Low Prevalence Of Syphilis Research Articles

Detection of syphilis among patients attending a General Hospital in Ogbakiri, River State, Nigeria

The syphilis-causing agent, Treponema pallidum, has long posed a threat to public health. In sub- Saharan Africa, it is a significant public health issue and is common in developing nations. This study looked into the syphilis prevalence among patients at Rivers State's Ogbakiri General Hospital. Eighty-nine samples were used in total for this investigation after haemolysing; those with fibrin and heavy particles were discarded. For these samples, stratified socio-demographic data were used. In the population, 31 (34.8%) patients were males and 58 (65.2%) were females. Ages ranged from 18 to 75, individuals between the ages of 18 and 30 made up 56.2% of the population; patients between the ages of 31 and 40 made up 10.1% patients between the ages of 41 and 60 made up 21.4% and patients aged 61 and beyond made up 12.4%. Also, 38 (42.7%) and 51 (57.3%) of the population, respectively, were singles and married, 13 (14.6%) of the study population had primary education, 45 (50.6%) had secondary education, and 23 (25.8%) had postsecondary education, according to the results of the educational status analysis. Based on occupational status, there were 8 (8.9%) nurses. According to the study, 2.2% of those who tested were positive for syphilis. Syphilis was found to be more common in people aged 61 to 75 (9.1%), males (3.2%), singles (5.3%) and higher educational status (4.3%). According to this report, Ogbakiri, Nigeria's Rivers State has a relatively low syphilis prevalence compared to other areas in the country.

Trends of HIV and syphilis prevalence among pregnant women in antenatal clinics in Togo: Analysis of sentinel serosurveillance results between 2008 and 2016

RésuméIntroductionLe but de notre étude était d'analyser les tendances de l'infection à VIH et de la syphilis chez les femmes enceintes en consultation prénatale (CPN) dans les structures de soins du Togo.MéthodesIl s'est agi d'une étude rétrospective analytique, couvrant la période de 2008 à 2016 et portant sur les femmes enceintes de 15 à 49 ans vues en CPN pour la première fois dans les services de santé maternelle et infantile au Togo.RésultatsDurant la période d’étude, 41 536 femmes enceintes ont été enregistrées. L’âge moyen des patientes était de 26 ± 6 ans en 2008, 2009 et 2010. La prévalence globale du VIH était passée de 3,4% en 2008 à 2,9% en 2016 (p = 0,0145). Elle est passée de 1% en 2008 à 0,5% en 2016 et de 3,6% en 2008 à 1,4% en 2016 (p < 0,0001) respectivement chez les 15-19 ans et les 20-24 ans. La prévalence de la syphilis baisse de façon significative de 2008 (1,3%) à 2016 (0,6%), (p < 0,0001). Elle est faible et non associée à l’âge en 2008, alors qu'elle était de 0,2% et 0,4% en 2016 respectivement dans la tranche d’âge de 15-19 ans et de 20-24 ans.ConclusionNotre étude documente une prévalence relativement faible de la syphilis et du VIH chez la femme enceinte au Togo, avec une baisse significative chez les adolescentes et les jeunes femmes témoignant de l'efficacité de l'augmentation du dépistage et de la prévention globale des IST, du VIH y compris l'approche traitement antirétroviral comme prévention (TASP, Treatment as prevention), et du programme d’élimination de la syphilis néonatale dans le pays.

ROUTINE SCREENING FOR SYPHILIS: IS IT TIME FOR RECONSIDERATION?

Abstract Syphilis is a sexually transmitted disease which is caused by Treponema pallidum. Its prevalence is higher in Africa, South-East Asia, and Western Pacific region. But in Iran, its prevalence is low and several epidemiological studies have reported no case of syphilis during routine screening programs. Also, we know from unpublished data that we have had no cases of syphilis in Hormozgan province for at least 10 years in about 300,000 individuals screened for VDRL. Routine screening for syphilis is associated with high costs to the health system and may be unnecessary in areas with very low incidence of syphilis. However, there is insufficient evidence available for recommendation of deleting routine screening for syphilis in areas with low prevalence of the disease, but it seems that doing large observational studies in these areas can be useful for establishing local protocols for syphilis screening based on the prevalence of disease in each area. In areas with low prevalence of syphilis, we recommend screening of syphilis only in high risk individuals.

Prevalence of HAV Ab, HEV (IgG), HSV2 IgG, and Syphilis Among Sheltered Homeless Adults in Tehran, 2012.

