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PubMed1991

Comparison of maternal and newborn serologic tests for syphilis.

OBJECTIVE: To compare the cord blood, newborn serum, and maternal serum for the diagnosis of congenital syphilis. DESIGN: Retrospective chart review. SETTING: Kings County Hospital Center, Brooklyn, NY. PATIENTS: Three hundred forty-eight mother-newborn pairs with positive syphilis serology. MEASUREMENTS AND RESULTS: One hundred fifteen newborns (33%) had rapid plasma reagin tests of cord blood that were nonreactive. Their mothers had positive serologic findings. There were 10% false-positive cord blood samples (cord blood rapid plasma reagin tests reactive, newborn serum rapid plasma reagin tests nonreactive) and 5% false-negative cord blood samples (cord rapid plasma reagin tests nonreactive, newborn serum rapid plasma reagin tests reactive). Thirty-three newborns had congenital syphilis. Seven newborns had cord titers fourfold higher than their mothers'; only four of these newborns had congenital syphilis. Maternal serology is superior to cord blood analysis for identifying newborns at risk of congenital syphilis.

False Negative Reactions↗

PubMed1998

Syphilis. Serology.

Microbiologic tests are essential in the diagnosis and management of patients with syphilis. Apart from the very early stage of disease (when T. pallidum may be detected in the lesions of primary syphilis before an antibody response is detectable) serology is the mainstay of laboratory testing. The performance of cardiolipin antigen ("reagin") and treponemal antigen (native and recombinant) tests is discussed in relation to the stage of syphilis, treatment status, and interactions between syphilis and HIV infection. Screening with cardiolipin antigen tests detects early stage disease, but treponemal antigen tests are required for the reliable detection of late-stage infection and the exclusion of syphilis in HIV-infected patients. EIA tests using treponemal antigen are sensitive and specific and fit well into current laboratory practices. Although the FTA-abs test is often considered the "gold standard" confirmatory test, its sensitivity is slightly lower than that of certain other treponemal antigen tests. A reactive antitreponemal IgM test correlates well with untreated or recently treated early infection, but specific IgM tests are often negative in untreated late-stage disease. Serial quantitative cardiolipin antigen tests remain the method of choice for monitoring the efficacy of treatment. The role of the laboratory in aiding a diagnosis of neurosyphilis and congenital infection is discussed briefly, as is the current status of newer technologies, such as PCR and immunoblotting.

Antibodies, Bacterial↗

PubMed1991

Risk factors for congenital syphilis.

A prospective study of newborns whose mothers had untreated or inadequately treated syphilis was undertaken. The infants were followed up for 3-4 months to ascertain whether they had congenital syphilis. A number of variables were analysed as possible predictive factors for the development of congenital syphilis. A maternal Venereal Disease Research Laboratory (VDRL) titre of 1:32 or above indicated which infants would develop congenital syphilis with a sensitivity of 93% and a specificity of 78%. The risk of a congenitally infected infant was significantly higher amongst the group of untreated mothers (p = 0.036). Low birthweight per se did not appear to be a predictor of the subsequent diagnosis of congenital syphilis. Using these simple predictive factors it may be possible to determine which at-risk infants would most benefit from careful supervision or a full 10-day course of therapy.

Birth Weight↗

PubMed1993

Maternal/congenital syphilis in a large tertiary-care urban hospital.

Among the women delivering a total of 9,591 infants in 1990 at Hutzel Hospital in Detroit, 148 had positive results in the rapid plasma reagin (RPR) and fluorescent treponemal antibody-absorption tests for syphilis. This group included primarily young, black, multigravid women with a history of crack cocaine use. RPR titers ranged from 1:1 to 1:256 among the 103 mothers not treated or inadequately treated for syphilis. Two mothers with very low RPR titers (1:2) delivered a stillborn infant and an infant with a reaction in the cerebrospinal fluid Venereal Disease Research Laboratory (CSF-VDRL) test, respectively. Seventy-five percent of the infants born to untreated or inadequately treated women had asymptomatic congenital syphilis. The remaining 25% were stillborn (6 infants) or had clinical features of congenital syphilis (3 infants), a reactive CSF-VDRL test (11 infants), or radiological evidence of periostitis or metaphysitis (6 infants). Abnormalities were documented in the placentas from 11 live births and one stillbirth. The resurgence of congenital syphilis highlights the need for better diagnostic tests and for studies that will determine optimal therapy for mother and infant.

