Rapid Plasma Reagin Research Articles

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Combination HIV prevention and treatment interventions (CHIs) have led to substantial declines in HIV incidence in sub-Saharan Africa; however, population-level data on non-HIV sexually transmitted infections (STIs) in the context of CHIs are rare. We aimed to assess STI burden following scale-up of CHIs in Uganda. The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study nested within a population-based cohort among inland agrarian and Lake Victoria fishing populations in southern Uganda. STIPS enrolled consenting residents aged 18-49 years in two communities (one inland and one fishing) between May and October, 2019, and measured the prevalence of chlamydia, gonorrhoea, trichomonas, syphilis, and herpes simplex virus 2 (HSV-2). Between May 27, 2019 and Oct 25, 2019, STIPS enrolled 1825 participants. HIV prevalence was 14·0% among the inland population and 39·8% among the fishing population, with about 90% HIV viral load suppression in both communities. Among inland and fishing populations, chlamydia prevalence was 9·6% (95% CI 7·9-11·7) and 9·9% (8·1-12·0), gonorrhoea prevalence 5·0% (3·8-6·7) and 8·4% (6·8-10·5), trichomonas prevalence 9·4% (7·7-11·5) and 12·2% (10·2-14·5), and HSV-2 prevalence 43·0% (39·9-46·3) and 64·4% (61·3-67·6), respectively. In the fishing population, syphilis seropositivity was 24·2% (21·5-27·2) with 9·4% (7·7-11·5) having high-titre (rapid plasma reagin ≥1:8) infection, including 16·9% (11·9-24·0%) of men living with HIV. Prevalence of at least one curable STI (chlamydia, gonorrhoea, trichomonas, or high-titre syphilis) was 51% higher among people living with HIV (vs HIV negative; adjusted prevalence risk ratio [PRR] 1·51; 95% CI 1·27-1·78), including among pregnant women (adjusted PRR 1·87, 1·11-3·17), with no differences by HIV suppression status. Despite near universal HIV treatment, STI burden remains extremely high in southern Uganda, particularly among people living with HIV. There is an urgent need to integrate STI care with HIV services in African settings. National Institutes of Health.

Evaluation of cerebrospinal fluid ubiquitin C-terminal hydrolase-L1, glial fibrillary acidic protein, and neurofilament light protein as novel markers for the diagnosis of neurosyphilis among HIV-negative patients

To evaluate the possibility of using cerebrospinal fluid (CSF) ubiquitin C-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and neurofilament light protein (NF-L) for the diagnosis of neurosyphilis (NS). A cross-sectional study of 576 subjects was conducted at Zhongshan Hospital from January 2021 to August 2022 to evaluate the diagnostic accuracy of CSF UCH-L1, GFAP, and NF-L for NS and analyze their correlations with CSF rapid plasma reagin (RPR), white blood cells (WBCs), and protein. Patients with NS had higher CSF UCH-L1, GFAP, and NF-L levels than patients with syphilis/non-NS and nonsyphilis. Using a cut-off point of 652.25 pg/ml, 548.89 pg/ml, and 48.38 pg/ml, CSF UCH-L1, GFAP, and NF-L had a sensitivity of 85.11%, 76.60%, and 82.98%, with a specificity of 92.22%, 85.56%, and 91.11%, respectively, for NS diagnosis. Moreover, parallel and serial testing algorithms improved their sensitivity and specificity to 93.62% and 98.89%, respectively. Interestingly, levels between patients with NS who are CSF RPR-positive and -negative did not differ and showed a weak or moderate correlation with WBC and CSF protein in patients with syphilis. CSF UCH-L1, GFAP, and NF-L can be used as novel markers for the diagnosis of NS, independent of CSF RPR, WBC, and proteins.