Background: This study investigated the prevalence for hepatitis A virus (HAV), hepatitis E virus (HEV), herpes simplex virus type 2 (HSV2) and syphilis among homeless in the city of Tehran. Methods: In this cross-sectional study, 596 homeless were recruited in Tehran. A researcher-designed questionnaire was used to study demographic data. Using enzyme-linked immunoassay, and rapid plasma reagin (RPR) test, we evaluated the seroprevalence of HAV anti-body, HEV IgG, herpes, HSV2 IgG, and syphilis among sheltered homeless in Tehran. The associations between the participant’s characteristics and infections were evaluated using logistic regression and chi-square. Results: A total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from June to August 2012. Their age mean was 42 years and meantime of being homeless was 24 months. Seroprevalence of syphilis, HEV IgG, HSV2 IgG and HAV Ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. History of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. Among people who had intravenous drug abuse, 48.25% had history of syringe sharing. Conclusion: The prevalence of HAV, HEV and HSV2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (STD). Our findings highlighted that significant healthcare needs of sheltered homeless people in Tehran are unmet and much more attention needs to be paid for the health of homeless people.

Traditional versus reverse syphilis algorithms: A comparison at a large academic medical center

ObjectivesAn increasing number of institutions are transitioning from the traditional syphilis testing algorithm (initial screening with nontreponemal tests) to the ‘reverse’ algorithm (initial screening with treponemal tests such as syphilis IgG). The aim of this study was to evaluate the switch in syphilis algorithm at an academic medical center with a population with low syphilis prevalence. Design and methodsWe performed a six-year retrospective study at the University of Iowa Hospitals and Clinics, an academic medical center, comparing the traditional algorithm (n=12,612) with the reverse algorithm (n=10,453). False positives were considered to be positive screens with negative confirmatory testing. ResultsUsing the traditional algorithm, 93 samples (0.7% of total) screened positive with RPR, with 40 of these samples having negative TP-PA testing (43% of positive screens, 0.3% of total). Using the reverse algorithm, 110 screened positive with syphilis IgG (1.1% of total), and 33 of these samples had both negative RPR and TP-PA (30% of positive screens, 0.3% of total). In both algorithms, higher RPR titers and syphilis IgG values were associated with increased probability of positive confirmation. ConclusionsIn this study at an academic medical center, the reverse algorithm had significantly more total positive screens than the traditional algorithm. Both algorithms produced equivalent rates of active infection. The quantitative difference in positives between the two algorithms are the category of patients who are syphilis IgG positive, RPR non-reactive, and TP-PA reactive. Specimens with higher RPR titers and syphilis IgG values are more likely to confirm positive.

Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study

ObjectivesThis study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis,...

Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis.

This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.

P09.37 Syphilis rapid test validation for treponemal diagnosis in guatemala, 2013–2014

Background International guidelines for syphilis testing recommend non-treponemal tests, and confirmation by more complex treponemal test such as Treponema pallidum haemagglutination (TPHA), enzyme-linked immunosorbent assay (ELISA) or others. Similar to HIV rapid tests, rapid treponemal tests can improve point-of-care testing in laboratories with limited capacities. We present main results of a validation for treponemal diagnosis performed in Guatemala. Methods A syphilis rapid test laboratory validation was performed in two phases during 2013–2014. First stage was performed using frozen serums from National Health Laboratory and second stage was performed using whole blood from pregnant women from peripheral health services from Guatemala City. Four treponemal rapid tests were evaluated in the first stage: Determine TP (DetTP), SD Syphilis (SDSyp), Omega Visitect (OVis), and Rapid Syphilis (RSyp). Only two tests were evaluated in the second stage: DetTP and SDSyp. For confirmation, TPHA was used for diagnosis of treponemal antibodies in serum and treponemal ELISA for plasma. Results A total of 460 serums were evaluated in first stage and 432 whole blood samples in second stage. Compared to TPHA, sensitivity ranged from 87.8% for RSyp to 99.2% in DetTP in serum and 100% for SDSyp and DetTP in whole blood. Specificity was lower, ranging from 74.8% for DetTP to 87.7% for SDSyp in serum and 100% for SDSyp and DetTP in whole blood. Conclusion Rapid treponemal tests are a useful diagnostic tool in syphilis. Sensibility was high enough to be used as a screening test, with good results in whole blood samples. Low prevalence of syphilis in the validation contributed to poor positive predictive values. The use of a reverse algorithm might be useful for implementation of this test in Guatemala. Disclosure of interest statement We declare that we have no conflicts of interest.

