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PubMed2006

Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia.

OBJECTIVE: To evaluate the performance of a point-of-care (POC) syphilis test when used in urban Bolivian maternity hospitals. METHODS: We tested 8892 pregnant women for syphilis using the Abbott Determine Syphilis TP rapid POC test and rapid plasma reagin (RPR) in the laboratory of four large urban maternity hospitals where national statistics reported a syphilis prevalence of at least 3%. Sera were stored and transferred to the national reference laboratory (INLASA) where RPR testing was repeated. When the reference laboratory staff observed a positive RPR result, a Treponema pallidum particle agglutination assay (TPPA) was performed to confirm these findings. We calculated test performance characteristics for the POC test and hospital RPR using RPR performed at the reference laboratory confirmed by TPPA as the reference standard. Participants received treatment during their initial visit based on the POC test results. RESULTS: The sensitivity, specificity, negative predictive value and positive predictive values of the POC syphilis test were: 91.8% (95% confidence intervals 88.4% to 94.5%), 98.5% (98.2% to 98.8%), 71.0% (66.6% to 75.2%), and 99.7% (99.5% to 99.8%), respectively. The RPR values were 75.7% (70.8% to 80.2%), 99.0% (98.9% to 99.3%), 76.9% (72.0% to 81.3%), and 99.0% (98.8% to 99.2%), respectively. CONCLUSION: The Abbott Determine Syphilis TP test proved to be more sensitive than routine RPR and had comparable specificity. POC testing may be a simple way to expand syphilis screening to clinics with no laboratory facilities, improve case detection, and facilitate treatment delivery.

Adolescent↗

PubMed2001

Risk factors for active syphilis and TPHA seroconversion in a rural African population.

OBJECTIVES: Syphilis is an important cause of morbidity in sub-Saharan Africa, and a cofactor for the sexual transmission of HIV. A better understanding of the prevalence and risk factors of syphilis in African populations would help to formulate effective interventions for its prevention and treatment. METHODS: The prevalence and incidence of syphilis were obtained from a cohort recruited in Mwanza, Tanzania. Two unmatched case-control studies nested within the cohort provide information on potential risk factors. RESULTS: The prevalence of active syphilis (TPHA positive and RPR positive any titre) was 7.5% in men and 9.1% in women, but in youths (aged 15-19 years) the prevalence was higher in women (6.6%) than in men (2.0%). The incidence of TPHA seroconversion was highest in women aged 15-19 at 3.4% per year, and around 2% per year at all ages among men. A higher prevalence of syphilis was found in those currently divorced or widowed (men: OR=1.61, women: OR=2.78), and those previously divorced or widowed (men: OR=1.51, women: OR=1.85). Among men, prevalence was associated with lack of circumcision (OR=1.89), traditional religion (OR=1.55), and reporting five or more partners during the past year (OR=1.81) while incidence was associated with no primary education (OR=2.17), farming (OR=3.85), and a self perceived high risk of STD (OR=3.56). In women, prevalence was associated with no primary education (OR=2.13), early sexual debut (OR=1.59), and a self perceived high risk of STD (OR=3.57), while incidence was associated with living away from the community (OR=2.72). CONCLUSION: The prevalence and incidence of syphilis remain high in this rural African population. More effort is needed to promote safer sexual behaviour, and to provide effective, accessible treatment. The high incidence of syphilis in young women calls for sexual health interventions targeted at adolescents.

Adolescent↗

PubMed1989

Syphilis detection in cerebrovascular disease.

To determine the importance of syphilis testing in cerebrovascular disease, we prospectively assessed 218 consecutive patients with either transient ischemic attack or completed stroke. The results from this study group were compared with those from a control group of 150 neurological patients without cerebrovascular disease. Of 275 patients from both groups specifically tested by the fluorescent treponemal antibody-absorption test, 34% of the study group were seropositive compared with 18% of the controls (chi 2 = 7.7, p less than 0.01). Fifty-four percent of the patients with a positive fluorescent treponemal antibody-absorption test underwent a cerebrospinal fluid examination; meningovascular syphilis was detected in one (0.4%) of these. This patient was a homosexual male with antibodies to the human immunodeficiency virus; a second patient, with possible meningovascular syphilis, also had antibodies to this virus. Despite the relatively high rate of syphilis seropositivity noted in our study group, syphilis was not found to be a common cause of cerebrovascular disease; therefore, routine screening is seen to be of low diagnostic yield. Attention to patients who are at higher risk for syphilitic infection, patients with clinical features suggestive of meningovascular syphilis, and the proper choice of serologic studies can help make the assessment of syphilis seropositivity more clinically appropriate and cost effective.

