Diagnosis Of Syphilis Research Articles

A Case of Latent Syphilis in Pregnancy Masked by Beçhet’s Disease

Syphilis in pregnancy is a worrisome topic due to its fetal consequences. The diagnosis and management of such a case might be intriguing when overlapped with Behçet’s disease, an inflammatory disease involving multiple organ systems. This case presents a 35-year-old pregnant female, a known case of Behçet’s disease and hypothyroidism, presenting at 33 weeks to the emergency department at Bahrain Defense Force (BDF) hospital with vaginal leaking and a solitary oral ulcer. As per the guidelines of the ministry of health, she underwent perinatal screening and was found to be positive for the venereal disease research laboratory (VDRL) test and was diagnosed with latent syphilis. The diagnosis of latent syphilis in a known case of Behçet’s disease presenting with a solitary oral ulcer is unpredictable. The importance of perinatal screening is emphasized in this case report. Keywords: Latent Syphilis, Behçet’s disease, Pregnancy

Severe monkeypox case associated with recent laboratory diagnosis of HIV: case report

Introduction: Monkeypox is a zoonosis caused by the smallpox virus. The first confirmed human case was in 1970, when the virus was isolated from a child in the Democratic Republic of the Congo. Since the beginning of May 2022, a large and unexpected outbreak has been documented globally, with the first cases initially described in the UK reaching around 70 countries today. The causes of this explosive increase in patients are not well understood, but exceed more than ten thousand10,000 infected by the third week of July 2022. Clinical and epidemiological presentations have been distinct from endemic cases and from small outbreaks previously described in non- endemic areas. Objective: The aim of this study was to describe the evolutionary and epidemiological, clinical characteristics of Monkeypox and human immunodeficiency virus co-infection in a patient treated at an STI/AIDS Reference Service in São Paulo, Brazil. Methods: information contained in this study was obtained through a review of the medical records, interviews with the patient, photographic record of the diagnostic methods, to which the patient was submitted and review of the literature. Results: A Brazilian man, with no epidemiological history of travel who was diagnosed with Monkeypox virus through polymerase chain reaction. At the same time of this diagnosis, he received a laboratory diagnosis of human immunodeficiency virus, Chlamydia Urethritis, and Late Latent Syphilis. Conclusion: To reduce the risk of the dissemination of Monkeypox, strategies at the public health level are necessary, with the dissemination of information and the development of prevention projects with targeted information and recommendations for vulnerable populations, especially men who have sex with men, with great prudence, seeking not to favor the development of stigmas as already experienced at the beginning of the human immunodeficiency virus epidemic.

Sensitivity and Specificity of Two Investigational Point of Care Tests for Syphilis and HIV (PoSH Study) for the Diagnosis and Treatment of Infectious Syphilis in Canada: A Cross Sectional Study

Sensitivity and Specificity of Two Investigational Point of Care Tests for Syphilis and HIV (PoSH Study) for the Diagnosis and Treatment of Infectious Syphilis in Canada: A Cross Sectional Study

Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey.

There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16-24 years, 5.5% in 25-34 years, 7.8% in ≥35 years, p trend =0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR=5.74, 95% CI: 1.20-27.44), followed by dating apps (aOR=2.99, 95% CI: 1.36-6.58), friends/family (aOR=2.99, 95% CI: 1.34-6.69) and social venues (e.g. bar) (aOR=2.73, 95% CI: 1.18-6.30). Group sex was strongly associated with STI positivity (aOR=6.24, 95% CI: 2.41-16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.

Laboratory diagnosis of syphilis. Current approaches and perspectives. Part II. Indirect (serological) diagnostic methods

Laboratory diagnosis of syphilis. Current approaches and perspectives. Part II. Indirect (serological) diagnostic methods

Detection of Treponema pallidum in whole blood samples of patients with syphilis by the polymerase chain reaction.

