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PubMed2005

Syphilis in adults.

Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.

Adult↗

PubMed1980

Immunoregulatory properties of serum from patients with different stages of syphilis.

The response of lymphocytes from 17 patients with primary, secondary, and tertiary syphilis to phytohaemagglutinin (PHA) and to allogeneic lymphocytes was normal in heterologous serum; however, the responsiveness of cells from some patients with primary and secondary disease was significantly reduced in the presence of autologous serum. As cells from healthy controls invariably responded better to these stimuli in autologous serum, the sera from 81 patients with syphilis were screened for immunosuppressive properties. Sera from 25 primary, 32 secondary, two tertiary, six congenital, and 16 latent cases of syphilis were examined for their ability to reduce the responsiveness of normal cells to PHA. These experiments were performed with test sera as the sole source of serum for the cultures or with test sera added to cultures containing optimally supportive amounts of pooled human plasma.Stimulation of normal cells from one control in human plasma and 20% test serum showed that only in sera from congenital cases of syphilis was the mean response significantly different from the response seen in control sera; a significant increase in the response to stimulation occurred. The range of response to PHA with sera from cases of primary and secondary syphilis was wider than with normal sera. Sera from five (20%) cases of primary and 14 (44%) cases of secondary syphilis appeared to be immunosuppressive. When retested on another sample of normal cells, these sera were consistently immunosuppressive even in the presence of 15% pooled human plasma. Thus, in early syphilis antigenic stimulation may result in the release from suppressor cells of non-specific immunoregulators of cell-mediated immunity. Such phenomena may be a prelude to the development of tolerance to treponemal antigens. In congenital syphilis the development of suppressor cells may be impaired, resulting in the apparent immunostimulatory properties of serum from such cases.

Cells, Cultured↗

PubMed1993

The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws.

OBJECTIVE: To study the localisation of treponemes and to analyse the inflammatory infiltrate in biopsy specimens from patients with primary or secondary syphilis, or early infectious yaws. MATERIALS AND METHODS: Skin biopsies originating from human lesions of primary (29x) or secondary (15x) syphilis (Rotterdam), or early yaws (18x) (West Sumatra) were studied. Different histochemical and immunohistochemical detection methods were used in this study. RESULTS AND CONCLUSION: The histochemical silver staining method according to Steiner revealed the presence of T. pallidum in all cases of primary syphilis studied. In 10 out of 14 cases of secondary syphilis, treponemes were demonstrated. With an immunofluorescence staining technique (IF) using anti-T. pallidum antiserum raised in rabbits (a-Tp), T. pallidum was demonstrated in 28 out of 29 cases of primary syphilis, and in 14 out of 14 studied cases of secondary syphilis. The silver staining method and IF showed identical localisations of T. pallidum (mainly in the dermal-epidermal junction zone or throughout the dermis). Using a-Tp antiserum in the indirect immunofluorescence technique, T. pertenue could be demonstrated in the dermis more often than with Steiner silver staining. However, epidermotropism of T. pertenue in yaws specimens was remarkable, compared with more mesodermotropism of T. pallidum; numbers of T. pertenue in the dermis were limited in all specimens. The dermal inflammatory infiltrate in primary and secondary syphilis was composed mainly of lymphocytes and plasma cells. In most cases more T (CD3 positive) cells than B (CD22 positive) cells were present. Regarding T cell subpopulations, in primary syphilis, T helper/inducer (CD4 positive) cells predominated in 86% of cases. In secondary syphilitic lesions, numbers of T helper/inducer cells were less frequent than or equal to T-suppressor/cytotoxic (CD8 positive) cells in 60% of cases. Remarkably, in yaws specimens the inflammatory infiltrate consisted mainly of IgG, but also IgA and IgM producing plasma cells. T or B lymphocytes were scarce, which is in sharp contrast with findings in syphilitic lesions.

Adolescent↗

PubMed1999

Syphilis, gonorrhoea, and drug abuse among pregnant women in Jefferson County, Alabama, US, 1980-94: monitoring trends through systematically collected health services data.

