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PubMed1979

Clinical evaluation of amoxycillin in the treatment of syphilis.

Following demonstration of in vitro activity of amoxycillin against Treponema pallidum, a clinical research group was set up to study the effects of amoxycillin against various stages of syphilitic infection in men. A total of eighty-nine cases, fifteen primary, twenty-nine secondary, thirty late and fifteen adult congenital patients have been investigated. One hundred per cent effectiveness was recorded for primary and secondary syphilis; 66.7% for late syphilis and 60% success for adult congenital syphilis. In 10.4% of cases there was a transient elevation of SGOT and SGPT although it is not certain whether this was a reaction to the drug itself. There were three incidences of drug-related rash and two other minor side-effects. Amoxycillin is thus a safe and effective oral agent for the treatment of all stages of syphilis in man.

Administration, Oral↗

PubMed1978

Laboratory support in the management of syphilis.

Recent developments in syphilis serology are set down. The approach today is more rational as it has some basis in immunological understandings. In spite of improvements, syphilis serology continues to have limitations, and differentiating active from inactive cases remains taxing. In primary and secondary syphilis, dark-ground microscopy is still the quickest and surest way to make the diagnosis. In latent syphilis and in late and congenital cases, as well as in instances of other treponemal infections, serological evidence of disease needs to be considered along with each patient's medical, social and sexual history, when and why they may have been given antibiotic treatment, and the results of radiological studies and cerebrospinal fluid examination. For some syphilitics, the decision to treat or not to treat remains a matter of art rather than science.

Adolescent↗

PubMed1977

Spinal syphilis: the problem of fluorescent treponemal antibody in the cerebrospinal fluid.

Spinal manifestations of syphilis are now uncommon. Three adults with presumptive nontabetic spinal syphilis are presented. This paper should serve as a reminder to physicians that cases of late syphilis continue to occur and may be manifested as obscure spinal syndromes and be misdiagnosed unless the possibility of syphilis is constantly kept in mind. Some of the clinical dilemmas associated with the reactivity of fluorescent treponemal antibody in the cerebrospinal fluid are discussed,

Absorption↗

PubMed1978

[Immunity in syphilis].

Following a brief review of the characteristics of the causative organism of syphilis, its maintenance in laboratory animals and its relationship to the treponemes of the tropical treponematoses, consideration is given to the immune reactions and the development of antibodies to the treponeme of syphilis. The individual tests used in the diagnosis of syphilis, especially the complement fixation reactions and the flocculation tests, as well as the reactions employing specific antigens, such as the Treponemal Immobilisation Test (TPI), the Reiter Protein Complement Fixation Test (RPCFT), the Fluorescent Treponemal Antibody Test (FTA-ABS) and the Treponema Pallidum Haemagglutination Assay (TPHA), are discussed in detail. An evaluation of the results of the tests and the possible sources of errors are considered. The problem of the persistence of treponemes after clinically successful treatment is analysed and existing literature reviewed. The paper ends with a discussion of existing knowledge on protective immunity against infection with Treponema pallidum and a reminder of the need for further research into the immunology of syphilis.

Antibodies, Bacterial↗

PubMed1978

Reversible sudden deafness in early acquired syphilis.

Although congenital syphilis is a well established cause of hearing loss, early acquired syphilis is frequently overlooked in the differential diagnosis of sensorineural deafness. This is due, in part, to a decrease in the incidence of syphilis and to the advent of penicillin in previous years which reduced this complication to a clinical rarity. However, with the increase in new cases of syphilis in the past decade, early acquired syphilitic deafness is being seen with increasing frequency. Along with it is the syndrome of early syphilitic meningitis with sudden sensorineural deafness. This potentially reversible condition should be considered in sexually active patients in whom sudden deafness develops. Early diagnosis and treatment are essential for maximum recovery of hearing.

Adult↗

PubMed1975

An introduction to diagnostic criteria of syphilis, treponarid and yaws (treponematoses) in dry bones, and some implications.

Diagnostic criteria of syphilis and some other diseases are proposed from a study of 424 crania and calvariae and 250 long bones in 22 medical museums in Europe. Yaws bone lesions in Uganda and changes in Australian aboriginal bones also contributed to the establishment of these criteria. Any deductions about disease in the past or isolated populations must depend upon acceptable diagnostic criteria; post mortem damage must be recognised. In crania and calvariae the sequence of changes of Virchow's caries sicca, and in long bones nodes/expansions with superficial cavitation are sound indicators of syphilis, and of yaws and treponarid in relevant geographical areas. Attention is called to the cause of sequestra in European calvariae labelled syphilis, the absence of sequestra due to haematogenous pyogenic osteomyelitis in Australian and other aboriginal bones and possibly in Europe before the Middle Ages. The number of bones with diagnostic criteria needed to demonstrate the endemicity of a particular infection in a past community is discussed. There is also need for an extensive application of diagnostic criteria of syphilis to pre-Columbian or pre-European bones everywhere. The uncertain future of old dry diseased bones in medical museums, and the need for reference centres to provide sound advice and guidance in palaeopathology are stressed.