Syphilis is caused by the bacterium Treponema pallidum. The diagnosis is based on clinical data and serological analysis; however, the sensitivity and specificity of such tests may vary depending on the type of test and stage of the infection. In order to overcome this premise, this study utilized the polymerase chain reaction (PCR) for the detection of T. pallidum DNA in whole blood samples of patients with syphilis. The blood samples from patients with or without symptoms of syphilis, but with positive results in enzyme-linked immunosorbent assay (ELISA), were included in this study. A venereal disease research laboratory (VDRL) test was performed for all collected sera samples. For PCR, the T. pallidum DNA was extracted from the collected blood samples and a specific primer set was designed to amplify 131 nucleotides of polA (Tp0105). The specificity of the primers was evaluated with the DNA of 17 different pathogens. From a total of 314 blood samples reactive in ELISA, 58.2% (183/314) of the samples were reactive in the VDRL test. In the PCR, 54% (168/314) of the ELISA-reactive samples were positive. In both tests (VDRL and PCR) 104 samples were positive. Of 104 positive samples for both tests, 71 were at the latent stage. Based on these results, it can be concluded that PCR with the designed set of primers can be utilized as a diagnostic method for T. pallidum detection in blood samples of patients with syphilis, especially those with latent infection. In addition, it can be utilized as a supplement for serological methods to improve the diagnosis of syphilis.

Does performance and operational superiority of point-of-care test make it the investigation of choice in confirming syphilis?

According to the World Health Organization, 6 million cases of syphilis occur every year. Serological tests for syphilis form the mainstay of diagnosis for syphilis. We evaluated the performance of point-of-care test (POCT) against other specific treponemal test for confirming the diagnosis of syphilis. Does performance and operational superiority of POCT make it the investigation of choice in confirming syphilis? Retrospectively, data were analyzed of 599 serum samples from Apex Regional sexually transmitted disease centre, Safdarjung Hospital, New Delhi, received for testing by syphilis treponemal assays (both nontreponemal reactive and nonreactive). These samples underwent treponemal testing for syphilis by the Treponema pallidum hemagglutination (TPHA), fluorescent treponemal antibody absorption test (FTA-ABS), and POCT. Performance characteristics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy), and operational characteristics of POCT and TPHA were evaluated against the gold standard FTA-ABS. A total of 599 samples were evaluated, of which 61.76% were positive by FTA-ABS. On analysis, the sensitivity was 91.08% and 91.89%, specificity was 89.08% and 87.34%, PPV was 93.09% and 92.14%, NPV was 86.08% and 86.96%, and diagnostic accuracy was 90.32% and 90.15% for POCT and TPHA, respectively. The lower cost, shorter turnaround time, lesser infrastructure and workforce need, and easy availability make the POCT operationally superior to TPHA. Owing to its operational superiority and higher specificity POCT can replace TPHA for confirming the diagnosis of Syphilis. POCT are affordable, equipment free, have room temperature storage, and yield result within 15 minutes, enabling same day testing and treatment. It can be used in a resource limited setting, for community setup or even self-testing.

Electrochemical platform for anti-cardiolipin antibody detection in human syphilitic serum

• We developed a biosensor platform based on an antigenic colloidal suspension as a biorecognition element. • The platform detects anti-cardiolipin (anti-C) antibodies in infected human serum. • The biosensor was able to detect the formation of immunocomplexes in serum samples. • We obtained a limit of detection of 1024 titer. Syphilis is a sexually transmitted disease with high morbidity and mortality rates. Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) testing are the most commonly used syphilis identification methods; however, both have low specificity. The available molecular assays are expensive and time-consuming. Electrochemical biosensors are an innovative approach for detecting multiple target analytes present in syphilis complex samples. In this work, we used a self-assembled monolayer (3-mercaptopropyl)trimethoxysilane (MPTS) to immobilize an antigenic colloidal suspension (containing cardiolipin, cholesterol, and lecithin) as a biorecognition element in a platform for detecting anti-cardiolipin (anti-C) antibodies in infected human serum. The biosensor platform was evaluated through cyclic voltammetry, electrochemical impedance spectroscopy, and atomic force microscopy. Microscopic evaluation revealed the formation of small cardiolipin-anti-C complexes at the maximum titer of 1:32, thus indicating the serum’s syphilis infection positivity. Anti-C antibody detection was evaluated by blocking electron current and oxidation–reduction processes at the electrode–electrolyte interface. The proposed sensor yielded a linear response (serum dilutions ranging from 1:8 to 1:1024 titer) with a regression coefficient of 0.97. We obtained a limit of detection of 1:1024 titer and high selectivity against interfering biomolecules. The developed biosensor may provide a promising alternative for syphilis diagnosis and follow-up treatment.