OBJECTIVE: To assess the association between self reported drug abuse and syphilis and gonorrhoea among pregnant women, Jefferson County, Alabama, United States, 1980-94. STUDY DESIGN: We analysed a prenatal care database and assessed the association of self reported drug use with seropositive syphilis and gonorrhoea using prevalence rates, multiple logistic regression models, and the Pearson correlation coefficient (r) for trends. RESULTS: Overall, 5.5% of the women acknowledged drug abuse, 1.4% had seropositive syphilis, and 4.8% had gonorrhoea. In a multivariate analysis, drug abuse was associated with syphilis (odds ratio 2.9, 95% confidence interval 1.6, 5.3) but not with gonorrhoea. Trends in the annual prevalence of drug abuse closely paralleled trends in the annual prevalence of syphilis, including simultaneous peaks in 1992 (drug abuse, 9.1%; syphilis, 3.2%). There was no such parallel trend between drug abuse and gonorrhoea. Annual prevalence of drug abuse correlated with the prevalence of syphilis (r = 0.89, p = 0.001) more than with the prevalence of gonorrhoea (r = 0.45, p = 0.201). CONCLUSION: Among pregnant women, an increase in drug abuse was closely associated with an epidemic of syphilis, but not of gonorrhoea. Systematically collected prenatal care data can usefully supplement surveillance of diseases and behavioural risk factors associated with them.

Adult↗

PubMed2000

Effect of a syphilis control programme on pregnancy outcome in Nairobi, Kenya.

OBJECTIVES: To assess the impact of a syphilis control programme of pregnant women on pregnancy outcome in Kenya. METHOD: Women who came to deliver to Pumwani Maternity Hospital (PMH) between April 1997 and March 1998 were tested for syphilis. Reactive rapid plasma reagin (RPR) tests were titrated and confirmed with treponema haemagglutination test (TPHA). Equal numbers of RPR and TPHA negative women were enrolled. Antenatal syphilis screening and treatment history were examined from the antenatal cards. RESULTS: Of 22,466 women giving birth, 12,414 (55%) were tested for syphilis. Out of these, 377 (3%) were RPR reactive of whom 296 were confirmed by TPHA. Syphilis sero-reactive women had a more risky sexual behaviour and coexistent HIV antibody positivity; 26% were HIV seropositive compared with 11% among syphilis negative mothers. The incidence of adverse obstetric outcome defined as low birth weight and stillbirth, was 9.5%. Syphilis seropositive women had a higher risk for adverse obstetric outcome (OR 4.1, 95% CI 2.4-7.2). Antenatal treatment of RPR reactive women significantly improved pregnancy outcome but the risk of adverse outcome remained 2.5-fold higher than the risk observed in uninfected mothers. CONCLUSIONS: These data confirm the adverse effect of syphilis on pregnancy outcome. This study also shows the efficacy of antenatal testing and prompt treatment of RPR reactive mothers on pregnancy outcome.

Female↗

PubMed2001

An evaluation of on-site testing for syphilis.

One of the major obstacles to the eradication of perinatal transmission of syphilis is the delay in obtaining the results of syphilis serological tests. The availability of on-site syphilis testing lead to this study which attempted to evaluate on-site syphilis testing performed by nursing staff. The seroprevalence of syphilis by laboratory rapid plasma reagin (RPR) was 8.2% (n=42). Twenty-one of the 42 women were correctly identified by the on-site test. The overall sensitivity of on-site testing was 50% [95% confidence interval (CI)=34.4-65.6]; specificity of 90.9% (95% CI=87.8-93.2). The on-site test correctly identified as uninfected 429 of the 471 women reported as RPR negative by the laboratory, giving a specificity of 91.1% (95% CI=88.1-93.4). The results of the study show that on-site RPR test had a sensitivity of 75% in respect of the clinically important titres of > or = 1:8. The specificity of the on-site test was 91.1% and on-site testing only failed to detect syphilis in those patients with titres of 1:1 and 1:2. On-site testing is a practical and cost-effective option to prevent congenital syphilis, in settings of a high prevalence of syphilis and using skilled testers.

Adolescent↗

PubMedDate not supplied

Primary and secondary syphilis: a histopathological study.

We present a study of biopsies taken from skin lesions of 44 patients presenting with primary or secondary syphilis. In most primary lesions erosion or, more often, ulceration was present, with a dense inflammatory infiltrate. In secondary syphilis a wide variety of histological changes was present. Blood vessels were frequently involved, with marked endothelial swelling and often proliferation. Treponemes were demonstrated with the Steiner staining method in all investigated cases of primary syphilis and in 71% of secondary syphilis cases. Treponemes were present throughout the dermis, particularly perivascularly, and in the dermal-epidermal junction zone. In two specimens of secondary syphilis treponemes were located predominantly in the epidermis, but there were always some microorganisms demonstrable in the dermis. The inflammatory infiltrate was often located in a perivascular coat-sleeve-like arrangement. In this study plasma cells and lymphocytes were present in all specimens of primary and secondary syphilis. Syphilitic lesions differed from yaws lesions mostly in the location of treponemes and the affection of blood vessels. In this histopathological study of early syphilis, treponemes did not show the epidermiotropic character of yaws, and blood vessel changes were more pronounced than in yaws. Unfortunately, due to the protean histopathological manifestations described in venereal syphilis and in yaws, these two treponemal diseases cannot always be differentiated on histological grounds alone.

