Positive Syphilis Serology Research Articles

Neurosyphilis in a clinical cohort of HIV-1-infected patients

To describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis. Comprehensive demographic, clinical, and therapeutic data were collected prospectively on all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells >10/microl; protein >50 mg/dl; reactive venereal diseases research laboratory], (b) an otherwise unexplained neurological finding. Of 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria (median age 38.6 years, 79.1% male). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18-7.02), a rapid plasma regain titer >1: 128 (2.83; 1.11-7.26), and male sex (2.46; 1.06-5.70). Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P = 0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis. Early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis.

Profile of Anti-Tp47 antibodies in patients with positive serology for syphilis analized by western blot

In Brazil, syphilis is still a great problem of public health. Serological test is essential for syphilis diagnosis and the current trend is the use of recombinant antigen in the treponemal tests, due to its confirmed higher sensibility and specificity. The purpose of the present study was to analyze the profile of anti-Tp47 antibodies in patients with positive serology for syphilis. One hundred positive sera samples were analyzed by Western Blot (WB) technique, using the recombinant antigen (rTp47). Ten of them did not present antibodies against the fraction rTp47, the results were confirmed by WB using native T. pallidum antigen. All ten samples had antibodies against the fractions Tp17 and Tp15 and presented low reactivity in VDRL, negative results or title below than 1:4. Considering that VDRL is used for therapeutic monitoring due to seroreversion of nontreponemal antibodies in response to the treatment, and that some studies reported loss of treponemal antibodies after treatment, we could speculate if these ten samples are cases of serological memory from patients previously treated for syphilis. In addition, although several features state the Tp47 fraction as one of the major antigenic components, based on our results we point out to the importance of including other antigenic proteins such as Tp17 and Tp15 in addition to Tp47 in tests for serological screening of syphilis.

Méningovascularite d’origine syphilitique : étude de cinq cas

Introduction Clinical manifestations of syphilis are highly variable, and currently on the rise. We report five cases of ischemic stroke related to neurosyphilis. Case report The cases of five men aged 37, 34, 41, 42 and 44 years are reported. A notion of a genital chancre was noted in three. The clinical presentation was typical of ischemic stroke in four patients. One presented with intellectual deterioration. Imaging revealed zones of ischemia in all five patients. Examination of the cerebrospinal fluid revealed lymphocytic meningitis and all five patients exhibited positive syphilis serology. Brain angiography demonstrated signs of arthritis in four patients and carotid dissection in one. Improvement was achieved with penicillin G in four patients. Conclusion When the cause is doubtful, the routine work-up for ischemic stroke in young subjects should include syphilis serology.

Psychiatric manifestations during the course of late (tertiary) syphilis: Diagnostic dilemmas and therapeutic considerations a propos of a case report

Introduction:Neurosyphilis results from infection of the brain, meninges or spinal cord by the spirochete Treponema pallidum and comprises a wide spectrum of clinical and pathological features including psychiatric symptoms. We report the case of a patient who presented with psychotic symptoms and was diagnosed with late syphilis.Case report:A 45-year-old male with anxiety, insomnia, auditory hallucinations, delusions of persecution and mild cognitive impairment of relative recent onset was admitted to the Department of Skin and Venereal Diseases because of serological evidence of syphilis (TPHA 1:320). Upon admission treatment with olanzapine (15 mg/d) was started. Further evaluation yielded positive syphilis serology (TPHA, RPR and FTA-abs) in serum, slight cerebral atrophy in CT and discrete aneurysmatous dilatation of the aortic arch by heart ultrasonography. CSF findings did not satisfy laboratory criteria for the confirmation of diagnosis of active neurosyphilis. Late (tertiary) syphilis with beginning cardiovascular involvement was diagnosed and treatment with benzathin penicillin was administered. Six months later he was readmitted for a follow-up examination. Psychiatric symptoms were improved.Conclusion:Although quite rare today, neurosyphilis should be considered in the differential diagnosis of patients with psychotic symptoms and positive syphilis serology, as the appropriate treatment depends on early and accurate diagnosis. Moreover, given the wide use of antibiotics, abortive cases of neurosyphilis with atypical presentation forms must also be considered. Finally, this case suggests that in addition to the appropriate antibiosis, treatment with antipsychotics seems to be effective in controlling psychiatric symptoms emerging in the course of late syphilis.