Syphilis in pregnancy at Public Health Centre III North Denpasar

Introduction: Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Syphilis in pregnancy is often asymptomatic, so early detection of syphilis is needed to prevent a poor pregnancy outcome and transmission of infection to the baby.Case: A 25-year-old woman, pregnant with her second child at 24 weeks of gestation, came without any health complaint for a routine prenatal check-up. On syphilis screening, reactive TPHA and RPR titer of 1:2 were found. The patient was diagnosed with syphilis infection in pregnancy. The patient has been treated with Benzathine Benzylpenicillin 2.4 million IU intramuscular injection once a week for 3 consecutive weeks.Conclusion: Syphilis is a sexually transmitted infection that infects pregnant women. Treponemal transmission in pregnant women was detected early in the ninth week of pregnancy. The diagnosis of syphilis was made by dark-field microscopy, treponemal antibody tests (TPHA, FTA-ABS), and non-treponemal antibody tests (VDRL, RPR). Penicillin is the gold standard therapy for syphilis in pregnant women.

Congenital syphilis present with pemphigus syphilitics and atelectatic congenital pneumonia: a case report

Background: Congenital syphilis is an infectious disease of newborns caused by Treponema pallidum, a spirochete bacterium, from vertical transmission from infected mother to fetus. Diagnosis of congenital syphilis can be difficult because two-thirds of affected infants are asymptomatic at birth, and the signs of symptomatic infants are diverse. Familiarity with the various presentations is essential to early diagnosis and treatment.Case Description: A male preterm, 35 weeks gestation baby, born by vaginal delivery from G1P0 mother with syphilis latent phase, with Treponema pallidum hemagglutination assay (TPHA) titer reactive (1:2560) with no treatment during the antenatal period. The baby was born with low birth weight, respiratory distress syndrome, hepatosplenomegaly, and skin rash. Diffuse desquamation and fissures also multiple eroded pale blisters are known as pemphigus syphilitics. TPHA was also reactive at the same level as the mother. Complete blood count showed severe respiratory acidosis (pH: 6,8), leucocytosis (46.420/uL), thrombocytosis (414.000/uL), lymphocytosis (40,3%), and monocytosis (16%). Radiology showed severe atelectatic left lung and course nodular congenital pneumonia of the right lung. The baby was intubated and injected with penicillin procaine 50.000 IU/kg/day intramuscularly in the neonatal intensive care unit (NICU). However, due to severe atelectatic lung and acidosis, this case resulted in a fatal outcome.Conclusion: Broad desquamation, multiple fissures, and eroded pale blisters (vesiculobullous lesions) known as pemphigus syphilitics should alert clinicians as an early manifestation of congenital syphilis. Other manifestations include congenital pneumonia, typically atelectatic or nodular type, and hepatosplenomegaly. Treatment should be started promptly to decrease its morbidity and mortality.

Risk Factors Associated with Gaps in Post-Treatment Surveillance for Perinatal Syphilis

During 2019, 1,870 cases of congenital syphilis were reported by the Centers for Disease Control and Prevention (CDC). Diagnosis and treatment of syphilis in mothers and newborns is dependent on post-treatment surveillance via serology for up to 15 months to ensure absence of infection. The objective of this study was to determine demographic, socioeconomic, obstetric and neonatal risk factors associated with gaps in adherence to recommended post-treatment surveillance.

Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis

ObjectiveSTIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries,...

