Cases Of Primary Syphilis Research Articles

A syphilis outbreak: recent trends in infectious syphilis in Birmingham, UK, in 2005 and control strategies

The objective of this study was to identify the demographic characteristics and sexual behaviour associated with primary, secondary and early latent syphilis in Birmingham and its epidemiologic and public health implications. All new patients diagnosed as having infectious syphilis in a genitourinary service in Birmingham in the period from January 2005 to December 2005 were studied retrospectively (history, physical examination, serology) to determine the stage of their disease. During the 12-month period, 69 new cases of primary, secondary and early latent syphilis were diagnosed. Patients were most commonly male (96%), aged between 20 and 44 years, symptomatic (84%) and were white men who had sex with men or Asian/Black Caribbean heterosexual men. Unemployment and having multiple partners were common in infected patients. Based on the results of this study, control measures are being undertaken, using enhanced surveillance, to focus on appropriate health promotion initiatives.

Papillite révélant une syphilis primaire

Objective Syphilitic ocular manifestations are polymorphous and usually occur during the secondary or tertiary stage of syphilis. We report a case of primary syphilis revealed by papillitis. Design A 22 year old man presented with blurred vision in the left eye and decreased visual acuity. Fundus examination and fluorescein angiography revealed a papilledema in the left eye and chorioretinitis in the right one. Clinical examination revealed a painless ulceration of the chin. Blood tests were positive for syphilis (positive reaction to the VDRL test and TPHA titer at 1/640) but negative for HIV. After penicillin therapy, the ocular manifestations resolved. Results Papillitis is a relatively rare ocular manifestation of syphilis. Our case is original because papillitis was the presenting manifestation of the disease and that it was concomitant with the primary chancre. Conclusion Systematic screening for syphilis should be performed in unexplained ocular inflammation.

Application of a noninvasive oral fluid test for detection of treponemal IgG in a predominantly HIV-infected population

The performance of a time-resolved fluorescence immunoassay (TRFIA) for detection of treponemal IgG from oral fluid specimens has been assessed in a predominantly HIV-infected population. Serological investigation is the method of choice for confirming clinical suspicion of syphilis; however, in the primary stage of disease, direct detection of treponemes in lesion fluid or Treponema pallidum DNA is recommended because of the reduced sensitivity of serological tests. There may be occasions when blood for serological investigation is difficult to obtain due to individual patient preference or logistical necessity to improve participation in screening initiatives, particularly in outreach situations. Collection of oral fluid for detection of treponemal antibody may prove an attractive alternative and, with this in mind, an oral fluid assay for detection of treponemal IgG was developed. Time-resolved fluorescence was used to detect treponemal IgG extracted from commercially available oral fluid collection devices. Paired serum and saliva samples were obtained from 210 individuals, 101 of whom were diagnosed with syphilis on the grounds of medical examination confirmed by serological testing. Oral fluid specimens from 14 subjects were rejected because they contained insufficient control antibody or were inhibitory. The population tested was predominantly men who have sex with men, many of whom were HIV infected. The overall sensitivity and specificity of the oral fluid assay was 95.8 and 86.1%, respectively, based on the 5th percentile of the positive results, and 93.7 and 91.1%, respectively, based on a cutoff derived by mixture model analysis. For individuals with primary syphilis, the optimum sensitivity of the oral fluid assay was 87.5%, whereas in those with disease classified as secondary syphilis and early latent syphilis, the sensitivity of the oral fluid assay was 100 and 94.7%, respectively. The oral fluid assay is a useful alternative to serological testing in certain situations, and further development of this technology to enable detection of treponemal IgM should increase its sensitivity for detecting cases of primary syphilis.

Modeling a Syphilis Outbreak Through Space and Time Using the Bayesian Maximum Entropy Approach

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. 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. 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. 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.

