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PubMed2005

[Perinatal mortality due to congenital syphilis: a quality-of-care indicator for women's and children's healthcare].

Syphilis is a persistent cause of perinatal mortality in Rio de Janeiro, Brazil, where this study was performed using data from the mortality data system and investigational reports for fetal and neonatal deaths, mandatory in municipal maternity hospitals. From 1996 to 1998, 13.1% of fetal deaths and 6.5% of neonatal deaths in municipal maternity hospitals were due to congenital syphilis. From 1999 to 2002, the proportions were 16.2% and 7.9%, respectively. For the city of Rio de Janeiro as a whole from 1999 and 2002, the proportions were 5.4% of fetal deaths and 2.2% of neonatal deaths. The perinatal mortality rate due to congenital syphilis remains stable in Rio de Janeiro, despite efforts initiated with congenital syphilis elimination campaigns in 1999 and 2000. We propose that the perinatal mortality rate due to congenital syphilis be used as an impact indicator for activities to control and eliminate congenital syphilis, based on the investigational reports for fetal and neonatal deaths. Such reports could be extended to the surveillance of other avoidable perinatal disease outcomes.

Birth Weight↗

PubMed2006

Oral manifestations of syphilis.

The past decade has shown a significant rise in the prevalence of infective syphilis in the developed world, and striking increases in its frequency have occurred in Eastern Europe, particularly the UK, and in the US. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Significant oral lesions such as gumma-associated bony destruction and a possible predisposition to oral squamous cell carcinoma are associated with tertiary disease. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. The aim of this report is to review syphilis-related oral lesions, as well as to summarize the relations between human immunodeficiency virus (HIV) and syphilis.

HIV Infections↗

PubMed1991

Public health intervention in a cocaine-related syphilis outbreak.

BACKGROUND: Cocaine users and prostitutes are at high risk for syphilis, but disease control is difficult among these populations. During a cocaine-related syphilis outbreak in Chester, Pennsylvania, in 1989, we conducted a control program at sites where sex and drugs were sold. METHODS: During a 2-week period, investigators recruited persons from these sites for interview, serologic testing, and empiric treatment. RESULTS: Among 136 persons screened, 25 (18%) had early syphilis and 26 others (19%) had recent sexual contact with early syphilis patients. All were treated at initial screening at a cost of $402 and 12 investigator hours per case, compared to $470 and 20 hours per case when treated during routine investigator activities. This program may have contributed to a short-term decline in syphilis incidence in Chester by reducing the period of infectivity of these patients. CONCLUSIONS: Screening and empiric treatment of persons at sites where sex and drugs are sold can be useful in short-term control of cocaine-related syphilis outbreaks.

Adolescent↗

PubMed1991

Diverging gonorrhea and syphilis trends in the 1980s: are they real?

BACKGROUND: The purpose of this study was to evaluate whether the divergence in national trends of gonorrhea and syphilis from 1986 to 1989 in the United States was real and if overall trends masked a contemporaneous increase in both diseases in a core group. METHODS: We analyzed the following: (1) reported cases of gonorrhea and primary and secondary syphilis in the United States for the years 1981 to 1989, (2) gonorrhea screening results from six states for the years 1985 to 1989, and (3) reported cases of gonorrhea and primary and secondary syphilis by census tract for the years 1986 to 1989 in one city. RESULTS: The incidence of gonorrhea decreased 22% in the United States from 1986 to 1989 while the incidence of primary and secondary syphilis increased 59%. Among Blacks, syphilis incidence increased 100% and gonorrhea incidence decreased 13%; among Whites and Hispanics, the incidence of both diseases decreased. Results from gonorrhea screening among females in six states agree with gonorrhea incidence trends in those areas. Race-specific and census tract analyses of data from a number of metropolitan areas where overall rates diverged did not demonstrate a group in which the incidence of both diseases increased. CONCLUSIONS: We conclude that diverging trends of gonorrhea and syphilis from 1986 to 1989 are real and emphasize differences in the epidemiologic characteristics of these two sexually transmitted diseases.

Epidemiologic Methods↗

PubMed2002

Management issues in syphilis.