163. High Prevalence of Urogenital and Rectal Mycoplasma genitalium in U.S. MSM with a History of STIs in the Last Year

Background M. genitalium (M. gen) is an under-recognized sexually transmitted bacterial pathogen that causes 15-25% of nongonococcal urethritis (NGU) in men. Asymptomatic M. gen may serve as a reservoir, lead to transmission to sexual contacts, and drive the development of drug resistance. M. gen may be associated with an increased risk of HIV acquisition, as seen in some studies. Data are limited on M. gen prevalence among U.S. men who have sex with men (MSM) living with HIV or HIV-uninfected and on pre-exposure prophylaxis (PrEP). MethodsWe analyzed baseline prevalence of urogenital and rectal M. gen using the Aptima Mycoplasma genitalium nucleic acid amplification test in participants enrolled in DoxyPEP, an ongoing randomized, open label trial of the effectiveness of doxycycline post-exposure prophylaxis (PEP) on incidence of gonorrhea, chlamydia, and early syphilis among MSM and transgender women living with HIV or on PrEP in San Francisco and Seattle (NCT03980223). Participants completing at least one follow up visit were also assessed for M. gen persistence, clearance, and incidence. Testing was at regular intervals and not symptom driven.ResultsThis analysis included 122 men; 34% with HIV and 66% on PrEP. In the prior 12 months, 18.9% had a diagnosis of syphilis, 58.2% chlamydia, and 63.9% gonorrhea. At baseline, M. gen was present in at least one site in 24%; 9% in the urine and 16% in the rectum, with 1 testing positive at both sites. M. gen presence was not associated with age, ethnicity, race, HIV status, number of partners in the past 3 months, or bacterial STI in the past 3 months. 65 participants had follow up tests a median of 9.1 months after baseline (IQR 7.8-9.8); among 7 participants with urogenital M. gen at baseline, M. gen cleared in 6 and persisted in 1. Among 11 participants with rectal M. gen at baseline, M. gen cleared in 4 cleared and persisted in 7. At follow up, M. gen was detected in 2 urine and 9 rectal specimens in those previously negative at these sites. Figure 1. Baseline prevalence of urogenital and rectal M. genitalium in MSM at high risk for STIs enrolled in DoxyPEP Figure 2. Detection of urogenital and rectal M. genitalium among participants with baseline and follow up testing ConclusionIn this cohort of MSM with a recent diagnosis of a bacterial STI, routine testing identified urogenital or rectal M. gen in 24% of participants at baseline and 31% at either baseline or follow-up. The association of persistent M. gen with the risk for subsequent symptomatic infection and drug resistance merits further investigation. Disclosures Emma D. Bainbridge, MD, MPH, Hologic (Grant/Research Support) Olusegun O. Soge, PhD, Hologic Inc. (Grant/Research Support)SpeeDx Inc. (Grant/Research Support) Annie Luetkemeyer, MD, Cepheid (Grant/Research Support)Hologic (Grant/Research Support)Mayne Pharma (Grant/Research Support)

857. Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections among Veterans

Abstract Background Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent a window of opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with encounters for STIs. Methods We conducted a retrospective cohort and nested case control study in the national Veterans Administration (VA) healthcare system to determine the frequency of PrEP discussion and initiation in association with clinical encounters for bacterial STIs (i.e. early syphilis, gonorrhea, and chlamydia). We used administrative data to identify patients with a first STI based on ICD 9 / 10 codes from January 2013–December 2018 , excluding patients with prior HIV diagnosis or PrEP use, or STI diagnosed in context of a visit to initiate PrEP (Figure 1). We used pharmacy data to determine the frequency of PrEP initiation within 90 days of the encounter for STI in this cohort. In the case control study, we matched 90 PrEP starters to 180 non-starters by day of STI diagnosis and reviewed chart notes from the STI diagnosis encounter to determine frequency of documentation of sexual history taking and PrEP discussions among subsequent PrEP initiators and non-initiators. Results We identified 23,312 patients with a first STI, of whom 90 (0.4%) started PrEP within 90 days. Adjusting for age, PrEP initiation was associated with urban residence (OR=5.0, 95Cl 1.8–13.4), White compared to Black race (OR=1.7, 95 Cl 1.1–2.8), and syphilis diagnosis (OR = 7.4, 95 Cl 4.7–11.6, table 1). Chart review revealed that discussion of PrEP was rare among people with STIs who did not subsequently start PrEP (1.1%, 95 CI 0.1–4.0, table 2). PrEP initiation was associated with documentation of any sexual history (80.0% of initiators vs. 51.0% of non-initiators, p < 0.01) and discussion of PrEP (52.2% vs. 1.1%, p < 0.01) during the initial STI diagnosis encounter. Figure 1. Study flow chart Table 1. Characteristics of patients with a first healthcare encounter with an STI diagnosis, by PrEP initiation within 90 days of encounter. N= 23,312 Table 2. Chart review findings from case control study. Ninety people who initiated PrEP (i.e., “cases”) were randomly matched to 180 who did not initiate PrEP (i.e., “controls”) by date of STI. Conclusion Discussion and initiation of PrEP were rare in association with healthcare encounters for STIs. Not all individuals with STIs will benefit from starting PrEP, but interventions are needed to improve low rates of sexual history-taking and discussion of PrEP during healthcare encounters for STIs. Disclosures Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor)

