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PubMedDate not supplied

[Syphilis outbreak in southeast France].

BACKGROUND: Since 2000, syphilis has reappeared in the form of an epidemic in France and more particularly, in the Paris region. However, there is little available data concerning other regions of France. The purpose of this study was to identify the chief characteristics of this epidemic in the Côte d'Azur region. PATIENTS AND METHODS: Between January 2001 and July 2003, cases of syphilis were collated by the Department of Dermatology and Infectious Diseases of Nice University Teaching Hospital and by the Department of Dermatology and Infectious Diseases of Fréjus hospital and based on spontaneous reports submitted by general practitioners in private practice. RESULTS: We collected 54 reports of cases of syphilis: 37 in the Alpes-Maritimes region and 17 in the eastern Var region. The epidemic chiefly affected men since 44 of the 54 cases reported (81%) concerned males. 70% of these men were contaminated during homosexual contact (31 patients). In the majority of cases, contamination concerned local subjects. 50% of the patients in the study were infected with human immunodeficiency virus (HIV). The clinical forms observed were distributed as follows: 12 primary syphilis, 28 secondary syphilis, 13 latent syphilis, 1 case not specified. There was no difference in terms of clinical form between patients with and without HIV. DISCUSSION: Syphilis, which had become rare in France as a whole and in our region in particular, reappeared in the form of an epidemic in the Côte d'Azur region after first resurfacing in the Paris region. This outbreak principally affected homosexual and bisexual male patients, half of whom were HIV-positive. Screening for syphilis, potentially latent, should thus be carried out routinely during initial assessment and at subsequent monitoring of HIV patients.

Adult↗

PubMed1997

Syphilis exposure in patients with uveitis.

PURPOSE: The purpose of the study is to determine the frequency of syphilis exposure in patients with uveitis, identify patient characteristics associated with serologic fluorescent treponemal antibody assays (FTA-ABS) reactivity, and examine the clinical implications of syphilis exposure in patients with uveitis. METHODS: A retrospective review of the records of 552 consecutive patients examined in the referral uveitis clinic of an urban eye hospital between January 1989 and January 1994 was performed. RESULTS: Forty-four (8%) of 552 consecutive patients with uveitis had serologic evidence of syphilis exposure on the basis of a strongly reactive serum FTA-ABS. Syphilis was presumed to be the sole cause of uveitis in 24 patients (4.3%) over the 5-year period. The racial demographic profile of those patients with serologic evidence of syphilis was consistent with the reported distribution of syphilis cases, but there were relatively few identifiable risk factors for sexually transmitted disease (including only three patients who were positive with human immunodeficiency virus). The choice of antibiotic treatment of these patients was variable and sometimes suboptimal. CONCLUSIONS: This study implicates syphilis exposure as a more common etiology of uveitis than did previous reports, advocates routine serum FTA-ABS testing of patients with uveitis, and indicates a need for a more aggressive role of the ophthalmologist in antibiotic treatment of patients with uveitis and syphilis exposure.

Adult↗

PubMed2001

Evaluation of recomWell Treponema, a novel recombinant antigen-based enzyme-linked immunosorbent assay for the diagnosis of syphilis.

OBJECTIVE: To evaluate the diagnostic performance of an enzyme immunosorbent assay (recomWell Treponema) for the diagnosis of syphilis. The novel recombinant antigens Tpn47, TpN17 and TpN15 were utilized. METHODS: A total of 782 human serum specimens, belonging to four different categories (blood donors, n = 200; routine laboratory screening for syphilis, n = 400; syphilis patients, n = 122; potential cross-reactors, n = 60), were evaluated to compare the sensitivity and specificity of the recomWell Treponema kit with a standard whole Treponema pallidum cell lysate antigen-based ELISA (Syphilis Screening) and with micro-haemagglutination (MHA-TP). RESULTS: The overall specificity and sensitivity of the recomWell Treponema IgG was 98.9% and 98.3%, respectively. The specificity and sensitivity of Syphilis Screening ELISA was 98.7% and 98.3%, respectively. The agreement between recomWell Treponema and Syphilis Screening was 100%, 97.8%, 95.9% and 95% among the blood donor specimens, screening samples, syphilis specimens and the potential cross-reactors, respectively. Values of concordance varying from 96.7% to 98.3% were found in the different groups of sera between recomWell Treponema and MHA-TP. In addition, recomWell Treponema demonstrated a good diagnostic performance when used to detect the IgM to T. pallidum. No false-positive sera were identified and, in 17/19 samples from primary infection, an IgM immune response was found. CONCLUSIONS: recomWell Treponema was shown to be a highly specific and sensitive method in all stages of syphilis screening and it can be considered as alternative to other ELISA tests based on native antigen preparations.