Adult↗

PubMed2004

Congenital syphilis in Russia: the value of counting epidemiologic cases and clinical cases.

BACKGROUND: Congenital syphilis (CS) reports in Russia increased 26-fold from 1991 to 1999. Case reports included only infants who were clinical cases, had persistent serologic changes, or confirmed syphilitic stillbirth. Although not reported, policies stipulate that infants of inadequately treated or untreated mothers receive preventive penicillin treatment. GOAL: We examined whether risk factors and consequences for epidemiologic cases of CS (infants of inadequately treated mothers) resembled those of clinical cases and differed from those of noncases (infants of adequately treated mothers). STUDY DESIGN: A retrospective record review from Maternity Houses in 5 sites identified 715 syphilis-infected women who gave birth. RESULTS: Among women with maternal syphilis, 11% (n = 81) of infants were clinical cases, 56% (n = 402) were epidemiologic cases, and 33% (n = 232) were noncases of CS. Compared with noncases, maternal risk factors for epidemiologic cases included nonresidence (P <0.01), late syphilis (P <0.01), unemployment (P <0.01), no prenatal care (P <0.01), and syphilis testing at >/=28 weeks (P <0.01). Each of these was also significant for being a clinical case. Associated consequences of CS for the epidemiologic cases included increases in stillbirth (P <0.01), preterm birth (P <0.01), low birth weight (P <0.01), transfer to a pediatric hospital (P <0.01), and abandonment (P <0.05). Each of these except stillbirth was significantly elevated among clinical cases. Nearly half of the epidemiologic cases had no record of any penicillin treatment for the infant. Epidemiologic cases were significantly more likely than noncases to have no clinical or laboratory follow up. CONCLUSION: In Russia, maternal risk factors and perinatal consequences for epidemiologic cases of CS resembled those of clinical cases. Expanding national reporting to include epidemiologic cases would strengthen CS prevention and monitoring.

Adult↗

PubMed1989

Serological screening tests for syphilis in pregnancy: results of a five year study (1983-87) in the Oxford region.

Between 1983 and 1987, 62 out of 76519 pregnancies in 51 mothers had a positive miniaturised Treponema pallidum haemagglutination assay (TPHA) test--1 in 1234, or 0.81 per 1000 births. About two thirds of these mothers had syphilis and the remainder non-venereal treponematoses such as yaws or pinta. Antenatal screening identified 13 patients with previously unknown acquired syphilis, 11 of whom were given antibiotics during pregnancy. There were six fetal losses among the 62 TPHA positive pregnancies, but none had evidence of congenital syphilis. No live born child in this study group showed stigmata of congenital syphilis. It is concluded that despite the current low incidence of syphilis in the United Kingdom it is imperative to continue antenatal serological screening and to emphasise the importance of early adequate treatment of the infection.

Cost-Benefit Analysis↗

PubMed1977

Observations on syphilis in Addis Ababa. 2. Prevalence and natural history.

Sera from various groups were tested for syphilis by cardiolipin, fluorescent treponemal antibody-absorbed (FTA-ABS), and treponemal haemagglutination (TPHA) tests. The proportion of positive results, 12.7%, obtained from an unselected urban population suggested that the prevalence of the disease had declined since 1953. The probable explanation is the widespread use of penicillin. Late manifestations of syphilis are much rarer in Ethiopia than would be predicted from the high incidence at the infectious stage and, if present, they affect the cardiovascular system. These findings confirm old observations. Llymphocytes from Ethiopians with early syphilis did not proliferate when cultured with Treponema pallidum in vitro, in contrast with cells from patients with cardiovascular syphilis. These findings differed from observations made previously on patients in England with early syphilis.

Adolescent↗

PubMed1980

Immunological responses in late syphilis.