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Retinitis after Long-Term Corticosteroid Use

A 61-year-old man presented with acute-onset blurriness in both eyes (OU). His medical history was significant for biopsy-negative temporal arteritis and long-term systemic corticosteroid use. On presentation, visual acuity was 20/40 with 3-4+ cells in the anterior chamber and 1+ cells in the vitreous OU. Fundus examination revealed elevated optic nerve margins and peripheral retinal whitening (Fig A). Laboratory work-up showed positive syphilis serology and elevated rapid plasma reagin 1:512. With the diagnosis of neurosyphilis the patient received intravenous penicillin, and vision improved to 20/20 with resolution of retinitis (Fig B).

Significance of Hematological Biomarkers in Association to Syphilitic Patients.

Venereal syphilis is a sexually transmitted disease, involving pathological activities mediating tissue destruction by extensive tissue necrosis. As such, the goal amongst researchers has been set to the identification of effective laboratory biomarkers that can reflect the broad spectrum of disease and ultimately aid in timely diagnosis and effective treatment of syphilis. This research aimed to study the applications of hematological biomarkers associated with syphilitic patients visiting a tertiary care hospital. A retrospective cross-sectional study was conducted in the syphilitic patients attending KIST Medical College and Teaching Hospital, Lalitpur, Nepal. A total of 25 syphilitic patients and 41 non-syphilitic participants were included. The rapid plasma reagin test and Treponema pallidum hemagglutination assay were used for the screening and confirmation of syphilis respectively. The hematological investigation was performed using a hematology analyzer. Statistical Package for Social Science version 17.0 was used for data analysis. A P value <0.05 was considered significant. Syphilitic patients showed significantly elevated levels of lymphocytes (39.8±11.5) (p=0.025), monocyte (1.9±0.8) (p=0.002), mean corpuscular volume (MCV) (92.6±12.9) (p=0.005), and mean corpuscular hemoglobin (MCH) (31.9±4.6) (p=0.008) and lowered levels of red blood cell (RBC) (4.2±0.3) (p=0.005) and platelets (237.2±628.6) (p=0.048) as compared to the lymphocytes (32.9±11.9), monocyte (0.6±1.2), MCV (83.9±8.8), MCH (34.3±1.5), RBC (4.6±0.7), and platelets (280.9±113.3) of the non-syphilitic participants. The results showed that the elevated levels of lymphocyte, monocyte, MCV, and MCH and lowered levels of RBC and platelets are highly specific hematological biomarkers for the diagnosis of patients with syphilis.

IS IT A HERXHEIMER REACTION OR ANAPHYLAXIS COMPLICATING USE OF PENICILLIN IN SYPHILIS TREATMENT?

<h3>Introduction</h3> Herxheimer reactions, similar to anaphylaxis, can occur after the first dose of penicillin and can be associated with dyspnea, hypotension, rash, vomiting and tachycardia. Herein we describe a case regarding a complication of syphilis treatment that was thought to be anaphylaxis, but further investigation suggested Herxheimer reaction. <h3>Case Description</h3> A 62-year-old man with a distant history of syphilis infection was seen by an outpatient ophthalmologist for 1.5 months of rapidly worsening vision in his right eye secondary to ocular syphilis. RPR testing was positive and the patient was directly admitted for treatment. The patient reported developing a reaction to penicillin more than thirty years prior which included vomiting, dyspnea, throat tightening, and a rash fitting the description of urticaria that was reflexively diagnosed as anaphylaxis at the time. Due to the 30-year history of penicillin allergy, the Allergy Immunology Service was consulted. The patient passed the indicated penicillin skin testing and challenge. On further evaluation, it was determined that he previously had rigors, fever, and chills, which were more compatible with Herxheimer Reaction. He was then started on penicillin G 4MU IV q4 hours. Fortunately, he did not develop an "ocular" Herxheimer reaction. <h3>Discussion</h3> Distinguishing anaphylaxis from a Herxheimer reaction in this patient is important for several reasons: (1) treatment can cause an ocular Herxheimer reaction, (2) avoidance of penicillin for 30 years may have led to delayed, more expensive, and less effective therapies, and (3) the cost of skin testing, challenge, and if-needed desensitization could have been avoided based on the history.

