Syphilis Research Articles

Improved efficiency using sequential automated immunoassays for syphilis screening in blood donors.

The serodiagnosis for syphilis usually follows two methodologies-a "traditional" algorithm using a non-treponemal test followed by confirmation using a treponemal test, or a "reverse" algorithm using a treponemal test followed by a non-treponemal test. There are limited reports in the literature of using a modified reverse algorithm (treponemal test followed by a second treponemal test), and to the best of knowledge, there are currently no published articles using two highly sensitive automated immunoassays to aid the serodiagnosis of syphilis. In addition, the Treponema pallidum particle agglutination (TPPA) assay is commonly used as a confirmatory test for the diagnosis of syphilis. With the withdrawal of the TPPA assay from Australia and presumably from the global market also, alternative testing algorithms are now required. This study provides proof of concept for using sequential immunoassays in the diagnosis of syphilis.

Lack of Serological Response by Delivery to Syphilis Treatment Does Not Impact Pregnancy Outcomes.

Objectives: Maternal syphilis can lead to serious adverse pregnancy outcomes, including neonatal death. A 4-fold decline in blood non-treponemal titer at six months after the treatment of syphilis compared to the baseline is considered as an adequate serological response. However, the duration of normal human gestation does not allow the ascertainment of an adequate serological response. Aim: The aim of this study was to assess correlations between the lack of a 4-fold decrease in non-treponemal titer by delivery after syphilis treatment and fetal and newborns' condition and serological outcomes. Methods: Fourteen pregnant patients (gestational age 16-22 weeks) diagnosed with early syphilis (secondary or latent) were treated with intramuscular benzathine penicillin and subsequently monitored clinically, serologically, and ultrasonographically at monthly intervals. Based on the non-treponemal test results at delivery, patients were stratified into two groups: those with a 4-fold decline in titers and those without such a decline. All newborns were clinically and serologically assessed for congenital syphilis at birth and then monitored until serological tests became negative. Results: Fifty percent of the included women did not achieve a 4-fold decline in non-treponemal titer by delivery. Patients from the group showing a 4-fold decline in RPR titer at delivery and those without such a decline did not differ in basic demographic and clinical characteristics or in ultrasound parameters used for fetal assessment. Based on the clinical and laboratory assessments of newborns on the day of delivery and during a 6-month follow-up, none were diagnosed with congenital syphilis or required treatment for syphilis. Conclusions: The lack of an adequate serological response to syphilis therapy by delivery among patients treated between 16 and 22 weeks of pregnancy does not appear to be associated with adverse fetal and neonatal outcomes.

The Renaissance of Secondary Syphilis: A Case Series

Abstract Sexually transmitted diseases/infections (STDs/STIs) are one of major public health concern, and syphilis in today’s era is not an uncommon diagnosis. The rising trend of syphilis cases can be attributed to changes in sexual practices such as individuals being engaged in oro-genital or anogenital sex, having multiple sexual partners, increase in men having sex with men, HIV co-infection, and drug abuse. Syphilis mimics many other diseases, and diagnosis can be delayed if the clinician is not aware of varied presentations. Often, unusual mucocutaneous manifestations have fascinated dermatologists, leading to diagnostic difficulties. In today’s era, cases of secondary and latent syphilis are being more commonly encountered than those of primary syphilis. Herein, we emphasize on varied mucocutaneous manifestations of secondary syphilis among young individuals. We would like to highlight the need for the implementation of sex education among adolescents/young adults to prevent STDs/STIs.

Hepatitis colestásica por sífilis secundaria en paciente con VIH: a propósito de un caso

Syphilis is a sexually transmitted disease caused by Treponema pallidum, and presents a variety of symptoms. Liver involvement in secondary syphilis is uncommon (1%), and can reach up to 3% in patients with HIV infection. We present the case of a 49-year-old man with the diagnosis of HIV on treatment with TARGA and an undetectable viral load, who attended the health center for jaundice, persistent headache, and hyperpigmented papular lesions on palms and soles. After laboratory tests and a cholangiopancreatography, the patient was diagnosed with cholestatic hepatitis due to secondary syphilis. The patient was treated with intravenous penicillin G sodium 3 million IU every 4 hours for 14 days, with a favorable clinical evolution and improvement of cholestasis.