Cerebrospinal Fluid↗

PubMed1990

Syphilis: test procedures and therapeutic strategies.

The diagnosis of syphilis is dependent mainly on serological tests. In primary syphilis there is a seronegative period when the diagnosis is dependent on demonstration of Treponema pallidum in lesional exudate. The most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR) and for confirmation the fluorescent treponemal antibody (FTA) and the treponema pallidum hemagglutination (TPHA) tests. The nonvenereal treponematoses have the same serological response as in syphilis. For the diagnosis of neurosyphilis, the cerebrospinal fluid (CSF) parameters available are insufficient. The albumin quotient for estimation of the blood-brain barrier function is recommended as well as the IgG index, which is a measure of intrathecal immunoglobulin production. Treponemal antibodies in CSF have high sensitivity for neurosyphilis, although the specificity is low. Although penicillin has been used as first-line therapy in syphilis for more than 40 years, T pallidum has not shown any signs of decreased sensitivity. T pallidum is still one of the most penicillin-sensitive microorganisms known. The standard treatment is depot preparations (benzathine penicillin and procaine penicillin) giving a continuous low penicillinaemia. Treatment failures in early syphilis have been exceedingly rare, although in neurosyphilis there have been several reports indicating that low-dose therapy is insufficient. With recommended treatment regimens, treponemicidal levels of penicillin in CSF are not achieved. Failure of therapy and rapid progression to neurosyphilis has recently been reported in patients coinfected with human immunodeficiency virus (HIV). It has been proposed that neurosyphilis and patients coinfected with syphilis and HIV should be treated with high intravenous doses of benzylpenicillin.

Antibodies, Bacterial↗

PubMedDate not supplied

[Results of the treatment of neurosyphilis and seroresistant latent syphilis by intravenous administration of potassium salt of penicillin G].

Potassium penicillin G was administered intravenously 4 times daily in doses of 6 million u for 10 days to 49 patients, 36 with central nervous system syphilis and 13 with latent seroresistant syphilis. Forty six patients were followed up after treatment. In 16 patients with central nervous system syphilis treated by this method another cerebrospinal fluid examination was done. Cerebrospinal fluid changes regressed completely in 13 patients, in three cases the improvement was incomplete. The titres of VDRL and FTA tests decreased in 23 patients with central nervous system syphilis and in 11 with latent seroresistant syphilis. In eight patients treated by this method seroresistance persisted and in four cases the titre fluctuated. The results of the study demonstrate the effectiveness and advantages of the treatment of central nervous system syphilis and latent seroresistant syphilis with crystalline penicillin administered intravenously.

Adult↗

PubMed1989

Examination of amniotic fluid in diagnosing congenital syphilis with fetal death.

The diagnosis of congenital syphilis is difficult, particularly in stillborn fetuses, who are often macerated and have undergone autolysis. These changes can obscure both syphilitic histologic findings and special stains for spirochetes in tissue specimens used to confirm the diagnosis of congenital syphilis. Five gravidas with untreated syphilis and fetal deaths underwent sonographic examination and amniocentesis. In all five cases, dark-field microscopic examination of the amniotic fluid showed spirochetes with morphology and motility characteristic of Treponema pallidum. Organisms were infrequent, but easily identified at 400x magnification and confirmed using an oil-immersion objective yielding a 900x magnification. After delivery, fetal-placental examination and autopsy showed clinical findings typical of congenital syphilis in all five cases. Histologic changes compatible with syphilis were found in all four autopsied fetuses. Silver impregnation stains were positive in two of five tissue specimens, and anti-treponemal monoclonal antibody immunofluorescence assays were positive in one of three amniotic fluid specimens examined retrospectively, further strengthening the specificity of the dark-field microscopic identification of spirochetes. This technique, which can make the diagnosis of congenital syphilis, is recommended for women with syphilis and a fetal death, especially if sonographic hydrops and/or edema is present or if an autopsy will not be performed.

Amniotic Fluid↗

PubMed1994

[Cutaneous tertiary syphilis with neurological symptoms].

