Clinical Syphilis Research Articles

Assessment of recombinant antigens Tp0100 and Tp1016 of Treponema pallidum for serological diagnosis of syphilis.

ObjectiveTo discover novel serodiagnostic candidates for the serological diagnosis of syphilis.MethodsTwo recombinant Treponema pallidum proteins Tp0100 and Tp1016 were expressed, purified, and identified by Western Blotting. A total of 600 clinical serum samples were tested with the Tp0100‐based ELISA, the Tp1016‐based ELISA, and the commercial LICA Syphilis TP kit (ChIVD, Beijing, China). The sensitivities were determined by testing 340 samples from individuals with clinically diagnosed primary, secondary, latent, and tertiary syphilis. The specificities were determined by screening 260 samples from healthy controls and individuals with potentially cross‐reactive infections, including leptospirosis, Lyme disease, hepatitis B, tuberculosis, rheumatoid arthritis, systemic lupus erythematosus. Kappa (κ) values were applied to compare the agreement between clinical syphilis diagnosis and the Tp0100‐based ELISA, the Tp1016‐based ELISA, or the LICA Syphilis TP test.ResultsUsing clinical syphilis diagnosis as the gold standard, Tp0100 exhibited an overall sensitivity of 95.6% and specificity of 98.1% for testing IgG antibody while Tp1016 demonstrated only an overall sensitivity of 75.0% and specificity of 79.6%. In contrast, the LICA Syphilis TP test revealed an overall sensitivity of 97.6% and specificity of 96.2%. In addition, the overall percent agreement and corresponding κ values were 96.7% (95% CI 95.6%–97.8%) and 0.93 for the Tp0100‐based ELISA, 77.0% (95% CI 74.3%–79.7%) and 0.54 for the Tp1016‐based ELISA, and 97.0% (95% CI 96.0%–98.0%) and 0.94 for the LICA Syphilis TP test, respectively.ConclusionThe recombinant T. pallidum protein Tp0100 shows promise as a novel diagnostic antigen in the serological tests for syphilis.

A cross-sectional descriptive study of clinical and serological prevalence of syphilis infection in people living with HIV and its effect on CD4+ T cells.

Context:The natural history of syphilis could be altered in the presence of HIV. It has been documented that syphilis infection increases the risk of HIV transmission by at least 3-fold.Aims:The aim of the study was (1) to study clinical presentation of syphilis in HIV individuals, (2) to estimate seroprevalence of syphilis in HIV individuals, and (3) to study the effect of syphilis infection on CD4+ T cells.Subjects and Methods:HIV-positive patients attending sexually transmitted infection clinic for a period of 1 year from June 2017 to May 2018 in the age group of 15–70 years were included in the study. A detailed history was taken; genital and dermatological examination was done. All patients were tested with VDRL and treponema pallidum hemagglutination assay (TPHA). Pearson's Chi-square test was used to compare categorical variables and Student's t-test was used to compare continuous variables.Results:Out of ninety study population, nine (10%) had clinical manifestations of syphilis. VDRL was positive with significant titers in all cases of syphilis. TPHA was positive in 88.9% of cases with clinical syphilis and 17.3% of cases without clinical manifestations of syphilis. Mean CD4 count was low among patients having syphilis infection compared to study population.Conclusion:This study shows high prevalence of syphilis in HIV and highlights the importance of preventing and promptly treating syphilis in people living with HIV, as the active infection is associated with fall in CD4 count, which leads to opportunistic infections.