Health Literacy of Pregnant Women about Screening for HIV, Syphilis and Hepatitis B in Jayapura City

Background: Early HIV, Syphilis and Hepatitis B screening literacy must be understood by women of childbearing age. If the mother does not know this, it will have an impact on sexually transmitted diseases. The aim of the study was to analyze factors related to screening of pregnant women. Method: Quantitative cross-sectional study, conducted at 13 Community Health Centers for two months. 100 pregnant women using proportional stratified sampling, questionnaire instrument. Chisquare analysis. Results: Age (p value = 0.027), income (p value = 0.011), attitude (p value = 0.000), PPIA (p value = 0.005) and counseling (p value = 0.026) have a significant relationship (p value < 0, 05) with the mother’s level of knowledge about screening. Education (p value = 0.634), employment (p value = 0.719), parity (p value = 0.938), antenatal care (p value = 0.191), access to information (p value = 0.323) have no significant relationship (p value >0 .05).

A clinical case of early congenital syphilis

Congenital syphilis results from vertical transmission of Treponema pallidum to the fetus from an infected mother who was not treated before 32 weeks of gestation. Thanks to the development of obstetric and gynecological services, incidence rates of congenital syphilis are decreasing annually, even against the background of an increase in cases of acquired syphilis among the adult population. Depending on the time of manifestation, early (onset before 2 years) and late (onset after 2 years) congenital syphilis are distinguished. The clinical picture of both congenital and acquired syphilis has wide variability and requires careful differential diagnosis with other diseases of infectious and non-infectious nature. The relatively rare frequency of occurrence and the polymorphism of clinical manifestations reduce the alertness of clinicians regarding this disease. Diagnosis is not difficult provided that a correct history is taken and direct (identification of the pathogen itself) and indirect (serological reactions) laboratory tests are carried out. However, the erased course with a small number of clinical manifestations may delay the early detection of the disease. Syphilitic infection in both mother and child is traditionally treated with beta-lactam antibiotics. The prognosis for life and health is individual in each case and depends on concomitant conditions. This article presents a clinical case of early congenital syphilis in a child whose mother was not observed in the antenatal clinic during pregnancy and was infected with Treponema pallidum in the II—III trimesters. Attention is focused on the importance of a thorough history taking even in the presence of non-specific symptoms.

Prevalence and Treatment Outcomes of Syphilis among People with Human Immunodeficiency Virus (HIV) Engaging in High-Risk Sexual Behavior: Real World Data from Northern Greece, 2019-2022.

In this study, we aimed to assess the prevalence of syphilis among people with human immunodeficiency virus (HIV; PWH) engaging in high-risk sexual behavior, determine the stage of syphilis, and evaluate treatment efficacy. A retrospective single-center cohort study was conducted at the AHEPA University General Hospital of Thessaloniki, focusing on PWH at high risk for sexually transmitted infections (STIs) attending outpatient care from January 2019 to December 2022. Sociodemographic and clinical data were collected, incident syphilis rates were identified, associations with HIV-related characteristics were explored, and the treatment response was assessed. Among 991 participants, 94 PWH were diagnosed with syphilis, representing 9.4% of the cohort. Incident syphilis cases experienced a decrease in the early COVID-19 era compared to 2019, followed by a gradual increase leading up to 2022. The majority of syphilis cases were asymptomatic latent syphilis (71.1%). Men who have sex with men (MSM) and younger individuals exhibited higher rates of co-infection during the study period. No significant association was found between incident syphilis and HIV-related factors. Most syphilis cases (86%) were treated with benzathine penicillin G (BPG). Treatment with BPG and doxycycline showed an increased success rate (96.7% vs. 92.9%), with no statistically significant difference observed between them (p = 0.438). This study highlights the alarming incidence of syphilis among PWH engaging in high-risk sexual behavior, particularly among younger MSM. BPG remains effective, and alternative regimens like doxycycline show promise, especially in settings with penicillin shortages or patient allergies.

"Syphilitic Hepatitis": A Comprehensive Review of Clinical Features, Diagnostic Approaches, and Management Considerations.

