Positive Syphilis Test Research Articles

1541. Prevalence of Asymptomatic Sexually Transmitted Infections (STIs) in a Philadelphia Ryan White HIV population

BackgroundIn 2018, Philadelphia County ranked 7th, 8th and 16th for chlamydia (CT), gonorrhea (GC), and syphilis cases, respectively, in the Centers for Disease Control (CDC) STI Surveillance Report. Asymptomatic presentations and lack of routine screening, especially at extragenital (i.e., pharyngeal and rectal) sites, increase the challenge of timely diagnosis and treatment. We determined extent of screening, reported symptoms, and asymptomatic infections.MethodsWe analyzed records of 372 patients receiving care at an urban, university-based Ryan White HIV clinic from 2016-2018. Outcomes included: positive GC/CT nucleic acid amplification tests from genital, pharyngeal, and rectal sites as well as new diagnoses of syphilis. We collected demographic data, risk factors for HIV transmission, time from HIV diagnosis, number of clinic visits, multiple sex partners, partner with STI, and injection drug use. We used logistic regression to model factors associated with STIs and determined prevalence of asymptomatic STIs.ResultsOf 372 participants, 234 (63%) were men, 262 (70%) were Black, 245 (66%) were over 40 years old, 148 (40%) identified as MSM, 140 (38%) reported inconsistent condom use, 89 (24%) reported multiple sex partners, 35 (9%) reported injection drug use, 141 (38%) had past STI, and 26 (7%) had partner with past STI. Mean time from HIV diagnosis was 12.3 years (SD, 8.8) and mean number of clinic visits was 2/year. Testing included 720 GC/CT urine, 176 GC/CT pharyngeal, 143 GC/CT rectal swabs and 887 syphilis blood tests. Asymptomatic GC/CT infections were seen in urine 6/22 (27%), pharyngeal 12/14 (86%) and rectal 28/31 (90%) swabs. And, of 39 new diagnoses of syphilis, 23 (59%) were asymptomatic. In multivariate analysis, men (aOR, 12.2, 95%CI, 2.7-55.3), < 40 years (3.2, 1.7-6.1), with clinic visit in 2018 (1.4, 1.2-1.8), and partner with STI (1.7, 0.9-2.8) were more likely to have a positive GC/CT test. Patients with positive syphilis test were more likely men (4.6, 1.1-20.2), with multiple sex partners (3.7, 1.7-8.0), and more recent HIV diagnosis (1.1, 1.0-1.1).Prevalence of Asymptomatic STIs ConclusionResults indicate the importance of routine, site-specific STI screening among patients living with HIV. Our findings can inform screening strategies among urban HIV populations.Disclosures All Authors: No reported disclosures

Papel do enfermeiro na inserção dos parceiros no pré-natal e tratamento de gestantes com sífilis

Objetivo: Identificar o papel do enfermeiro na inserção do parceiro no pré-natal e no tratamento de gestantes com exames positivos para sífilis. Métodos: Trata-se de uma revisão de literatura dos últimos dez anos, nas bases de dados: MEDLINE, LILACS, BDENF inseridos na BVSALUD; utilizando os descritores Sífilis; Gravidez; Recém-Nascido; Parceiros Sexuais; Enfermagem; e Terapêutica, cruzados por meio do conector booleano AND e OR. Resultados: Foram incluídos 22 artigos disponíveis na integra e nos últimos dez anos de pesquisa e publicação, nos idiomas português, inglês e espanhol. Conclusão: O enfermeiro tem um papel fundamental no acompanhamento e tratamento das gestantes com sífilis, além de que, o pré-natal das gestantes com exames de sífilis positivos é mais efetivo se houver a inclusão do parceiro. É necessário que seja realizado mais estudos sobre o papel do enfermeiro na abordagem dos parceiros das gestantes com sífilis.

Rectal douching in a community sample of men and women.