Changes in the Syphilis Rapid Plasma Reagin Titer Between Diagnosis and Treatment.

We compared the rapid plasma reagin (RPR) titer on the day of initial presentation with that on the day of syphilis treatment to inform clinical practice as to whether a repeated RPR test should be recommended. We undertook a retrospective study between 1 March 2011 and 31 December 2020 at the Melbourne Sexual Health Centre in Australia among individuals who underwent syphilis serology on the day of initial presentation and the day of treatment, if the latter were within 14 days after initial presentation. We calculated the percentage of individuals with a ≥4-fold change in RPR titer, stratified by the time between initial presentation and treatment and by syphilis stage. Among the 766 included syphilis cases, the median duration between initial presentation and treatment was 6 days (interquartile range, 5-7 days). Of these cases, 14.8% (n = 113) had a ≥4-fold increase or decrease during this interval. The number of cases with a ≥4-fold increase or decrease in RPR titer increased with increasing time between initial presentation and treatment, from 5.7% (n = 6) 1-3 days after initial presentation to 26.2% (n = 27) at 10-14 days (Ptrend < .001). There was no significant difference in the number of cases with a ≥4-fold increase or decrease in RPR titer between syphilis stages (P = .66). Our data support the recommendation of repeating the RPR titer if the day of initial presentation and the day of treatment are different, even when treatment is within a few days after initial presentation.

Couple-level determinants of syphilis infection among heterosexual married couples of reproductive age in Guangdong Province, China: A population-based cross-sectional study.

Syphilis remains a major public health problem worldwide, and its prevention requires knowledge of factors that go beyond the individual-level. However, most syphilis-related studies have focused on individual-level and regional-level factors, neglecting couple-level factors. Thus, this study aimed to explore couple-level determinants of syphilis infection among heterosexual married couples. This population-based cross-sectional study used data from heterosexual married couples who participated in the National Free Preconception Health Examination Project in Guangdong Province, China during 2014-2019. The syphilis infection was tested by the rapid plasma reagin test. Couple-level data were obtained by combining information provided by the man and woman living in the same household. Multivariate logistic models were employed to explore the couple-level determinants of syphilis infection by gender after adjusting for potential confounders. A total of 1,755,156 couples were recruited in this analysis. The seroprevalence was 0.25% (95%CI: 0.24-0.25%) and 0.26% (95%CI: 0.25-0.27%) among men and women, respectively. The median age was 28.0 (interquartile range, IQR: 25.0-31.0) years, and the median duration of marriage was 0.2 (IQR: 0.0-2.5) years. After adjusting for individual and regional-level variables, duration of marriage was a protective factor for syphilis infection in men (adjusted odds ratios, AOR: 0.97; 95% CI: 0.96-0.98) and women (AOR: 0.95, 95% CI: 0.94-0.96). The age gap and the difference in education level between the husband and wife were associated with syphilis infection, but these associations were somewhat different between men and women. Condom use was negatively associated with syphilis infection in men (AOR: 0.77; 95% CI: 0.70-0.84) and women (AOR: 0.77, 95% CI: 0.71-0.84). Our results also showed that couple mobility and the number of children were not statistically significant determinants of syphilis infection among heterosexual married couples. This study contributes to a more comprehensive understanding of syphilis outcomes in individuals in the context of marriage in China. Several couple-level factors are indeed associated with syphilis infection, but these associations differ between men and women. Couple-based strategies that engage both women and men and efforts to promote condom use among heterosexual married couples need to be developed and further evaluated for syphilis prevention.