INTRODUCTION: The tertiary cutaneous syphilis is now extremely rare. We report a case of tubercular cutaneous syphilis associated with neurological dysfunction. We emphasize the difficulties to interpret serologic and CSF tests for the diagnosis of neurosyphilis. CASE REPORT: A 63 year-old-woman had nodular, purplish and painless cutaneous lesions on forehead and forearm for 6 months. The biopsy showed a dermohypodermic lymphoplasmocytic granuloma, without necrosis, with endothelitis. Syphilis serologic tests were positive: VDRL = 512 U; TPHA = 40,960 U; FTA abs: IgG = 72,000 U; IgM = 1,350 U; Nelson test = 100 p. 100 (1,200 U). HIV test was negative. There was a past history of a positive syphilis serologic test when the patient was 20-year-old. The patient complained of shaking and her family spoke of gradual mental deterioration and behaviour troubles. The neurological examination showed a major frontal syndrome, cerebellar dysfunction with dysarthria and a major labial and lingual tremor. There is no lymphocytosis nor increased protein in the CSF; VDRL test was negative, TPHA test was positive, FTA abs = 4,000 U (IgG), and TPHA was increased. Penicillin G 16 millions units/day was given intravenously for 20 days; a slow increase was made in association with steroids at the beginning. The cutaneous lesions regressed in 14 days, but the neurologic state did not change. Six months later, there was still no IgM, TPHA decreased and VDRL was unchanged. DISCUSSION: While the diagnosis of tertiary cutaneous syphilis was correct, the neurological abnormalities are difficult to classify. The symptoms were those of general paresis, but there is no argument favouring biological CSF activity (no increase in protein or lymphocytosis, negative VDRL). Nevertheless, in the context of very positive serologic tests and tertiary cutaneous syphilis, we treated this case as a neurological syphilis. The treatment regimen and the need of current cures are still under discussion.

Facial Dermatoses↗

PubMed1993

Syphilis-associated perinatal and infant mortality in rural Malawi.

In Mangochi District, a rural area of Malawi, the prevalence of active syphilis was 3.6% among 3591 women who had singleton births and who were negative for human immunodeficiency virus (HIV). Compared with non-syphilitic women, those with active syphilis (positive Venereal Disease Research Laboratory/rapid plasmin reagin tests (titre > or = 1:8) and a reactive microhaemagglutination assay) were more likely to experience stillbirths as well as the early and late neonatal deaths and even postneonatal deaths of their children. Characteristics associated with active syphilis were not very useful in targeting women at high risk of having the condition, which makes universal screening in antenatal programmes the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a programme to prevent congenital syphilis in the perinatal, neonatal, and post-neonatal periods is evident. In considering resource allocation to child survival programmes in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system.

Child Welfare↗

PubMed1993

Comparison of early and late latent syphilis--Colorado, 1991.

Latent syphilis (i.e., the presence of serological evidence for syphilis without clinical manifestations) is divided into early latent ([EL] less than 1-year's duration) and late latent ([LL] more than 1-year's duration) stages (1). LL syphilis, which is often associated with low nontreponemal test (e.g., rapid plasma reagin [RPR]) titers and is presumed to have been acquired in the distant past, is not routinely included in syphilis surveillance reports and analyses. Although a separate classification of "unknown latent syphilis" has been proposed (1), in practice, duration is unknown for nearly all syphilis cases that are classified as LL. This report compares EL and LL syphilis cases in Colorado during 1991 and demonstrates substantial overlap in their characteristics.

Adolescent↗

PubMed1993

[WR in patients with secondary syphilis and HIV infection].

In recent years, there have been sporadic reports of aberrant manifestations of syphilis and a changed syphilis serology in AIDS patients, which might indicate difficulties in diagnosing the infection and monitoring the response to penicillin treatment. Six male patients aged 25 to 42 years with asymptomatic HIV infection and secondary syphilis were retrospectively compared with a control group of seven HIV-negative males aged 26 to 52 years with secondary syphilis. All patients presented with macular-papular exanthema of secondary syphilis; in all cases it was also their first episode of the disease. The median WR titre was 13 (range 11 to 20) in syphilis patients with HIV and nine (8 to 14) in the control group (p = 0.1). The median time until WR was found non-reactive after penicillin was four months (3 to 16) and five months (3 to 9), respectively (p = 0.8). Thus, in this small series there was no statistically significant difference in the WR-titres of asymptomatic HIV positive and HIV negative patients with secondary syphilis, although there was a tendency towards initially higher WR titre in the HIV group, as reported by others.

Adult↗

PubMed1998

Recognizing and treating syphilis in pregnancy.