2318 A Rare Case of Cytomegalovirus Hepatitis Complicated by Secondary Syphilis Hepatitis in an Immunocompetent Patient

INTRODUCTION: Cytomegalovirus (CMV) hepatitis most commonly presents with subclinical transaminitis and less commonly with the elevation of alkaline phosphatase (ALP) and total bilirubin (TB). Syphilis hepatitis, on the other hand, generally has a non-specific presentation with a more cholestatic picture. We present a rare case of cholestatic hepatitis from acute CMV infection complicated by syphilis hepatitis. CASE DESCRIPTION/METHODS: A 57-year-old homosexual man presented to the emergency room with complaints of intermittent fever and general malaise for the past two weeks. Blood work showed aspartate aminotransferase (AST) of 235 U/L, alanine aminotransferase (ALT) of 284 U/L, ALP of 940 U/L. TB and coagulation profile were normal. Acute hepatitis A, B, C, Epstein-Barr virus, and herpes simplex virus were ruled out. HIV was negative. Workup for autoimmune hepatitis, primary biliary cholangitis, alpha-1-antitrypsin deficiency, and Wilson’s disease was all negative. Abdominal CT scan with contrast was notable for hepatosplenomegaly without liver lesion. CMV IgM was positive with PCR of 7490 copies/mL, indicating acute CMV infection. The patient subsequently improved without treatment. He presented two months later with worsening liver tests with a peaked ALP of 1981 U/L, TB of 1.6 mg/dL, AST 230 U/L, ALT 195 U/L, associated with the macular rash on his trunk, abdomen, both palms, and soles. Abdominal MRI with contrast showed three < 2cm liver lesions. The patient was subsequently diagnosed with secondary syphilis with rapid plasma reagin (RPR) of 1:16 and confirmatory positive fluorescent treponemal antibody absorption (FTA-ABS). Biopsy of the liver lesions showed granulomatous inflammation with negative immunohistochemistry for CMV which was compatible with clinical syphilis hepatitis. The patient was treated with penicillin G. His rash resolved in 2 months with significant improvement of liver tests. The CMV PCR and RPR were negative with normalization of liver enzymes in 4 months. Follow-up MRI showed resolution of the liver lesions. DISCUSSION: Our patient initially had an atypical presentation of acute CMV hepatitis with cholestatic features. He subsequently developed secondary syphilis associated hepatitis with severe intrahepatic cholestasis and liver lesions. This is, to our knowledge, the first case of CMV hepatitis complicated by syphilis hepatitis. Resolving CMV hepatitis with recurrent elevation in liver tests warrant the workup for possible superimposed liver disease.

Differential influence of race and environment on indeterminate reactivities to non-treponemal and treponemal antigens by immuno-chromatographic dual syphilis rapid test.

IntroductionSyphilis rapid test results may be influenced by numerous environmental and genetic factors.MethodsThe proportion of false positive syphilis non-treponemal (NT) and treponemal (T) test results using immuno-chromatographic dual syphilis rapid test on serum from Cameroonian blacks (n=103) versus French blacks (n=104) or French caucasians (n=51), all HIV-negative and free of clinical syphilis, was examined.ResultsBlack individuals in Cameroon had a significantly higher frequency of false positive NT or T tests than black individuals in France. black individuals in France had a higher frequency of indeterminate NT tests as compared to caucasians in France.ConclusionBoth racial and environmental factors may affect immuno-chromatographic dual syphilis rapid testing.

Analysis on the clinical value of methods used for the detection of treponema pallidum antibody

To explore the clinical value of five methods commonly used for the detection of clinical syphilis antibody. A total of 160 confirmed syphilis cases were chosen as the experimental group while 200 non-syphilis cases were set as the control group. Serum specimens were detected by methods as Treponema pallidum particle agglutination assay (TPPA), chemiluminescent microparticle immune assay (CMIA), enzyme linked immunosorbent assay (ELISA), emulsion method (TP-AD) and toluidine red unheated serum test (TRUST). Sensitivity and specificity were evaluated on five methods. Titers of syphilis antibody in different stages and pre/post on treatment among syphilis patients were compared and analyzed under the five methods. The sensitivity vs. specificity of TPPA, CMIA, ELISA, TP-AD and TRUST appeared as 100.00% vs. 99.50%, 99.38% vs. 99.00%, 98.12% vs. 99.00%, 94.38% vs. 94.50% and 85.62% vs. 95.50%, respectively. Among the patients at primary or latent stages, the syphilis antibody positive rate detected by TRUST appeared lower than that detected by ELISA, TPPA, CMIA or TP-AD, and the differences were statistically significant (P<0.01). There were no statistical differences in the syphilis antibody positive rate of syphilis patients in the secondary or tertiary stages detected by five methods (P>0.05). In each stage of the syphilis patients, the syphilis antibody positive rate detected by ELISA or of CMIA combined with TRUST both reached 100.00%. Before and after treatment in 121 cases of confirmed syphilis, there was statistically significant difference in the syphilis antibody positive rate detected by TRUST method (P<0.05). There was no statistical significance in the syphilis antibody positive rate detected by other four methods (P>0.05). The sensitivity and specificity of TPPA, CMIA and ELISA methods were better. METHODS as ELISA or as CMIA combined with TRUST both appeared reliable for syphilis screening in every stage of the disease. TRUST was suitable for the determination of active stage syphilis and monitoring the effects after treatment.

