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PubMed2006

Utility of the Determine Syphilis TP rapid test in commercial sex venues in Peru.

OBJECTIVES: This study sought to evaluate the utility of the Determine Syphilis TP test performed in Peruvian commercial sex venues for the detection of active syphilis; and determine the feasibility of integrating rapid syphilis testing for female sex workers (FSW) into existing health outreach services. METHODS: We tested 3586 female sex workers for syphilis by Determine in the field using whole blood fingerstick, and by rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) in a central laboratory in Lima using sera. RESULTS: 97.4% of the FSW offered rapid syphilis testing participated; and among those who tested positive, 87% visited the local health centre for treatment. More than twice as many specimens were RPR reactive using serum in Lima (5.7%) than tested positive by whole blood Determine in the field (2.8%), and although most were confirmed by TPHA, only a small proportion (0.7%) were RPR reactive at >or=1:8 dilutions, and likely indicating active syphilis. Sensitivity, specificity and positive predictive value of the Determine Syphilis TP test in whole blood when compared to serum RPR reactivity at any dilution confirmed by TPHA as the gold standard were 39.3%, 99.2% and 71.4%, respectively. Sensitivity improved to 64.0% when using serum RPR >or=1:8 confirmed by TPHA. Invalid tests were rare (0.3%). CONCLUSIONS: Rapid syphilis testing in sex work venues proved feasible, but Determine using whole blood obtained by fingerstick was substantially less sensitive than reported in previous laboratory-based studies using serum. Although easy to perform in outreach venues, the utility of this rapid syphilis test was relatively low in settings where a large proportion of the targeted population has been previously tested and treated.

Feasibility Studies↗

PubMed1988

Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus?

To assess the value of serological tests in diagnosing and monitoring the response to treatment of syphilis in patients infected with the human immunodeficiency virus (HIV), case notes of eight homosexual men with a history of treated syphilis, positive reactions to serological tests for syphilis, and documented subsequent conversion to HIV seropositivity were studied. No change was noted in serological markers of syphilis after HIV infection. The case notes of one man with primary syphilis, four men with secondary syphilis, and three men with latent syphilis, of whom all were HIV seropositive, were also studied. In seven of these patients the serological responses to infection and after treatment were consistent with the experience of syphilis in HIV seronegative patients. In one man treated for secondary syphilis, and confirmed as HIV seropositive eight months after treatment, the rapid plasma reagin (RPR) test result continued to be positive at a high titre for up to 20 months after treatment.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Syphilis intervention in pregnancy: Zambian demonstration project.

Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries, including Zambia. It is the foremost risk factor for mid-trimester abortions, stillbirths, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff. During the post-intervention phase the steps of pre-intervention phase were repeated to evaluate the impact of intervention. Overall, 8.0% of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p greater than 0.05). Fifty seven percent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 5.0), stillbirth (RR 3.6), prematurity (RR 2.6) and low birth weight (RR 7.8). The overall risk of adverse outcomes due to syphilis was 8.29 (95% confidence interval 6.53, 10.53). The new methods of health education were effective and the percentage of women who had their first prenatal visit under 16 weeks of gestation improved from 9.4 to 42.5. Although screening and treatment during intervention was suboptimal, the adverse outcomes attributable to syphilis were reduced to 28.3%; this is almost a two-third reduction when compared with 72.4% of adverse outcomes at control centres (p < less than 0.001). The intervention is culturally and politically acceptable in Zambia. The cost of each prenatal screening is US$0.60 and of averting each adverse outcome US$12. In countries with high rates of syphilis, there is an urgent need for STD control and Maternal and Child Health (MCH) programmes to pool their resources together to revitalise the prenatal care.

Adult↗

PubMed1992

IgM rheumatoid factor removal and performance of the FTA-ABS (IgM) test in congenital syphilis.

