Positive Syphilis Test Research Articles

Natural History of Syphilitic Aortitis

No large studies of cardiovascular syphilis at necropsy have been reported since 1964. We examined at necropsy 90 patients who had characteristic morphologic findings of syphilitic aortitis. None had ever undergone cardiovascular surgery. With the exception of 2 cases seen more recently, the hearts and aortas of the 90 patients were examined and categorized by one of us (W.C.R.) from 1966 to 1990. All 90 had extensive involvement of the tubular portion of the ascending aorta by the syphilitic process, which spared the sinuses of Valsalva in all but 4 patients. The aortic arch was also involved in 49 (91%) of 54 patients and the descending thoracic aorta in 47 (90%) of 52 patients. Syphilis was the cause of death in 23 (26%) of the 90 patients. It was secondary to rupture of the ascending or descending thoracic aorta in 12, severe aortic regurgitation leading to heart failure in 10, and severe narrowing of the aortic ostium of the right coronary artery in 1 patient. Of the 40 patients who had undergone serologic testing for syphilis, 28 (70%) had a positive (reactive) finding. Those patients with a negative or nonreactive test or who did not undergo a serologic test for syphilis had morphologic and histologic findings in the aorta at necropsy similar to the findings of those patients who had had a positive serologic test for syphilis. In conclusion, cardiovascular syphilis has not disappeared. In patients with dilated ascending aortas, with or without aortic regurgitation, a serologic test for syphilis is recommended. If the findings are positive or if characteristic morphologic features of cardiovascular syphilis are suspected, irrespective of the results of the serologic tests, antibiotic therapy appears desirable.

Adequacy of testing, empiric treatment, and referral for adult male emergency department patients with possible chlamydia and/or gonorrhoea urethritis

This study evaluated the adequacy of testing, empiric treatment and referral for further evaluation of adult male emergency department (ED) patients with possible chlamydia and/or gonorrhoea urethritis. Of 968 adult male ED patients, 84% were tested for chlamydia and gonorrhoea, 16% for HIV and 27% for syphilis; 92% received empiric treatment for chlamydia and gonorrhoea and 71% were referred for further evaluation; of those tested, 29% were infected with chlamydia, gonorrhoea or both; and 3% of those tested had a positive syphilis test. The results of logistic regression modelling indicated that testing, treatment and referral were not related to a history of sexual contact with someone known to have a sexually transmitted disease or to the patient's ultimate diagnosis of a laboratory-confirmed infection. Compliance with Centers for Disease Control and Prevention (CDC) recommendations for chlamydia and gonorrhoea testing and treatment regimens was high, but was poor for HIV testing. More explicit guidance from CDC regarding syphilis testing and referral for further evaluation is needed.

Current value of serologic test for syphilis as a surrogate marker for blood‐borne viral infections among blood donors in the United States

Serologic screening for syphilis has been justified in part as a surrogate marker for infections caused by other pathogens such as human immunodeficiency virus (HIV). This study assessed the current surrogate value of the test. Testing results for blood donors with the American Red Cross Blood Services between January 1, 2006, and December 31, 2007, were analyzed. All donations were tested according to standard procedures for markers of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), human T-lymphotropic virus (HTLV), syphilis, and other infections. The frequency of window-period (w-p) infections interdicted by syphilis testing was estimated. There were significantly higher frequencies of HIV, HCV, hepatitis B surface antigen (HBsAg), and HTLV confirmed-positive donations among those with positive syphilis test results, although the sensitivity of syphilis test positivity in these groups was low. Among more than 3 million repeat donors with complete testing through reactive donation confirmation for both syphilis and HIV (anti-HIV and HIV RNA), 225 seroconverted for syphilis but not for anti-HIV or HIV RNA and 83 converted for HIV (anti-HIV or HIV RNA) but not for syphilis, with only 1 who converted for both syphilis and HIV, resulting in an incidence ratio of 150 (95% confidence interval, 21-1080) and a sensitivity of 1.2 percent. No syphilis seroconverters converted for HCV, HBsAg, or anti-HTLV. Syphilis testing presents no surrogate value for incident HCV, HBV, and HTLV infections and could only remove approximately 1 HIV w-p unit of every 148 million donations.