Inguinal phlegmon and positive serology for syphilis after penile bite laceration: true, true and unrelated

Among many causes of penile injury, sexual activity is infrequently reported. The present case involved delay in recognition, which led to development of a phlegmon near major vascular structures. Positive serologic evidence of syphilis was an incidental finding.

Communicable diseases in the immigrant population attended to in a tropical medicine unit: Epidemiological aspects and public health issues

For geographical and historical reasons, Spain is receiving an increasing number of immigrants. The aim of this study was to evaluate some epidemiological aspects and the main public health issues of communicable diseases in Barcelona's immigrant population. From 2001 to 2004, a population of immigrants from tropical, subtropical regions and Eastern Europe was attended to in our centre. Each patient was offered a complete screening for tropical and common diseases. The prevalence and demographical characteristics of eight diseases with a potential risk of transmission in our setting were studied: latent and active tuberculosis, syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), Chagas disease, Giardia intestinalis and Entamoeba histolytica/Entamoeba dispar. In all, 2464 immigrants mainly from sub-Saharan Africa were seen. Among the patients who underwent the screening, 46.5% had a positive tuberculin skin test (>or=10 mm), incidence of active tuberculosis was 324.7/100,000 immigrants in the period of the study, 6.4% had a positive syphilis serology, 7.7% had a positive HBsAg, 3.1% had a positive serology for HCV and 2.8% were HIV positive, 41 patients from Latin America with risk factors for American Trypanosomiasis were screened for Chagas disease by immunofluorescence assay and 34% had a positive result; 5.4% of stools parasitological tests were positive for G. intestinalis; 4.2% for E. histolytica/E. dispar. Communicable diseases in immigrant population could lead to emerging and re-emerging infections in the European Union with important issues for public health. European countries may have to establish guidelines for screening of infectious diseases in immigrants from low-income countries.

Sexually transmitted infections among UK street-based sex workers

Background:Female sex workers are a heterogeneous group and recent reports of declining incidence of sexually transmitted infections (STIs) do not apply to all populations. This is an observational study of...

Syphilis in Immigrants and the Canadian Immigration Medical Examination

Immigrants to Canada must undergo screening for syphilis. This study presents the results of syphilis screening from 2000 to 2004 and describes its impact on Canadian syphilis reporting and epidemiology. The study identifies migrant groups at risk of syphilis disease. All permanent resident applicants 15 years of age or older; younger individuals who have syphilis risk factors, and long-term temporary resident applicants are required to have non-treponemal syphilis screening done. Reactive results were confirmed. Immigration-related syphilis screening results were analyzed for year, migrant origin, migrant age and classification. A total of 2,209 individuals were found with positive syphilis serology from the screening of 2,001,417 applicants. The sex ratio of positive cases was M:F = 1.4. Rates per 100,000 applicants were: refugees 286, refugee claimants 267, family class 187, temporary residents 85, and economic class 63. Age and geographic distribution reflected sexual transmission, known international prevalence, and the Canadian processes of immigration. Certain immigration class applicants from syphilis high-prevalence source countries are a significant source of syphilis notifications in Canada. Identifiable populations and the immigration application medical processes represent global public health policy and program opportunities at the national level.

Pregnancy outcome in HIV-positive women in Enugu, Nigeria

SummaryThis is a retrospective case-control study of 62 HIV-positive women and 100 HIV-negative controls who delivered in the University of Nigeria Teaching Hospital, Enugu, from 2 August, 2002 to 31 March, 2004. The HIV-positive women were relatively younger and of lower mean parity than the HIV-negative controls. They were also significantly more likely to have positive syphilis serology, higher mean duration of labour, perineal tear, puerperal sepsis and higher mean duration of hospital stay, higher prevalence of low birth weight, birth asphyxia and more admissions to the Newborn Special Care Unit than the controls (p < 0.05). However, there was no significant difference in the two groups in the prevalence of hepatitis B surface antigenaemia, recurrent vulvovaginitis, abortions, stillbirths, congenital anomalies, pre-term delivery, mean interval between rupture of membranes and delivery and mode of delivery (p > 0.05). All (100%) the HIV-negative and 96.8% of the seropositive women had voluntary counselling and testing (VCT). There was no maternal death in either group. Untreated maternal HIV infection is associated with adverse pregnancy outcomes in the form of increased maternal and fetal morbidities. Hence for optimal outcomes, prevention of mother-to-child transmission (PMTCT) programmes must incorporate combination drug treatment for the mother as early in pregnancy as possible.