OBJECTIVE: To determine the performance of the FTA-ABS (IgM) test in congenital syphilis after eliminating interference by IgM rheumatoid factor (RF) and preventing competitive inhibition by IgG. DESIGN: The FTA-ABS (IgM) test was carried out before and after RF removal (achieved by immunoprecipitation of the IgG) in infants with congenital syphilis and controls. SETTING: Newborns delivered in the Peninsula Maternal and Neonatal Services in Cape Town and infants presenting at Red Cross War Memorial Children's Hospital. SUBJECTS: Infants with congenital syphilis aged 0-4 months were divided into those with clinical signs at presentation and those who were asymptomatic at delivery. In addition, patients without congenital syphilis but with similar clinical signs at presentation were investigated as were control infants. OUTCOME MEASURE: The diagnosis of congenital syphilis was based on the criteria suggested by Kaufman et al (1977). RESULTS: Amongst symptomatic infants with congenital syphilis the FTA-ABS (IgM) test was positive in 34 (92%) of 37 cases prior to abolishing the RF effect and in 29 (78.4%) of 37 cases afterwards (p = 0.19). In 12 cases of congenital syphilis who were asymptomatic at birth, 10 had positive FTA-ABS (IgM) tests before RF removal and only three had positive tests afterwards (p = 0.006). False positive tests were not found amongst 15 symptomatic infants whose clinical features mimicked those of the infants with congenital syphilis. Among 51 healthy infants the test had a false-positive rate of 2% in newborns and 13% in older infants. The false positive reactions were eradicated by IgG precipitation. CONCLUSIONS: Following IgG and RF removal there was an improvement in the specificity of the FTA-ABS (IgM) test but this was at the expense of a loss of sensitivity, particularly in asymptomatic newborns. For newborns, if the FTA-ABS (IgM) test was positive, the patient was likely to require treatment for congenital syphilis, regardless of whether the result was due to the presence of RF or specific IgM.

Humans↗

PubMed1999

Preschoolers with syphilis.

Syphilis in preschoolers is rarely described in current medical literature, despite the rise in syphilis in both the adult and the pediatric populations during the past decade. Since that time, 3 children between 3 and 4 years of age have been diagnosed with syphilis at the Children's Hospital of Philadelphia. The presentations and clinical manifestations of syphilis in these 3 children are described, and the difficulty in identifying the source of infection is discussed. The presentations of these children included nephrosis and secondary syphilis, the corymbiform and palmar rash of syphilis, and subtle signs of late congenital infection in an otherwise asymptomatic child. One child had documented congenital infection, 1 had probable congenital infection that went untreated, and 1 did not have appropriate neonatal testing documented. None of the children gave a verbal history of sexual abuse, although it is likely that all three cases resulted from sexual abuse. The evaluation of preschool children with syphilis is confounded by the interpretation of acquired infection in consideration of a history of possible or documented congenital disease. The assessment is complicated further by problems with recognition of clinical disease, the inability of young children to provide a history, prenatal and neonatal testing methods used, changes in treatment recommendations made during the past decade, and inadequate follow-up to document cure of congenitally infected infants. With the increase in syphilis seen in recent years, physicians are more likely to encounter preschoolers with syphilis. Our ability to document acquired infection, however, is hampered by the difficulties encountered in following recommended guidelines for evaluation and follow-up and by limitations in interviewing young victims of sexual abuse, which may impair our ability to protect children from additional harm. Understanding the pathophysiology and progression of this disease remains challenging even in this modern era.

Child Abuse, Sexual↗

PubMed1990

Partner notification: can it control epidemic syphilis?