Thirty-one serum samples from 18 patients with clinically established late syphilis and 1319 from patients at other stages of the disease were fractionated by density gradient ultracentrifugation and examined for antilipoidal and antitreponemal antibodies of the IgM and IgG classes. Sera from the patients with late syphilis always showed persistent concentrations of antilipoidal IgM and IgG and of antitreponemal IgG but never yielded detectable concentrations of antitreponemal IgM. When treated, these patients' antibody titres did not decline. Patients with secondary or latent syphilis also showed this serological picture after treatment but only transiently; their antibody titres continued to decline in a way which clearly distinguished them from the cases of late syphilis. It is suggested that patients whose sera persist in showing the stable pattern described may develop late symptomatic syphilis.

Adult↗

PubMed1982

Syphilis in pregnant women in Zambia.

Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed.

Female↗

PubMedDate not supplied

Syphilis in clinical psychiatry: a review.

Syphilis is a potentially fatal infectious disease that has a long history of association with psychiatry. Recent developments in epidemiology, diagnosis, and treatment guidelines warrant a review of the current relationship of syphilis to clinical psychiatry. After a recent peak of incidence in the United States, syphilis is once again on the decline. Although the prevalence of syphilis remains endemic in certain locations, it has been targeted for elimination. Meanwhile, diagnostic testing remains complex and imperfect, especially for the detection of late stages of infection and neurosyphilis. The U.S. Public Health Service recently revised guidelines for the evaluation and management for syphilis. This paper discusses these developments and their specific implications to psychiatric practice. The likelihood of discovering previously unsuspected cases through screening and recommendations on high-risk groups to screen are discussed. A case example illustrates some of the key concepts.

Adult↗

PubMed2001

Syphilis in New South Wales (Australia) prisons.

This paper describes the prevalence of, and risk factors for, exposure to syphilis in a random sample of male and female prisoners. We found that only 2% of male and 1% of female prison inmates in New South Wales (NSW) had confirmed evidence of untreated syphilis, and none appeared to be in an infectious phase. In the multivariate analysis, indigenous ethnicity remained the most potent predictor for confirmed syphilis (either past or present). There was some evidence to suggest that syphilis among indigenous prisoners may be associated with limited access to health services outside prison. The epidemiology of syphilis reflects that of the general community suggesting that prisons could be used as sentinel sites to help evaluate the effectiveness of STD prevention and control strategies.

Adult↗

PubMed1953

Congenital syphilis in California.

Routine serologic tests for syphilis (as required by California law governing prenatal examination) and penicillin therapy during pregnancy for infected mothers have been major factors in the prevention of congenital syphilis in California during the past ten years. In 1940 one of each 822 infants had the disease, as indicated by morbidity reports of congenital syphilis in infants under the age of one year. In 1950 the ratio was one in 8,148. To determine why congenital syphilis continues to occur, a study of the 134 cases reported over a two-year period was made with the cooperation of local health officers and practicing physicians. It showed that in 76 per cent of cases the mother did not consult a physician prior to delivery or reported so late in pregnancy that the infant was born before adequate penicillin therapy could be given. In another 15 per cent syphilis developed in the mother during pregnancy after a negative reaction to a prenatal serologic test. The other 9 per cent of cases were due to various factors, such as infectious relapse or reinfection in previously adequately treated mothers. The study indicated that most cases occur in the lower socioeconomic population groups. Seventy-four per cent of cases were in infants delivered in county hospitals.

California↗

PubMed1989

Congenital syphilis--who is at risk? A prevalence study at Baragwanath Hospital, Johannesburg, 1985-1986.

The prevalence of syphilis (or positive serology) in pregnant mothers delivering at Baragwanath Hospital, Johannesburg, was assessed in order to try to establish the prevalence of congenital syphilis and possibly to identify a specific population at risk. From August 1985 to January 1986 all mothers admitted to the major delivery wards were screened to determine whether they were booked or unbooked patients and whether they were seroreactive for syphilis. Infants of seropositive mothers were examined for clinical signs of congenital syphilis. A total of 9,071 patients were screened, 25% unbooked. The prevalence of mothers who had positive serological results with the rapid plasma reagin (RPR) test greater than or equal to 8 U was 1.8% in the booked patients opposed to 9.6% in the unbooked group (P less than 0.00001). During the study period 41 infected infants were found--23 symptomatic, 15 stillborn and 3 aborted fetuses. All these neonates were born to unbooked mothers and had positive RPR test results greater than or equal to 8 U. The results highlight the fact that congenital syphilis is still an important cause of infant morbidity and mortality and that the unbooked mother is at risk of having an affected offspring, especially when her RPR test is seroreactive greater than or equal to 8 U.