A STUDY ON CLINICAL, SEROLOGICAL CHARACTERISTICS OF SECONDARY SYPHILIS PATIENTS AT CAN THO HOSPITAL OF DERMATO-VENEROLOGY IN 2021

Background: Syphilis is a chronic infectious disease caused by Treponema pallidum. Classically, syphilis is classified into 4 stages including primary, secondary, latent and tertiary syphilis. Many of its manifestations are cutaneous, making it of interest and importance to dermatologists, especially as morbidity from syphilis rises in the developed world and continues in the developing world. Objectives: 1). To describe the clinical characteristics of secondary syphilis patients at Can Tho Hospital of Dermato-Venereology in 2021; 2). Todescribe the serological characteristics of secondary syphilis patients at Can Tho Hospital of Dermato-Venereology in 2021. Materials and methods: A cross-sectional descriptive study was carried out on 52 secondary syphilis patients who were treated at Can Tho Hospital of Dermato-Venereology. Results: Lesions of macules, papules, pustules, scales, mucous patches were 73.1%, 55.8%, 0%, 23.1%, 11.5%, 7.7%, respectively. The highest percentage of sites was on the palms and/or soles with 86.5%. Serum RPR titer had the highest rate was R256, accounting for 57.7%, most of the patients had serum TPHA titer of R1280, accounting for 73.8%. Conclusions: Secondary syphilis patients have a variety of clinical manifestations and affected sites, most of serum PRP and TPHA titers are usually high with values of R256 and R1280, respectively.

S3020 Hepatitis From a Sexually Transmitted Bacterial Infection

Introduction: Syphilis is a multisystemic, sexually transmitted infection (STI) that is caused by the spirochete Treponema pallidum. Hepatic involvement is rare. We present a patient who was diagnosed with syphilitic hepatitis (SH). Case Description/Methods: A 54-year-old male presented to the hospital with one week of sharp upper abdominal pain, jaundice, poor appetite, and a 25-lb. weight loss. He also reported multiple sexual partners and a rash that developed 2 months ago. Vital signs were within normal range. Physical examination revealed scleral icterus, a soft, non-tender abdomen, a plaque-like penile lesion and small, circular lesions on his palms and soles of feet. Laboratory studies revealed aspartate aminotransferase (AST) 164 U/L, alanine aminotransferase (ALT) 207 U/L, alkaline phosphatase (ALP) 1395 U/L, total bilirubin 5.6 mg/dL, gamma-glutamyl transferase 782 U/L. Hepatitis panel, acetaminophen and alcohol levels were negative. Chronic liver disease work-up was unremarkable. Treponemal antibody and rapid plasma reagin test were both positive. HIV test and cerebrospinal fluid venereal disease research laboratory (VDRL) test were negative. Abdominal ultrasound and CT scan of the abdomen were unremarkable. Magnetic resonance cholangiopancreatography was notable for hepatomegaly and hepatitis. Patient received 1 dose of penicillin G 2.4 million units intramuscularly with remarkable improvement in his symptoms and liver function tests. He was discharged home with close follow-up with gastroenterology and infectious disease. Discussion: SH occurs in 0.2-9.7% of patients with syphilis and is most commonly seen in the primary and secondary disease stages. Clinical manifestations include a maculopapular rash (involving the trunk, palms and/or soles of feet), fatigue, poor appetite, hepatomegaly and icterus. Liver function tests (LFTs) may reveal a marked increase in ALP and GGT in comparison to ALT and AST. SH is diagnosed with abnormal LFTs, serological evidence of syphilis, exclusion of other liver diseases and LFTs returning to normal after antibiotic therapy as in our patient. The histological features of SH include inflammatory infiltration of the bile duct and hepatic granulomas. Spirochetes are often difficult to identify in liver tissue. Penicillin is the mainstay of treatment. Clinicians should consider syphilitic hepatitis in a patient with abnormal LFTs (especially ALP) and a rash involving the palms and soles of feet in the appropriate clinical context.