Profile of blood donors with serologic tests reactive for the presence of syphilis in São Paulo, Brazil

Syphilis screening of blood donors is a common practice worldwide, but very little is known about the meaning of a positive serologic test for syphilis in blood donors and the risk profile of these donors. The aim of this study was to determine the demographic characteristics and risk behaviors of blood donors with recent and past syphilis and their implications for blood bank testing and deferral strategies. Demographic characteristics, category of donation, number of previous donations, sexual behavior, and history of sexually transmitted diseases were reviewed comparing blood donors with recent and past syphilis from January 1, 1999, to December 31, 2003. A total of 2439 interviews were reviewed, including 2161 (88.6%) donors with past and 278 (11.4%) with recent syphilis infection. Factors associated with recent infection included younger age (< or = 20 years odds ratio [OR], 36.5; 95% confidence interval [CI], 15.8-84.1), two previous donations (OR, 2.7; 95% CI, 1.9-3.9), male-male sex (homosexual OR, 8.2; 95% CI, 3.2-20.8; and bisexual OR, 11.4; 95% CI, 3.6-36.3), two or more partners in the past 12 months (OR, 2.3; 95% CI, 1.3-4.0), symptoms for syphilis (OR, 4.5; 95% CI, 2.8-7.1), and human immunodeficiency virus (HIV) seropositivity (OR, 39.6; 95% CI, 4.6-339.8). Community donors were also associated with recent syphilis infection (OR, 1.5; 95% CI, 1.2-1.9) compared to replacement donors. Sexual history, including male-male sex and multiple partners, were strongly associated with recent syphilis infection, which in turn was strongly associated with HIV. Continuous and vigilant surveillance that includes assessing sexual history and other factors associated with syphilis are needed to guide blood safety policies.

Manifest psychosis in neurosyphilis

Introduction Recent surveys have assessed a remarkable increase in the prevalence of infectious syphilis. If left untreated, 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. Case Report The authors present a case of an acute psychosis during and after pregnancy in a 37-year-old woman, which was identified as a manifestation of neurosyphilis after admission to a psychiatric ward. The positive screening test for syphilis provided the first hint of syphilis and gave direction for further diagnosis and specific treatment. Subsequently, the patient was treated with psychotropic medication concurrent with an adequate antibiotic treatment for neurosyphilis and was simultaneously psychologically monitored. An improvement of psychotic symptoms during antibiotic therapy was observed. Conclusion This case emphasises that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases. Owing to current epidemiological data and difficulties in diagnosing syphilis, routine screening tests in the psychiatric field are necessary.

Use of low birth weight as selecting criterion for the routine surveillance of congenital anomalies of infectious origin.

Introduction: Surveillance of congenital anomalies receives importance in the world-wide context of eradicating the congenital rubella syndrome. Objective: To identify the congenital anomalies and to consider the low birth weight a criterion to test IgM for the complex TORCH. Methodology: Surveillance of the congenital specific and non specific anomalies of the congenital rubella syndrome(CRS) and low birth weight in ten hospitals. It was considered as case, everything new born with some congenital anomaly or low weight for the gestational age. Serum tests for rubella, toxoplasmosis, citomegalovirus, herpes and parvovirus were practiced. For the negative cases cariotype was performed. Results: A total of 840 cases were selected, 669 by low weight for the gestational age, 52 by anomalies not related to CRS, 52; by anomalies that could be related to the CRS, 105. The most frequent anomalies were congenital heart diseases, 5.1%; hepatosplenomegalies, 3.9%; and microcephalies, 1.2%. There were confirmatory IgM titles for rubella in 0.5% of cases; toxoplasmosis 1.4%; citomegalovirus 1.5%; parvovirus 1.2%; herpes 0.5%; and positive test for congenital syphilis, 3.7%. In total there were 8.8% positive results for any congenital infectious disease. The relative risk for low birth weight having IgM positive rubella was RR = 2.83 (IC: 1.26:6.36-0.95). Discussion and conclusions: The surveillance for CRS, through the monitoring of febrile in the first year and by the presence of some specific congenital anomalies, could be improved in sensitivity by means of the routine monitoring of congenital anomalies, with the inclusion of low birth weight, like a selecting criterion to study the infectious agents.