STUDY OBJECTIVE: During 1987, the rate of syphilis among heterosexual adults in Oregon increased 159%, yet the number of cases of gonorrhea remained stable. Our study was done to evaluate why the same control measures contained gonorrhea but not syphilis in this population. DESIGN: Exploratory case-control study. SETTING: Public health clinics in Portland, and Salem, Oregon. PATIENTS: All 146 heterosexual adults with early syphilis and all 164 heterosexual adults with acute gonorrhea reported to the public health clinics during April to July 1988. INTERVENTION: A questionnaire was administered to all syphilis case-patients and control patients (those with gonorrhea) at the beginning of the routine, sexually transmitted disease (STD), investigative interview. MEASUREMENTS AND MAIN RESULTS: Syphilis case-patients had contact with an average of 5.0 sex partners for whom they could not supply locating information sufficient to initiate partner notification. In contrast, patients with gonorrhea had contact with an average of 0.4 sex partners for whom they could not supply locating information (P less than 0.005). The 28% (41 of 146) of syphilis case-patients who reported having exchanged sex for drugs or money accounted for 72% (527 of 729) of the unlocatable partners exposed to syphilis. In contrast, the 17% (28 of 164) of patients with gonorrhea who reported having exchanged sex for drugs or money accounted for 36% (25 of 69) of the unlocatable partners exposed to gonorrhea. CONCLUSIONS: Because patients infected with syphilis have relatively large numbers of anonymous sexual encounters, prevention strategies that supplement partner notification are urgently needed to control the syphilis epidemic among adults.

Adolescent↗

PubMed1992

Gastric syphilis: five recent cases and a review of the literature.

OBJECTIVE: To describe five cases of early syphilis with gastric involvement and to review the literature pertaining to this disorder. DATA IDENTIFICATION: Five patients were diagnosed with gastric syphilis at Kings County Hospital and the Brooklyn Veterans Affairs Hospital between 1987 and 1990. English-language articles pertaining to gastric syphilis were identified by searching MEDLINE and by manually reviewing bibliographies of retrieved articles. STUDY SELECTION: Sources containing information pertinent to the clinical manifestations and diagnosis of gastric syphilis were selected. DATA SYNTHESIS: The most common clinical manifestations of gastric syphilis are abdominal pain, vomiting, and weight loss. Endoscopic findings in the stomach range from minimal nodularity and erythema to deep ulceration. Complications of gastric syphilis include hemorrhage, gastric outlet obstruction, and perforation. The diagnosis can be confirmed by serologic testing and by demonstration of spirochetes on silver and immunofluorescent stains of gastric mucosal biopsy specimens. Response to treatment is usually prompt and complete. CONCLUSIONS: The current syphilis epidemic will likely result in an increased incidence of gastric syphilis. Unless syphilis is considered as a cause of gastric mucosal inflammation and ulceration, misdiagnosis may delay appropriate treatment, and serious complications can occur.

Adult↗

PubMed1998

Syphilis in Murewa District, Zimbabwe: an old problem that rages on.

OBJECTIVE: To determine the prevalence of syphilis among pregnant women and women giving birth in health centres in a rural district and to identify problems associate with syphilis control in the same district. DESIGN: Cross sectional descriptive study. SETTING: Murewa District health facilities. SUBJECTS: Women attending health facilities in this district for antenatal care or delivery between February and May 1993. MAIN OUTCOME MEASURES: Syphilis sero-prevalence rate. Factors associated with poor syphilis control. RESULTS: Even though it is recommended that all women attending clinics for antenatal care (ANC) should be screened for syphilis at first visit only 308 (20%) out of 1,556 first visit attenders were screened during the study period. Three hundred and sixty six (33%) out of 1,096 women giving birth in health institutions were screened. The RPR/TPHA sero positivity rate for antenatal women was 9.2% while that for women delivering was 9.8%. A positive RPR was not significantly associated with the women's age, parity, infant's birth weight, sex or pregnancy outcome. Factors associated with poor syphilis control in this district included: lack of motivation and appreciation of the seriousness of syphilis in pregnancy; lack of transport to send specimens and receive results from Murewa District Hospital; poor record keeping; loss to follow up of women being tested or after starting treatment; lack of contact tracing and treatment of contacts and difficulties in implementing the 10 day neonatal regime and follow up of these infants. CONCLUSION: Syphilis remains poorly controlled in Murewa district and may be contributing significantly to high perinatal mortality rates. There is need to strengthen the syphilis control programme through motivation and training of health workers, decentralisation of testing and treatment of the condition and improved contact tracing. A repeat RPR test at delivery may not be cost effective.