Rectal douching (RD) may be a vector for sexually transmitted infection (STI) acquisition. The aim of this study was to describe the relationship between RD, and the prevalence of various STIs and sexual behaviors in a sample of women and men in Long Beach, California. Five hundred and forty-seven men (mean age 42.8 years) and 530 women (mean age 37 years) recruited from a community-based setting between April 2010 and August 2014 completed the Risk Behavior Assessment and a questionnaire eliciting information on use of lubricants and enemas for vaginal intercourse (VI) and anal intercourse (AI). Participants were screened for high-risk behaviors for human immunodeficiency virus infection including injection drug use. Bivariate analyses were conducted separately for women and men. Based on the empirical results, separate logistic regression models for women and men were constructed. Sensitivity analysis was conducted to assess model fit for reduced samples of only those men and women who reported AI. For men, RD was associated with a lower odds of being hepatitis C antibody positive, greater odds of being positive for hepatitis B virus surface antigen, syphilis, and using lubricants for receptive anal intercourse (RAI). RD in women was associated with higher odds of a positive test for syphilis, ever vaginally douching for VI, and using lubricants for RAI. Men and women who practice RD report positive syphilis test results and use of lubricants for RAI. RD should not be perceived as preventing STIs.

Comparing age and sex trends of chlamydia, gonorrhoea, hepatitis and syphilis infections in Samoa in 2012 and 2017.

In Samoa, the seroprevalence rates of sexually transmitted infections other than HIV have been endemically high over the past decade, despite years of prevention programming. Odds ratio and χ2 tests were conducted to compare the rates of positivity of chlamydia, gonorrhoea, hepatitis B and C, and syphilis across age groups from 2012 and 2017 surveillance data in Samoa. Young people aged 15–19 years were significantly more likely to have a chlamydia infection compared to all other age groups in both 2012 and 2017. Hepatitis B infections were more common in males and those aged 30 and above in both 2012 and 2017. Hepatitis C had no significant differences in age, but it was more common in males in 2012 and more common in females in 2017. Older age groups (aged 45 and above) were more likely to have a positive syphilis test in both 2014 and 2017 when compared to those aged 15–24 years. The results of this analysis confirm previously observed trends in Samoa for younger age groups’ prevalence of chlamydia and gonorrhoea, and for older age groups’ prevalence of hepatitis B and C. But the analysis also unexpectedly found that older age groups (aged 45 and above) are more likely to test positive for syphilis (for years 2014 and 2017). Further studies are needed to assess behavioural risk factors associated with older populations to explain the increase in risk and to design interventions suited to this demographic.

Prevalence and factors associated with HIV and syphilis infection among children aged 0\u201336\xa0months in Kilimanjaro, Tanzania: a community-based cross-sectional study

BackgroundChildhood mortality is high in sub-Saharan Africa. Mother-to-child transmission (MTCT) of HIV and congenital syphilis are among significant causes. Dual elimination of these two infections is one of the international goals. Community-based studies on the burden of HIV and syphilis among children will contribute to fine-tuning the interventions to achieve the elimination goal. This study aims to describe the prevalence of HIV and syphilis among children aged 0–36 months and associated factors in northern Tanzania.MethodsThis was a community-based cross-sectional study, which was conducted in all the seven districts of Kilimanjaro region. Multistage sampling was used, and a total of 2452 children aged 0 to 36 months and their primary caretakers were enrolled. Interviews were conducted with the mother/caretaker, and dried blood samples were collected from the children and processed for laboratory diagnosis of HIV and syphilis. HIV ELISA was first performed on all the samples. Positive samples of children < 18 months were confirmed using PCR.ResultsThe prevalence of HIV among 2452 children aged 0–36 months was 1.7% (n = 42). There was a significant difference in the distribution of HIV by age of the child, maternal antenatal attendance, and breastfeeding history.The prevalence of syphilis was 0.4% (n = 10). Five of the children were more than 1 year old. All children with a positive test for syphilis were from Moshi rural district, and their mothers consumed alcohol. No child was co-infected with HIV and syphilis.ConclusionsThough the prevalence of the two infections was low, detecting syphilis in children suggests a missed opportunity in screening women during pregnancy. The region may be on track with the goal to achieve dual elimination of mother-to-child transmitted HIV and syphilis. However, efforts are needed to reduce missed opportunities for screening women for syphilis and HIV early in pregnancy and retesting at 3rd trimester/delivery. Strategies to improve testing for HIV-exposed children are needed.