Syphilis is a sexually transmitted infection which is systemic from the outset and has increased in incidence worldwide over the last decade. There has been concern as to whether or not co-infection with HIV can modify the clinical presentation of syphilis and, as a genital ulcer disease, it can facilitate the transmission of HIV infection. Diagnosis is based on the microscopic identification of the causative treponeme and serological testing. Recommendations for the treatment of syphilis have been based on expert opinion, case series, some clinical trials and 50 years of clinical experience. Penicillin, given intramuscularly, is the mainstay of treatment and the favoured preparations for early infectious syphilis are benzathine penicillin as a single injection or a course of daily procaine penicillin injections for 10 to 14 days. The duration of treatment is longer for late syphilis. There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. The main alternative to penicillin is doxycycline, but the place of azithromycin and ceftriaxone is yet to be established. It is not necessary to carry out examination of the cerebrospinal fluid in patients with early infectious syphilis but it should be performed in those with neurological or ocular signs, psychiatric signs or symptoms, when there is evidence of treatment failure and in those who are co-infected with HIV. Follow-up is an essential part of management and should be particularly assiduous, for at least 24 months, in those co-infected with HIV. Partner notification should be mandatory to try to contain the spread of infection.

Contact Tracing↗

PubMed1993

Gastric syphilis: radiologic findings.

Syphilis, a venereal infection caused by the spirochetal bacterium Treponema pallidum, has long been considered a primary public health concern in the United States. With the onset of the antibiotic era, the prevalence of the disease dramatically plummeted, as did interest in its radiologic manifestations. Rolfs and Nakashima [1] have shown that the prevalence of primary and secondary syphilis increased 34% from 1981 to 1989, to its highest level since 1949. Given this dramatic increase, classic manifestations of syphilis may warrant renewed attention. In its secondary and tertiary stages, syphilis can cause a wide range of gastric lesions that can mimic many other entities, from gastritis or benign ulcer disease to gastric carcinoma. Indeed, the acute gastritis of early secondary syphilis produces the earliest radiologically detectable signs of the disease. Cases of gastric syphilis submitted to the Armed Forces Institute of Pathology and cases drawn from the University of Cincinnati teaching file are used to illustrate the varied findings in this disease.

Diagnosis, Differential↗

PubMed1998

The significance of syphilis serology tests on long-term hemodialysis patients.

BACKGROUND: Syphilis is a sexually transmitted disease. Blood transfusion and blood contact are also routes of infection. Patients on long-term hemodialysis are at risk during their therapy. The aim of this study is to investigate the incidence of syphilis in hemodialysis patients, possible nosocomial infection and methods of treatment. MATERIALS AND METHODS: A total of 556 uremic patients on maintenance hemodialysis at our hospital on June 1996 were enrolled in the study. They all received syphilis screening tests. The rapid plasma reagin (RPR) test was used as the primary screening tests and Treponema pallidum hemagglutination assay (TPHA) test as the confirmation test. According to the test results, patients were classified into false and true-positive groups. The titer of both tests were recorded. The patients in the true-positive group were further divided into the untreated and treated group depending on whether they had already received treatment. The serial change of RPR test titer of the treated group was reviewed. RESULTS: Thirty-one patients (5.6%) had positive RPR test results and 10 patients (1.8%) had false-positive results. The titers of both RPR and TPHA tests were rather low in the positive groups. Most of the confirmed syphilis patients were asymptomatic and diagnosed serologically. In the treated group, the RPR test titer did not show significant decline and no seroconversion was noted after treatment. CONCLUSION: We observed that infectious syphilis patients exist in our hemodialysis unit and survey for this disease is necessary. The titers of both positive RPR and TPHA tests are low. Most diagnosed patients had latent syphilis, and serologic response to treatment is probably the same as in general population.

Aged↗

PubMed1998

An analysis of the value of some antigen-antibody interactions used as diagnostic indicators in a treponemal Western blot (TWB) test for syphilis.