The Clinical Spectrum of General Paralysis of the Insane: a Historical Cohort Study.

Objectives General Paralysis of the Insane (GPI), or Dementia Paralytica, was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalisation. Syphilis re-emerged worldwide at the turn of the 20th to 21st century, and, considering the incubation period of 10-30 years, a revival of GPI may be expected within the next one or two decades. Early diagnosis and treatment improve prognosis and, therefore, a renewed clinical awareness of signs and symptoms of GPI is needed. Aims This historical cohort study aims to investigate the clinical presentation of GPI in patients deceased at the Vincent van Gogh psychiatric hospital in Venray, the Netherlands, in the period 1924-1954. Methods Annual hospital reports and individual patient's records were used for identification of patients with an established diagnosis of GPI, usually based on a combination of clinical data and positive syphilis serology. Results Individual clinical records of 105 patients (91 men; 14 women) with GPI were available for evaluation. Median age for men (50.4 years; range 31.5 to 82.1 years) was higher than for women (43.1 years; range 34.4 to 58.4 years): p = 0.01. Most patients completed elementary school only and belonged to the lower working class. Lack of judgement and insight, hyperactivity, and confusion were the most frequently documented psychiatric symptoms, whereas speech disorders, pupillary abnormalities, micturition disorders, dementia, and cranial nerve involvement were the most frequently reported neurological symptoms. Conclusions The clinical presentation of GPI displays a wide range of cognitive, affective, psychotic and focal neurological symptoms.

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

BackgroundSyphilis point-of-care tests may reduce morbidity and ongoing transmission by increasing the proportion of people rapidly treated. Syphilis stage and co-infection with HIV may influence test performance. We evaluated four commercially available syphilis point-of-care devices in a head-to-head comparison using sera from laboratories in Australia.MethodsPoint-of-care tests were evaluated using sera stored at Sydney and Melbourne laboratories. Sensitivity and specificity were calculated by standard methods, comparing point-of-care results to treponemal immunoassay (IA) reference test results. Additional analyses by clinical syphilis stage, HIV status, and non-treponemal antibody titre were performed. Non-overlapping 95% confidence intervals (CI) were considered statistically significant differences in estimates.ResultsIn total 1203 specimens were tested (736 IA-reactive, 467 IA-nonreactive). Point-of-care test sensitivities were: Determine 97.3%(95%CI:95.8–98.3), Onsite 92.5%(90.3–94.3), DPP 89.8%(87.3–91.9) and Bioline 87.8%(85.1–90.0). Specificities were: Determine 96.4%(94.1–97.8), Onsite 92.5%(90.3–94.3), DPP 98.3%(96.5–99.2), and Bioline 98.5%(96.8–99.3). Sensitivity of the Determine test was 100% for primary and 100% for secondary syphilis. The three other tests had reduced sensitivity among primary (80.4–90.2%) compared to secondary syphilis (94.3–98.6%). No significant differences in sensitivity were observed by HIV status. Test sensitivities were significantly higher among high-RPR titre (RPR≥8) (range: 94.6–99.5%) than RPR non-reactive infections (range: 76.3–92.9%).ConclusionsThe Determine test had the highest sensitivity overall. All tests were most sensitive among high-RPR titre infections. Point-of-care tests have a role in syphilis control programs however in developed countries with established laboratory infrastructures, the lower sensitivities of some tests observed in primary syphilis suggest these would need to be supplemented with additional tests among populations where syphilis incidence is high to avoid missing early syphilis cases.