Maternal Syphilis and Intimate Partner Violence in Bolivia

Use a gender perspective to analyze a partner notification study conducted in antenatal clinics in Bolivia to assess the association between intimate partner violence (IPV) and partner notification. Guide the implementation of a safe, feasible, and culturally appropriate partner notification strategy in Bolivia in order to reduce the potential of IPV. We conducted a cross-sectional survey with women (n = 209) and their notified partners (n = 137) and structured interviews with a subsample of participants. Nearly 40% of women reported IPV in the past year and 28% mentioned fear of violence as a barrier to notifying their partners. Overall, 65% of women reported that they had notified their partners about their positive syphilis test results. Women who did not perceive violence as a barrier had greater odds of notifying their partner of their syphilis status (OR = 1.82; CI [0.93-3.60]; P <0.08). Women who could not protect themselves against partners' syphilis had a lower odds of notifying their partner (OR = 0.06; CI [0.049-0.656]; P <0.0001). Women who notified their partners said it was a favorable experience. Most men said they responded well to their partner's disclosure but could understand other men acting violently, especially when infidelity was involved. The majority of women who participated were able to notify male partners of their positive syphilis diagnosis but also reported high levels of domestic violence. The data suggest that public health practitioners should concomitantly screen for IPV and syphilis during pregnancy and assist women in abusive relationships on how to communicate sensitive disclosure information to partners.

7B.1 Pathogenesis of the antiphospholipid syndrome (APS)

The APS is a thrombophilic condition that is identified by phenomenologic surrogate tests that were derived from the biologic false positive (BFP) syphilis test and the paradoxical “lupus anticoagulant” (LAC) phenomenon, described about 50 years ago [1]. Current diagnosis of the syndrome requires that the patients have clinical manifestations such as thrombosis and/or spontaneous pregnancy losses and at least 1 positive test that is confirmed at least 12 weeks later [2]. The major antigenic target for “antiphospholipid” antibodies is b2-glycoprotein I (b2GPI), a phospholipid-binding protein that is a member of the short-chain consensus repeat (SCR) superfamily. The protein has a “J” shape and is composed of an extended chain of 5 SCR domains. The structure of SCR domain V deviates from the standard fold of the 4 other domains and contains the putative phospholipid-binding site [3]. It has recently been reported that IgG antibodies recognizing an epitope in domain I of b2GPI consisting of Gly40 Arg43 have LAC activity and are strongly associated with thrombosis [4]. Several mechanisms have been proposed to explain how antiphospholipid antibodies might cause susceptibilities to pregnancy losses and to thrombosis [1]. Among these are mechanisms that affect platelet function, prostaglandin synthesis, endothelial cell signaling, apoptosis, effects on protein C and S activities, the endothelial protein C receptor, protein Z function and antiphospholipid antibody-mediated activation of complement with subsequent release of TNF-alpha, and the antiphospholipid antibodymediated disruption of annexin A5 (AnxA5) discussed below. AnxA5 is a potent anticoagulant protein whose anticoagulant properties are a consequence of its high affinity for anionic phospholipid [5,6]. The protein forms 2-D crystals on phospholipid surfaces [7 9] that shield the phospholipid from availability for the critical phospholipid-dependent coagulation reactions. AnxA5 forms noncovalent polymers by forming trimers [7 9], and then trimers of the trimers over phospholipid bilayers. Figure 1 shows a colorized lower power AFM image of the crystal array, demonstrating the highly ordered screen-like structure; panel B shows a higher power detail of this array, with the central space filled with an individual trimer; panel C shows 6 trimers (the thin black circle delineates 1 trimer) that are arrayed in a hexagonal configuration. These 2-D arrays shield phospholipids from availability for the phospholipiddependent coagulation reactions. Fig. 1.