Prevalence of sexually transmissible infections (STI) among male patients with STI in Denpasar and Makassar, Indonesia: are symptoms of urethritis sufficient to guide syndromic treatment?

There are few data on sexually transmissible infections in men in Indonesia. We conducted a prevalence study and compared symptoms alone with clinical signs to manage urethritis. We recruited symptomatic male patients at public clinics, and used standardised questionnaires, examinations and laboratory tests. We recruited 273 men and the prevalences were Neisseria gonorrhoeae 18.2%, Chlamydia trachomatis 10.1%, and positive syphilis serology 5.2%. Four cases of HIV were detected. Urethral symptoms detected 91.7% of N. gonorrhoeae and/or C. trachomatis, and positive predictive value (PPV) was 41.8%, compared with clinical confirmation (sensitivity 86.1%, PPV 37.6%). Most cases of syphilis were asymptomatic, supporting routine screening for syphilis. Urethral symptoms predicted infection with N. gonorrhoeae/C. trachomatis better than clinical signs.

Frequency of Gynecologic Follow-Up and Cervical Cancer Screening in the Swiss HIV Cohort Study

According to current recommendations, HIV-infected women should have at least 1 gynecologic examination per year. To analyze factors associated with frequency of gynecologic follow-up and cervical cancer screening among HIV-infected women followed in the Swiss HIV Cohort Study (SHCS). Half-yearly questionnaires between April 2001 and December 2004. At every follow-up visit, the women were asked if they had had a gynecologic examination and a cervical smear since their last visit. Longitudinal models were fitted with these variables as outcomes. A total of 2186 women were included in the analysis. Of the 1146 women with complete follow-up in the SHCS, 35.3% had a gynecologic examination in each time period, whereas 7.4% had never gone to a gynecologist. Factors associated with a poor gynecologic follow-up were older age, nonwhite ethnicity, less education, underweight, obesity, being sexually inactive, intravenous drug use, smoking, having a private infectious disease specialist as a care provider, HIV viral load <400 copies/mL, and no previous cervical dysplasia. No association was seen for living alone, CD4 cell count, and positive serology for syphilis. Gynecologic care among well-followed HIV-positive women is poor and needs to be improved.

Treatment of neurosyphilis

In 2001, the incidence of primary and secondary syphilis increased in the United States for the first time in a decade. Increasing rates of early syphilis among men who have sex with men have been reported in many American cities, with similar outbreaks noted in Canada and Europe. In San Francisco, the increase has been particularly sharp and accompanied by an increase in the incidence of neurosyphilis. Early neurosyphilis develops within weeks to years of primary infection and primarily involves the meninges. Syndromes include syphilitic meningitis (often accompanied by cranial neuropathies), meningovascular syphilis (with associated ischemic stroke), or asymptomatic neurosyphilis. Late neurosyphilis occurs years to decades after exposure as cerebral or spinal gummatous disease or the classic parenchymal forms affecting the brain (general paresis or syphilitic encephalitis) or spinal cord and nerve roots (tabes dorsalis). Treponema pallidum, the causative agent, cannot be cultured in vitro, and microscopic techniques are laborious. Thus, diagnosis depends on serologic tests and cerebrospinal fluid (CSF) examination. The suboptimal sensitivity and specificity of these tests complicate diagnosis, particularly among patients coinfected with HIV. CSF examination should be performed to evaluate for neurosyphilis in all patients with positive serum syphilis serology and neurologic, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. Intravenous penicillin G is the recommended treatment for all forms of neurosyphilis and for syphilitic eye disease. An outpatient alternative, if adherence can be assured, is intramuscular benzathine penicillin with oral probenecid. Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. Syphilis facilitates transmission of HIV (and vice versa), and thus all patients diagnosed with syphilis should be offered HIV testing.