Interdigital syphilis: a rare form of secondary syphilis

A 39-year-old man with bilateral painful erosions in his toe web spaces and on the penile shaft was misdiagnosed as having Gram-negative toe web infection, and treated with broad-spectrum oral antibiotics. Further evaluation revealed positive serological tests for syphilis. Pedal interdigital syphilis is a rare manifestation of secondary syphilis.

430. Impact of a Pharmacist-Managed Sexually Transmitted Disease (STD) Test Result Review Service at a Veterans Affairs Medical Center

BackgroundThe CDC recommends annual STD screenings in all sexually active women ³25 years old and men who have sex with men. Given the increased incidence of STDs and the need to improve their management, in September 2018 infectious diseases clinical pharmacists implemented a pharmacist-managed STD quality improvement project (QI) that reviewed positive STD test results with feedback to providers. We present the results of this QI project below.MethodsThe QI project consisted of prospective, daily reviews of all positive chlamydia, gonorrhea or syphilis tests (post-implementation period: 9/2018 to 2/2019). Patient electronic medical records were reviewed and assessed for the need for additional laboratory tests and to determine whether appropriate treatment was received, with feedback provided to the primary provider. In addition, risk factors were assessed to determine the appropriateness of human immunodeficiency virus (HIV) Pre-Exposure Prophylaxis (PrEP). A retrospective review of positive STD results from 9/2017 to 2/2018 was also conducted (pre-implementation period) for comparison. The purpose of this project was to evaluate the impact of pharmacist test result review on the appropriate testing, review appropriateness of prescribed treatments of patients diagnosed with any STD according to accepted clinical guidelines, and to inform the need for and the areas of focus for educating providers in the emergency room and primary care clinics on the management of these patients. Descriptive statistics, Chi square, and Fisher’s exacts tests were used to analyze the outcomes of the project.ResultsA total of 144 patients were included in the project (pre-implementation, n = 47; post-implementation n = 74). Please refer to the table for other results.ConclusionThe implementation of a pharmacist-managed STD test review service decreased time to treatment and time to STD test result review. More patients in the post-implementation period received appropriate therapy compared with patients in the pre-intervention period. These findings indicate that there is a role for a pharmacist-managed STD test review service in assisting providers with quickly and appropriately connecting patients to care. Disclosures All authors: No reported disclosures.

Molecular surveillance of hepatitis C virus genotypes identifies the emergence of a genotype 4d lineage among men in Quebec, 2001-2017.

Molecular phylogenetics are generally used to confirm hepatitis C virus (HCV) transmission events. In addition, the Laboratoire de santé publique du Québec (LSPQ) has been using molecular phylogenetics for surveillance of HCV genotyping since November 2001. To describe the emergence of a specific lineage of HCV genotype 4d (G4d) and its characteristics using molecular phylogenetics as a surveillance tool for identifying HCV strain clustering. The LSPQ prospectively applied Sanger sequencing and phylogenetic analysis to determine the HCV genotype on samples collected from November 2001 to December 2017. When a major G4d cluster was identified, demographic information, HIV-infection status and syphilis test results were analyzed. Phylogenetic analyses performed on approximately 22,000 cases identified 122 G4d cases. One major G4d cluster composed of 37 cases was singled out. Two cases were identified in 2010, 10 from 2011-2014 and 25 from 2015-2017. Cases in the cluster were concentrated in two urban health regions. Compared to the other G4d cases, cluster cases were all male (p<0.001) and more likely to be HIV-positive (adjusted risk ratio: 4.4; 95% confidence interval: 2.5-7.9). A positive syphilis test result was observed for 27 (73%) of the cluster cases. The sequences in this cluster and of four outlier cases were located on the same monophyletic lineage as G4d sequences reported in HIV-positive men who have sex with men (MSM) in Europe. Molecular phylogenetics enabled the identification and surveillance of ongoing transmission of a specific HCV G4d lineage in HIV-positive and HIV-negative men in Quebec and its cross-continental spread. This information can orient intervention strategies to avoid transmission of HCV in MSM.