Syphilitic hepatitis is a very rare presentation of syphilis infection, characterized by inflammation of the liver due to the invasion of hepatic tissue by the bacterium Treponema pallidum. This review article provides an in-depth analysis of the existing body of information pertaining to syphilitic hepatitis. The article primarily concentrates on key aspects such as the epidemiology, clinical manifestations, diagnostic methods, and therapeutic approaches associated with this condition. Despite its rarity, awareness of syphilitic hepatitis is vital for accurate diagnosis and appropriate intervention. The clinical presentations frequently exhibit similarities with many liver illnesses, hence presenting difficulties in making an accurate diagnosis. Common symptoms include fatigue, stomach pain, and jaundice. Diagnostic procedures encompass the use of serological assays, including rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS), in conjunction with imaging modalities to evaluate hepatic engagement. The primary therapeutic approach is the prompt initiation of antibiotic therapy, with a particular emphasis on penicillin, to eradicate the causative bacterial infection and facilitate the restoration of liver function. Failure to swiftly manage this condition may result in substantial morbidity. In summary, syphilitic hepatitis is a very uncommon but medically relevant manifestation of syphilis infection. The significance of increased clinical suspicion, precise diagnostic techniques, and prompt antibiotic administration is emphasized in this review since these are crucial in reducing the potentially severe outcomes associated with this illness.

Temporal evolution of newly diagnosed and late syphilis prevalence: a notification analysis over the past 10 years in the state of Tocantins and the northern region of Brazil

Syphilis, a sexually or vertically transmitted pathology during gestation, represents a significant threat to maternal and child health. The absence of early diagnosis during pregnancy can result in vertical transmission, leading to recent or late congenital syphilis, both associated with severe sequelae and potentially fatal outcomes for the newborn. This study aimed to analyze epidemiological data regarding cases of gestational syphilis in the State of Tocantins, comparing them with the Northern region of Brazil over the last decade. The results revealed that, despite awareness initiatives in primary care, cases of recent congenital syphilis remain prevalent, with the years 2017 and 2018 recording the highest notification rates. It is concluded that the increase in the prevalence of recently diagnosed syphilis signals the need for improvement in health policies in Tocantins and the Northern region. The importance of early screening during prenatal care is emphasized, highlighting that accurate diagnosis and effective treatment can exempt the pregnant woman and the baby from potential future sequelae.

Clinical presentation of early syphilis and genomic sequences of Treponema pallidum strains in patient specimens and isolates obtained by rabbit inoculation.

The global resurgence of syphilis necessitates vaccine development. We collected ulcer exudates and blood from 17 primary syphilis (PS) participants and skin biopsies and blood from 51 secondary syphilis (SS) participants in Guangzhou, China for Treponema pallidum subsp. pallidum (TPA) qPCR, whole genome sequencing (WGS), and isolation of TPA in rabbits. TPA DNA was detected in 15 of 17 ulcer exudates and 3 of 17 blood PS specimens. TPA DNA was detected in 50 of 51 SS skin biopsies and 27 of 51 blood specimens. TPA was isolated from 47 rabbits with success rates of 71% (12/17) and 69% (35/51), respectively, from ulcer exudates and SS bloods. We obtained paired genomic sequences from 24 clinical samples and corresponding rabbit isolates. Six SS14- and two Nichols-clade genome pairs contained rare discordances. Forty-one of the 51 unique TPA genomes clustered within SS14 subgroups largely from East Asia, while 10 fell into Nichols C and E subgroups. Our TPA detection rate was high from PS ulcer exudates and SS skin biopsies and over 50% from SS blood, with TPA isolation in over two-thirds of samples. Our results support the use of WGS from rabbit isolates to inform vaccine development.

Rare case of pulmonary syphilis

Syphilis is a well known bacterium that has a great response to antibiotic treatment. Even though it is well known it can present with a wide array of symptoms. If left untreated, Syphilis will progress through primary, secondary, latent, and tertiary stages. In Secondary Syphilis, the bacterium can become disseminated and could potentially affect any organ. In Tertiary Syphilis, the central nervous system could be affected. These issues could be very detrimental to the patient and could be debilitating. In the past 20 years there has been a slight increase in the numbers of Syphilis seen in the U.S. which could be due to increasing number of men who have sex with men and increasing HIV numbers. The case discussed below entails a young HIV positive female who fulfilled all the guideline recommendations for Pulmonary Syphilis and responded very well to treatment. Pulmonary Syphilis is rare but due to its potential to cause widespread damage, it needs to be taken into consideration whenever an immunocompromised or high-risk patient presents with positive serology, respiratory symptoms, and imaging evidence. Due to its good response to treatment, if detected early patients can be treated appropriately and effectively in a time efficient manner

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria.