Ceftriaxone given repeatedly cures manifest syphilis in the rabbit.

Repeated intramuscular injection of ceftriaxone to rabbits with manifest syphilitic orchitis leads to clinical cure as does penicillin, given the serum levels reached are similar to the ones obtained clinically in man. Totally different to untreated controls the Treponema pallidum hemagglutination (TPHA) titers remain relatively low and later even tend to decrease further. Thus, it seems justified to start clinical trials on the definite role of ceftriaxone in the treatment of clinical syphilis.

Treponema pallidum immune adherence test for serodiagnosis of syphilis. 3: Clinical significance and evaluation of treatment.

Antibody titres were measured in patients with clinical syphilis, and the effect of treatment on the results of the Treponema pallidum immune adherence (TPIA) test is reported. In the Treponema pallidum haemagglutination (TPHA) test little change in antibody titre occurred after treatment while in the fluorescent treponemal antibody-absorbed (FTA-ABS) test only a slight decrease occurred. The decrease in the antibody titre in the TPIA test was similar to that in the glass plate test, but the findings were different. From the results of gel filtration of sera obtained from patients with syphilis at different intervals after treatment it was apparent that the decrease in antibody titre after treatment mainly concerned the IgM antibody; thus, because of the high sensitivity of the TPIA test to IgM antibody the test is useful in evaluating the effect of treatment.

St. Denis Patron Saint of Syphilitics: A POSTSCRIPT TO THE PARIS MEETING OF THE M.S.S.V.D., MAY 12, 1961

One of the special pleasures of the recent meeting of the Medical Society for the Study of Venereal Diseases in Paris, was the visit to the Cathedral of N6tre Dame. Among the many small chapels of the Cathedral was that of St. Denis, which reminded me of the apparently little-known fact, noted some years ago by William Sargant in his book Battle for the Mind (1957), that St. Denis is the saint of syphilitics. While our guide knew the traditional story of St. Denis, he was unaware of this fact. It is hardly surprising that venereologists know little of St. Denis. He receives only a fleeting mention in Howles's Synopsis of Clinical Syphilis (1943), where we find Castiglione's story of how Thierry de Hery, a physician, said to a priest while he knelt before the statue of VIII at St. Denis, Charles VIII is a good enough saint for me. He put 30,000 francs in my pocket when he brought the pox to France. The Catholic Encyclopaedia states that a saint must first be canonized and then assigned by tradition, arising from popular devotion or by election, as a special intercessor. For this reason he is honoured by clergy and people. The term patron therefore, carries a wider meaning than titular, which is applied solely to the of a church or institution. On March 23, 1638, the legislation of Pope Urban VII defined the reasons for the selection of patrons, but the patronage of many remains confused, e.g. in the case of saints of countries, some countries have none while others have several. The Middle Ages was an age of faith and it is not surprising to find a natural extension of patronage to cover life's ordinary interests-such as health, family, and trades. In pre-reformation England alone, 40,000 religious corporations existed, including ecclesiastical bodies of all kinds, monasteries, convents, military orders, industrial and professional guilds, and

Untreated syphilis in the male Negro: X. Twenty years of clinical observation of untreated syphilitic and presumably nonsyphilitic groups