Symptomatic congenital syphilis in a tertiary neonatal unit in Cape Town, South Africa: High morbidity and mortality in a preventable disease.

Despite preventive measures and effective treatment, congenital syphilis continues to impact significantly on neonatal morbidity and mortality. There has been no recent South African (SA) published literature reviewing congenital syphilis, particularly in the context of a tertiary neonatal setting. To describe the clinical features of symptomatic neonates with congenital syphilis and to identify modifiable patient, clinical and health facility factors that contributed to syphilis infection. All positive serological tests for syphilis performed in neonates at Groote Schuur Hospital (GSH), Cape Town, SA, between 1 January 2011 and 31 December 2013 were obtained. Folders were reviewed, and neonates with clinical signs of congenital syphilis were included. Of 50 symptomatic neonates, 19 (38%) died. Twenty-eight mothers (56%) were unbooked and therefore received no antenatal care. Most mothers (98%) were inadequately treated. Health worker-related failures included poor notification and partner tracing as well as failure to recheck syphilis serology after 32 weeks' gestation in mothers who initially tested negative. Thirty-four neonates required intensive care unit admission. Two significant predictors of mortality were 1-minute and 5-minute Apgar scores &lt;5. Hydrops fetalis was an independent risk factor for mortality, as were moderate to severely abnormal cranial ultrasound scan findings. Congenital syphilis in neonates admitted to the GSH neonatal unit was associated with substantial morbidity and mortality. The modifiable factors identified represent inadequate antenatal healthcare and health system failures. These factors are longstanding, highlighting the need to establish governance and audit processes and address the continuing socioeconomic and sociocultural barriers that mothers face as a way forward in ultimately eliminating this entirely preventable disease.

Study of prevalence of biological false positive serological tests for syphilis in pregnancy

Study of prevalence of biological false positive serological tests for syphilis in pregnancy

1296. Potential use of Sexually Transmitted Infection (STI) Testing for Expanding HIV Pre-Exposure Prophylaxis (PrEP) at an Urban Hospital Center

BackgroundDespite the high efficacy of PrEP, it continues to be underutilized. We examined the extent to which patients with a documented positive test for STIs were provided PrEP at an urban municipal medical center.MethodsWe reviewed data of all patients seen between January 1, 2014 and July 30, 2017 who were > 18 years old and had an initial HIV negative test and ≥1 positive test for Chlamydia, Gonorrhea, or Syphilis. We examined PrEP prescription data by gender, race/ethnicity, and clinic location. Differences between groups were compared using Chi-squared analysis and logistic regression.ResultsOf 1,142 initially HIV− patients who were identified as having a positive STI result, 52% were female, 89% either Black or Hispanic, with a median age of 40 years (quartiles 30, 47). 58% had Medicare/Medicaid and 34% were self-pay or uninsured (Table 1). Only 25 (2.1%) of 1,142 patients who had ≥1 STI test positive were prescribed PrEP. No women received PrEP. Whites (aOR: 21.7 [95% CI:4.4, 107, P < 0.001] and Hispanics (aOR:6.64 [95% CI:1.35, 32.8, P = 0.02] were both more likely to receive PrEP than Blacks, after adjusting for age, sex, marital status, and insurance. All PrEP prescriptions originated from the Medicine, Emergency, or HIV specialty clinics although most STI testing was obtained in Emergency and Obstetrical/Gynecological clinics (Table 2).ConclusionThere were significant missed opportunities for HIV prevention among patients with STIs within the medical center, particularly among Hispanic and Black patients. Enrichment programs to educate providers and increase PrEP prescriptions may have a major impact on expanding HIV prevention, especially for women. Disclosures All authors: No reported disclosures.