Antibodies, Bacterial↗

PubMed2002

Nosocomial transmission of syphilis during haemodialysis in a developing country.

Patients with end-stage renal disease (n = 187) secondary to diverse aetiologies who underwent haemodialysis (HD) between November 1996 and November 2000 were routinely screened for syphilis using the rapid plasma reagin (RPR) test and confirmed by means of a microhemagglutination assay for Treponema pallidum. All the confirmed syphilis patients were asymptomatic and were diagnosed serologically. A true seroprevalence of 6.9% (13/187) and a biological false seropositivity of 4.2% (8/187) for syphilis were recorded. Most (11/13) of the true seropositive patients were aged between 51 and 80 y. Whilst 10/13 patients were true syphilis seropositive at the time of first HD, 3/13 patients became true seropositive an average of 12 months (range 10-14 months) after HD. Penicillin treatment was given to all 13 patients simultaneously only after the appearance of 3 new true syphilis seropositive cases. Complete seroreversion was observed in 4/10 patients in the pre-HD true syphilis seropositive group of presumptive transmitters who became RPR-negative, whereas the 3 new true seropositive cases showed a serial 4-fold decline in RPR titres 12 months after penicillin therapy, suggestive of an active disease with adequate therapeutic response. These results clearly indicate that latent syphilis is prevalent in long-term elderly HD patients. The true seroconversion of 3 new patients who had undergone HD for an average of 12 months is indicative of nosocomial transmission and the silently active nature of the disease, which necessitates regular monitoring of syphilis serology among HD patients.

Adolescent↗

PubMed1985

Antigens of Treponema pallidum recognized by IgG and IgM antibodies during syphilis in humans.

IgG and IgM antibody specificities for antigens of Treponema pallidum Nichols strain were determined by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and the western blot technique in sera from patients with untreated syphilis, normal persons, persons with biologic false-positive tests for syphilis, and sexual contacts of persons with infectious syphilis. IgG reactivities of sera from individuals with primary syphilis varied considerably but consistently exhibited strong reactivity to a 48-kilodalton band. Sera from patients with secondary and early latent syphilis uniformly demonstrated reactivity to 22 separate polypeptide antigens; decreased reactivity was seen in late latent syphilis. Normal and biologic false-positive sera showed weak IgG reactivity against none to 12 polypeptides. Sera from asymptomatic contacts of persons with infectious syphilis showed reactivity to a varying number of treponemal antigens, including some reactions not seen with normal sera. IgM reactivity was most prominent in secondary syphilis but was demonstrable at all stages of disease.

Antibodies, Bacterial↗

PubMed1992

Association of biologic false-positive reactions for syphilis with human immunodeficiency virus infection.

The prevalence of biologic false-positive (BFP) reactions for syphilis (reactive rapid plasma reagin [RPR] test, nonreactive fluorescent treponemal antibody absorption [FTA-ABS] test) among patients attending two sexually transmitted disease (STD) clinics was evaluated to assess relationships between BFP reactions and human immunodeficiency virus (HIV) infection. Among 4863 patients, 357 (7.3%) had serologic evidence of syphilis and 4.9% had HIV infection. Only 40 patients (0.8% of total patients, 11% of those with reactive RPR tests) had BFP serologic tests for syphilis. There were no demographic differences between true syphilis and BFP patients as to sex, age, or intravenous drug use. BFP patients tended to have lower RPR titers (less than or equal to 1:4) than did true syphilis patients. After excluding 317 patients with reactive FTA-ABS tests, BFP RPR tests were seen in 6 (4%) of 159 HIV-seropositive patients and 34 (0.8%) of 4387 HIV-seronegative patients (odds ratio, 5.0; 95% confidence interval, 1.9-12.7). Although more common among HIV-infected than HIV-uninfected patients, BFP reactions are relatively rare among STD clinic patients, and 89% of patients with reactive RPR or VDRL serologic tests for syphilis had current or prior syphilis infection. The RPR test remains useful for guiding decisions regarding therapy for syphilis.

Adult↗

PubMed2003

Evaluation of syphilis reactor grids: optimizing impact.