We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient's rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.

Performance Assessment of Treponemal and Nontreponemal Tests for the Diagnosis of Acquired Syphilis.

There are a variety of nontreponemal test (NTT) and treponemal test (TT) kits for the serologic diagnosis of syphilis. Because of the complexity of the infection (multiple clinical stages) and the different antigens used in these kits, a systematic evaluation of the accuracy of the currently available commercial tests is warranted. Our objective was to evaluate the performance of commercially available tests for the diagnosis of syphilis infection. In this study, we analyzed one NTT (Venereal Disease Research Laboratory [VDRL] test, Wiener Laboratories, Rosario, Argentina) and two TTs (fluorescent treponemal antibody absorption [FTA-ABS] test, Euroimmun, Lübeck, Germany, and syphilis recombinant ELISA v. 4.0 test [ELISA], Wiener Laboratories, Rosario, Argentina) using a panel of 187 samples, including serum samples from 31 individuals with primary syphilis, 77 with secondary syphilis, and 79 with latent syphilis. An additional 192 samples from uninfected individuals and 323 serum samples from individuals with other diseases were included. The sensitivities of the VDRL, ELISA, and FTA-ABS tests were 97.9%, 100%, and 96.3%, respectively. The VDRL and ELISA tests showed a specificity of 100%, and the FTA-ABS test showed a specificity of 99.5%. Accuracy was 98.9% for the VDRL test, 100% for the ELISA, and 97.9% for the FTA-ABS test. For primary, secondary, and latent syphilis, the ELISA achieved a diagnostic performance of 100%, whereas the sensitivity for the VDRL and FTA-ABS tests ranged from 96.8% to 98.7% and 93.7% to 98.7%, respectively. No difference was observed when the tests were used as traditional or reverse algorithms. In general, all three tests are able to discriminate positive and negative samples for syphilis, regardless of the diagnostic algorithm.

Epidemiological characteristics of syphilis in mainland China, 2004 to 2019.

Syphilis is a globally prevalent sexually transmitted infection. This study aimed to elucidate the epidemiological characteristics of syphilis in China from 2004 to 2019. Incidence data for syphilis across 31 provinces in mainland China were obtained from the Data Center of China Public Health Science for the period from 2004 to 2019. Epidemiological methods and the Chi-squared test were used to analyze the temporal, regional, and disease stage distributions of syphilis. In total, 5,527,399 syphilis cases were reported in China from 2004 to 2019, with an average annual prevalence of 25.7063 per 100,000 population and overall increasing trend. In terms of regional distribution, high-incidence provinces included Shanghai, Zhejiang, Fujian, Guangxi, Guangdong, Xinjiang, Ningxia, and Qinghai. The proportion of latent syphilis increased from 20.41% in 2004 to 82.95% in 2019, with an upward trend each year. Syphilis incidence exhibited an overall increasing trend in China, and latent syphilis was predominant. Syphilis incidences considerably varied among regions, and syphilis was detected from coastal to inland provinces. Thus, syphilis prevention and control programs should be tailored according to the specific epidemiological characteristics of each region.

ORAL MANIFESTATION OF SECONDARY SYPHILIS IN A PATIENT WITH IMMUNOSUPPRESSION ASSOCIATED WITH HIV/AIDS - CASE REPORT

ORAL MANIFESTATION OF SECONDARY SYPHILIS IN A PATIENT WITH IMMUNOSUPPRESSION ASSOCIATED WITH HIV/AIDS - CASE REPORT

Treponema Pallidum rapid syphilis compared diagnostic algorithm syphilis in men who have sex with men (MSM).