Monitoring response rate of blood donors concerning positive screening tests for HIV and syphilis: an institutional approach toward donor hemovigilance

Objective To investigate the response rate among our blood donors when notified about their positive screening results of HIV and syphilis. Study setting An observational study conducted at a Division of Hematology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital from January 2013 to December 2014. Materials and methods Computerized donor inventory data were retrieved. The frequency of screening-positive donors for HIV and syphilis was calculated and the donors were informed through telephone to provide fresh samples for confirmatory tests. The frequency of those donors who responded by providing fresh blood sample was computed. Results Of the total 1684 screening-positive doors, 255 were reactive for syphilis and 11 were reactive for HIV. Only 232 (91%) of the venereal disease research laboratory positive were successfully contacted, out of these only 65 (28%) gave fresh samples and treponema pallidum particle agglutination (TPHA) test results confirmed 56 (86%) donors as positive and nine (14%) as negative for syphilis. On the other hand, of the11 anti-HIV-reactive donors 10 (91%) were successfully approached, five (50%) donors showed a positive response by giving fresh samples for Western blot confirmatory test, which affirmed three (60%) donors to be positive and two (40%) donors to be negative for HIV. Conclusion The results reverberate the lack of awareness among our blood donors. Better predonation counseling can improve the overall outcome.

Seroprevalence of syphilis and herpes simplex virus type 2 and its association with sexual behaviour factors (a cross-sectional study among men who have sex with men in Manado, Indonesia)

Aims: This study investigated the seroprevalence and sexual risk behavior factors associated with syphilis and herpes simplex virus type 2 (HSV-2) among men who have sex with men (MSM), in Manado, Indonesia. Methods: Serum samples and questionnaires regarding their socio-demographic and sexual behaviour were collected from 60 MSM in Manado . Samples were screened for anti-HSV-2 IgG for herpes, the Venereal Disease Research Laboratory (VDRL) and the Treponema Pallidum Haemagglutination (TPHA) test for syphilis. A cross sectional method was used in this study . Results: Of 60 MSM (median age was 20 years), 35% had homosexual orientation and 65% had bisexual orientation. First sexual intercourse of most participants (48.3%) within 16 to 18 years old. In the last 12 months, most participants (55%) had only one male sex partner. There were 63.3% and 16.7% participants performed oral and anal intercourse. About 23.3% participants used condom consistently, but only 35.7% used compatible lubricant. Seropositivity of VDRL and TPHA was detected in 5% participants and anti-HSV-2 IgG in 23.3% participants. The positive serology test for syphilis was associated with sexual intercourse mode (p= 0.001). Significant association was found between anti-HSV-2 IgG seropositivity and condom-use behaviour (p=0,028). Conclusions: The study demonstrated 5% and 23.3% positivity of serology test for syphilis and anti-HSV-2 IgG respectively. Seropositivity of syphilis was correlated with oral and anal intercourse while HSV-2 with no condom-use behaviour among MSM in Manado, Indonesia. Keywords : syphilis, herpes simplex virus type 2, men who have sex with men, sexual behaviou r, Manado

Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy.

Direct-acting antivirals (DAAa) cure hepatitis C virus (HCV) infections in 95% of infected patients. Modeling studies predict that universal HCV treatment will lead to a decrease in the incidence of new infections but real-life data are lacking. The incidence of HCV among Dutch human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) has been high for >10 years. In 2015 DAAs became available to all Dutch HCV patients and resulted in a rapid treatment uptake in HIV-positive MSM. We assessed whether this uptake was followed by a decrease in the incidence of HCV infections. Two prospective studies of treatment for acute HCV infection enrolled patients in 17 Dutch HIV centers, having 76% of the total HIV-positive MSM population in care in the Netherlands. Patients were recruited in 2014 and 2016, the years before and after unrestricted DAA availability. We compared the HCV incidence in both years. The incidence of acute HCV infection decreased from 93 infections during 8290 person-years of follow-up (PYFU) in 2014 (11.2/1000 PYFU; 95% confidence interval [CI], 9.1-13.7) to 49 during 8961 PYFU in 2016 (5.5/1000 PYFU; 4.1-7.2). The incidence rate ratio of 2016 compared with 2014 was 0.49 (95% CI, .35-.69). Simultaneously, a significant increase in the percentage positive syphilis (+2.2%) and gonorrhea (+2.8%) tests in HIV-positive MSM was observed at sexual health clinics across the Netherlands and contradicts a decrease in risk behavior as an alternative explanation. Unrestricted DAA availability in the Netherlands was followed by a 51% decrease in acute HCV infections among HIV-positive MSM.