Adolescent↗

PubMed2006

Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar es Salaam, Tanzania.

BACKGROUND: According to the latest Tanzanian National AIDS Control Programme (NACP) report a total of 147,271 individuals donated blood during the year 2002. However, blood safety remains an issue of major concern in transfusion medicine in Tanzania where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate. Most of the donated blood is screened for HIV alone. METHODS: We determined among blood donors at Muhimbili National Hospital (MNH), the seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg) and syphilis by donor type, sex and age and to determine association, if any, in the occurrence of the pathogens. The sample included 1599 consecutive donors, 1424(89.1%) males and 175 (10.9%) females, who donated blood between April 2004 and May, 2005. Most of them 1125 (70.4%) were replacement donors and a few 474 (29.6%) voluntary donors. Their age (in years) ranged from 16 to 69, and most (72.2%) were between 20-39 years. RESULTS: Two hundred and fifty four (15.9%) of the donated blood had serological evidence of infection with at least one pathogen and 28 (1.8%) had multiple infections. The current seroprevalence of HIV, HBsAg, HCV and syphilis among blood donors at MNH in Dar es Salaam was found to be 3.8%, 8.8%, 1.5% and 4.7%, respectively. Respective seroprevalences among HIV seronegative blood donors were 8.7% for HBV, 1.6% for HCV and 4.6% for syphilis. The differences in the prevalence of HIV and syphilis infections between replacement and voluntary donors were statistically significant (P < 0.05). Syphilis was the only infection that occurred more frequently among HIV infected (12.1%) than non-infected (4.6%) blood donors (P < 0.05), and whose prevalence increased with age (X2 = 58.5 df = 5, P < 0.001). There were no significant sex differences in the occurrence of pathogens. Finally, there were significant associations in the occurrence of HBsAg and syphilis (OR = 2.2, 95% CI 1.1.-4.2) and HIV and syphilis (OR = 2.2, 95% CI 1.0-5.3). CONCLUSION: The high (15.9%) seroprevalence of blood-borne infections in blood donated at MNH calls for routine screening of blood donors for HBV, HCV, HIV and syphilis and for strict selection criteria of donors, with emphasis on getting young voluntary donors and for establishment of strict guidelines for blood transfusions.

Adolescent↗

PubMed2002

Investigation of isolated positive syphilis enzyme immunoassay (ICE Murex) results.

This study was conducted to determine the significance of an isolated positive (where all other syphilis serology is negative) syphilis enzyme immunoassay (EIA) test (ICE syphilis: Murex Diagnostics) in a sexual health clinic population. There were significantly greater numbers of isolated positive syphilis EIA tests at Sydney Sexual Health Centre (SSHC) (22/5478) compared to lower risk populations; Southeastern Sydney antenatal clinics (1/11,560, P<0.01) and Sydney Children's Hospital (0/3550, P<0.01). We conducted a case control study comparing the cases at SSHC with two control groups drawn from the clinic population. A manual review of the case medical records searched for a history of suggested syphilis. Within the 22 cases, 32% had clinical grounds for suspecting that the EIA test signified syphilis. Men reporting homosexual contact in the past 12 months significantly distinguished cases from controls who tested negative for syphilis (OR=6.06). An isolated positive EIA test should prompt further investigation for syphilis, past or present.

Ambulatory Care Facilities↗

PubMed1999

Elimination and reintroduction of primary and secondary syphilis.

OBJECTIVES: This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. METHODS: Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. RESULTS: During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were sero-positive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. CONCLUSIONS: As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem.

Adult↗

PubMed2000

A decision to end a periodic syphilis-screening program in the Kimberley region.

Syphilis rates in the Kimberley region of far-northern Western Australia are among the highest in the nation. In 1986, a formal program of periodic syphilis screening was established. Decreasing syphilis rates since the early 1990s prompted, in 1999, re-evaluation of the value of periodic screening. All confirmed cases of syphilis identified in the Kimberley between January 1996 and early December 1999 as a result of syphilis serology were classified by reason for the test and staged according to disease progression. During the study period, 196 cases of syphilis (117 male, 79 female) were diagnosed; 14 (7.1%) were primary, 32 (16.3%) secondary and 150 (76.5%) latent. The periodic screening program contributed only about 10 per cent of cases, whereas testing as a result of sexually transmitted disease symptoms, sexually transmitted disease contact, institutional screening and other screening contributed the remaining cases. In January 2000, the periodic syphilis-screening program was discontinued. The effect of this policy change will be closely monitored using indicators to ensure that, should the decision not to screen prove to have been misjudged, any increase in syphilis incidence is detected early and managed appropriately.