This report is one of a series in a continuing study of untreated syphilis in the male Negro by the United States Public Health Service. The study consists of 600 men who have been followed clinically, serologically, and pathologically (to post-mortem examination in over 63 per cent of the deceased patients). This study is unique because of the inclusion of nonsyphilitic individuals of comparable ages to the syphilitic patients at the onset of the study; furthermore, these “controls” have been followed as intensively for the past twenty years as have the syphilitic men. In this report, methods and problems in diagnosis of clinical syphilis are described as they were encountered in the collection of the statistical data obtained. Clinical findings are reported from physical examination, medical history, x-ray and fluoroscopy, serologic testing, electrocardiography, and neurologic examination; comparisons between syphilitic and nonsyphilitic individuals are shown usually by age groups; these comparisons have been subjected to statistical tests for significance. 1. 1. Findings in this study seem to confirm the impression that, in male Negroes with untreated syphilis, the cardiovascular system frequently is involved. 2. 2. Among the 23 living men who have developed some form of late syphilis, not one has received adequate therapy prior to the recent survey. 3. 3. Problems of diagnosis of syphilis among the aged are complex, especially in evaluating findings related to the cardiovascular system.

Study of the TPI test in clinical syphilis.

In previous publications it has been reported that the Treponema pallidum immobilization (TPI) test may be expected to be reactive in untreated or treated late syphilis. * This study of seroreactivity in patients having untreated and treated late syphilis was undertaken to compare the sensitivity in late syphilis of the TPI test, as modified by Portnoy, Harris, and Olansky, with other serologic tests for syphilis, e. g., Kahn quantitative, Kolmer (cardiolipin) quantitative, and VDRL slide flocculation test quantitative. CLINICAL MATERIAL One hundred and twenty patients having untreated or treated late syphilis were selected from inpatients and outpatients attendant at the Delgado Outpatient Clinic, New Orleans; Board of Health venereal disease clinic, Chicago; Mayo Clinic, Rochester, Minn.; and Macon County Health Department, Tuskegee, Ala. In all patients, spinal fluid examinations had been performed at some time, and serologic tests for syphilis were performed at

Study of the TPI test in clinical syphilis. II. Comparison with the VDRL slide test in treated early symptomatic syphilis.

In patients having primary and secondary syphilis, adequately treated, the Treponema pallidum immobilization (TPI) test and other serologic tests for syphilis (STS) may be reactive or nonreactive. * The test results to some extent depend on the length of time after treatment the blood was drawn, the individual's response to treatment, and the stage of his treatment. It has been observed that the TPI test generally remains reactive for longer periods of time after treatment than the commonly used STS.† This study of patients with treated early symptomatic syphilis was undertaken to compare the reactivity of the TPI test, as modified, 5 with the VDRL slide test quantitative. Also, attempts were made to ascertain temporal relationships of results of the TPI test and the VDRL slide test to adequate treatment for the disease in its dark-field positive stages. CLINICAL MATERIAL One hundred eighty-eight patients, who had been

THE PROVOCATIVE SEROLOGICAL REACTION IN LATE SYPHILIS: ITS RELATION TO TECHNICAL FACTORS

Excerpt With the simplification of treatment as the result of the demonstrated efficacy of penicillin, the major problem in clinical syphilis at the present time is the differentiation of positive ...

NATURE OF ANTIGENS AND ANTIBODIES IN SEROLOGY OF SYPHILIS

SEROLOGIC tests for syphilis have come to be recognized as necessary laboratory aids in the diagnosis, management and prognosis of clinical syphilis. Yet, for many years the actual antigen-antibody mechanisms involved have not been adequately explained. The apparent anomaly of lipidal beef heart antigen's being associated with a high degree of specificity in reacting with syphilitic serum has been a source of much concern, especially to the immunologist. It is not the purpose of this report to solve this vexing problem, but to review the present immunologic and physicochemical concepts of the nature of the antigens and antibodies involved. ANTIGENS The nature of the antigens involved in the serologic tests for syphilis will be considered first. In the original serologic test for syphilis, Wassermann, Neisser and Bruck1discovered that aqueous extracts of syphilitic tissue effected complement fixation when mixed with syphilitic serum. One year later, Laridsteiner and