Adolescent↗

PubMed1999

[Syphilis in adolescent mothers in the city of Posadas, Province of Misiones].

During three months (April to June 1997) 1,238 consecutive pregnant women were studied at the time of delivery at the Madariaga public Hospital. Syphilis was confirmed in 26 (2.1%) women, and 15 cases (57.7%) of congenital syphilis were demonstrated in newborns one of whom was a stillborn. Of the syphilitic women 61.5% were 20 years old (average), 65.4% were single, 19.2% had a stable partner and 15.4% were married; 70% of them had finished elementary school (seven years), but despite this discrete level of instruction and that they were benefited with free health attention, 73% of them had not started or completed the pregnancy control. None of these women acted as sexual workers or were drug users; 57.7% were unemployed and the remainder worked as domestic servants or were still going to school. Menarca started at 13 (average) and the age of the first sexual activity was 15 (average). The distribution of the cases of syphilis within the city area shows four clusters that coincide with the lower income population, but not with marginal groups. The failure to submit to medical control during pregnancy among syphilitic women is directly linked with an increased risk for congenital syphilis. The specific prevalence of syphilis in women (20 years old or less) pregnant or not, shows an alarming hidden epidemic situation. An interinstitutional and communitary program, with direct interventions within the detected population clusters, is now underway in order to control syphilis. Undesired pregnancy and syphilis seem to be associated with adolescent unsafe sex conducts. A coordinated program between Public Health Service and National Misiones University is operating, visiting home by home, in order to decrease or eliminate congenital syphilis and is considered a priority health problem. Unfortunately, if sexual conducts do not undergo changes in the near future, at least by the correct use of condoms, HIV will replace syphilis.

Adolescent↗

PubMed2001

Congenital syphilis--United States, 2000.

In 1998, CDC initiated intensive efforts to eliminate syphilis from the United States. The following year, the National Syphilis Elimination Plan was launched with the goal of reducing primary and secondary (P&S) syphilis in adults to <0.4 cases per 100,000 population. A decrease in syphilis among women of reproductive age usually is followed by reductions in congenital syphilis (CS) rates. CS occurs when the spirochete Treponema pallidum is transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis during pregnancy may lead to stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment, and bone deformities. One of the national health objectives for 2000 was to reduce the rate of CS to <40 cases per 100,000 live-born infants. To evaluate progress toward this goal, the CS rate for 2000 was compared with the rate for 1997, the year before syphilis elimination efforts began. This report summarizes 1997-2000 CS surveillance data, which indicate that CS rates have decreased substantially among most racial/ethnic minority populations and that the elimination of CS in the United States is feasible because of the limited number of cases and highly focal distribution. To increase the percentage of women at risk who receive screening for syphilis during pregnancy, collaborative efforts are needed among health-care providers, health insurers, policymakers, and the public.

Adolescent↗

PubMed1992

[Routine screening for syphilis in neurology is not useful].