The number of primary and secondary syphilis cases in young women rose dramatically in the late 1980s and early 1990s, due to illicit drug use and the exchange of drugs for sex. Of infants born to mothers with primary or secondary syphilis, up to 50% will be premature, stillborn, or die in the neonatal period; further, most of these children are born with congenital disease that may not be apparent for years. While appropriate treatment of the pregnant female can prevent congenital syphilis, the major deterrent has been the inability to effectively identify these women and get them to undergo treatment. In determining a penicillin regimen, the clinician must consider the stage of maternal infection, the length of fetal exposure, and physiologic changes in pregnancy that can affect the pharmacokinetics of antibiotics. Treatment decisions may be further complicated in patients who are allergic to penicillin or infected with HIV. The pathogenesis of congenital syphilis is not completely understood, but placental invasion is the presumed major route. All women should be screened for syphilis with a nontreponemal test (eg, rapid plasma reagin [RPR] or venereal disease research laboratory [VDRL] test) in the first trimester. Those at high risk should be retested at 28 weeks and near delivery. Even with appropriate treatment of syphilis during pregnancy, fetal infection may still occur in up to 14% of cases. Treating syphilis during pregnancy can be difficult due to physiologic changes that can alter drug levels and the risk that drugs will induce uterine contractions or compromise the health of the fetus. While there are added risks and potential complications, treatment regimens parallel those in nonpregnant women.

Female↗

PubMedDate not supplied

Syphilis in an urban community.

Recent reports of changes in the epidemiology of syphilis prompted a review of syphilis in our urban community. All records of positive syphilis serology reported to the City of Scarborough Health Department between 1990-94 were reviewed for key epidemiological variables. While infectious stages of syphilis were reported more often among young adults, incidence for all stages increased among successive age groups, with a male/female ratio of 1.0. One in five cases were identified during immigration screening, with a disproportionate number of cases immigrating from the Caribbean, Africa and Subcontinental India. Overall, the incidence of syphilis decreased during the study. However, a correlation of 0.95 was found between the provincial incidence of syphilis and number of tests ordered. The observed decrease in syphilis, therefore, may represent a decrease in detection owing to lack of testing.

Adolescent↗

PubMed1994

[Specific IgM tests in syphilis diagnosis].

A total of 359 sera of untreated patients with syphilis were examined by three methods for the detection of Treponema pallidum specific IgM antibodies, the 19S-IgM-FTA-ABS test, the IgM solid phase haemadsorption assay (IgM-SPHA), and the IgM Captia assay. The results were compared and evaluated. In primary syphilis, the 19S-IgM-FTA-ABS and IgM-captia yielded reactive results in all patients, whereas only 40% were positive in the IgM-SPHA; the corresponding values for early latent syphilis wee 96.0%, 89.8% and 73.1%, respectively. In secondary syphilis, the reactivity of one serum out of 27 was missed by IgM captia and that of another, by the IgM-SPHA. Mean values (ELISA units = extinction/cut-off) of IgM-captia were higher in primary (2.25) than in secondary syphilis (1.70). In neurosyphilis, only the IgM-SPHA test detected reactivity in all sera, sensitivity for 19S-IgM FTA-ABS and IgM-Captia was 50.0% and 23.1%, respectively. Specificity of the IgM-Captia test results, determined in 386 sera, was 91.2%. The results of specific IgM tests are essential in the diagnosis of congenital syphilis as well as in the recognition of reinfection; they indicate the need for treatment and are useful in the assessment of the effectiveness of therapy.

Antibody Specificity↗

PubMed1984

Inadequate treatment of syphilis in pregnancy.

Pregnant women with untreated syphilis have high rates of adverse pregnancy outcome. Early syphilis in pregnancy, if not treated, results in 40% loss either by spontaneous abortions, stillbirth, or perinatal death. Another 40% of such pregnancies result in an infant born with congenital syphilis. Only 20% of such pregnancies result in a normal infant. Currently recommended treatment of early syphilis in pregnant women uses a dosage of 2.4 million U of benzathine penicillin G. Because of the potentially disastrous effect syphilis has on pregnancy outcome, the occurrence of any treatment failure must be considered seriously. In this brief report we present clinical summaries of four pregnant women treated for syphilis who represent probable treatment failures.

Adult↗

PubMed1986

Syphilis tests in diagnostic and therapeutic decision making.

Predictive value calculations were used to derive diagnostic guidelines for syphilis. Specificity of the VDRL (Venereal Disease Research Laboratory) and treponemal tests is high in healthy persons but less in elderly and ill persons. Sensitivity of the VDRL test is high in secondary and early latent syphilis but reduced in primary and late syphilis or in cerebrospinal fluid evaluations. Primary syphilis should be diagnosed by darkfield microscopy, with VDRL confirmation for atypical lesions. Screening of asymptomatic persons with the VDRL test, followed by treponemal test confirmation on positive sera, is recommended for all pregnant women, contacts of persons with infectious syphilis, and other high-risk groups. Quantitative VDRL assessment at 3, 6, and 12 months after treatment should be used to assess the adequacy of treatment for both late latent and early syphilis. Cerebrospinal fluid VDRL assessment and cell count should be restricted to seropositive persons with a high risk of neurosyphilis.