BACKGROUND: A syphilis reactor grid (SRG) is an administrative tool based on the sex, age, and serologic titer of persons with reactive serologic tests for syphilis (reactors) that is used by Sexually Transmitted Disease program staff to prioritize follow-up investigations of persons who may have syphilis. The National Plan to Eliminate Syphilis from the United States recommends that state and local health departments regularly evaluate the effectiveness of their SRGs. However, there are limited methods for SRG evaluation that are feasible for sexually transmitted disease programs. GOAL: To evaluate the sensitivity and predictive value of five currently used SRGs. STUDY DESIGN: Comparative evaluation of five SRGs in four different populations. RESULTS: The percentage of true syphilis cases not assigned to an investigation by an SRG (missed cases) was dependent on syphilis prevalence among reactors and on the SRG. The percentage of reactors assigned to an investigation by an SRG that were not true cases was primarily dependent on syphilis prevalence among reactors, not SRG design. Cases missed by SRGs were predominantly men aged 30 to 50 years and women aged 20 to 40 years who had low or intermediate serologic titers. CONCLUSION: Monitoring the prevalence of syphilis among reactors is critical because in areas with high prevalence, most SRGs miss a substantial number of cases, and in areas with low prevalence, some SRGs can reduce unnecessary investigations.

Adolescent↗

PubMed1986

Enzyme linked immunosorbent assays with Treponema pallidum or axial filament of T phagedenis biotype Reiter as antigen: evaluation as screening tests for syphilis.

Enzyme linked immunosorbent assays with an ultrasonicate of Treponema pallidum (TP-ELISA) or axial filament of Treponema phagedenis biotype Reiter (AF-ELISA) were developed to detect treponemal antibody. TP-ELISA and AF-ELISA were compared with the T pallidum haemagglutination assay (TPHA), the fluorescent treponemal antibody-absorbed (FTA-ABS) test, and the Venereal Disease Research Laboratory (VDRL) test for sensitivity and specificity of serodiagnosis of syphilis. A total of 1423 serum samples, 253 from patients with various stages of syphilis, 500 from patients attending a sexually transmitted disease (STD) clinic, and 670 from people without syphilis, were investigated. At all stages of syphilis the sensitivity of the TP-ELISA, the AF-ELISA, the TPHA, and the FTA-ABS test did not differ significantly, except that the AF-ELISA was less sensitive than the TPHA (p less than 0.05) for treated syphilis. In primary syphilis, neurosyphilis, and treated syphilis the TP-ELISA and AF-ELISA were significantly more sensitive than the VDRL test (p less than 0.05). The specificity of all tests was comparable (p greater than 0.05). The TP-ELISA and AF-ELISA appear to be good alternatives to the TPHA as screening tests for syphilis. Because of the easy availability of a well defined antigen the AF-ELISA seems to be better suited for large scale testing.

Antigens, Bacterial↗

PubMed2000

Recent declines in reported syphilis rates in eastern Europe and central Asia: are the epidemics over?

BACKGROUND: Since the early 1990s, major syphilis epidemics have occurred in the Newly Independent States (NIS) of the former Soviet Union. The new and rapidly changing societal and economic conditions in these countries challenge their traditional approaches to the control of sexually transmitted infections (STI). Nevertheless, following a steady increase until 1997, reported syphilis incidence has declined during the past 3 years in most parts of the region. We examine these trends against a background of ongoing changes in service delivery, care seeking behaviour, and case finding practices. METHODS: National syphilis surveillance data reported to the WHO Regional Office for Europe were compiled and analysed, and supplemented with information presented at recent expert meetings and with results from ongoing research. RESULTS: Since 1997, reported syphilis incidence either stabilised or declined in many locations in the NIS, but further increased in others, especially in rural areas. Congenital syphilis continued to increase in all countries, except Latvia. The proportion of self presenting cases versus cases detected through screening declined, and so did notifications of early compared with late forms of syphilis. Patients increasingly seek care in the private formal and informal healthcare sectors which hardly participate in case reporting. CONCLUSIONS: Recent declines in syphilis notifications in the NIS are at least partially a reflection of a reduced intensity of active case finding and of changes in reporting completeness because of a shift in service utilisation from the public to the private/informal sectors. Syphilis rates are still high, indicating that both public and private sectors have to respond more efficiently to the needs of many people at risk of STI. The collection of serial STI prevalence data is recommended to be able to validate trends in notifications.