S3185 The Great Imitator Spares No Organ: A Case of Syphilitic Hepatitis in an Immunocompetent Patient

Introduction: Syphilis, infamously known as the “great imitator,” is an infectious disease caused by the spirochete Treponema pallidum and can affect many organs. Though uncommon, syphilis can also affect the liver, often manifesting as elevated liver enzymes. Herein we describe the case of a 48-year-old immunocompetent male who was found to have a syphilis-induced acute liver injury. Case Description/Methods: A 48-year-old male presented with a two-week history of dry cough, fever, anorexia, and sore throat. He initially presented to an outside hospital where he was diagnosed with community-acquired pneumonia and discharged on amoxicillin-clavulanate. Given poor improvement in symptoms, he presented to our emergency department several days later and noted additional symptoms of headache, blurry vision, and rash. On admission, liver enzymes were elevated (Table 1), and a mild maculopapular rash was noted on his trunk and extremities. Clinical findings and liver injury were attributed to a drug injury in the setting of recent amoxicillin-clavulanate use. However, the liver injury persisted, prompting additional evaluation. Acute and chronic liver serology tests were unrevealing except for a positive anti-mitochondrial antibody, 44 units, and anti-nuclear antibodies, titers of 1:160. Syphilis screen with rapid plasma reagin was reactive with a titer of 1:32. Given neurological symptoms, a lumbar puncture was performed and revealed a reactive fluorescent treponemal antibody test absorption test. The patient was diagnosed with secondary syphilis complicated by neurosyphilis and syphilitic hepatitis. The patient completed a two-week course of intravenous penicillin with complete resolution in symptoms. After initiation of penicillin, the patient's liver chemistries downtrended and normalized after treatment, confirming the diagnosis of syphilitic hepatitis. Discussion: Syphilitic hepatitis is an uncommon manifestation of syphilis. Suspicion should be raised in patients with elevated liver chemistries, in particular cholestatic pattern, who also have manifestations such as maculopapular rash, low grade fever, arthralgias, headache, and changes in vision. This case highlights the importance of maintaining a broad differential and avoiding anchoring bias when approaching elevated liver chemistries. Table 1. - Liver Function Tests Baseline Outside Hospital Presentation Week 1 Week 3 Alkaline phosphatase (IU/L) 78 1126 1118 997 437 ALT (IU/L) 14 225 231 224 53 AST (IU/L) 19 130 154 139 37 Total bilirubin (mg/dL) 0.8 1.9 4.3 2.0 0.9

A RARE CASE OF KIKUCHI-FUJIMOTO DISEASE IN THE SETTING OF ASPLENIA

A RARE CASE OF KIKUCHI-FUJIMOTO DISEASE IN THE SETTING OF ASPLENIA

S2017 Double Trouble: A Case of Co-Infection With Campylobacter and Giardia in a HIV-Positive Patient

Introduction: Patients with immunosuppressed states such as uncontrolled HIV are at increased risk for opportunistic infections including acute infectious diarrhea. Here, we present a case of a noncompliant HIV patient who presented with a complaint of acute diarrhea with resulting weight loss. Work-up was significant for co-infection with giardia and campylobacter as a result of receptive anal sexual intercourse. Case Description/Methods: A 45-year-old transgender male to female patient with a past medical history of poorly controlled HIV infection not actively on antiviral therapy and chronic Hepatitis B (HBV) infection presented with initial complaint of acute diarrhea for one week with accompanying weight loss. The patient concurrently complained of a diffuse, painful, pruritic rash for 5 days. A thorough history revealed the patient had just returned from Miami, where she reported multiple sexual partners with recent unprotected oral and anal intercourse. On initial presentation, the patient was tachycardic and febrile to 104.8, with generalized abdominal tenderness and a diffuse macular rash involving scalp, torso, genitals, and extremities, including palms and soles. The patient was admitted and started on acyclovir, vancomycin and ceftriaxone. A comprehensive stool panel was positive for both campylobacter and giardia. The patient was also noted to have CMV viremia, a HIV viral load of 38,000, and a positive rapid plasma reagin. The infectious disease team was consulted and the patient was treated with a single dose of tinidazole and 2 doses of metronidazole followed by a 7-day course of ciprofloxacin. Her acute diarrhea resolved, at which point she restarted antiretroviral therapy, and completed a 14-day course of penicillin for her syphilis. She was discharged home with close follow up with her infectious disease specialist. Discussion: This case highlights the increased risk of opportunistic infections in the setting of poorly controlled HIV and unprotected sexual intercourse as highlighted by this patient’s co-infection with both giardia and campylobacter. Campylobacter and giardia are 2 commonly associated foodborne illnesses, however they can be transmitted via unprotected oral-anal sex. In addition to compliance with HIV treatment, patients should consider barrier methods during receptive sex to prevent fecal-oral transmission. In sum, our case highlights the importance of keeping a broad differential of infectious causes of diarrhea, especially in the immunocompromised population.