Syphilis infection can be asymptomatic and difficult to diagnose based on clinical symptoms. Early detection and treatment are critical for preventing and controlling syphilis as well as long-term serious complications. A serological examination based on the diagnostic algorithm was used to confirm the diagnosis of syphilis. Syphilis is frequent in high-risk groups, such as men who have sex with men (MSM). Treponema pallidum (TP) rapid can be used for early syphilis detection. The diagnostic value of TP rapid with diagnostic algorithm (RPR-TPHA) utilizing whole blood in MSM should be studied. To determine the diagnostic value of TP rapid syphilis test compared to a diagnostic algorithm (RPR-TPHA) among MSM. A diagnostic test with a cross-sectional design at Dr Mohammad Hoesin Palembang General Hospital from November 2022 to January 2023. The sampling method was consecutive sampling with a total sample of 83 MSM based on inclusion and exclusion criteria. All samples were tested for RPR, TPHA, and TP rapid. The diagnostic value of TP rapid was evaluated with RPR-TPHA as a diagnostic algorithm for syphilis. The sensitivity and specificity value of the TP rapid compare diagnostic algorithm as gold standard were 95.8% and 96.6% respectively. Other metrics: positive predictive value (PPV) 92%, negative predictive value (NPV) 98%, positive likelihood ratio (PLR) 28.27, negative likelihood ratio (NLR) 0.04, accuracy 96% and AUC 0.962. The TP rapid test has a high diagnostic value and can be used to establish an early diagnosis of syphilis in MSM.

Secondary syphilis with tuberculosis co-infection: A rare case

Secondary syphilis with tuberculosis co-infection: A rare case

Letter in response to “Frequency of asymptomatic neurosyphilis in patients with latent syphilis: A 4-year retrospective study from a tertiary care center”

Letter in response to “Frequency of asymptomatic neurosyphilis in patients with latent syphilis: A 4-year retrospective study from a tertiary care center”

Clinical Updates in Sexually Transmitted Infections, 2024.

Sexually transmitted infections (STIs) continue to increase in the United States with more than 2.5 million cases of gonorrhea, chlamydia, and syphilis reported to the Centers for Disease Control and Prevention in 2022. Untreated STIs in women can lead to adverse outcomes, including pelvic inflammatory disease, infertility, chronic pelvic pain, and pregnancy complications such as ectopic pregnancy, early pregnancy loss, stillbirth, and neonatal transmission. STI-related guidelines can be complex and are frequently updated, making it challenging to stay informed on current guidance. This article provides high-yield updates to support clinicians managing STIs by highlighting changes in screening, diagnosis, and treatment. One important topic includes new guidance on syphilis screening, including a clarified description of high community rates of syphilis based on Healthy People 2030 goals, defined as a case rate of primary or secondary syphilis > 4.6 per 100,000. Reproductive aged persons living in counties above this threshold should be offered syphilis screening. Additionally, American College of Obstetricians & Gynecologists now recommends syphilis screening three times during pregnancy regardless of risk-at the first prenatal visit, during the third trimester, and at delivery. In addition, new guidance to support consideration for extragenital screening for gonorrhea and chlamydia in women at sites such as the anus and pharynx is discussed. Other topics include the most recent chlamydia, gonorrhea, trichomoniasis, and pelvic inflammatory disease treatment recommendations; screening and treatment guidance for Mycoplasma genitalium; genital herpes screening indications and current diagnostic challenges; and the diagnosis and management of mpox in women and during pregnancy.

Determination of molecular types and resistance to macrolides in <i>Treponema pallidum</i> isolates isolated in the Russian Federation

Background. The number of syphilis cases in the Russian Federation increased significantly in 2022. Control of heterogeneity of Treponema pallidum subtypes is important to monitor the emergence and spread of antibiotic-resistant strains Aims. To determine molecular subtypes and resistance to macrolides in T. pallidum isolates isolated in the Russian Federation in 2022. Methods. We analyzed DNA isolated from 49 samples of clinical material obtained from patients from dermatovenerological treatment and prevention facilities in three federal districts (CFD, SFD, SCFD) of the Russian Federation in 2022 with diagnoses of primary syphilis and secondary syphilis. T. pallidum DNA isolation and confirmation of the presence of genetic material were performed according to the existing algorithms. To search for genetic determinants of resistance to macrolides, a fragment of the 23S rRNA gene was analyzed. Primary decoding of nucleotide sequences was performed in Sequencing Analysis 5.3.1. Mega 11 program was used to align the analyzed fragments of target genes to T. pallidum reference sequences. Results. In 2022, three subtypes of T. pallidum were identified in the territory of the represented federal districts of the Russian Federation: 14d/f, 14d/g, 14d/d with continued dominance of subtype 14d/f. The macrolide-resistant subtype 14d/d was identified in two federal districts, which is new for the Russian Federation. Conclusions. The population of T. pallidum continues to expand in the Russian Federation, including the emergence of azithromycin-resistant strains. The data obtained confirm the need for continuous monitoring of circulating strains and may facilitate understanding of their geographic distribution.