Demographic determinants of syphilis seroprevalence among U.S. blood donors, 2011-2012.

BackgroundNo cases of transfusion-transmitted syphilis have been described for over four decades. While there is mandatory transfusion screening for syphilis, the absence of transmission is in part ascribed to a low prevalence of syphilis in the blood donor population, the concomitant use of antibiotics in a high proportion of transfusion recipients, allied with poor survival of T. pallidum during refrigerated storage of blood products.MethodsA cross-sectional retrospective data analysis was conducted to ascertain the prevalence of Treponema pallidum antibodies in U.S. blood donors by demography and geography. Routine blood donation testing data and demographics were extracted from the data warehouse of a large network of U.S. blood centers. Crude and adjusted prevalence of T. pallidum antibodies and active syphilis infection were calculated, and GIS mapping was used to illustrate geographic distribution.ResultsThe prevalence of T. pallidum seropositivity and active syphilis in first time donors was 162.6 (95% CI 145.5-181.2) per 100,000 donors and 15.8 (95% CI 10.8-22.3) per 100,000 donors, respectively. The odds of T. pallidum seropositivity were significantly elevated in African American (OR = 18.9, 95% CI 14.2-25.2), and Hispanic (OR = 2.8, 95% CI 2.0-3.8) as compared to Caucasian donors. Similarly, the odds of active T. pallidum infections were significantly higher in African American (OR 15.0, 95% CI 7.0-32.3) and Hispanic (OR = 5.8, 95% CI 2.9-11.6) as compared to Caucasian donors. Syphilis seropositivity was associated with first time blood donation, increasing age, lower education, birth outside the US, and positive tests for HIV and HCV. Geographically, T. pallidum seropositivity was increased in southern and western regions of the US.ConclusionsGiven the low seroprevalence of syphilis in blood donors, continued screening remains debatable; however it may provide a public health benefit through surveillance of at-risk populations.

Finding a needle in the haystack: the costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia.

BackgroundIn March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out.MethodsInformation on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study.ResultsDuring the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60.ConclusionsScreening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

The discordant results in serum through reverse syphilis screening algorithm

The emerging reverse sequence on syphilis screening program generates special discordant results, characterized with the appearance of both positive treponemal test and negative nontreponemal test at the same time. The aim of this study was to analyze the characteristics of the discordant results among low syphilis prevalence population in China, to provide evidence for improving the process of reverse sequence syphilis screening program. Laboratory data was retrospectively analyzed, under reverse sequence screening algorithm selecting ELISA as the initial screening test for syphilis. All the screening reactive samples were tested by TPPA for confirmation and by quantitative TRUST for the reactivity of syphilis. 666 out of a total of 21 049 serum samples were reactive under the screening program. Among the 666 reactive samples, 169 were reactive to TRUST. One in the 169 samples was confirmed negative on TPPA, and the faulse positive rate on ELISA was 0.6% (1/169). In those 666 reactive samples, 497 were nonreactive to TRUST. 74 in the 497 samples were confirmed negative to TPPA, with faulse positive rate of ELISA as 14.9% (74/497). In the group of 591 TPPA confirmed positive samples, the TRUST negative rate was found 71.6% (423/591), significantly higher than the TRUST positive rate(chi-square test, χ(2) = 110.025, P = 0.000). Among the results from reverse sequence syphilis screening program, majority of the samples which showed positive treponemal antibody, would have negative nontreponemal antibody. We therefore recommended a more reasonable reverse sequence syphilis algorithm to be used. Faulse positivity could be eliminated if TPPA was performed on all screening reactive samples by ELISA a first and then followed by quantitative TRUST on samples that were TPPA confirmed as positive.