Densiometric quantitation and spreadsheet normalization were used to refine the parameters defining a treponemal Western blot (TWB) test for syphilis. Initially using 84 defined reactive and 105 defined non-reactive sera, we determined that the immune response to the 17 kDa antigen was the most critical of the following three candidate test determinants: the 47 kDa, 17 kDa and 15.5 kDa bands. In a second study using 124 cases of clinically diagnosed syphilis and 354 "normal" donors, a diluted serum sample was included as a minimal reactive control for the 17-kDa immune response. Reactivity to all three test determinants was obligatory for a test result to be interpreted as positive. Of the 124 cases of syphilis, 7 were nonreactive by TWB (sensitivity = 94%); of the 354 normal donors, 7 tested reactive (specificity = 98%). Forty (11%) normal serum samples had detectable but less than minimal reactivity to the 17 kDa band. Frequencies of immune response to a larger group of 12 antigens were tallied for the 124 clinically diagnosed cases of syphilis and an equal subset (124) of the normal group. In the normal subset, 72% and 52% of the samples had detectable reactivity to the 47 and 15.5 kDa antigens, respectively, while 10%, 5% and 3% reacted with the 17, 24 and 44.5 kDa antigens, respectively. Follow-up TWB testing of the clinically diagnosed cases revealed that previously untreated patients with primary or secondary syphilis were more likely to a show decrease in TWB reactivity than patients with latent symptoms who had been treated previously. As a diagnostic indicator of syphilis, the 17-kDa antigen was found to have the best combined attributes of sensitivity and specificity. Although, the highly specific 44.5 kDal and 24 kDal bands were often redundant as diagnostic indicators they are useful for the interpretation of borderline results. In addition, absence of the highly sensitive 47 and 15.5 kDa indicators should be useful in resolving some problem diagnoses.

Antibodies, Bacterial↗

PubMed1999

Two recent cases of tertiary syphilis.

Tertiary syphilis is now a rare disease in Europe, mainly as a result of occasional antibiotherapy for concomitant infections. However early syphilis is rising in USA and Germany, and it is necessary to maintain an high level of knowledge and suspicion to achieve a diagnosis in the tertiary stage of the disease. In this report two patients with benign tertiary syphilis are described. The first one is a 55-year-old female with erythemato-violaceous annular scaling plaques on the right buttock and scapula and on both thighs, which had a negative and then a low VDRL titer. The second case is a 33-year-old mentally handicapped female with erythematous plaques, with psoriasiform scaling in the trunk and well defined crusted ulcers on the face, which also had negative VDRL. Biopsy of the skin lesions revealed plasmocytic infiltrate with endothelial swelling without granulomas and with negative silver stains in both patients. The investigation for cardiovascular and neurological involvement was negative in both patients. Diagnosis of tertiary syphilis can be difficult as clinical pictures can be misleading, similar to other granulomatous diseases, and serological titers can be low or negative. We recall the necessity of ruling out neurological and cardiac involvement in this stage of syphilis. These cases are reported as a reminder of the possibility of syphilis, so that new cases are not misdiagnosed and mistreated as other diseases.

Adult↗

PubMedDate not supplied

Two recent cases of tertiary syphilis.

Adult↗

PubMed1999

Inadvertent use of Bicillin C-R for treatment of syphilis--Maryland, 1998.

In October 1998, the Maryland Department of Health and Mental Hygiene (MDH) was notified that a public sexually transmitted disease (STD) clinic in a county (county A) had used a nonrecommended preparation to treat syphilis patients during January-October 1998. The clinic had been inadequately treating syphilis patients or syphilis contacts with Bicillin C-R (a mixture of 1.2 million units [MU] benzathine penicillin G [BPG] and 1.2 MU procaine penicillin G), rather than with Bicillin L-A (2.4 MU BPG). Compared with short-acting procaine penicillin G, BPG has a longer half-life considered essential for effective syphilis treatment because it yields sustained spirochetecidal levels needed to treat the slowly reproducing agent of syphilis, Treponema pallidum. The inadvertent use of Bicillin C-R, which contains only half the recommended dose of BPG for syphilis, was recognized by a health-care provider at the STD clinic in a neighboring county (county B) approximately 1 month after county B had borrowed BPG from county A. This report summarizes the investigation of the use of Bicillin C-R to treat STD patients in county A and discusses the frequency of Bicillin C-R use in STD clinics nationwide. Findings of this investigation indicate that inadvertent Bicillin C-R use is more frequent than previously known and that preventive measures should be taken to minimize such use.