Adolescent↗

PubMedDate not supplied

Prevalence and incidence of syphilis and its association with HIV-1 infection in a population-based study in the Kagera region of Tanzania.

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control. Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987. The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk. In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Economic and programmatic aspects of congenital syphilis prevention.

A review of the economic and programmatic aspects of congenital syphilis was conducted and recommendations made for improvement of its prevention. Congenital syphilis is a preventable disease and the tools to prevent it have been available for decades. In both industrialized and developing countries, but particularly the latter, the prevention of congenital syphilis by antenatal screening is cost-effective and may be cost-saving. Yet, globally, there are probably >500 000 fetal deaths a year from congenital syphilis, a figure rivalling that from mother-to-child transmission of human immunodeficiency virus (HIV), which receives far greater attention. The reasons that congenital syphilis persists vary, with international and national under-appreciation of the burden of congenital syphilis and insufficient political will to provide effective antenatal screening programmes probably being the main reasons. All causes are amenable to effective intervention programmes. The prevention of congenital syphilis should be a global priority; international agencies and national programmes should be committed to improving antenatal care (ANC) services including syphilis detection and prevention.

Cost-Benefit Analysis↗

PubMed2004

The prevention and management of congenital syphilis: an overview and recommendations.

The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.

Female↗

PubMed2006

[Issues of congenital syphilis in the past twenty years. II. Clinical picture].

The paper describes the clinical picture and management of congenital syphilis. In the introduction the origin of syphilis is mentioned. The etiologic agent -- Treponema pallidum subsp. pallidum (Tp) -- is transmitted to fetus almost exclusively via placenta. Perinatal infections are less frequent, and postnatal infections are only exceptionally. The symptoms of congenital syphilis may be divided into prenatal (syphilis materno-fetalis), neonatal, and rarely seen postnatal. Prenatal symptoms causing the immaturity of fetus are recognizable from the 7th month of pregnancy and associated with miscarriages, premature deliveries of still-born babies or live neonates with congenital syphilis. Neonatal and postnatal symptoms are manifested only after birth. They may present immediately at birth, develop within first two years of life as early congenital syphilis, or (similarly to acquired syphilis) later in life as a late localized form, often seen many years after birth, even at puberty -- late congenital syphilis. The clinical picture depends on many factors -- primarily on the duration of the infection in mother and the stage of pregnancy.

Female↗

PubMed1991

Characteristics of patients with syphilis attending Baltimore STD clinics. Multiple high-risk subgroups and interactions with human immunodeficiency virus infection.

Medical records of 341 patients with syphilis seen at a health department sexually transmitted disease clinic were reviewed to assess membership in high-risk subgroups and interactions with human immunodeficiency virus (HIV) infection. When compared with the entire clinic population, patients with syphilis tended to be older and were more likely to acknowledge intravenous drug use, more often had a history of syphilis, and, among men, were more often homosexually active. Half of the men with syphilis and one third of the women fell into one or more of these high-risk subgroups. Patients with syphilis were also more likely to test positive for HIV infection than other patients attending the clinic. Patients admitting to intravenous drug use, prior syphilis, or being homosexually active were significantly more likely to be HIV seropositive than patients without these characteristics, even though patients with these characteristics were significantly more likely to refuse HIV serologic testing. Although clinical stage of syphilis at presentation did not differ when patients with and without concurrent HIV infection were compared, geometric mean rapid plasma reagin titers were significantly higher in HIV-infected patients with secondary syphilis.

Adult↗

PubMed1997

Long-term trends of the incidence of syphilis and gonorrhoea in the Slovak Republic during 1947-1994, with special regard to young age groups.

During the Second World War and after the War venereal diseases (Syphilis and Gonorrhoea) were wide-spread. By a single census in October 1947 were notified 2960 syphilitic patients. In the years 1949-1951 intensive and effective preventive measures were introduced as compulsatory notification system of venereal diseases, sexual contact-tracing investigations, correct and rapid diagnosis of venereal diseases, rapid and efficient therapy of patients with syphilis, followup (post-treatment observations) for all patients, routine serological tests for syphilis, in expectant mothers at ante-natal clinics, periodical screening of high-risk groups, patients in each calendar year at their hospitalization, to taking up a post and a special drive against syphilis ("PN-action"). The results of these measures are manifested by substantial fall in the number of cases of syphilis and gonorrhoea. In the years 1948-1955 18,151 patients suffering from syphilis were notified. The changes of the incidence of syphilis and gonorrhoea are illustrated by statistical data (Tab. 1-9). Syphilis congenita occurs sporadicly, there is a substantial fall in the number of syphilitic pregnant. After 1989 there has been a greater group mobility and a substantial rise in active and passive tourisms and occupational travel activity, especially abroad. Changes of the sexual behaviour were expressed, especially a greater tolerance whether heterosexual or homosexual, sexual freedom, sexual promiscuity and especially prostitution.