Clicical analysis of 112 pregnant women infected by syphilis

目的 探讨妊娠梅毒的临床特点和影响妊娠结局的因素,降低先天性梅毒的发生率.方法 112例血清学检查确诊为梅毒孕妇,根据妊娠期是否行全疗程抗梅毒治疗,分为治疗组与未治疗组,治疗组52例,行全疗程抗梅毒治疗;未治疗组42例,未能行全疗程抗梅毒治疗;18例妊娠梅毒孕妇自行选择提前终止妊娠.比较两组孕妇的妊娠结局和新生儿梅毒的发生情况.结果 (1)112例妊娠梅毒患者中一期梅毒2例(1.8%),二期15例(13.4%)及潜伏梅毒95例(84.8%).(2)妊娠结局:治疗组足月分娩率为90.4%(47/52),未治疗组为16.7%(7/42),两组比较差异有显著意义(P<0.01).治疗组早产及死产死胎发生率分别为5.8%(3/52)、3.8%(2/52),明显低于未治疗组的19.0%(8/42)、52.4%(22/42),两组比较差异有显著意义(P<0.01).治疗组先天性梅毒儿发生率20.0%(10/50)明显低于未治疗组80.0%(12/15),两组比较差异有显著意义(P<0.01).(3)治疗孕妇其孕周与用药治疗关系显示:治疗孕周越早,先天性梅毒患儿发生率越低(P<0.01).结论 (1)妊娠梅毒患者临床分期以潜伏梅毒为主,体征及症状不典型,容易误诊.因此,妊娠早期常规梅毒筛查特别重要.(2)妊娠梅毒有危害胎儿的严重合并症,有效的抗梅毒治疗是改善妊娠梅毒患者妊娠结局和降低先天性梅毒发生率的关键。

A Case of Primary Syphilis in the Rectum

A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.

Oral syphilis—re-emergence of an old disease with oral manifestations

Three representative cases of oral primary syphilis are presented. We wish to highlight the resurgence of this disease, which has occurred recently in the western world, particularly in Europe and the United States of America. Since the initial presentation may be oral, it is important to include syphilis in the differential diagnosis of patients presenting to oral diagnostic clinics with atypical oral ulceration. Recent developments in the serological diagnostic tests and treatment are reviewed. Early diagnosis and treatment has significant implications, not only for the patient, but also for previous and future transmission to contacts. Early syphilis is a highly infectious disease in which the lesions heal spontaneously, despite inappropriate treatment which may appear curative, and yet the patient remains infectious. It is therefore important that clinicians maintain a high clinical index of suspicion and crucial that an accurate diagnosis be made at presentation.

Transmission of Primary and Secondary Syphilis by Oral Sex—Chicago, Illinois, 1998-2002

During 1998-2002, the STD/HIV Prevention and Care Program of the Chicago Department of Public Health (CDPH) recorded 1,582 cases of primary and secondary (P&S) syphilis, the most of any U.S. city. Although case numbers and overall rates remained stable in Chicago during this period, patterns of transmission changed substantially. Throughout most of the 1990s, P&S syphilis was reported almost exclusively among heterosexuals. During 1998-2000, however, men who have sex with men (MSM) accounted for approximately 15% of Chicago's P&S syphilis morbidity. Since 2001, MSM have accounted for nearly 60% of patients with P&S syphilis. During 2000-2002, CDPH conducted interviews with persons with syphilis; some MSM reported they had engaged in only oral sex and were surprised to have acquired syphilis. In response, CDPH began collecting information on oral sex from persons with syphilis. To assess the role of oral sex in the transmission of P&S syphilis in Chicago, CDPH analyzed surveillance data and interview responses. This report summarizes the results of these analyses, which suggested that a substantial proportion (13.7%) of syphilis cases were attributed to oral sex, particularly among MSM. Persons who are not in a long-term monogamous relationship and who engage in oral sex should use barrier protection (e.g., male condoms or other barrier methods) to reduce the risk for sexually transmitted disease (STD) transmission.

Neuro-ophthalmological syndromes for neurologists

The conditions or syndromes to be considered in this article are summarised in table 1. Many are seen relatively infrequently in neurological practice. Among 4000 successive outpatient referrals, pupillary abnormalities...

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.

Community participation eliminates yaws in Ecuador.