P5.089 Confirmation of High Specificity of an Automated ELISA Test For Serological Diagnosis of Syphilis - Results from Confirmatory Testing After Syphilis Screening and Sensitivity Analysis in the Absence of a Gold Standard

Background In clinical microbiology laboratories, serological diagnostic assays are usually implemented after evaluation using a selected sample collection. We have previously evaluated the performance of the Bioelisa Syphilis 3.0 compared with the Treponema pallidum Particle Agglutination (TPPA) in a selected collection of serum samples (syphilis positivity rate 44%) and found a sensitivity and specificity of both 100%. In the current study we have compared the specificity of Bioelisa Syphilis 3.0 after clinical implementation as a syphilis screening test with the specificity found in the previous evaluation to assess whether the high specificity would stand up in clinical practise. Methods We included 14,622 sera (positivity rate 0.9%) sent to the laboratory for syphilis serology in the period between October 2007 and February 2010. Results We confirm the initially reported specificity and further narrow down its confidence interval (specificity 99.5%, 95% CI 99.4–99.6%), and show that this high specificity is valid across diverse patient categories. Here we demonstrate that differences in positive predictive values between patient categories reflect the prevalence of syphilis in these categories, and are not due to differences in specificity. In addition, in a sensitivity analysis we show that these conclusions are robust for several assumptions. Conclusion Our analysis shows that the high specificity found in the initial study, stands up after implementation in a population with a low syphilis prevalence (0.9%). Using a selected serum sample collection is therefore a valid manner in the evaluation of syphilis serological diagnostic assays. Confirmatory syphilis testing remains mandatory in low prevalence populations, even when the screening test has a very high specificity.

Syphilis and HIV-1 among parturient women in Salvador, Brazil: low prevalence of syphilis and high rate of loss to follow-up in HIV-infected women

BackgroundThe occurrence of syphilis and HIV-1 infections during pregnancy are major risks to the fetus due to mother-to-child transmission (MTCT). ObjectivesTo determine peripartum seroprevalence and risk factors of syphilis and HIV-1 infection among pregnant women in Salvador, Brazil, and the rate of HIV-1 MTCT. MethodsCross-sectional study of pregnant women who were admitted for delivery in a reference maternity hospital between May 2008 and March 2009 was conducted. Women were screened for HIV-1 infection and syphilis, and interviewed regarding demographic, behavioral and obstetric data. Newborns to HIV-infected mothers were tested by b-DNA and DNA-PCR to detect HIV-1. ResultsA total 3300/8516 women were evaluated. Mean age was 25.8±7.3 years. HIV-1 and syphilis seroprevalence rates were 0.84% (28/3300) and 0.51% (17/3300), respectively. HIV-1 infection was associated with: low education (p=0.04), having a partner with known HIV infection (p<0.0001) or with previous sexually transmitted infection (p<0.0001), blood transfusion (p=0.003), or accidental exposure to blood (p=0.003). Syphilis was associated with being Caucasian (p=0.02), having no steady partner (p=0.02), being a housewife (p=0.01), having an intravenous drug user (IVDU) sexual partner (p=0.04) or a sexual partner with previous STI (p<0.001). Higher education (p=0.04) was protective against HIV-infection. Attending a prenatal care program was protective against syphilis (p=0.008) and HIV-1 (p=0.02). No case of HIV-1 MTCT was detected, but 25% of children born to HIV-infected mothers were lost to follow up. ConclusionsIn Salvador, peripartum prevalence of syphilis and HIV-1 infection among pregnant women were low, and associated with classic risk factors for both infections. The great proportion of very late diagnosis of HIV infection, and the high rate of loss of follow-up among positive mothers and their infants are of high concern.

Consistently Low Prevalence of Syphilis among Female Sex Workers in Jinan, China: Findings from Two Consecutive Respondent Driven Sampling Surveys

BackgroundRoutine surveillance using convenient sampling found low prevalence of HIV and syphilis among female sex workers in China. Two consecutive surveys using respondent driven sampling were conducted in 2008 and 2009 to examine the prevalence of HIV and syphilis among female sex workers in Jinan, China.MethodsA face-to-face interview was conducted to collect demographic, behavioral and service utilization information using a structured questionnaire. Blood samples were drawn for serological tests of HIV-1 antibody and syphilis antibody. Respondent Driven Sampling Analysis Tool was used to generate population level estimates.ResultsIn 2008 and in 2009, 363 and 432 subjects were recruited and surveyed respectively. Prevalence of syphilis was 2.8% in 2008 and 2.2% in 2009, while no HIV case was found in both years. Results are comparable to those from routine sentinel surveillance system in the city. Only 60.8% subjects in 2008 and 48.3% in 2009 reported a consistent condom use with clients during the past month. Over 50% subjects had not been covered by any HIV-related services in the past year, with only 15.6% subjects in 2008 and 13.1% in 2009 ever tested for HIV.ConclusionsDespite the low prevalence of syphilis and HIV, risk behaviors are common. Targeted interventions to promote the safe sex and utilization of existing intervention services are still needed to keep the epidemic from growing.