Adolescent↗

PubMed1989

Changes of serum IgG antibody reactivity to protein antigens of Treponema pallidum in syphilis patients after treatment.

The changes of serum IgG antibody reactivity to protein antigens of Treponema pallidum after treatment of syphilis were observed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot. Until 9 to 12 months after treatment, it was seen that there was a loss of several antibodies and some diminution in their reactivity in primary, secondary and early latent syphilis, but no changes occurred in late latent and reinfected syphilis. In primary syphilis, there was a significant loss of two IgG antibodies to the treponemal antigens of molecular weights 68,500 and 47,000 at 11 months after treatment. According to our previous study, the treponemal antigen of molecular weight 68,500 was T. pallidum specific and appeared only in primary syphilis, and that of molecular weight 47,000 was one of the major antigens of T. pallidum. The reaction between serum IgG antibodies of 14 patients who had been treated for secondary, early latent and late latent syphilis 2 to 14 years ago and major antigens of T. pallidum was observed and any loss or decrease in reactivity was not discovered. From the results obtained, it was concluded that the observation of serum IgG antibody reactivity to protein antigens of T. pallidum is not helpful in evaluating the efficacy of treatment in secondary, early latent, late latent and reinfected syphilis. However, serum IgG antibodies to treponemal antigens of molecular weights 68,500 and 47,000 could possibly be useful in the assessment of the efficacy of treatment in primary syphilis.

Antibodies, Bacterial↗

PubMed1999

Primary and secondary syphilis--United States, 1998.

Rates of primary and secondary (P&S) syphilis have been declining in the United States since the last national epidemic in 1990. Syphilis causes substantial morbidity and mortality in the form of cardiac and neurologic disease, stillbirth and developmental disability from congenital syphilis, and by facilitating transmission of human immunodeficiency virus. Syphilis is both preventable and curable and has been successfully controlled in most developed countries. In the United States, declines in P&S syphilis have been followed by epidemics occurring approximately every 7-10 years. During 1960-1990, these cyclical epidemics resulted in progressively higher peaks in morbidity. To evaluate the epidemiology of syphilis in the United States, CDC analyzed notifiable disease surveillance data for 1998. This report summarizes the results of that analysis, which indicate that in 1998 P&S syphilis declined to the lowest rates ever reported in the United States and that syphilis transmission increasingly is concentrated in fewer geographic areas.

Humans↗

PubMed2001

Outbreak of syphilis among men who have sex with men--Southern California, 2000.

Syphilis is a sexually transmitted disease (STD) caused by infection with the spirochete Treponema pallidum, and like other genital ulcer diseases, syphilis enhances the transmission of human immunodeficiency virus (HIV). During the 1990s, syphilis occurred predominantly among heterosexual blacks in the South and in large cities. However, recent outbreaks of syphilis have occurred among men who have sex with men (MSM). A large syphilis outbreak occurred among MSM during January-July 2000 in southern California. During the outbreak period, the proportion of primary and secondary (P&S) syphilis cases among MSM increased to 51% from 26% for the same period in 1999. This report summarizes the findings of an investigation of this syphilis outbreak, which indicate a substantial increase in the number of syphilis cases among MSM, many of whom are HIV-positive. These data suggest that concern about HIV infection may be declining among MSM and emphasize the importance of strengthening efforts to prevent HIV infection in this population in the United States.

California↗

PubMed2001

Risk factors for syphilis among HIV-1 infected pregnant women in Dar es Salaam, Tanzania.

This study was conducted to determine the risk factors for recent (active) syphilis among HIV-1 seropositive pregnant women (N = 1058) in Dar es Salaam, Tanzania, Recruitment of study participants (N = 1058) was done between April 1995 and June 1997 at four main prenatal clinics in Dar es Salaam city. Study subjects were interviewed to obtain information about potential risk factors, and blood and genital specimens were collected for detection of syphilis and other genital infections. The prevalence of active syphilis was 5.9%. After adjusting for other risk factors, women without their own source of income had a 50% lower risk of syphilis (OR = 0.5, 95% CI: 0.3-0.9). The risk of active syphilis was significantly increased among women with genital ulceration on examination (OR = 8.4, 95% CI: 1.5-47.7), and in those with trichomoniasis (OR = 2.2, 95% CI: 1.2-3.8). HIV-related immunodeficiency was not associated with increased risk of syphilis. These results show that syphilis and other genital infections are a major problem among HIV infected women. Prevention of syphilis and other genital infections is urgently needed in this population.