Other Central Nervous System Infections(Including Fungal Infection, Tuberculosis, and Parasitic Infection)

This review describes cryptococcal meningoencephalitis, tuberculous meningitis, neurosyphilis, and toxoplasma encephalitis. Central nervous system infections are neurological emergencies associated with mortality or other outcomes. Therefore, early diagnosis and treatment are critical. Fungal or gondii infections are rare and affect compromised hosts who are HIV positive, have diabetes, or take immunosuppressive or anticancer drugs. Cryptococcal antigens in the serum and cerebrospinal fluid are useful for the diagnosis of cryptococcal meningoencephalitis. RPR and TPHA tests are useful for the diagnosis of neurosyphilis. Cryptococcal meningoencephalitis and tuberculous meningitis often develop into hydrocephalus, making VP shunt necessary. Antifungal drugs for cryptococcal meningitis are limited by the blood-brain barrier, making a full recovery difficult; in such situations, intraventricular antifungal treatment is required.

Prevalence of syphilis coinfection in hepatitis C virus positive prenatal patients from Alberta during a pilot routine screening program.

BACKGROUND: Alberta routinely screens pregnant patients for select communicable diseases. Hepatitis C virus (HCV) was added to the prenatal screening panel as part of a provincial pilot program in February 2020. This retrospective cross-sectional study aimed to characterize the prevalence of syphilis coinfections in prenatal patients infected with HCV following implementation of the pilot program.METHODS: Routine prenatal HCV and syphilis testing data were extracted from the Public Health Laboratory Information System over a 21-month period. HCV positivity was defined as HCV enzyme immunoassay (EIA) reactive with detected HCV ribonucleic acid (RNA) following molecular confirmation, and positive results were examined for syphilis coinfections. All patients reactive on a syphilis EIA and confirmatory Treponema pallidum particle agglutination (TPPA) or follow-up rapid plasma reagin (RPR) test were considered positive for syphilis. Descriptive statistics for coinfected patients were analyzed. RESULTS: Eighty-seven prenatal patients were identified to be positive for HCV. Of those, 19 (21.8%) were reactive on the syphilis EIA and 17 (19.5%) had confirmed infections with the TPPA or RPR tests. For HCV/syphilis coinfected patients, the majority resided in metropolitan regions (64.6%), were from the lowest income quintile neighbourhoods (47.1%) and had previously tested positive for HCV (82.4%) and syphilis (64.6%) at the public health laboratory. CONCLUSIONS: The prevalence of syphilis coinfections in prenatal patients infected with HCV is high in Alberta. HCV/syphilis coinfection prevalence should be further investigated in other jurisdictions and prenatal cohorts to better understand testing and treatment options for prevention of congenital transmission.

Comparison of syphilis testing by reverse algorithm and conventional method among blood donors in a tertiary care center