Association between eye diagnosis and positive syphilis test results in a large, urban sexually transmitted infection/primary care clinic population.

In 2015, the Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO) released clinical advisories on rising cases of ocular syphilis. We examined the association between eye disease and syphilis infection among primary care and sexually transmitted infection (STI) clinic patients attending an urban lesbian, gay, bisexual, transgender (LGBT) health center. We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between 1 January 2010 and 31 December 2015. Confirmed eye diagnosis was based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status, and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (enzyme immunoassay [EIA], rapid plasma reagin [RPR] titer, fluorescent treponemal antibody absorption [FTA-Abs], Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations. During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2288 (3.2%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) ( p < 0.01). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV-positive. Patients with eye disease had 5.97 (95% CI: 3.70, 9.63) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender/sexual orientation, insurance status, and HIV status, this association between positive syphilis test and eye disease decreased but was still significant (OR 2.00, 95% CI 1.17, 3.41). Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests even after adjusting for other risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.

Measuring Transitions in Sexual Risk Among Men Who Have Sex With Men: The Novel Use of Latent Class and Latent Transition Analysis in HIV Sentinel Surveillance.

New combination human acquired deficiency (HIV) prevention strategies that include biomedical and primary prevention approaches add complexity to the task of measuring sexual risk. Latent transition models are beneficial for understanding complex phenomena; therefore, we trialed the application of latent class and latent transition models to HIV surveillance data. Our aims were to identify sexual risk states and model individuals' transitions between states. A total of 4,685 HIV-negative men who have sex with men (MSM) completed behavioral questionnaires alongside tests for HIV and sexually transmissible infections at one of 2 Melbourne, Victoria, Australia, general practices (2007-2013). We found 4 distinct classes of sexual risk, which we labeled "monogamous" (n=1,224), "risk minimizer" (n=1,443), "risk potential" (n=1,335), and "risk taker" (n=683). A positive syphilis, gonorrhea, or chlamydia test was significantly associated with class membership. Among a subset of 516 MSM who had at least 3 clinic visits, there was general stability across risk classes; MSM had on average a 0.70 (i.e., 70%) probability of remaining in the same class between visits 1 and 2 and between visits 2 and 3. Monogamous MSM were one exception; the probability of remaining in the monogamous class was 0.51 between visits 1 and 2. Latent transition analyses identified unobserved risk patterns in surveillance data, characterized high-risk MSM, and quantified transitions over time.

Improving the antenatal and post-partum management of women presenting to Sexual Health Services with positive syphilis serology through audit.

The incidence of congenital syphilis remains low in the UK, but the morbidity and mortality to babies born to women who are untreated for the condition make testing for the disease antenatally one of the most cost-effective screening programmes. Women attending North Middlesex Hospital, UK with a positive syphilis test at their antenatal booking visit are referred to St Ann's Sexual Health Clinic, London, for management and contact tracing. We were concerned that our initial audit revealed that a large proportion of women referred to our service never attended and recorded partner notification was poor. Following the implementation of recommendations, specifically the introduction of an electronic referral system, re-audit showed an improvement in attendance, contact tracing, documentation and communication.