In a retrospective study the results of the screening for syphilis in one of the neurological wards of the Academic Medical Centre in Amsterdam were analysed. The Venereal Disease Research Laboratory test (VDRL) and the Treponema Pallidum Haemagglutination Assay (TPHA) in serum were used for screening. The data for analysis were obtained via the hospital computer data base and via the medical files of the department of neurology. During the 5-year study period (1986-1990) 2378 adult patients were admitted and 1247 (52.4%) of them were screened. In seven (0.56%) patients both tests were positive. Three of them had been treated for syphilis in the past and showed no symptoms of active syphilis. Four (0.32%) patients suffered from active neurosyphilis. In three of these four patients syphilis was suspected on admission and confirmed by the tests. In one patient the diagnosis of syphilis was not considered. The positive test results became available shortly before she died of pneumonia and were without consequences. None of the 32 (2.6%) patients with a positive TPHA and a negative VDRL was diagnosed as having (neuro-)syphilis. Two (0.16%) patients had a false-positive VDRL. We conclude that routine serological examination for syphilis of every patient admitted to a neurological ward is not useful. We advise a limited screening of patients who belong to a group with high risk for syphilis and patients with symptoms and signs that can be caused by syphilis, such as dementia or ischaemic strokes at a relatively young age.

Adult↗

PubMedDate not supplied

Quantitative profile of cardiolipin and group treponemal IgD antibodies in syphilis estimated by single radial immunodiffusion technique (SRID).

150 serum samples (reactive in VDRL, Reiter-ELISA, FTA-Abs tests), from male patients 25-45 years old, in various stages of syphilis whether treated or untreated, were tested for IgD by SRID. On 154 sera from healthy males 25-45 years old, the reference normal values for IgD levels were established, as: 0-131.2 IU/ml with a mean of 29.92 +/- 29.61 IU/ml. Cardiolipin and group treponemal fraction values for IgD class were obtained by assessing the difference between the immunodiffusion diameter values produced by sera before and after complete absorption with VDRL antigen or delipidated T. reiteri suspension. The individual, mean +/- SD values (expressed in IU/ml) and the percentage of cardiolipin and treponemal IgD of the total IgD class were calculated for each stage. The mean value of the total IgD class, excepting secondary syphilis (sigma 2) 52.53 +/- 26.66 IU/ml), did not overstep the normal levels but all minimal individual values from syphilitic patients (7.09-14.89 IU/ml) surpassed significantly the normal minimal values which were less than or equal to 3.54 IU/ml. The total lack of cardiolipin (IgD and the presence of group treponemal IgD in all sera of the syphilis stages studied were manifest. The group treponemal IgD mean values ranged between 7-9 IU/ml, with a maximum of 19.32 +/- 10.58 IU/ml in sigma 2 followed by latent syphilis (sigma lat) with a mean value of 9.37 +/- 4.9 IU/ml. A significant percentage of treponemal IgD vs total IgD was recorded: primary syphilis (sigma 1) 32.01%, primary-secondary syphilis (sigma 1-2) 28.76%, sigma 2 36.77%, sigma lat and treated persistent seroreactive syphilis (sigma t+) 29.61%. The high proportion of treponemal IgD in latent and treated persistent reactive syphilis suggests a steady activation of B lymphocytes by treponemal antigens and presumably is an expression of an active infectious process. The absence of cardiolipin IgD and the presence of only the treponemal IgD, in all sera from all stages, might confer to their detection an extremely specific diagnostic value in syphilis.

Adult↗

PubMed1988

Diagnostic and therapeutic approach to Ethiopian immigrants seropositive for syphilis.

Serologic tests for syphilis are frequently positive in Ethiopian Jewish immigrants in Israel. Forty-three of 358 adults (greater than 15 years of age) examined were found to have positive treponemal tests. Of the 418 children (1 to 15 years of age) none were found to have positive treponemal serology. Forty seropositive adults were examined for signs of tertiary syphilis and underwent lumbar puncture. No evidence of skin or cardiovascular involvement of tertiary syphilis was found. In three patients whose cerebrospinal fluid (CSF) was reactive in treponemal tests, there was no evidence of neuropsychiatric involvement. CSF cell count and protein content were normal in all three, and VDRL in the CSF was negative. None of the subjects was found to have stigmata of congenital syphilis. Negative serological findings in all the children led us to hypothesize whether the disease in question is venereal syphilis with an unusual course rather than endemic syphilis or yaws, both of which are known to exist in Africa. Due to the apparent benign course of syphilis in this ethnic group and recent evidence that lumbar puncture is not mandatory in patients with latent syphilis or asymptomatic neurosyphilis, we suggest that CSF should not be routinely examined in these patients. In view of the recommendations in the literature and the data that we have collected, we strongly feel that treatment with weekly i.m. injections of 2.4 x 10(6) u benzathine penicillin for a 3-week period is sufficient.