Bone and Bones↗

PubMed1977

Pinta, yaws, and venereal syphilis in Colombia.

Three treponemal infections of man have coexisted in Colombia, South America for centuries. In former years, Colombia and Mexico were the world's most highly endemic countries for pinta. Within Colombia, highest rates of infection with pinta occurred among the mestizo and Indian populations in the Andean and Caribbean departments of Huila, Tolima, Antiochia, Magdalena and Cesar. Yaws occurred primarily in rural areas along the Pacific coast among descendants of African slaves. Infectious syphilis is most often reported from the three largest urban areas, and from three other densely populated departments in the Andean region. During the 21-year period from 1954 to 1974, almost four times as many cases of pinta as yaws were reported. The incidence rates of yaws and pinta have declined almost in parallel in Colombia, even though there has been a national campaign against yaws, but not against pinta. The incidence of primary and secondary syphilis increased only slightly during the same period. The total burden of reported treponematoses (excluding tertiary and congenital syphilis) declinded by over 40 per cent, while the ratios of reported yaws, pinta and infectious syphilis rose from 1:3:4 in 1954 to 1:7:975 in 1974.

Colombia↗

PubMed2003

Serodiagnosis of syphilis: antibodies to recombinant Tp0453, Tp92, and Gpd proteins are sensitive and specific indicators of infection by Treponema pallidum.

Syphilis serodiagnosis relies on a combination of nonspecific screening tests (antilipoidal antibodies) and Treponema pallidum-specific tests (anti-T. pallidum antibodies). We studied a group of six recombinant T. pallidum antigens for their sensitivities and specificities with sera from individuals with syphilis (n = 43), relapsing fever (n = 8), Lyme disease (n = 8), and leptospirosis (n = 9) and from uninfected individuals (n = 15). Three recombinant proteins, Tp0155, Tp0483, and Tp0751, demonstrated sensitivity values that ranged from 28 to 42%. In contrast, three other recombinant proteins exhibited the following sensitivity and specificity values: Tp0453, 100% sensitivity and 100% specificity; Tp92 (Tp0326), 98% sensitivity and 97% specificity; and Gpd (Tp0257), 91% sensitivity and 93% specificity. Tp0453, Tp92, and Gpd also were recognized by sera from individuals with early primary syphilis that were nonreactive with the antilipoidal Venereal Disease Research Laboratory test. The reactivities of syphilis patient sera with Tp0453, Tp92, and Gpd were proportional to the titers of these sera with the treponemal test MHA-TP (microhemagglutination assay for T. pallidum). Thus, the recombinant T. pallidum antigens Tp0453, Tp92, and Gpd show promise as diagnostic antigens in the enzyme-linked immunosorbent assay-based assay.

Antigens, Bacterial↗

PubMed1979

Treatment monitoring in syphilis using the autoanalyser.

Treatment monitoring in syphilis using the automated Reiter protein complement fixation test and the automated reagin test was investigated over a two-year period. Clearly defined response patterns were demonstrated in primary and secondary syphilis and, to a lesser extent, in latent syphilis, thus facilitating the assessment of treatment and the identification of treatment failures and reinfection. No obvious treatment failures were detected in those patients receiving penicillin, but two failures were noted in a group of patients with secondary syphilis treated with doxycyline. The combination of two automated tests overcame some of the disadvantages inherent in the use of a single reagin test.

Antibodies↗

PubMed1978

[Syphilis serology: "ELISA", a third generation test].

The characteristics and the working modalities of ELISA (Enzyme Linked Immunosorbent Assay) are outlined at the onset. Subsequently, the Authors refer the data relevant to the use of ELISA in the syphilis serodiagnosis, by describing the operative phases for the working out of the test with the enzyme peroxidase, and reporting the results of the clinical investigation performed on primary and secondary syphilis in progress, on treated primary and secondary syphilis (examinations performed 1 to 10 years after the end of therapy), on healthy blood donors, and on samples of false biological positivities. On the basis of the analysis of the results, the Authors feel that ELISA for its characteristics of sensitivity, easiness in carrying out, rapidity and reproducibility, might find a rational indication in the modern serodiagnosis of the syphilis.

Blood Donors↗

PubMedDate not supplied

[Immunoelectrophoretic study of serum from patients with untreated recently adquired syphilis].

An immunoelectrophoretic study of serum from patients with non-treated recently acquired syphilis (RAS) is made for the first time in our country. Increases in IgM and IgG fractions were detected; the increase of the former exceeded to the latter in patients with cutaneous symptomatic recently acquired syphilis (CSRAS) in comparison with those having mucous cutaneous symptomatic recently acquired syphilis (MCSRAS). IgG were increased in 100% of patients with this latter disease, although both fractions were increased in patients with latent recently acquired syphilis (LRAS).