Direct Comparison of the Traditional and Reverse Syphilis Screening Algorithms in a Population with a Low Prevalence of Syphilis

We describe the first direct comparison of the reverse and traditional syphilis screening algorithms in a population with a low prevalence of syphilis. Among 1,000 patients tested, the results for 6 patients were falsely reactive by reverse screening, compared to none by traditional testing. However, reverse screening identified 2 patients with possible latent syphilis that were not detected by rapid plasma reagin (RPR).

P1-S1.48 Prevalence of syphilis in antenatal clinic attenders and associated risk factors

BackgroundMaternal syphilis can adversely affect pregnancy outcomes. This can be averted if women are tested and treated adequately during pregnancy. As part of a programme towards the introduction of routine...

Herpes simplex virus type 2 infection among female sex workers in Shanghai, China

A study with two cross-sectional surveys in two consecutive years was conducted in Shanghai, China to examine the seroprevalence of herpes simplex virus type 2 (HSV-2), syphilis and HIV among female sex workers (FSW). A total of 793 FSW participated in the survey, 382 in 2008 only, 382 in 2009 only, and 29 in both 2008 and 2009. The majority of them were less than 30 years and two-thirds were married. All were migrants and a half was from rural areas. Some of them have stayed in Shanghai and engaged in commercial sex for more than two years. Their knowledge of HIV/AIDS was limited. Condom use was not common for both marital sex and non-commercial extramarital sex but fairly frequent for commercial sex. Two-percent were using drugs in the past year. Nearly one quarter reported having syndromes of sexually transmitted diseases (STD) in the past year, with a substantial proportion of them untreated or treated inappropriately. No one was HIV-infected. The overall HSV-2 seroprevalence was 47.3% (375/793), 45.5% (187/411) in 2008 and 50.1% (206/411) in 2009. The overall prevalence of syphilis was 4.5% (36/793), 7.0% (29/411) in 2008 and 2.4% (10/411) in 2009. Multiple logistic regression analyses indicated that HSV-2 infection was statistically associated with age, type of working venue, origin, and period of staying in Shanghai; whereas syphilis infection was statistically associated with year of participation and smoking status. In conclusion, HSV-2 is highly prevalent among FSW in Shanghai, with a relatively low prevalence of syphilis. The currently low HIV epidemic in this population provides a window of opportunity to implement tailored HIV/STD prevention and control efforts targeting them, with particular attentions to large numbers of HSV-2-infected FSW and their clients.

Low prevalence of syphilis in Brazilian inmates

Low prevalence of syphilis in Brazilian inmates

Prevalence of Treponema pallidum Infection among Human Immunodeficiency Virus Seropositive Persons and Their Corresponding CD4 Counts in a Nigerian Cohort

Background: Sexually transmitted infections are a major public health problem especially with the advent of HIV/AIDS. This study was conducted to determine the prevalence of Syphilis among HIV seropositive persons. The study population was seropositive persons accessing antiretroviral therapy (ART) at the Federal Medical Center Keffi. Methodology: Venous blood (5ml) was collected from each of the 200 consenting participants between February and August 2010. Their syphilis serostatus was determined using Rapid Plasma Reagin test and confirmed by an immunochromatographic rapid syphilis test kit. The CD4 count of the positive sample was also determined. Results: Of the 200 persons screened, 56 were males and 144 were females. The prevalence of Treponema pallidum in this study population was 0.5% (1/200). The HIVsyphilis positive was a married man aged 35 years and with a CD4 cell count of ≥ 200 cells/uL. Conclusion: This study reported a very low prevalence of syphilis among HIV positive persons. It is recommended that the sexual partner(s) of the study index case should be traced and also treated to prevent reinfection and/or continued spread of the infection. Despite the low prevalence in this study, syphilis screening among those with HIV should be advocated routinely to avoid the complications associated with the dual infection.

Detecção de sífilis por ensaios de ELISA e VDRL em doadores de sangue do Hemonúcleo de Guarapuava, Estado do Paraná

The aim of this study was to evaluate the syphilis seroprevalence among 5,752 blood donors who were attended at the blood center of Guarapuava, State of Paraná, in 2006. The seropositivity rates were 2.1% for enzyme Linked Immuno Sorbent Assay and 0.2% for Veneral Disease Research Laboratory, thus showing low prevalence of syphilis among the individuals who came to this blood bank.