Cross-Sectional Studies↗

PubMed1988

Gestational and congenital syphilis.

The frequency of congenital syphilis continues to increase throughout the United States during the 1980s. Untreated maternal infection can lead to stillbirth, premature labor, congenital infection, and neonatal death. Preventive measures, based on control of early syphilis in women, prenatal care, improved diagnosis and diligent followup, can help to decrease the incidence of congenital syphilis. The clinical presentation and recommended regimens for therapy of the gravida with syphilis and neonates with suspected congenital syphilis are reviewed.

Adult↗

PubMed1979

The laboratory diagnosis of congenital syphilis: a review.

The serodiagnosis of congenital syphilis is reviewed. Maternal history is the least reliable criterion for detecting congenital syphilis. A positive maternal history may or may not be valid; a negative maternal history does not rule out the possibility of congenital syphilis. Syphilis serology performed on the infant is a better criterion for detecting asymptomatic congenital syphilis or delayed onset. Serial VDRL titers on the infants are the best diagnostic tool presently available. A decreasing titer indicates the presence of maternally derived antibodies. The FTA-ABS (IgM) is still not sufficiently evaluated and standardized for routine clinical application.

Antibodies, Bacterial↗

PubMed1997

Single-dose benzathine penicillin in infants at risk of congenital syphilis--results of a randomised study.

OBJECTIVE: To determine the efficacy of single-dose benzathine penicillin G in infants at high risk of congenital syphilis. DESIGN: Randomised study comparing benzathine penicillin with no therapy. SETTING: Peninsula Maternal and Neonatal Service, Cape Town. SUBJECTS: Asymptomatic infants born to mothers with untreated syphilis whose VDRL titre was 32 or more. OUTCOME MEASURES: The number of cases of congenital syphilis was determined by results of IgM Western blots and follow-up VDRL titres. RESULTS AND CONCLUSIONS: Of 8 patients followed up in the non-treatment group, 4 had congenital syphilis while 0/11 had the disease (P = 0.035) in the group receiving benzathine penicillin. Although the exact failure rate is unknown, benzathine penicillin is effective in preventing symptomatic congenital syphilis when administered to high-risk newborns.

Blotting, Western↗

PubMed2004

Managing Syphilis in the HIV-infected Patient.

Syphilis has re-emerged in the United States and elsewhere, and clinicians caring for HIV-infected patients are challenged with syphilis diagnosis and management decisions. HIV alters the natural history of syphilis to an extent that is poorly understood, and initial presentation may be more varied in coinfected patients. Although commonly available diagnostic assays for syphilis should be interpreted as usual, such tests rely on antibody measurement and may be an imperfect indicator of active infection. Assessment of all available clinical and risk behavior data remains critically important in the diagnosis of syphilis in coinfected patients. Treatment of syphilis in such patients requires stage-appropriate therapy, with careful serologic monitoring to assess response. Clinicians must have heightened appreciation of the role of frequent risk assessment, serologic screening, symptom recognition, and follow-up of treated patients, as well as an understanding of public health functions such as sex partner treatment and communicable disease reporting.

Journal Article↗

PubMed1976

Late syphilis. Otologic symptoms and results of the FTA-ABS test.

The clinician occasionally encounters a patient whose cochleovestibular symptoms are thought to be due to late syphilis mainly on the basis of a reactive FTA-ABS test. I describe 21 such patients, 11 of whom had either a spurious- or a false-positive reaction. The following suggestions may avoid an inaccurate diagnosis of late syphilis in such patients: (1) repeat all reactive serological tests for syphilis (STS); (2) rule out false-positive reactions; (3) request the degree of fluorescence (1+ to 4+) on all reactive FTA-ABS tests; (4) obtain a Treponema pallidum immobilization (TPI) test on all patients with repeatedly reactive (1+) FTA-ABS tests--a nonreactive TPI test rules out the diagnosis of syphilis; (5) if a TPI test cannot be performed, a repeatedly reactive (1+) FTA-ABS test in the absence of a reactive nontreponemal STS probably represents a false-positive reaction; (6) clinical judgment is the final determinant of whether a patient has or should be treated for late syphilis.

Adult↗