Adolescent↗

PubMed1978

A child with the nephrotic syndrome associated with endemic syphilis.

A 21-month old infant with endemic syphilis who presented with nephrotic syndrome is described. Clinically, the features correlated well with those of renal disease associated with secondary syphilis. The onset of renal disease in association with syphilis after early infancy may be a valuable aid in drawing attention to the possibility of endemic syphilis. Morphologically the features were those of an immune complex-mediated glomerulonephritis. We regard the presence of a large number of immature-looking glomeruli as a retrogressive phenomenon.

Humans↗

PubMedDate not supplied

Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment.

A retrospective questionnaire survey of a sample of 173 of the 360 cases of early congenital syphilis reported in 1972 revealed serious problems with diagnostic certainty, prevention, and treatment of congenital syphilis. Only 24 (13.9%) of the reported cases could be categorized as probably or definite cases based on criteria developed from a literature review. Forty percent of the mothers received no prenatal care and an additional 19% received no prenatal care until the third trimester. Initial and followup serologic testing was inadequate in those who received care. Eighty-three different penicillin treatment schedules were used in the treatment of 128 infants. Carefully reasoned diagnostic and therapeutic decision making about the management of congenital syphilis appears to be lacking.

Adolescent↗

PubMed1978

Venereal syphilis in tropical Africa.

A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin.

Humans↗

PubMed1978

Bell's palsy and secondary syphilis: CSF spirochetes detected by immunofluorescence.

Although Bell's palsy is usually idiopathic, occasional cases may have an identifiable infectious cause. When facial paralysis results from syphilis, it usually develops during the tertiary meningovascular stage. We report a 30-year-old man with secondary syphilis who developed facial paralysis associated with acute syphilitic meningitis. Spirochetes were identified in the cerebrospinal fluid by immunofluorescence using standard reagents from the fluorescent treponemal antibody absorption (FTA-ABS) test. Patients with Bell's palsy should be screened for syphilis with a blood FTA-ABS test, and treatment with corticosteroids should be considered only after an infectious cause has been excluded.

Adult↗

PubMed1977

Quantitative evaluation of the FTA-ABS-IgM and VDRL test in treated and untreated syphilis.

Observations made on fluorescent treponemal antibody absorption (FTA-ABS) immunoglobulin M (IgM) titres in patients with untreated early syphilis showed non-reactive or weakly reactive results in patients with primary (one of five cases) and secondary (two of 16 cases) lesions. In patients with primary (19.5%) and secondary (15%) syphilis sera remained reactive with increased titres for more than one year after treatment. The respective figures in the results of the Venereal Disease Research Laboratory (VDRL) test were zero in primary and 20% in secondary syphilis. The non-reactive FTA-ABS IgM results may possibly be explained by competitive inhibition of IgM by immunoglobulin G (IgG). The persistence of reactivity in a comparable percentage has been observed by other investigators (Grin et al., 1974; Wilkinson and Rodin, 1976). The current results therefore suggest that FTA-ABS IgM titres are less reliable for assessing the effect of treatment than the course of the VDRL titres. The phenomenon of a decrease in FTA-ABS IgM titres soon after treatment with a later rise before final non-reactivity is a matter for further investigation.

Adult↗

PubMed1977

A patient with primary syphilis of the hand.

The case history of a man with primary syphilis of the right hand is described. This type of luetic condition nowadays is rare. The incidence of genital, anorectal, and extragenital primary syphilis in both men and women and in sailors presenting at the Venereological Outpatient Clinic of the Department of Dermatology of the University Hospital Rotterdam-Dijkzigt during a period of seven years was studied. In sailors and women only genital primary lesions were found, whereas in male civilians 6.3% of cases of primary syphilis had anorectal lesions. The primary lesions in this study were different from those reported in earlier literature.

Adult↗

PubMed1979

Epidemiology of infectious syphilis at a tertiary hospital.

In 19 of 20 patients in whom the correct diagnosis of primary or secondary syphilis was not obvious initially, a positive routine admission VDRL test result was the first indication of the correct diagnosis. A retrospective study during a one-month period to correlate hospital admissions by clinical service with required routine admission serologic tests for syphilis disclosed an overall compliance rate of only 37.1% (range, 94.6% to 8.0%). Of the 38 patients who did have a positive admission VDRL test result, 55.3% were falsely positive. The false-positive rate was slightly higher for weakly reactive titers than it was for higher titers. The routine serologic testing program uncovered 129 and 116 new cases of syphilis during 1976 and 1977, respectively. The decision to continue the routine admission VDRL screening program was made because the consequences of an incorrect diagnosis could be very great for an individual patient.

Adolescent↗