Protective antibody levels against hepatitis B among serodiagnosed syphilis cases: Need to integrate national control programs with immunization guidelines?

Abstract

Background: The intersecting routes of transmission in conjunction with hepatocyte injury caused by hepatotropic viruses and Treponema pallidum independently add to the importance of hepatitis B virus (HBV) seroprotection in syphilis. Furthermore, the deficit in the clinical suspicion and stigma associated could at least be partially responsible for the underdiagnosis of syphilitic hepatitis, which is caused by the effect of T. pallidum on hepatocytes. Materials and Methods: Sera from eighty patients, serologically confirmed for syphilis by conventional algorithm, were included in the study. Levels of anti-HBs antibody were determined by ELISA for all serologically confirmed cases of syphilis. Results: Majority of the patients who tested positive for syphilis as per conventional algorithm, hailed from antiretroviral therapy (ART) and sexually transmitted infection (STI) clinics. Levels of anti-HBs antibody of all the patients were found to be below 10 mIU/ml. Conclusion: The absence of protective levels of anti-HBs antibody among all the patients in the study group, despite the inclusion of HBV vaccination in the national immunization program and proximity to tertiary health-care facilities, underscores the pressing need to reinforce and revise our approach to immunization. High-risk groups, such as ART and STI clinic attendees, solicit further enforcement of accelerated immunization strategies in excess to existing dosing schedules.