1349. How Anchored is the Chancre? A Chart Review of Syphilis Treatment by a Safety Net Emergency Department in Atlanta, GA

Abstract Background Since reaching its nadir in 2000, syphilis has re-emerged as a public health threat in the U.S. The incidence of syphilis is disproportionately high in Atlanta, the epicenter of the HIV epidemic in the U.S. South. Given that syphilis infection is a strong predictor of HIV infection, identifying patients with syphilis is an important and underutilized method for connecting patients to HIV prevention and care services. Emergency departments (EDs) act as a critical access point to care in safety net health systems. We describe the recognition and empiric treatment of syphilis in the ED of Grady Healthcare System, a safety net hospital serving Atlanta. Methods We performed a retrospective chart review on all reactive rapid plasma reagin (RPR) tests collected from patients 18 years and older at the Grady ED from 5/1/20 to 10/31/20. We abstracted reported reason for testing, diagnosis, treatment administered, and location of treatment from the electronic health record. Results From 5/1/20 to 10/31/20, 148 patients with reactive RPR tests were identified. Reasons for testing were broad and included the evaluation of neurologic symptoms (47), genital/anal lesions (31), and a history of syphilis (18) (Table 1). 74 patients had presumed active syphilis (50%), 34 had previously treated syphilis (23%), 12 had false positives (8%), and 28 had an unclear diagnosis (19%) (Table 2). Of those with presumed primary syphilis who were discharged from the ED, 53% (8/15) received empiric treatment in the ED; 59% (10/17) of those with secondary syphilis received empiric treatment prior to discharge. Of the patients discharged from the ED, clinical follow up was indicated for 52% (31/59) given lack of empiric treatment or of confirmed prior treatment. Contact was attempted for 39% (12/31), but only 29% (9/31) were ultimately treated at Grady. Table 1: Abstracted Reasons for Testing for Syphilis in the ED For ED patients from 5/1/20-10/31/20 who had reactive RPRs, reasons for syphilis testing were taken from the chief complaint, history, or medical decision making documentation of ED providers, admitting providers, or consultants. Table 2: Syphilis Diagnoses of ED patients with reactive RPRs ED patients with a positive RPR from 5/1/20-10/31/20 were chart reviewed to determine their diagnosis. Previous RPR, treponemal antibodies, CSF results, media images, progress notes, and descriptions by medical staff were reviewed to attempt to retroactively determine the most likely syphilis diagnosis. Conclusion Reactive RPRs were common in this acute care setting and most represented active syphilis infection. Empiric treatment was most likely to be provided for patients with clear syphilis syndromes. However, a majority of patients who were discharged without empiric treatment did not receive follow up. Institutional protocols for following up reactive tests after discharge represent an opportunity to connect patients with syphilis treatment and HIV prevention services. Disclosures All Authors: No reported disclosures