Traditional testing algorithm for syphilis begins with screening non-treponemal test followed by confirmatory treponemal test. Reverse algorithm first screens with a treponemal test; reactive samples are then tested by Rapid plasma reagin test (RPR) which is used to assess disease activity. Discordant syphilis IgG and RPR results are resolved by a second treponemal test, Treponema pallidum hemagglutination assay (TPHA) as recommended by the Centres for Disease Control and Prevention laboratories. To evaluate the analytical performance of reverse algorithms in syphilis infection among donors in comparison with traditional methods and the prevalence of syphilis among blood donor populations.This was a cross sectional study done in the department of transfusion medicine from January 2019 to February 2020 which comprised of 8635 blood donors. After donation all the blood samples were screened for syphilis using chemiluminescent immunoassay (Vitros syphilis TPA assay) in Vitros 3600 EQ/ECIQ immunodiagnostic system and RPR (omega RPR test kit) irrespective of each other’s result. Whenever chemiluminescence immunoassay or RPR turns positive, the samples were sent for TPHA (Immutrep TPHA test kit) keeping it as the gold standard method.Among 8635 samples tested, seroreactivity of CLIA (Vitros syphilis TPA assay) was 0.25 % whereas for traditional algorithm 0.13%. Sensitivity, specificity and accuracy of reverse algorithm in comparison with traditional was 100 %, 70.6%, 78.3% and 36.4% ,75% and 65.1% respectively. In comparison with TPHA, Vitros TPA assay in reverse algorithm showed moderate agreement (k=0.56, p=0) which was statistically significant whereas RPR showed slight agreement (k=0.11, p=0.47). Negative predictive value of CLIA was 100% (p=0) which was statistically significant. Positive predictive value of reverse algorithm was 54.5% and 33.3% for traditional algorithm (p=0.04).

Seroprevalence of syphilis and its predictors among pregnant women in Buno Bedele zone, southwest Ethiopia: a community-based cross-sectional study

ObjectivesThe study was aimed at assessing the prevalence of syphilis and associated factors among pregnant women with antenatal care follow-up.DesignA health facility-based, cross-sectional study.SettingThe study was conducted in 12 health...

Syphilis-related Ocular Inflammation in HIV-positive and HIV-negative Patients

ABSTRACT Purpose To evaluate the clinical characteristics and visual outcomes of ocular syphilis in human immunodeficiency virus (HIV)-positive and negative patients. Methods We performed a retrospective chart review of all patients with newly diagnosed ocular syphilis between January 2015 and August 2021. Results 68 eyes of 41 patients (22 eyes in 12 HIV-positive patients, 46 eyes in 29 HIV-negative patients) were included. The most common ophthalmic feature was posterior uveitis in HIV-positive and anterior uveitis in HIV-negative patients; 58.3% (7 out of 12 patients) of HIV-positive and 48.2% (14 out of 29 patients) of HIV-negative patients were diagnosed with neurosyphilis. There were no significant differences in laterality, presence of concurrent rash, rapid plasma reagin (RPR) titers, presenting, and final corrected visual acuity between both groups. Conclusion Nearly one-fifth of eyes may suffer from severe visual loss of ≤ 20/200. HIV co-infection may not result in visual outcomes in syphilis.

Clinical Challenge in Urology: A Nonhealing Wound on the Glans Penis

A 63-year-old male presented to his surgeon 6 months following circumcision for phimosis with complaints of a nonhealing wound on the glans penis. He reported persistent bleeding, pain, and progressive difficulty urinating in the months following the procedure. He was noted to have a grossly dehisced circumcision, with erythematous, beefy granulation tissue involving the entire glans (Fig. 1). Biopsy taken from the glans demonstrated pseudoepitheliomatous hyperplasia, intraepidermal microabscess formation, and focal subepidermal vesiculation overlying brisk inflammation including neutrophils, plasma cells, eosinophils, and lymphocytes (Fig. 2). Infectious workup revealed MRSA on tissue culture (treated without clinical improvement), negative HSV PCR, and negative special stains and tissue cultures for mycobacterial and fungal species. Further laboratory evaluation included rapid plasma reagin (RPR), antineutrophilic cytoplasmic autoantibody (ANCA), Hepatitis A/B/C, HIV, Lyme, antineutrophilic antibody (ANA), and tuberculosis interferon-γ release assay (IGRA)—all were unremarkable/negative. There was no clinical improvement with topical lidocaine, antibiotic ointment, testosterone, halobetasol cream, and courses of oral antibiotics and fluconazole.