Pregnancy outcome in HIV seropositive women in Abakaliki, Nigeria

Objective : To study the seroprevalence and the effect of HIV infection on pregnancy outcome. Methods : From January 2000 to December 2004, 231 HIV seropositve women and 200 HIV seronegative matched groups from Abakaliki, Nigeria were recruited into a prospective study and followed until delivery. Results : The HIV seroprevalence was 5.4%. All the HIV seropositive women were asymptomatic and 12.7% (n=30) defaulted (including 80% of previously diagnosed cases) during the antenatal clinic follow-up and were excluded from further analysis. Majority (52.5%) of the seropositive women were at the peak (20-29 years) of their reproductive years and women of low parity were commonly affected. The seropositive women are significantly more likely than control to have recurrent vulvovaginitis, positive syphilis serology, perineal tear, postpartum haemorrhage, puerperal infection, birth asphyxia and increased perinatal mortality (P 0.05) in both groups. Delay in management contributed to maternal morbidity and perinatal mortality among the HIV seropositive mothers. Only six (2.9%) of the mothers and none of babies had antiretroviral therapy because of irregular supply in the hospital. Conclusion : There is need for the Obstetrician to ensure proper management of HIV seropositve mothers and for government to make the subsidized antiretroviral drugs widely available so as to reduce mother to child transmission of HIV virus. Keywords : HIV, pregnancy, outcome Orient Journal of Medicine Vol. 17(3&4) 2005: 25-30

Decline in sexually transmitted infection prevalence and HIV incidence in female barworkers attending prevention and care services in Mbeya Region, Tanzania

To assess trends in sexually transmitted infection (STI) prevalence and HIV incidence and associated factors in a cohort of female barworkers exposed to behavioural interventions and STI screening and treatment. An open cohort of 600 female barworkers in Mbeya Region, Tanzania was offered 3-monthly information and education sessions on HIV/STI and reproductive health, voluntary HIV counselling and testing and clinical health check-ups including STI syndromic management with simple STI laboratory support. Outcome assessments included HIV, herpes simplex virus type 2 (HSV-2) and syphilis serology, polymerase chain reaction for Neisseria gonorrhoeae, Chlamydia trachomatis and ulcerative STI, microscopy for Trichomonas vaginalis, Candida albicans and bacterial vaginosis and interviews on sociodemographic and behavioural characteristics. Over a period of 30 months 600 barworkers were enrolled at the baseline examination round and 153 thereafter as replacements for losses to follow-up. At 3-monthly examinations the prevalence of gonorrhoea declined steadily from 22.2 to 6.8% (odds ratio for trend per quarter: 0.81; P < 0.001). The prevalence of all other STI/RTI, except for genital herpes and bacterial vaginosis, also decreased significantly. HIV incidence declined from 13.9/100 to 5.0/100 person-years over three consecutive 9-month periods. HIV incidence was significantly associated with genital ulcers and positive syphilis serology, but not with genital herpes or HSV-2 seropositivity. A relatively simple intervention consisting of regular 3-monthly STI screening and syndromic management in combination with HIV/STI information and counselling sessions was well accepted and effective in reducing STI among barworkers. Such interventions should be implemented more widely in high-risk environments in sub-Saharan Africa.

Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi‐city study

To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority.

Integrating Prevention of Mother-to-Child HIV Transmission Into Routine Antenatal Care

With funds from Elizabeth Glaser Pediatric AIDS Foundation, the Cameroon Baptist Convention Health Board implemented a program to prevent mother-to-child transmission of HIV-1 (PMTCT) as part of its routine antenatal care, with single-dose maternal and infant peripartum nevirapine (NVP) prophylaxis of HIV-positive mothers and their babies. Nurses, midwives, nurse aides, and trained birth attendants counseled pregnant women, obtained risk factor data, and offered free HIV testing with same-day results. From February 2000 through December 2004, this program rapidly expanded to 115 facilities in 6 of Cameroon's 10 provinces, not only to large hospitals but to remote health centers staffed by trained birth attendants. We trained 690 health workers in PMTCT and counseled 68,635 women, 91.9% of whom accepted HIV testing. Of 63,094 women tested, 8.7% were HIV-1-positive. Independent risk factors for HIV-1 infection included young age at first sexual intercourse, multiple sex partners, and positive syphilis serology (P < 0.001 for each). We counseled 98.7% of positive and negative mothers on a posttest basis. Of 5550 HIV-positive mothers, we counseled 5433 (97.9%) on single-dose NVP prophylaxis. Consistent training and programmatic support contributed to rapid upscaling and high uptake and counseling rates.