270. New Onset Seizure Presented as Neurosyphilis

BackgroundThe term “neurosyphilis” refers to infection of the central nervous system (CNS) by Treponema pallidum. It can occur at any time after initial infection. Early in the course of syphilis, the most common forms of neurosyphilis involve the cerebrospinal fluid (CSF), meninges, and vasculature (asymptomatic meningitis, symptomatic meningitis, and meningovascular disease). Late in disease, the most common forms involve the brain and spinal cord parenchyma (general paralysis of the insane and tabes dorsalis).MethodsA 31-year-old man who suddenly developed a new onset generalized tonic clonic seizure, was admitted to the emergency department. He had no history of epilepsy and denied any vision or gait problems. The brain MRI showed no abnormalities. He had a history of rapid plasma reagent (RPR) titer 1:32 and a positive fluorescent treponemal antibody absorption (FTA-ABS) test in 2017. However, the RPR result was non-reactive when he retested a week later and therefore was not diagnosed with syphilis and did not get treated at that time. His most recent RPR titer was 1:16. HIV serology and other STD tests were all negative. His wife and his 3 kids were negative for syphilis. Due to serological evidence of syphilis and neurological symptoms, we arranged him to get a lumbar puncture to rule out neurosyphilis. ResultsHis CSF study showed positive venereal disease research laboratory (VDRL), WBC cell count 44 cells/ul (lymphocytes 80%, Neutrophil 20%), Glucose 50 mg/dl, Protein 75 mg/dl. Based on the CSF study, he was diagnosed with neurosyphilis and was treated with intravenous Penicillin G 3-4 million units every 4 hours for 14 days, followed by Benzathine Penicillin 2.4million units intramuscularly on day 21. ConclusionThis is an unusual case because his false negative RPR result has hindered the prompt diagnosis and management of syphilis. RPR is a nontreponemal test and therefore it is not always reliable as a diagnostic criteria. False negatives in RPR may occur in certain conditions such as in early primary or in late stage syphilis and prozone phenomenon. This case illustrates the importance of using a reverse sequence algorithm in diagnosing syphilis. Thorough history taking is also crucial in conjunction with serological tests to determine the diagnosis and to ensure appropriate treatment.Disclosures All Authors: No reported disclosures

New Syphilis Cases in Older Adults, 2004-2019: An Analysis of Surveillance Data From South China.

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

Status Epilepticus and Neurosyphilis: A Case Report and a Narrative Review

Neurosyphilis is a rare but life-threatening complication of syphilis that can develop even decades after the primary infection and can be unrecognized. Seizures and status epilepticus (SE) may represent the first manifestation in a previously undiagnosed syphilitic patient. We present an exemplification case of a new onset refractory status epilepticus caused by neurosyphilis and we reviewed the existing literature. We selected all studies reporting cases of SE in the context both of patients with a known diagnosis of syphilis and as the first manifestation of neurosyphilis. We identified 50 patients, mostly composed of immunocompetent, middle-aged males. Thirty-nine patients (83%) presented a new onset SE. A history of subtle and rapidly progressive mood and/or cognitive impairment suggesting a limbic encephalitis-like presentation was frequently observed. Focal frontal or temporal SE was reported in 26. Brain MRI frequently showed T2/FLAIR hyperintensities widely involving the medial temporal structures and the frontal lobes. This review should increase the clinician’s awareness of neurosyphilis as a possible etiology of a new onset SE of unknown etiology, especially in the context of a “limbic encephalitis”-like clinical presentation. Prompt recognition and treatment for neurosyphilis partially or completely reverse neurologic sequelae, changing the natural history of the disease.

Emotionology in the 16th Century and the Diagnoses of syphilis, pest, mental illness by Paracelsus