Diagnostic Tests, Routine↗

PubMed2000

Tracing a syphilis outbreak through cyberspace.

CONTEXT: A recent outbreak of syphilis among users of an Internet chat room challenged traditional methods of partner notification and community education because locating information on sexual partners was limited to screen names and privacy concerns precluded identifying sexual partners through the Internet service provider. OBJECTIVES: To determine the association of Internet use and acquisition of syphilis and to describe innovative methods of partner notification in cyberspace. DESIGN, SETTING, AND PATIENTS: Outbreak investigation conducted at the San Francisco (Calif) Department of Public Health (SFDPH) in June-August 1999 of 7 cases of early syphilis among gay men linked to an online chat room; case-control study of 6 gay men with syphilis reported to SFDPH in July-August 1999 (cases) and 32 gay men without syphilis who presented to a city clinic in April-July 1999 (controls). MAIN OUTCOME MEASURES: Association of syphilis infection with Internet use, Internet use among cases vs controls, and partner notification methods and partner evaluation indexes. RESULTS: During the outbreak, cases were significantly more likely than controls to have met their sexual partners through use of the Internet (67% vs 19%; odds ratio, 8.7; P =.03). We notified and confirmed testing for 42% of named partners; the mean number of sexual partners medically evaluated per index case was 5.9. CONCLUSIONS: In this study, meeting sexual partners through the Internet was associated with acquisition of syphilis among gay men. Public health efforts must continually adapt disease control procedures to new venues, carefully weighing the rights to privacy vs the need to protect public health. JAMA. 2000;284:447-449

Adult↗

PubMed2006

Modeling a syphilis outbreak through space and time using the Bayesian maximum entropy approach.

PURPOSE: The aim of the study is to describe changes in the spatial distribution of syphilis before, during, and after an outbreak in Baltimore, MD, by using Bayesian maximum entropy (BME), a modern geostatistical technique for space-time analysis and mapping. METHODS: BME was used to conduct simple and composite space-time analyses of the density of syphilis infection based on primary, secondary and early latent syphilis cases reported to the Baltimore City Health Department between January 1, 1994, and December 31, 2002. RESULTS: Spatiotemporal covariance plots indicated that the distribution of the density of syphilis cases showed both spatial and temporal dependence. Temporally dependent disease maps suggested that syphilis increased within two geographic core areas of infection and spread outward. A new core area of infection was established to the northwest. As the outbreak waned, density diminished and receded in all core areas. Morbidity remained elevated in the two original central and new northwestern core areas after the outbreak. CONCLUSIONS: Density of syphilis infection was a simple informative measure easily compared across years. The BME approach was useful for quantitatively and qualitatively describing the spatial development and spread of syphilis. Our results are specific to Baltimore; however, the BME approach is generalizable to other settings and diseases.

Baltimore↗

PubMed2006

HIV, HBV, HCV, and syphilis co-infections among patients attending the STD clinics of district hospitals in Northern India.

OBJECTIVE: The objective of the study was to assess the risk of co-infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis among patients attending sexually transmitted disease (STD) clinics, antenatal clinics (ANC) and Ob-Gyn outpatients department (OPD) clinics which were part of the sentinel surveillance program. METHODS: A serological screening was carried out during the period August-November 2002 to assess the risk of infection with HIV-1/2, and co-infection with HBV, HCV, and syphilis among the outpatients attending STD clinics, Ob-Gyn OPD clinics, and ANC of three district hospitals (Agra, Etawah, and Farrukhabad) of Uttar Pradesh state in Northern India. Unlinked and coded serum samples received from 863 patients (635 females and 228 males) were screened by laboratory tests commonly used for laboratory diagnosis of HIV, HBV, HCV, and syphilis. RESULTS: Among the 863 samples serological reactivity was detected for HIV-1/2 in 21 (2.4%), HBV in 25 (2.9%), HCV in nine (1.0%), and syphilis in 47 (5.4%). The incidence of HBV was higher among males than females, i.e. 10/228 (4.4%) versus 15/635 (2.4%). Co-infection was observed for HIV-HBV in two (0.2%), HBV-HCV in one (0.1%), and HIV-syphilis in one (0.1%). None were found to have co-infection with HIV-HCV, HBV-syphilis, and HCV-syphilis. Age, sex, literacy level, occupation, locality, migration, and presence of different sexually transmitted infections did not significantly influence the rate of HIV positives. CONCLUSION: A substantial percentage of the outpatients seen in the clinics of the district hospital in Uttar Pradesh harbor HIV and viral hepatitis infections, which otherwise would remain undiagnosed without serological screening.

Adolescent↗