Community Health Services↗

PubMed2002

[Syphilis in the third millenium].

BACKGROUND: For several decades the clinical picture of all stages of syphilis has been assumed to be immutable. The aim of the study was to describe the real spectrum of cutaneous and mucosal manifestations and organ changes and to ascertain whether the incidence of the disease has an increasing trend. METHODS AND RESULTS: The studied group included 92 patients (44 males, 48 females, average was 31.3 years) diagnosed in years 1992 to 1998 at our clinics. The diagnose was confirmed by a microscopic and/or serologic examination. Number of patients with the primary syphilis increased more than twice (1992 versus 1997), incidence of newly registered manifestations of the secondary syphilis has also increased (1996 to 1998), number of hospitalised patients in the stadium of syphilis latens increased at least twice (1992 versus 1996). Higher was the number of proven cases in pregnant patients: number of dead births increased twice, inborn forms of syphilis were three times more frequent. Among the newly described clinical forms the specific gastritis and specific uveitis were diagnosed. In immunosuppressed patients forms of lues maligna and the blue toes syndrome were identified. However, those forms were not diagnosed among our group of studied patients. CONCLUSIONS: During the last 10 years a significant increase of incidence of syphilis was reported in the population of Czech Republic. Such dangerous and almost explosive rise of new cases has been accompanied with increased number of inborn forms and with the occurrence of new clinical manifestations, namely in immunosuppressed patients.

Adult↗

PubMed2002

Moving toward the eradication of syphilis.

This study analyzed syphilis incidence among active duty U.S. Sailors and Marines and explored opportunities and strategies for the Department of the Navy to contribute to the achievement of the National Syphilis Elimination Plan. From 1987 through 1999, there were 1,886 cases of syphilis among active duty members reported to the Navy Environmental Health Center. Most were male (90%), younger than 30 years (81%), and black (64%). Most were diagnosed within the continental United States (79%). Incidence rates of primary and secondary syphilis per 100,000 among the active duty force declined steadily, from 37 in 1990 to 3 in 1999. Strategies suggested to further reduce syphilis among active duty members include the following: (1) Navy Medicine adoption and tracking of the national target of < 0.4 cases per 100,000 by 2005; (2) expand training of medical professionals in client-centered prevention counseling; (3) include affected populations in the design of interventions; (4) conduct outcome evaluations of educational interventions; (5) examine condom access policies; and (6) evaluate the current syphilis surveillance system.

Adolescent↗

PubMed2001

Re-emerging syphilis in the UK: a behavioural analysis of infected individuals.

In-depth interviews with 27 individuals infected with syphilis in a recent UK outbreak (out of a total of 58 diagnosed between May 1999 and August 2000 in three city hospitals) were carried out to examine behaviour and attitudes. Most (23/27) participants were homosexual men, seven of whom were HIV positive. Between them, the 23 gay men had 1,494 different contacts in the twelve months prior to their awareness of having syphilis, but only 10% of these contacts could be named. While oral sex (usually unprotected) was the most prevalent behaviour (median = 30 partners per year), only 39% perceived unprotected oral sex as a syphilis risk (c.f. 70% for anal sex). Many gay men (61%) used gamma hydroxybutyrate (GHB) during sex as an aphrodisiac. This syphilis-infected subset of the population had high levels of unprotected and anonymous sex, which brings into question the usefulness of contact tracing to control syphilis outbreaks. The majority of partners were casual oral sex partners. More awareness is urgently needed around syphilis symptoms and risks, and risks of using drugs to reduce sexual inhibitions.

HIV Infections↗

PubMed2002

[An etiological and clinicopathological study of early syphilis in oropharynx].