Yaws is no longer a national and international health priority for intervention, but there is still a negative perception of the disease in the few affected communities. A survey in 1988 in the northern region of Ecuador documented a prevalence of 16.5% of clinical cases and 96.3% of serological cases. A continuous, long-term community-based surveillance programme was therefore put in place focusing on yaws as one of the sentinel diseases. The results of this intervention are reported here. In 1993, a second survey showed a reduction in the prevalence of clinical cases to 1.4% and of serological cases to 4.7%. Between 1993 and 1998, no other clinical cases were detected and the serological prevalence in 1998 was 3.5%, corresponding with clinical cases of primary or congenital syphilis, latent yaws under follow-up, and individuals with low serological titres indicating a 'serological scar'. These data indicate that yaws has been eliminated. Another important outcome of the intervention is the increased self-confidence in the communities that health problems can be tackled.

CONTINUING INCREASES IN SEXUAL RISK BEHAVIOR AND SEXUALLY TRANSMITTED DISEASES AMONG MEN WHO HAVE SEX WITH MEN: SAN FRANCISCO, CALIF, 1999–2001

We recently reported on worrisome increases in sexual risk behavior, sexually transmitted diseases (STDs), and HIV incidence among men who have sex with men (MSM) during a period of increasing use of highly active antiretroviral therapy (HAART), from 1994 to 1999.1 We have since obtained data on sexual risk behavior for 2000 and 2001. In addition, we have added to our surveys questions on whether unsafe sex was occurring with partners of unknown HIV serostatus, updated trends in male rectal gonorrhea, and provided data on primary and secondary syphilis cases among MSM. As previously reported, the Stop AIDS Project conducts serial cross-sectional surveys of MSM in a variety of community settings in the course of outreach health education. The street-based intercept survey asks questions about sexual behavior in the preceding 6 months, including anal sex, condom use, number of sexual partners, and knowledge of partners’ HIV serostatus. Overall, 10 568 MSM completed the survey between 1999 and 2001. The proportion of MSM reporting any anal sex in the last 6 months increased from 67% in 1999 to 74% in 2001 (Figure 1a ▶). The proportion of respondents reporting any unprotected anal sex increased from 32% to 38%, with a parallel increase from 18% to 23% in the proportion reporting unprotected anal sex with 2 or more partners (Figure 1b ▶). Between 1999 and 2001, the proportion reporting unprotected anal sex with 2 or more partners of unknown HIV serostatus increased from 10% to 15% for respondents who reported being HIV-negative and from 19% to 25% for those who said they were HIV-positive (Figure 1c ▶). Although a decline in the number of respondents was noted from 1999 to 2001, there were no substantial shifts in respondents’ age or race over time and no differences in trends in sexual risk behavior within demographic groups. FIGURE 1 —Trends in sexual risk behavior and sexually transmitted diseases among men who have sex with men: San Francisco, Calif, 1999–2001. STD surveillance data corroborate continued increases in sexual risk behavior. Reported cases of male rectal gonorrhea increased from 162 in 1999 (updated from 160 in our prior report1 owing to delays in reporting) to 237 in 2001 (Figure 1d ▶). The number of primary and secondary syphilis cases among MSM increased from only 6 cases in 1998 to 115 cases in 2001. We conclude that the increases in unsafe sex seen from 1994 to 1999, in association with the availability of HAART, were not isolated but rather reflect an ongoing trend. Moreover, data on HIV serostatus of partners suggest that much of this unsafe sex is occurring among partners who are serodiscordant.

Examining the direct costs and effectiveness of syphilis detection by selective screening and partner notification.

Selective screening and partner notification are two principal means of preventing and controlling syphilis in the United States, yet few studies have been undertaken to compare and evaluate the cost or effectiveness of detecting syphilis using either strategy. The objective of this paper is to assess from the perspective of a health department the cost-effectiveness of selective screening compared with the strategy of partner notification in the detection of early syphilis in Houston, Texas, in 1994 and 1995. The cost-effectiveness analysis was performed using the recurring direct costs associated with detecting syphilis by both strategies. The middle estimates for the total direct costs associated with selective screening and partner notification were $579,101 and $229,529, respectively, for the 1466 and the 567 cases of early syphilis detected. On a cost per case basis, selective screening was more cost-effective than partner notification in the detection of primary, secondary and maternal syphilis cases. However, when consideration was given to prophylactic treatment, partner notification was more cost-effective in the detection of all early stage disease. Our findings suggest that the relative benefit of partner notification over selective screening depends on prophylactic treatment and an increase in worker productivity.