Indicações da punção liquórica nos portadores de sífilis

O crescimento recente da incidência da sífilis, principalmente nos últimos 15 anos com a emergência da AIDS, parece conduzir ao aumento dos casos atípicos observados na prática médica diária. A freqüência da co-infecção HIV/sífilis entre homossexuais masculinos em grandes centros urbanos varia entre 20 e 70%; nesses casos, com úlceras persistentes e rápida progressão para os estádios mais tardios. Dentre as complicações mais graves da doença não tratada ou mal conduzida encontra-se a neurolues, que pode produzir manifestações neurológicas e psiquiátricas variadas, por vezes incapacitantes. O diagnóstico pode ser feito pela punção liquórica, pela qual se avaliam a celularidade, as proteínas e se realizam testes treponêmicos e não-treponêmicos. O exame do LCR deveria ser realizado em todos os doentes com sorologia positiva para sífilis, ou doença neuropsiquiátrica, ou oftálmica, ou terciária, ou naqueles em que a terapia falhou e nos doentes infectados pelo HIV com sífilis latente ou de duração ignorada. Entretanto, a neurolues é improvável quando o VDRL sérico estiver negativo. Nesses casos, a punção do liquor não é recomendada. Há razoável certeza quando houver síndrome neuropsiquiátrica associada com VDRL liquórico positivo.

“Primary” antiphospholipid syndrome evolving into Waldenstrom’s macroglobulinaemia: a case report

A 57-year-old woman with a history of transient ischaemic attacks and six recurrent foetal losses accompanied by elevations of antiphospholipid antibodies was diagnosed as having a "primary" antiphospholipid syndrome. She was followed up for 5 years, and she developed anaemia, leucopenia and splenomegaly. A bone marrow trephine was diagnostic of Waldenstrom's macroglobulinaemia. A false positive serological test for syphilis was demonstrated and apparently had been noted in her second pregnancy more than 20 years prior to her presentation with an antiphospholipid syndrome. There had previously been no indication to perform serum electrophoretic studies. This case illustrates the importance of this investigation in any middle-aged patient presenting with an antiphospholipid syndrome and a monoclonal gammopathy This finding might presage the development of a more serious condition, even years later (as in our patient).

A case of systemic lupus erythematosus associated with thrombotic thrombocytopenic purpura and hemophagocytic syndrome

A 44-year-old female. Developed polyarthralgia in August 2002. The patient was diagnosed with systemic lupus erythematosus (SLE) in November, due to polyarthralgia, leukopenia, anti ds-DNA antibody positive, antinuclear antibody positive, and false positive serologic test for syphilis. Hypocomplementemia continued even after the steroid treatment was conducted with insufficient control. In November 2003, ran fever and observed polyarthralgia. In December, gross hematuria and purpura appeared. The patient was hospitalized on December 25. Thrombotic thrombocytopenic purpura (TTP) was suspected from the emergence of fragmented red cells, hemolysis, thrombocytopenic purpura, headache, renal dysfunction and fever. As hemophagocytic syndrome (HPS) was suspected from hyper-ferritinemia, bone marrow aspiration was conducted. Macrophage confirmed hemophagocytic image and the patient was diagnosed with HPS complication. Methylprednisolone pulse therapy was conducted for three days, followed by the administration of prednisolone 60 mg. Plasma exchange therapy was also conducted from the first day of hospitalization. Recurrence of TTP after plasma exchange therapy, but it improved by additional plasma exchange. Low vWF-CP (ADAMTS-13) activity was observed in this case, and anti-vWF-CP antibody was positive. TTP and HPS are both critical intractable complications of SLE. Bearing in mind the possibility of simultaneous complication of both symptoms, prompt diagnosis is crucial for life-saving.

Case 39-2005

A 63-year-old woman from Cameroon was referred to infectious-disease specialists because of a positive serologic test for syphilis and persistent peripheral-blood eosinophilia. In addition, a routine chest radiograph had shown a dilated aorta with calcification. Stool examination disclosed parasitic infections, which were treated, but eosinophilia persisted. A diagnostic test was performed.

Syphilis and blood donors: what we know, what we do not know, and what we need to know.