Adolescent↗

PubMed2006

Respondent-driven sampling of injection drug users in two U.S.-Mexico border cities: recruitment dynamics and impact on estimates of HIV and syphilis prevalence.

Respondent-driven sampling (RDS), a chain referral sampling approach, is increasingly used to recruit participants from hard-to-reach populations, such as injection drug users (IDUs). Using RDS, we recruited IDUs in Tijuana and Ciudad (Cd.) Juárez, two Mexican cities bordering San Diego, CA and El Paso, TX, respectively, and compared recruitment dynamics, reported network size, and estimates of HIV and syphilis prevalence. Between February and April 2005, we used RDS to recruit IDUs in Tijuana (15 seeds, 207 recruits) and Cd. Juárez (9 seeds, 197 recruits), Mexico for a cross-sectional study of behavioral and contextual factors associated with HIV, HCV and syphilis infections. All subjects provided informed consent, an anonymous interview, and a venous blood sample for serologic testing of HIV, HCV, HBV (Cd. Juárez only) and syphilis antibody. Log-linear models were used to analyze the association between the state of the recruiter and that of the recruitee in the referral chains, and population estimates of the presence of syphilis antibody were obtained, correcting for biased sampling using RDS-based estimators. Sampling of the targeted 200 recruits per city was achieved rapidly (2 months in Tijuana, 2 weeks in Cd. Juárez). After excluding seeds and missing data, the sample prevalence of HCV, HIV and syphilis were 96.6, 1.9 and 13.5% respectively in Tijuana, and 95.3, 4.1, and 2.7% respectively in Cd. Juárez (where HBV prevalence was 84.7%). Syphilis cases were clustered in recruitment trees. RDS-corrected estimates of syphilis antibody prevalence ranged from 12.8 to 26.8% in Tijuana and from 2.9 to 15.6% in Ciudad Juárez, depending on how recruitment patterns were modeled, and assumptions about how network size affected an individual's probability of being included in the sample. RDS was an effective method to rapidly recruit IDUs in these cities. Although the frequency of HIV was low, syphilis prevalence was high, particularly in Tijuana. RDS-corrected estimates of syphilis prevalence were sensitive to model assumptions, suggesting that further validation of RDS is necessary.

Adolescent↗

PubMed2006

The economic value of reductions in gonorrhea and syphilis incidence in the United States, 1990-2003.

BACKGROUND: Prevention efforts can reduce the considerable health and economic burdens imposed by sexually transmitted diseases (STDs). The objective of this study was to estimate the reduction in direct medical costs associated with reductions in gonorrhea and syphilis incidence in the United States from 1990 to 2003. METHODS: Using published estimates of the per-case costs of STDs, we estimated the annual costs from 1990 to 2003 of four main outcomes: primary and secondary (P&S) syphilis, congenital syphilis, gonorrhea, and HIV costs attributable to the facilitative effects of gonorrhea and syphilis on HIV transmission and acquisition. RESULTS: Reductions in syphilis and gonorrhea from 1990 to 2003 have saved an estimated 5.0 billion dollars (in 2003 U.S. dollars): 1.1 billion dollars in costs associated with P&S syphilis, congenital syphilis, and gonorrhea, and 3.9 billion dollars in HIV costs attributable to syphilis and gonorrhea. In additional analyses, the estimated reductions in disease burden were substantially lower (1) when calculated incrementally (rather than cumulatively) and (2) when long-term costs of STDs were excluded. CONCLUSIONS: These estimated reductions in the burden of gonorrhea and syphilis show the economic benefits of reducing the incidence of these STDs and preventing their resurgence.