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.

Outbreak of Primary and Secondary Syphilis—Guilford County, North Carolina, 1996-1997

In 1996 and 1997, 153 cases of primary and secondary (P&S) syphilis were reported each year in Guilford County, North Carolina, a 147% increase from the 62 cases reported in 1994 (Figure 1). The incidence of P&S syphilis in Guilford County during 1996-1997 was 40.5 cases per 100,000 persons, substantially higher than the national health objective for 2000 of four cases per 100,000 (objective 19.3). In comparison, the number of P&S syphilis cases in North Carolina declined 57% from 1994 to 1997 (Figure 1), to a rate of 10.9 per 100,000 in 1997. This report summarizes the results of an investigation conducted by the Guilford County Health Department (GCHD), the North Carolina Division of Epidemiology, and CDC, which suggest this ongoing outbreak has been associated with missed opportunities for syphilis screening and treatment in high-risk settings, increased exchange of sex for money or drugs, and substantial rates of coinfection with syphilis and human immunodeficiency virus (HIV) among those tested.

Primary and Secondary Syphilis--United States, 1997

In October 1999, CDC, in collaboration with other federal partners, initiated the National Plan to Eliminate Syphilis in the United States. Syphilis elimination is defined as the absence of sustained transmission (i.e., no transmission after 90 days of the report of an imported index case). The national goals for syphilis elimination are to reduce the annual number of primary and secondary (P&S) syphilis cases to <1,000 cases (rate: 0.4 per 100,000 population) and to increase the number of syphilis-free counties to 90% by 2005. To characterize the epidemiology of syphilis in the United States, CDC analyzed national notifiable disease surveillance data for 2000-2001. This report summarizes the results of that analysis, which indicate that the number of reported cases of P&S syphilis increased slightly in 2001. This increase occurred only among men; the number of P&S syphilis cases continued to decline among women and among non-Hispanic blacks. The available data indicate that syphilis cases occurring among men who have sex with men (MSM) contributed to the increase in cases. The data suggest that, although efforts to reduce syphilis among women and non-Hispanic blacks appear effective and should continue, efforts to prevent and treat syphilis among MSM need to be improved.

Is elimination of endemic syphilis transmission a realistic goal for the USA?

in 1937, Thomas Parran, Surgeon-General of the USA, outlined five critical components he felt were needed for syphilis control as part of efforts to help build public resolve to address the problem, which he referred to as “a shadow on the land”.’ His formula included: (1) case finding through serological screening; (2) prompt, effective therapy for infected persons; (3) identification of people exposed to infectious syphilis; (4) mandatory serological evaluation of people who might transmit infections to others (in 1937 this translated into premarital and obstetric serological testing); and (5) public education about the disease, its manifestations, its consequences, and its general societal importance. These principles have since been adopted to one degree or another as part of efforts to control most other sexually transmitted diseases (STDs) including HIV. In addition, they have worked for syphilis control. Combined with accurate diagnostic tests and effective therapy, Parran’s strategy has helped to nearly eliminate endemic transmission of syphilis from most of western Europe.2,3 These successes, while providing support for Parran’s concepts, have not occurred throughout the world. In many developing nations, syphilis remains as common as it was in the USA early in the 20th century when about 10% of the population was believed to be infected.3’4 Still more notably, in the USA where Parran set forth his formula and where substantially more health care resources are available for STD control, syphilis rates have remained ‘rive-fold to ten-fold higher than for most other developed nations? Working with the Congress of the USA, the Centers for Disease Control and Prevention (CDC) have recently been requested to outline additional efforts and investments needed to eliminate syphilis transmission within the USA The time may be right for such an initiative. In the past 7 years, US syphilis rates have declined precipitously for reasons which are not completely understood. In 1990, the largest number (50 578) of cases of primary and secondary syphilis in 40 years were reported to the CDC (figure l).’ By 1996 the numbers had fallen over 77% to 11 387, and in 1997 fewer than 10 000 cases were reported. These continuing declines have been perceived as a potential window of opportunity for efforts to eliminate endemic transmission of syphilis within the USA. The likelihood of achieving this goal will be determined by the interplay of biological characteristics of the aetiologic agent (Treponema pallidurn), currently available diagnostic tests and therapy, and, possibly, new tools for syphilis control currently under investigation. Most importantly, however, the impact of efforts to eliminate endemic syphilis