The lack of transfusion-transmitted syphilis in the United States in the past 30 years has led us to question the rationale for continued syphilis testing of blood donors. In addition, the significance of a confirmed positive syphilis test result in a blood donor is not clear. The following 2 questions have been raised: (1) Are we detecting any truly infectious donors? and (2) If not, what is the significance of a confirmed positive test for syphilis in contemporary blood donors? This review will summarize what is and what is not known about syphilis testing in blood donors and will discuss the need for further research to answer these questions.

Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program.

To evaluate results of screening for syphilis, gonorrhea, and chlamydia among youth in a federally funded job training program. Data were evaluated from medical records of 12,881 randomly selected students in 54 U.S. job training centers during 1996. The intake medical evaluation includes serologic testing for syphilis. The policy was for females to receive a pelvic examination with gonorrhea and chlamydia testing and for males to be first screened with a urine leukocyte esterase (LE) assay, with follow-up gonorrhea and chlamydia testing for those with positive LE results. Adjusting for our sampling strategy, among females, an estimated 9.2% had a positive chlamydia test, 2.7% a positive gonorrhea test, and 0.4% had a positive syphilis test. Gonorrhea and chlamydia rates among females were highest in African-American followed by Native American students. Chlamydia infection was most common in younger women < or = 17 years of age. An estimated 0.1% of males had a positive syphilis test, and 4.8% of males a positive urine LE test. Of 103 LE-positive males tested for gonorrhea and chlamydia, only 27 (26%) had a positive test for one of these STDs. Our study supports routine screening of adolescents for gonorrhea and chlamydia, including those youth from socioeconomically disadvantaged backgrounds. Because individuals from such backgrounds may not regularly interact with traditional clinical health care systems, screening and treatment should be offered in alternative settings, such as the job training program described in this study.

Assessment of non-heart-beating donor (NHBD) kidneys for viability on machine perfusion.

The shortage of organs has resulted in renewed interest in organs from non-heart-beating donors (NHBD). Viability assessment of such organs may reduce the incidence of delayed graft function and primary non-function. In Phase III of the NHBD programme, introduction of machine perfusion enabled the assessment of these marginal donors. Since then the graft survival has been 88.4% compared with the previous phase where machine perfusion or viability assessment was not done (45.5%). The parameters used were total glutathione S-transferase (GST) in the perfusate, the intrarenal vascular resistance (IRVR) and flow characteristics over time. All NHBD kidneys were machine perfused through a locally developed perfusion system. The viability was assessed by serial measurements of the above-mentioned parameters. Forty-two local NHBD kidneys were retrieved and one kidney was imported, of which 19 donors (i.e. 38 kidneys) were of the uncontrolled (category II) donors. After viability assessment on machine perfusion; two kidneys were discarded due to positive tests for syphilis, four kidneys had high total GST levels, five kidneys due to high IRVR and poor flow characteristics and one did not flush on retrieval. Three kidneys were exported after viability tests. In 28 NHBD kidney recipients, immediate graft function was seen in two kidneys, 22 (84.6%) developed delayed graft function. One kidney had primary non-function, and two recipients lost their grafts, due to chronic rejection and renal vein thrombosis. There were two deaths, unrelated to transplantation. Graft survival was achieved in 88.4% (23/26 graft survival in phase III) of cases. Machine perfusion and assessment of NHBD kidneys has been successfully introduced to the Newcastle NHBD programme. This approach, using renal transplants from largely category II donors produced a success rate of 88.4% which was significantly better than the phase II period (45.5%) of the program (p=0.023, Fisher 2 tail test).

Symptoms and findings related to HIV in women in rural Gutu District, Zimbabwe, 1992 to 1993.