NEUROSYPHILIS IN THERAPEUTIC PRACTICE: CLINICAL OBSERVATION

Objective : to describe a clinical case of neurosyphilis diagnosed in a therapeutic inpatient facility. Materials and methods . Female patient T., 61, was hospitalized in the therapeutic department of a general hospital with referral diagnosis of “Stage II hypertensive heart disease, risk 4. Hypertensive crisis of 03.12.2015” with complaints of general fatigue, episodes of transient memory loss with full recovery, unstable blood pressure level. The patient was examined: She underwent treponemal and nontreponemal serological tests for antibodies against Treponema рallidum, hepatitis, human immunodeficiency virus; electrocardiogram; angiography of carotid and vertebral arteries; magnetic resonance imaging (MRI) of the brain with contrast; serological and microscopic examinations of the cerebrospinal fluid (CSF). Results . The patient»s medical history described episodes of transient global amnesia with full memory recovery, more frequent in the last year; arterial hypertension; chronic urinary tract infection; and chronic cholecystitis with frequent courses of antibacterial therapy (ceftriaxone). Since 1986, a positive serological reaction for syphilis was observed (Wassermann reaction (WR) +++) due to a history of primary syphilis. Considering reliable history of syphilis, positive serum confirmation tests for syphilis (nontreponemal: rapid plasma reagin test 3+; treponemal: passive hemagglutination reaction 4+, antibodies against T. pallidum (total) – present), history of neuropsychological symptoms (transient amnesia) and acute neurological symptoms before hospitalization (transient ischemic attack), brain MRI data (2 lesions of cerebral circulation disorders of ischemic type in the cortical branches of left and right mesencephalic arteries), a diagnosis of neurosyphilis was proposed, and lumbar puncture was performed for confirmation. Inflammatory characteristics of the CSF (cytosis 19/3, neutrophilia up to 12 cells, insignificant lymphocytosis up to 7 cells) and positive confirmation serological reactions (nontreponemal test: serum microprecipitation reaction negative, treponemal test: immunoassay: total antibodies – positivity coefficient (PC) 4.3; immunoglobulin G – PC 2.8) were indications for standard therapy for the “neurosyphilis” diagnosis with subsequent serological control of the CSF and serum. Conclusion . The clinical case demonstrates complexity of neurosyphilis diagnosis due to a lack of pronounced clinical manifestations of the disease and advisability of a multidisciplinary approach to treatment of these patients.

Biologically false positive serologic reactions for syphilis in patients with benign uterus tumors

The mechanism of formation of active and chronic false positive reactions serologic syphilis tests is described. Spontaneous negativation of acute false positive serologic reactions develops in 6 months. Chronic false positive serologic reactions persist for a long time, sometimes during the whole life time. Chronic false positive serologic reactions for syphilis are the diagnostic criteria for systemic lupus. Chronic false positive serologic reactions before and during the evaluation of clinical symptoms in other connective tissue diseases, endocrinologic, oncologic pathology are described. The Hughes ’syndrome is the most often cause of false positive serologic syphilis tests. 3 cases of false positive serologic syphilis tests in patients with benign uterus tumors are presented.

Gestational Syphilis and Stillbirth in Latin America and the Caribbean.

Abstract Objective To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean. Methods In a retrospective study, data on stillbirth and gestational syphilis extracted from the Sistema Informatico Perinatal database were analyzed for deliveries in 11 countries between January 1, 2009, and December 31, 2012. Potential confounders were examined, and binary logistic regression analysis was performed to assess the association between gestational syphilis and stillbirth. Results Among 368 151 deliveries, 3875 (1.1%) were by women with a positive syphilis test, and 1461 (0.4%) were stillbirths. Among the stillbirths, 29 (2.0%) were delivered by women with a positive syphilis test. After controlling for country, congenital anomalies, gestational age at labor, maternal age, and previous stillbirth, gestational syphilis was significantly associated with stillbirth (odds ratio 1.88, 95% confidence interval 1.25–2.83; P = 0.002). Conclusion Gestational syphilis contributes to stillbirth in Latin America and the Caribbean. Interventions targeting gestational syphilis are highly cost-effective and should be implemented across the region.