Adolescent↗

PubMed2004

Trends in primary and secondary syphilis and HIV infections in men who have sex with men--San Francisco and Los Angeles, California, 1998-2002.

Because syphilis infection facilitates acquisition and transmission of human immunodeficiency virus (HIV), recent outbreaks of syphilis among men who have sex with men (MSM) in major U.S. cities, including San Francisco and Los Angeles, and reported increases in sexual risk behavior have raised concerns about potential increases in HIV transmission. In 2002, MSM accounted for the majority of primary and secondary (P&S) syphilis cases in men reported in San Francisco (93%) and Los Angeles (81%). To investigate a potential change in HIV incidence associated with the syphilis outbreaks in the two cities, local, state, and federal health officials analyzed data from HIV counseling and testing centers and a municipal sexually transmitted disease (STD) clinic. This report describes the results of that investigation, which indicated that, as of 2002, the outbreaks of syphilis had not had a substantial impact on HIV incidence among MSM in these two cities. However, the continued increase in syphilis cases in MSM underscores the need for integrated HIV- and STD-prevention strategies to control syphilis outbreaks and prevent potential increases in HIV infections (6,7) and for further systematic studies of HIV incidence among MSM infected with syphilis.

Adult↗

PubMed2006

Primary and secondary syphilis--United States, 2003-2004.

In 2000, the rate of primary and secondary (P&S) syphilis in the United States was 2.1 cases per 100,000 population, the lowest since reporting began in 1941. From 2001 to 2004, the P&S syphilis rate increased to 2.7, primarily as a result of increases in cases among men who have sex with men (MSM). To characterize the recent epidemiology of syphilis in the United States, CDC analyzed national notifiable disease surveillance data for 2000-2004, focusing on 2003-2004. This report describes the results of that analysis, which indicated that the disparity between syphilis rates among blacks and whites in 2004 increased for the first time since 1993 and is associated with a substantial increase of syphilis among black men. Syphilis rates continue to increase among MSM. After declining for 13 years, the rate of P&S syphilis in 2004, compared with 2003, increased in the South and remained the same among women. The findings underscore the need for enhanced prevention measures among blacks and MSM. In addition, enhanced surveillance is needed to detect any early increases in P&S syphilis among women.

Female↗

PubMed2006

Comparative evaluation of three different treponemal enzyme immunoassays for syphilis.

BACKGROUND: To reduce human errors and subjective interpretation, automation is currently a trend. However, replacing any tests with automation must first be validated. OBJECTIVE: Evaluate the EIA tests performance characteristics of three commercially available enzyme immunoassays; Enzygnost Syphilis (Dade Behring Ltd), Syphilis EIA 480 (Newmarket Laboratory Ltd) and ICE* Syphilis (Abbott Murex). MATERIAL AND METHOD: Three thousand and fifty-five serum samples were obtained from all workers who came for physical check ups before working abroad at the physical check-up unit of the out- patient department at Siriraj Hospital between February and August, 2001. Serum specimens known to be positive with VDRL and TPHA or FTA-ABS tests were included in the present study. RESULTS: Of all the samples, 2953 were from workers who came for physical check ups; 102 were selected from known specimens positive with the Venereal Disease Research Laboratory test (VDRL) and Treponema Pallidum Hemagglutination Assay (TPHA) or Fluorescent Treponemal Antibody ABSorption (FTA-ABS) test. A true positive result was determined when the sample was reactive either with two out of three enzyme immunoassays and TPHA or FTA-ABS, or both TPHA and FTA-ABS. A true negative result was determined when the aforementioned were absent. The sensitivity and specificity of Enzygnost Syphilis, Syphilis EIA 480 and ICE* Syphilis were 100% and 97.89%, 100% and 99.59%, and 99.1% and 99.76%, respectively. The results suggest that the specificity of Enzygnost Syphilis is the lowest among these three enzyme immunoassays; the price is also the cheapest. The decision to replace an existing test depends not only on the performance characteristics but also on other factors such as cost effectiveness, turnaround time, instrument maintenance, etc. The present study shows performance characteristics, whereas an economic evaluation is only briefly mentioned regarding a hospital's decision in making test selection. CONCLUSION: Among the three commercial kits, the specificity of Enzygnost Syphilis was the lowest. However, the replacement of any existing test depends greatly on the purpose of the individual laboratory whereas performance characteristics will provide us with an appropriate economic evaluation.

Adult↗