Adolescent↗

PubMed2000

Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response.

OBJECTIVE: To determine the relative frequencies of signs in posterior segment ocular syphilis, the response to a neurosyphilis regimen of penicillin, and differences in findings between human immunodeficiency virus (HIV)-coinfected and -noncoinfected patients in a community setting. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: Fourteen consecutive patients with posterior segment ocular syphilis over a 14-year period within or during the acquired immune deficiency syndrome era. INTERVENTION: Neurosyphilis intravenous penicillin regimen. MAIN OUTCOME MEASURES: Initial and final visual acuity; treponemal and nontreponemal serologic analyses; cerebrospinal fluid cell count, protein, and Venereal Disease Research Laboratory analyses; posterior segment signs; and relapses and recurrences. RESULTS: Blacks and males were predominantly affected. Five (36%) of patients were HIV coinfected, and ocular syphilis led to the HIV infection diagnosis in three. Four (29%) patients had received previous antibiotic therapy for primary or secondary syphilis, raising the suspicion of relapse. Two patients had negative nontreponemal serologic results. All patients responded rapidly to neurosyphilis therapy. One patient subsequently relapsed after neurosyphilis therapy, and a second was reinfected with recurrence of ocular involvement. One previously undescribed retinal manifestation was discovered: a sectorial retinochoroiditis with delayed retinal circulation in the involved area. CONCLUSIONS: Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection. Conventional syphilis staging is of little use in understanding ocular syphilis. A high suspicion for this diagnosis is appropriate, especially in poorer black males with posterior segment inflammatory disease. Human immunodeficiency virus coinfection with ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term. Awareness of the multiple presentations of posterior segment ocular syphilis will aid ophthalmologists in averting misdiagnosis or delayed diagnosis.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Amplification of the DNA polymerase I gene of Treponema pallidum from whole blood of persons with syphilis.

Previous reports suggest that Treponema pallidum bacteremia occurs in persons with syphilis exposure ('incubating syphilis') and in persons with primary or secondary syphilis. During a recent syphilis outbreak, whole blood samples from 32 persons with suspected syphilis or syphilis exposure were screened using polymerase chain reaction (PCR) to amplify the DNA polymerase I gene (polA) of T. pallidum. Of the 32 samples, polA was amplified from 13 (41%). Of these 13, three were determined to have incubating syphilis; two had primary or secondary syphilis and eight had latent syphilis. This study demonstrates that spirochetemia can occur throughout the course of T. pallidum infection.

Adult↗

PubMed1997

Epidemiology of syphilis in pregnancy in rural South Africa: opportunities for control.

The paper describes the epidemiology, risk factors and impact on pregnancy outcome of syphilis in pregnant women in rural South Africa. Prevalence was determined from laboratory records. A case-control study of 200 women (50 cases with syphilis) was done to investigate possible risk factors. To determine the impact on pregnancy outcome, and to evaluate the effect of treatment, a retrospective cohort was constructed. Overall prevalence of syphilis was 6.5%; it was highest in the urban antenatal clinic (9%). The odds ratios for syphilis in women gravidity 3-5 compared to gravidity 6 was 3.2 and 2.3 compared to women with gravidity 2 or less. For women with a previous birth, those with a previous perinatal death were 3.2 times more likely to have syphilis after adjusting for other risk factors. Pregnancy outcome was available for 187 women. The adjusted odds ratio of an adverse pregnancy outcome in women with syphilis was 11.8. All still births occurred in women with syphilis. The prevalence of syphilis is high in this rural area and screening should be applied to all women. Although screening was comprehensive, less than half of the detected cases were fully treated and a poor perinatal outcome ensued. On-site testing for syphilis at the time of booking would allow treatment to start immediately.

Adolescent↗