease (STD) who admitted to cocaine use were enrolled and screened for syphilis with the automated reagin test (ART). Patients were questioned about past syphilis episodes, sexual behavior, and drug use patterns. Reactive ARTs were confirmed with the microhemagglutination antibody to Treponema pallidum (MHA-TP) or the fluorescent treponema antibody-absorbed (FTA-ABS) test. Additionally, treponemal tests were performed in 68 of 79 ART-negative patients. Twenty-four women and 78 men were included in the sample over the 6-month period from December 1989 through May 1990. Of those enrolled, 64% used crack, only 24% were exclusively intravenous users, and 6% were exclusively nasal users. The remaining 6% utilized multiple routes of drug administration. Nine latent syphilis patients (8.8%) were diagnosed and an additional 20 (19.6%) patients were found to have had previous syphilis. Among the 24 women studied, 5 (20.8%) had latent syphilis. Fifty-eight percent of women had either latent or previously treated syphilis as compared to 19% of men (P = 0.0006). These data suggest that elicitation of a history of cocaine use from urban hospital emergency department patients may be helpful in identifying patients with latent syphilis. Detection and treatment of latently infected women in this setting could prevent a significant number of congenital syphilis cases.

Adolescent↗

PubMedDate not supplied

Routine serologic screening for syphilis in hospitalized patients: high prevalence of unsuspected infection in the elderly.

BACKGROUND AND OBJECTIVES: To evaluate the potential yield of routine serologic testing for syphilis in hospitalized patients. STUDY DESIGN: Sera from consecutive patients admitted to an inpatient general medical service of a Baltimore hospital were tested using the RPR and FTA-ABS tests for syphilis. Two hundred ninety-one (149 males and 142 females) of 344 patients (85%) hospitalized during the study period participated, with ages ranging from 17 to 98 years. Seventy-seven percent of participants were African-American. Results of serologic tests for syphilis and human immunodeficiency virus were correlated with questionnaire responses. Associations were sought between results of serologic testing and demographic characteristics, medical problems, and a history of syphilis. RESULTS: No patient had an admitting diagnosis of syphilis. Thirty-seven patients (13%) had both reactive RPR and FTA-ABS tests. Although serologic evidence of syphilis was significantly associated with age older than 50 years and with a history of syphilis, 59% of patients with both reactive RPR and FTA-ABS tests did not give a history of syphilis. Ten percent of patients were HIV seropositive; however HIV seropositivity was not significantly associated with serologic evidence of syphilis. CONCLUSION: Unsuspected latent syphilis was common in this population. Routine serologic screening for syphilis should be considered in some hospitals.

Adolescent↗