Adolescent↗

PubMed1993

Maternal and congenital syphilis in Brooklyn, NY. Epidemiology, transmission, and diagnosis.

OBJECTIVE: To define the epidemiology, to determine factors associated with transmission, and to describe the clinical and laboratory features of congenital syphilis. DESIGN: Retrospective chart review and prospective analysis. SETTING: Kings County Hospital Center, Brooklyn, NY. PATIENTS: A total of 403 pregnancies during a 23-month period associated with positive syphilis serological findings. RESULTS: Seventy-three pregnancies (18%) resulted in congenital syphilis (35 live-born and 40 stillborn neonates). Pregnancies associated with congenital syphilis were significantly associated with lack of prenatal care, lack of maternal therapy for syphilis, and a higher rapid plasma reagin titer, but not with a reported history of "crack" or cocaine use, although detection of cocaine in urine samples was more likely with positive syphilis serology. CONCLUSION: Most live-born infants with congenital syphilis (23 of 35) lacked rash, hepatosplenomegaly, or adenopathy but were identified by laboratory tests (roentgenograms, cerebrospinal fluid VDRL test, conjugated bilirubin determination, or aspartate aminotransferase levels in serum samples). Half of the infants with congenital syphilis were stillborn.

Delivery, Obstetric↗

PubMedDate not supplied

Patterns of syphilis testing in the elderly.

OBJECTIVE: To evaluate the frequency of inconsistencies in the use of laboratory tests for syphilis among the elderly in an acute care setting. DESIGN: Retrospective medical record review. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: All patients 60 years of age and older who had: 1) positive tests for syphilis and no lumbar puncture performed (n = 71), 2) lumbar punctures performed and no positive test for syphilis (n = 68), and 3) positive tests for syphilis and lumbar punctures performed (n = 8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The chronology and results of syphilis tests were abstracted from the medical records. Documentation of signs and symptoms of neurosyphilis, including dementia and depression, were abstracted from the medical records by a second reviewer. Most patients had inadequate evaluations; 51 had no follow-up of positive syphilis tests and 43 had cerebrospinal fluid syphilis tests in the absence of positive blood tests for syphilis or signs and symptoms of neurosyphilis. CONCLUSIONS: The inconsistent pattern of serologic testing in this study suggests that the testing was done as a routine procedure and not for a specific purpose. For a majority of the tested individuals, the results did not provide a public health benefit or contribute to the individual's well-being.

Aged↗

PubMed1995

Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy.

OBJECTIVE: To describe clinical and treatment aspects of syphilis infection among patients seropositive for the human immunodeficiency virus (HIV). PATIENTS AND METHODS: Results of serologic tests for syphilis, CD4+ T-lymphocyte counts, and clinical response to therapy were retrospectively monitored in 100 HIV-infected adults with syphilis from a tertiary-care military HIV program. RESULTS: Of the 1,206 HIV-infected patients, 100 (8.3%) in the cohort had syphilis; 61 patients were treated for active syphilis. Serologic or clinical relapse eventually occurred in 10 of the 56 treated patients (17.9%) with follow-up available; 7 of the 10 who relapsed had previously received high-dose intravenous or procaine penicillin therapy. Relapse occurred more than 12 months after initial therapy in 6 of 10 patients (60%) who experienced relapse; 5 patients experienced multiple relapses. The mean CD4+ T-lymphocyte count was not predictive of relapse. Patients with reactive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test titers (4 of 7 patients [57%]) or the rash of secondary syphilis (4 of 14 patients [29%]) were at highest risk of subsequent relapse or treatment failure when monitored for an average of 2 years. CONCLUSION: Standard penicillin regimens, including high-dose intravenous penicillin, transiently lowered serum VDRL titers in nearly all cases, but were sometimes inadequate in preventing serologic and clinical relapse in patients infected with HIV type-1, especially among those with secondary syphilis and reactive CSF VDRL titers. Careful long-term follow-up is essential, and repeated courses of therapy may be needed for patients infected with HIV type-1 who have syphilis.

AIDS-Related Opportunistic Infections↗