Health indicators among low income women who report a history of sex work: the population based Northern California Young Women's Survey

We examined differences in demographic characteristics, HIV related risk behaviour, prevalence of sexually transmitted infections (STI), and HIV and other health concerns among women with and without a history of sex work. A secondary analysis of a population based, cross sectional survey of young, low income women in northern California. Of the 2543 women interviewed, 8.9% reported a history of sex work. These women reported more lifetime male sexual partners, were more likely to use drugs before sex, and were more likely to have a history of having sex with partners at high risk for HIV (that is, men who have sex with men, inject drugs, or were known to be HIV positive). They were significantly more likely to have positive serology for syphilis, herpes simplex virus type 2 (HSV-2), and hepatitis C regardless of their personal injecting drug use history; however, they were no more likely to have HIV, chlamydia, gonorrhoea, hepatitis A or hepatitis B infection compared to women without a history of sex work. Women with a history of sex work were significantly more likely to have a history of sexual coercion and tobacco use. These data measure the population prevalence of sex work among low income women and associated STI. Women with a history of sex work have health concerns beyond STI and HIV treatment and prevention.

The "Great Imitator." Syphilis as Causative Agent of Isolated, Concurrent, Acute Hepatitis and Meningitis

The first described case of acute concurrent hepatitis and meningitis as the isolated mode of presentation of syphilis in an HIV-infected homosexual man undergoing antiretroviral therapy is presented and discussed, on the ground of literature evidences and relevant epidemiological, diagnostic, therapeutic, and public health implications. A negligible epidemiological and medical history and the absence of other signs and symptoms of syphilis delayed the diagnosis, which was later confirmed through associated positive serum and cerebrospinal fluid syphilis serology. Histopathologic studies of the liver were also performed, as well as brain computed tomography scan. High-dose intravenous penicillin administration led to a rapid cure of both complications. When facing young patients with some signs and symptoms of hepatic and meningeal involvement, a syphilitic etiology should not be underestimated, especially when concurrent conditions (HIV disease and antiretroviral therapy in our case) may render differential diagnosis even more difficult. The recent resurgence of syphilis also focuses important public health issues, as a sign of a reduced attention to barrier preventive measures against sexually transmitted diseases.

Coimbra University Hospitals’ Bone and Tissue Bank: Twenty-two Years of Experience

We report the microbiological contamination rate of sterilely procured 3953 tissue allografts obtained during 22 years of activity for musculoskeletal reconstruction from 1982 to 2003. From 1987 to 2000, allograft retrievals were performed in 191 cadaveric donors and in 323 living donors. In the former group 30 retrievals (15.7%) were excluded based on laboratory criteria. Among living donors 108 femoral heads (33.4%) were also excluded by the same criteria. The microbiological contamination rate of sterilely procured allografts in the operating room was 8.3% for cadaveric donors and 18.2% for living donors. A questionable positive serology for HIV antigen was registered in two non–heart-beating donors. Hepatitis C virus antibodies were positive in two other non–heart-beating donors. Hepatitis B virus serological markers were positive or questionable in more than 11 non–heart-beating donors. In living donors 20 femoral heads were excluded (6.1%) due a positive or questionable hepatitis B virus serology. One femoral head donor showed a positive HTLV-I antibody and another one a positive syphilis serology. No positive serology cases for the HIV antibodies were found. No cases were registered of transmission of viral diseases from the donor to the recipient. Our extremely rigorous criteria led to the exclusion of a considerable number of both donors and allografts.

Extensive annular verrucous late secondary syphilis

We report an illustrative case of an apparently healthy 38-year-old man with a past history of alopecia universalis who developed extensive, slightly pruritic, infiltrated annular verrucous lesions of the scalp, perioral, lumbar, perianal and genital areas over a 6-month period. The combination of an unusual clinical presentation, positive syphilis serology and rapid response to penicillin therapy was consistent with a diagnosis of extensive annular and verrucous late secondary syphilis. We present this case to illustrate a rare and potentially misleading clinical feature of late secondary syphilis, a disease considered to be of the past but still present in today's practice.