Early Syphilis in an Active Duty Military Population and the Surrounding Civilian Community, 1985–1993

Syphilis among active duty soldiers at Fort Bragg, North Carolina, and the nonmilitary population of Cumberland County was examined during a 9-year period encompassing the most recent nationwide syphilis epidemic. A total of 762 cases of primary and secondary syphilis were recorded between 1985 and 1993, 27% of which occurred in soldiers. The epidemic struck both military and civilian populations simultaneously; epidemic curves in the two populations were parallel, peaking in 1990-1991, with highest annual incidences of 122.6/ 100,000 (military) and 48.0/100,000 (civilian). Individual risk factor data were not available for analysis, but a relationship was observed between primary and secondary syphilis diagnoses in both populations and cocaine arrests in Cumberland County. Our findings provide epidemiological support for a high degree of interplay between the military and the surrounding civilian communities that has significant implications for control of sexually transmitted diseases. Enhanced collaboration between military and civilian public health authorities is essential to the control of syphilis and other sexually transmitted diseases.

Prevalence, burden, and control of syphilis in Haiti's rural artibonite region

Objectives: A study was conducted to determine the prevalence and health consequences of syphilis and to evaluate existing control measures in a Haitian rural district of 200,000 people served by 12 community dispensaries and Hospital Albert Schweitzer. Methods: Syphilis seroprevalence among consecutive women receiving antenatal services was assessed using rapid plasma reagin (RPR) screening and fluorescent treponemal antibody absorption (FTA-ABS) confirmatory testing. Hospital and dispensary records were used to review genital ulcer disease and syphilis cases seen during 1995. Results: Of 811 pregnant women attending prenatal clinics during a 3-month period in 1996, 46 (5.7%) were RPR reactive. Syphilis seroreactivity was confirmed in 45 (97.8%) of 46 samples by FTA-ABS. Of 649 women attending dispensaries in the valley 41 (6.3%) were syphilis seroreactive compared with 4 (2.5%) of 162 women attending dispensaries in the mountains (OR = 2.66; P = 0.056). In 1995, 620 cases of genital ulcer disease were seen at the community dispensaries. At the central hospital, 257 new diagnoses of syphilis were made in 1995, including 30 cases of primary and secondary syphilis, 168 cases of latent disease, 17 cases of recurrent infection, 9 cases of tertiary disease, and 33 cases of congenital syphilis. Conclusions: The 33 cases of congenital syphilis, a rate of 550 cases for 100,000 live births, clearly demonstrated a failure of local control measures. Decentralized prenatal screening for syphilis, same-day treatment of seroreactors, and strengthened partner treatment were initiated. Further studies to improve primary prevention of syphilis in rural populations have been started. Other strategies, including mass treatment of high-risk groups, should be investigated.

Neurosífilis y efecto prozona

Neurosyphilis (NS) is an entity which still frequently presents to our Neurology Department. The prozone phenomenon occurs in approximately 2% of all cases of late primary syphilis or secondary syphilis; we have found no cases described of prozone and neurosyphilis occurring together. We present the unusual case of a 44 year old patient with NS and dementia PGP (progressive general paralysis). Initially serum VDRL was negative, but in CSF reacted at dilutions of 1:32. When serum VDRL was repeated using dilutions, it was reactive 1:128 and serum FTA was also reactive. The patient was treated with i.v. crystalline penicillin, after which his condition improved. We wish to draw attention to the possibility that patients with a dementia syndrome and negative serum VDRL may have the prozone phenomenon, and the laboratory should therefore be asked to do serial dilutions.