A Synopsis of Clinical Syphilis

Journal Article A Synopsis of Clinical Syphilis Get access A Synopsis of Clinical Syphilis. By James Kirby Howles, B.S., M.D., M.M.S., Professor of Dermatology and Syphilology, and Director of the Department, Louisiana State University School of Medicine; Senior Visiting Physician, Charity Hospital of Louisiana at New Orleans: Visiting Physician, French Hospital, Mercy Hospital, Hotel Dieu, Southern Baptist Hospital and Touro Infirmary. Cloth. Pp. 671, with 121 Text Illustrations and 2 Color Plates. $6.00. St. Louis: The C. V. Mosby Company, 1943. American Journal of Clinical Pathology, Volume 13, Issue 12, 1 December 1943, Page 676, https://doi.org/10.1093/ajcp/13.12.676a Published: 01 December 1943

KLINE FLOCCULATION TEST

At the Queens General Hospital the Kline precipitation test by both diagnostic and exclusion procedures is done routinely. If both procedures give a completely negative result, no other serologic test is considered necessary. Whenever the Kline test shows any degree of positiveness, a Wasserman test is performed. The results of the precipitation and of the complement fixation test do not always agree exactly. This has caused some confusion in the minds of the clinicians. In an attempt to clear up this doubt, a study was conducted to interpret the significance of the serologic tests in terms of clinical syphilis. As Moore 1 recently pointed out, each laboratory must determine the reliability of its own reports if they are to have any value. That serologic tests are of prime importance in the diagnosis of syphilis must be accepted when it is considered how few patients give a history or clinical evidence

Iodobismitol in Experimental Syphilis

In a previous report, it was shown that iodobismitol (N.N.R.) exerts prophylactic and curative effects on the experimental syphilis of rabbits. Since then, confirmations of the antisyphilitic action in rabbits have been made by Levaditi, Vaisman, Manin and Schoen and by Strandberg and Sjögren, da Nova Gomes and de Oleveira, and Carrillo, Schujman and Campos in clinical syphilis, the latter authors agreeing with Mehrtens and Pouppirt. These reports also contain confirmation of other claims for iodobismitol, namely, electronegativity of iodobismuthite, rapid absorption, sustained excretion, low toxicity and positive cerebrospinal penetration. The chemotherapeutic tests begun in this laboratory 7 years ago have been continued and this report submits the final results on the curative effects of iodobismitol together with some interesting comparisons. The procedure was the same as that used previously, except that during the past 2 years curative treatment with iodobismitol was given in 3 divided doses within 1 week, instead of 1 single dose. Since 1 week of a rabbit's life (expectancy about 8 years) is equal to about 8 weeks of a man's life (expectancy about 60 years), the treatment-period was the equivalent of clinical medication for 2 months, which is a fairly common initial period in practice. The iodobismitol was injected intramuscularly in a range of doses to permit determination of the minimum effective dose and “therapeutic index”, if possible. The virus was a strain of treponema pallida from a penile chancre, and, by this time, has had 37 passages through rabbits. Fully developed scrotal chancres containing treponema appeared in 3 to 4 weeks after inoculation of the virus. Lymph-node transfers were made 3 months after injection of the bismuth, using generally 3 rabbits, sometimes 4, for tests of lymph-node infectiousness. Virus infected but untreated rabbits were used as controls throughout. Examinations of all rabbits were made routinely in the usual manner. A total of 60 rabbits was used, at least 3 for each dose of iodobismitol. Inasmuch as the results with single and divided doses of the iodobismitol were the same, they were put together, and medians used for the curves in Fig. 1.

The Comparative Value of the Serologic and Roentgenologic Diagnoses of Congenital Syphilis