To relate self-reported morbidity and clinical findings to HIV-status in rural women in Zimbabwe. A cross sectional study. 12 randomly selected villages in rural Gutu District, Zimbabwe. In 1992 to 1993 all women of fertile age (15 to 44 years) in the selected villages were interviewed and examined (n = 1,213). Retrospectively, HIV status was assessed anonymously from frozen blood samples. Self-reported morbidity, body mass index (BMI), arm circumference, palpable lymphnodes, prevalence of syphilis, haemoglobin, HIV status. Overall HIV prevalence was 22%. Mean haemoglobin (Hb) was significantly lower (p < 0.005) and anaemia was significantly more common (p < 0.001) among HIV positive women. Syphilis prevalence was 2.2%, a positive syphilis test increased the risk of being HIV positive three-fold. Persistent cough was significantly more common in HIV positives (OR = 3.0, 95% CI 1.4-6.2). Palpable lymphnodes was the most common clinical finding and generalised lymph adenopathy had a positive predictive value of 67% for HIV. Self-reported morbidity was low and no increased pregnancy loss was reported related to HIV. The low morbidity found in 1992 to 1993, in spite of the high prevalence, indicates a fairly short duration of the HIV infection and would also have contributed to the late awareness of the problem.

The decline in the mortality rates of cervical cancer and a plausible explanation in Shandong, China

The aim of the present study is to describe the temporal trends in mortality rates of cervical cancer in Shandong Province, China, and to elucidate their likely explanations. Three retrospective surveys of all causes of death in 1970-1974, 1985-1989 and 1990-1992 in Shandong were carried out. An age-period-cohort analysis based on similar survey data from Qixia, a county in Shandong, from 1970 to 1994 was performed. A correlation analysis between prevalence of syphilis and cervical cancer mortality rates three decades later was conducted. A cross-sectional survey of risk factors for cervical cancer was conducted in 1991 in one city and 12 villages in the province. A marked decline in cervical cancer mortality rates was observed from 1970 to 1992 and in successive birth cohorts from 1892 to 1927, and rates remained relatively constant in subsequent birth cohorts through that of 1952. The decline in these rates was strongly correlated with a decline in positive serological tests for syphilis 32 years previously. The percentages of women with selected risk factors were lower in younger women (30-54 years) than in older women (55-69 years) in both cities and rural areas. These trends are compatible with a decrease in risk of exposure to sexually transmitted factors at an early age after the founding of the People's Republic of China in 1949, and a decline in lifetime duration of exposure to possible co-factors in successive birth cohorts who reached sexual maturity before that time.

Large artery vasculopathy in HIV-positive patients: Another vasculitic enigma

Human immunodeficiency virus (HIV) infection has impacted on all the systems of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either aneurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient ischemic attacks, hypertension, ischemia to the lower extremity, or a mass at the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected included the common carotid, abdominal aorta, common iliac, femoral, and popliteal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syphilis. Microbiologic culture of both blood and thrombus contents was positive for Staphylococcus aureus in 1 case; no other organisms were cultured. The key histological features were within the adventitia: leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels, proliferation of slit-like vascular channels, chronic inflammation, and fibrosis. There was associated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification. Atheroma and marked intimal thickening were not evident We believe that the occurrence of this large vessel vasculopathy (mainly aneurysmal) often with multiple lesions in young HIV-positive patients, is characteristic of possible infective or immune complex origin, with leukocytoclastic vasculitis of vasa vasora and periadventitial vessels being pivotal in many cases.

Congenital syphilis

The evaluation of the asymptomatic infant born to a mother with a positive serologic screening test for syphilis remains a difficult clinical challenge. Certain epidemiological and maternal factors help identify children at high risk for congenital syphilis, although the potentially disastrous outcome of unrecognized infection requires careful evaluation of all infants born to mothers with a positive serologic test. Evaluation requires complete physical examination for the protean and usually subtle signs in the newborn, assessment of the effectiveness of maternal treatment, comparison of maternal and newborn serologic test results, and often cerebrospinal fluid analysis and radiographic evaluation of the newborn. Treatment is recommended for all symptomatic newborns and for selected asymptomatic newborns at high risk. Follow-up during infancy of all newborns whose mothers had a positive serologic test is essential to ensure eradication of infection in treated newborns or absence of infection in untreated newborns.

Rates of and risk factors for trichomoniasis among pregnant inmates in New York City.

Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission. To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City. Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia. The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis. Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population.