OBJECTIVE: To investigate the characteristics of the early stage treponema pallidum infected tissue in ear, nose, oropharynx and larynx and to raise relevance ratio of syphilis in nose and oropharynx and enhance doctor's self-protection awareness. METHODS: The histopathologic characteristics were studied by using HE staining, Warthin-Starry (W-S) staining was adopted to examine the treponema pallidum(TP) in lesion issue and its exudates smear for 12 cases biopsy tissues of suspicious syphilis. The diagnosis was confirmed by venereal disease research laboratory (VDRL), rapid plasma reagin circle test(RPR), treponema pallidum hemagglutination test(TPHA) and fluorescent treponemal antibody-absorption test (FTA-ABS). Treat with curing syphilis methods which published by nation. RESULTS: In the 12 cases mucous membrane specimen, the squamous epithelium proliferated, neutrophilic granulocyte infiltrated, within inherent membrane generous plasmacyte and lymphocyte infiltrated. W-S staining: plenty of treponema pallidum were found inside mucous membrane epithelium and exudate smear. Serology examination: 11 cases VDRL(++++), 7 cases RPR (+), 11 cases TPHA(+), 1 case FTA-ABS(+). After systemic treatment, 11 cases are clinically recovered. All patients serology become negative. CONCLUSION: W-S staining method can directly demonstrate histopathologic characteristics in early syphilis, in intrinsic membrane numerous plasmacyte infiltration. Combining with specific syphilis serology examination could increase diagnosis rate of syphilis in nose and oropharynx.

Adult↗

PubMed1954

Treatment of early infectious syphilis with N,N'-dibenzylethylenediamine dipenicillin G; a second report.

A new penicillin salt-N,N'-dibenzylethylenediamine dipenicillin G (Bicillin)(a)-was given, in single injections of 2,500,000 units, to 196 patients with early infectious syphilis. The seronegativity rates after three months were 65% for primary syphilis cases and 25% for secondary syphilis patients; after six months, the rates were 80% and 60%, respectively. At the end of the 21-month observation period, satisfactory results were recorded in 96.6%-100.0% of the primary syphilis patients, and in 92%-95% of those treated for secondary syphilis. The respective cumulative re-treatment rates were 3.4% and 4.1%.The results of the secondary syphilis treatment were then compared with those obtained with single-injection schedules of 2,400,000 and 4,800,000 units of procaine penicillin G in oil with 2% aluminium monostearate (PAM). The cumulative re-treatment rates 21 months after treatment were: Bicillin, 4.1%; PAM (2.4 million units), 14.2%; and PAM (4.8 million units), 5.1%. It would thus appear that a single injection of 2,500,000 units of Bicillin is as effective as one of 4,800,000 units of PAM.

Communicable Diseases↗

PubMed1992

[Congenital syphilis and syphilitic mothers. Survey of the past 10 years].

Two hundred and sixty-two newborn infants, born to mothers with a positive syphilis serology, have been studied. Twenty-six newborn infants had congenital syphilis and two hundred and thirty-six were considered as newborn infants from syphilitic mothers. This study has demonstrated that the newborn infants with congenital syphilis have been born to mothers with greatest risk factors. Newborn infants with congenital syphilis born to mothers on treatment during the pregnancy had a milder case of congenital syphilis than newborn infants born to mothers without treatment during the pregnancy. A diagnostic test for the treatment in these newborns has been proposed; if the test score is less than 5, we are dealing with a child of a syphilitic mother that does not need treatment and if the test results are higher than 5 we can confirm the diagnosis of congenital syphilis and immediate treatment must be started.

Female↗

PubMed2003

Primary and secondary syphilis--United States, 2002.

After declining every year during 1990-2000, the rate of primary and secondary (P&S) syphilis in the United States increased in 2001. To characterize the epidemiology of syphilis in the United States, CDC analyzed national surveillance data for 2002. This report summarizes the results of that analysis, which indicate that the number of reported cases of P&S syphilis increased 12.4% in 2002. As in 2001, this increase occurred only among men, suggesting that this increase occurred particularly among men who have sex with men (MSM). For the 12th consecutive year, the number of P&S syphilis cases declined among women and non-Hispanic blacks. These data suggest that although efforts to reduce syphilis among these populations have been effective, additional intervention strategies are needed to prevent syphilis among MSM.

Female↗