The time to diagnose congenital syphilis is immediately after birth, hence the importance of the development of accurate methods which will establish beyond a question of doubt the presence of syphilitic infection in the newborn. The clinical aspects of syphilis have changed considerably in the last 25 years. It is rare that one encounters in hospital practice fully developed, clinical syphilis. The general rule is that there is very little clinical indication of syphilis. Furthermore, clinicians rarely make exhaustive searches for the presence of syphilis. The great majority rely upon the examination of the blood or spinal fluid, or both. In congenital syphilis, unless one is aware that the mother has syphilis, and unless definite evidence of syphilis is present in the newborn, such as skin lesions, etc., the detection of syphilis has, up to recent times, depended entirely upon examination of the blood. Lately, the roentgenologic diagnosis of syphilitic involvement of the osseous system has been developed to a high degree of accuracy. The diagnosis of congenital syphilis by serologic methods applied to the cord blood has had varying degrees of success, and there is a general opinion among many obstetricians that the examination of the cord blood is not very accurate. It is important to emphasize now that, in reviewing the literature, one must pay careful attention to the methods employed for the serologic diagnosis of syphilis. In Mount Sinai Hospital, a complement fixation test, the Kahn test, and Kline's micro-precipitation test have been used routinely. A description of the technic and the results obtained on cases other than obstetric has been reported from this laboratory (1). The same tests were applied to maternal blood and blood obtained from the cord at delivery. In a few cases, blood was taken from the fontanel. In all instances of positive serology, re-checks were made on blood obtained from the fontanel. Cord blood is very apt to be antecomplementary, according to Kolmer (2), yet in about one thousand examinations we have had no antecomplementary reactions, and we attribute this to the technic used in obtaining the blood. As soon as the child has been delivered, the cord is wiped dry with a sterile sponge, cut through with sterile scissors which have not been used for any other purpose during the course of the delivery, and the blood allowed to drip freely into a test tube. The tube is immediately corked and sent to the laboratory. We feel that, if the tests are carried out properly—and it must be remembered that these tests for syphilis are highly technical and must be done with great care—the results have a very high degree of accuracy. Furthermore, it is our opinion that, if similar tests serve to diagnose acquired syphilis without clinical manifestations, they should be equally applicable to the blood of mothers and newborn infants.

Gastric syphilis data accumulated from 89 cases

Eighty-nine of a group of 151 patients with gastric lesions and syphilis were found to have gastric syphilis. These were selected from among approximately 25,000 patients with syphilis. The diagnosis was based on the combined results of prolonged therapeutic tests, histopathologic studies, morphologic changes in the roentgenologic characteristics, and restoration of gastric function. The demonstration of the existence of other evidence of clinical syphilis is not pertinent to the diagnosis of gastric syphilis. Of the 89 patients with gastric syphilis, 73 per cent had positive Wassermann reaction of the blood as the only other evidence of syphilis, and 6 per cent had negative serologic reactions. The incidence of clinical signs of syphilis was almost as high in those cases with gastric carcinoma (16 per cent) as it was in those with syphilides of the stomach (27 per cent). Recognition of the Spirochaeta pallida in excised gastric tissue as the conclusive means of diagnosis is a diagnostic requirement demanded by the scientific purist. I would prefer to see among the diagnostic criteria for gastric syphilis one demanding a histopathologic study to eliminate carcinoma. Although the Spirochaeta pallida may be demonstrated in the gummatous type of gastric ulcer, in cases of diffuse syphilitic fibrosis the organism has not as yet been recognized. Numerous instances of the bizarre character of both the clinical and microscopic features of gastric syphilis merely confirm the knowledge that syphilis is a protean disease. The incidence of cure in gastric syphilis is less than the occasional cases with dramatic improvement leads us to believe. In this study, 37 per cent were cured, and the condition of 27 per cent was improved. The result of treatment in the fibrosed syphilitic stomach is unsatisfactory, and plastic gastric operation offers slight help. Linitis plastica is a term that should be reserved for small-cell carcinoma of the stomach, and should not be used in relation to gastric syphilis because of the attendant confusion. Spontaneous involution or antisyphilitic treatment may account for the fibrotic leatherbottle stomach, for which the name of gastric syphilitic fibrosis is suggested. In patients in whom the gastric lesion is reported as operable but of indeterminate type the therapeutic test should be limited when the response is exceptionally slow and an exploratory laparotomy done, rather than subject the patient to a too prolonged test. As in all forms of syphilis, early diagnosis and early institution of treatment are rewarded by a higher incidence of cure than is obtained otherwise, a fact forcibly emphasized by this study.