이 글은 질병이 세균이나 바이러스의 작용이 아니라 질병 증후군에 대한각 시대의 지각이라는 전제에서 출발하여, 근대 의학의 비조 중의 하나인파라켈수스가 진폐증, 매독, 페스트, 정신병을 무엇으로 진단했으며, 그 때병과 감정은 어떻게 의미화되는지 분석했다. 분석의 결과는 다음과 같았다. 첫째, 병은 체액의 불균형이 아니라 외부 물질이 신체 기관에 화학적으로일으킨 오작동이다. 둘째, 그 오작동에는 인간 주체의 도덕적 태도 및 감정과 천체의 감정이 함께 작용한다. 셋째, 천체의 개입은 오로지 인간의 도덕적, 감정적 태도에 의해서 촉발되는 바, 인간의 부도덕한 감정적 상상이 인간 체내에 “몸(corpus)”을 만들고, 그 몸이 별에 “상상”으로 각인되면, 별은그에 감정적으로 반응하여 그것을 독으로 전환시킨 뒤 그 독의 상상을 인간 몸에 보내고, 그 상상은 인체 내에서 물질화된다. 페스트 독이 만연한 곳에서 페스트에 대한 공포를 느끼면 페스트에 감염되는 이유는 바로 페스트에 대한 공포 속에 인상으로 각인된 페스트 증후군이 인체 내에서 물질화되기 때문이다. 성비투스 무도병이라는 정신병의 발발 경로도 정확히 그에일치하여, 인간이 춤을 추고자 하는 욕망을 품으면 그 죄스러운 감정이 신체 기관에 각인되어 물질화된다. 파라켈수스는 생애 말년에 이 입론을 확대하여, 신을 멀리하는 것, 신적인 도덕을 위반하는 것, 분노와 증오와 공포를느끼는 것 모두를 정신병의 지표로 간주했다. 필자는 16세기 루터파 지역에 독특했던 종말론이 ‘교파화’ 작업의 추동력이 되었던 바, 파라켈수스의 의학을 그 교파화 과정의 일부로 해석했다. 그릇된 감정을 악마화하는 것은감정의 규율화 작업이었을 것이기 때문이다. 더불어, 감정이 신체적 질병을일으킬 수 있었으니만큼 그 시대가 감정에 ‘물질적’ 행위능력을 부여했으며, 인간의 감정이 신체와 외부 물질과 별과 동일 평면에서 상호작용하고있었음도 알 수 있었다.This essay analyzes the diagnoses of miners’ diseases, syphilis, pest by Paracelsus, based on the assumptions that the diseases are not something of bacteria or virus but the perceptions of the people at that time about various illness syndromes. The results are as following. First, the diseases were not from the unbalance of the humors but the chemical dysfunction of corporal organs caused by the organic inappropriate separation and distillation of intake outside materials. Second, the corporal chemical processes were in part reduced to the moral and emotional attitudes of human subjects and the firmament. Third, the stary interventions resulted only from human subjectivity. The unmoral and emotional attitudes generated a “corpus” in the body, the impression of which was imposed on the stars, while the stars transformed the impression into a poison, the impression of which materialized itself in the human body. Pracelsus argued that syphilis and pest were born by that mechanism. So he suggested, one who had fear of pest in the area poisoned with pest would be infected with pest. He inferred the occurrence of St. Vitus chorea by the same logic. Paracelsus in the last days of his life expanded the argument into a wide moral theory of mental diseases, so that all ungodly attitudes and unmoral emotions were proof of the madness. This essay suggests that the medical arguments of Paracelsus should be regarded as an example of the apocalyptic sensibility of the German Lutheran in the 16th century, and that Paracelsus unintendedly contributed to the social and moral disciplining of the people by disciplining their emotions.

Syphilis Testing and Diagnosis Among People With Human Immunodeficiency Virus (HIV) Engaged in Care at 4 US Clinical Sites, 2014-2018.

Despite rising rates of syphilis among people with human immunodeficiency virus (HIV; PWH) in the United States, there is no optimal syphilis screening frequency or prioritization. We reviewed records of all PWH in care between 1 January 2014 and 16 November 2018 from 4 sites in the Centers for AIDS Research Network of Integrated Clinical Systems Cohort (CNICS; N = 8455). We calculated rates of syphilis testing and incident syphilis and used Cox proportional hazards models modified for recurrent events to examine demographic and clinical predictors of testing and diagnosis. Participants contributed 29 568 person-years of follow-up. The rate of syphilis testing was 118 tests per 100 person-years (95% confidence interval [CI]: 117-119). The rate of incident syphilis was 4.7 cases per 100 person-years (95% CI: 4.5-5.0). Syphilis diagnosis rates were highest among younger cisgender men who have sex with men and transgender women, Hispanic individuals, people who inject drugs, and those with detectable HIV RNA, rectal infections, and hepatitis C. We identified PWH who may benefit from more frequent syphilis testing and interventions for syphilis prevention.