Serological Screening For Syphilis Research Articles

Prevalence of syphilis reactivity in patients with stroke, cognitive impairment and extrapyramidal syndromes: a retrospective study.

In the last two decades, there has been a resurgence of syphilis worldwide. However, epidemiological data on neurosyphilis are inconsistent for the lack of reporting data and diagnostic gold standard tests. The aim of the present study was to estimate the prevalence of syphilis reactivity in a cohort of patients with neurological diseases of our hospital. We retrospectively analyzed the medical records of the patients hospitalized at the Stroke Unit of the Neurology Clinic and those suffering from cognitive impairment hospitalized at the acute ward of the Geriatrics Clinic between January 2017 and December 2019. Also the patients who attended the Movement disorder outpatient clinic during the same study period were examined. To detect syphilis reactivity a qualitative specific treponemal test on patient’s serum was performed: the Treponema pallidum haemagglutination assay (TPHA). A total of 652 patients were admitted and 315 of them (52%) were submitted to a routine screening for syphilis: 307 (97%) were negative while 8 (3%) had a positive syphilis serology. The TPHA-positive patients (4 males, 4 females) were 2 patients with stroke, 5 with cognitive impairment and 1 with Parkinsonism with a mean age of 83 years, suffering from multiple comorbidities. Although the patients we have retrospectively studied have not undergone lumbar puncture to confirm the diagnosis of neurosyphilis, the not negligible syphilis reactivity rate found in our series suggests that serological screening for syphilis should be reviewed as a routine screening test in neurology and geriatrics departments, especially if the clinical presentation of the neurological diseases is atypical.

Immunochip for Syphilis Serodiagnostics with the Use of Extended Array of Treponema pallidum Recombinant Antigens.

An immunochip for multiple parallel detection of specific serum IgG in serological screening for syphilis is based on the use of an extended array of Treponema pallidum recombinant proteins and includes traditionally used immunodominant antigens (Tp15, Tp17, Tp47, and TmpA) and new synthetic proteins (Tp0277, Tp0319, Tp0453, Tp0684, Tp0965, and Tp1038). The use of individual antigens has demonstrated high analytical value of Tp0277 (periplasmatic C-terminal protease), Tp0319 (cytoplasmic membrane-associated lipoprotein TmpC), and external membrane-associated protein Tp0453 with transporting function, all of them improving significantly the efficiency of screening for syphilis in comparison with the traditional array of antigens. Multiparametric analysis of the results obtained on the immunochip with the use of linear discriminant analysis confirmed the efficiency of extended array of T. pallidum diagnostic antigens. Due to proposed modification, the "positive" and "negative" sera are clearly differentiated: the serological study showed 94.1% sensitivity and 100% specificity.

Syphilitic Aortic Aneurysm in the Third Millennium.

A 69-year-old man presented with precordial pain and a dilated ascending aorta with the suspicion of an intramural hematoma. At emergency operation, the aorta appeared grossly thickened with diffuse intimal scarring. Retrospectively, the patient tested positive to serologic screening for syphilis with histologic findings also compatible with a syphilitic aortitis.

The epidemiological characteristics of maternal syphilis and neonatal outcomes with intervention in Jiangyin from 2014 to 2015

Background: To discuss the epidemic characteristics of syphilis during pregnancy and pregnancy outcomes with perinatal intervention in Jiangyin. Materials and Methods: A retrospective analysis of maternal syphilis cases in Jiangyin from January 2014 to December 2015. Results: Serological screening for syphilis was performed for 25,360 pregnant women cases from 2014 to 2015, and 83 cases with syphilis were identified. The positive rate was 3.27% (83/25,360), the detection rate of syphilis during pregnancy was 78.86% (20,000/25,360), and the standard treatment rate of maternal syphilis was 72.29% (60/83). The epidemiological survey results were as follows: Single-factor analysis showed that age, household registry, occupation, educational level, economic income, number of sexual partners, marital status, and if a sex partner had syphilis influenced whether a pregnant women would be infected with syphilis (p p Conclusions: Pregnancy syphilis remained common among itinerant, low income populations with low education, and infected sexual partners in Jiangyin from 2014 to 2015. In the past two years, the city has paid attention to prevention, screening and treatment, and preliminary results show that the maternal syphilis treatment rate is high and neonatal outcomes have significantly improved. It is necessary to improve screening efforts, strengthen awareness and education, standardize treatment, and improve maternal and neonatal outcomes.

Prise en charge diagnostique des uvéites : recommandations d’un groupe d’experts

IntroductionDiagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis. MethodsRecommendations were developed by a multidisciplinary panel of 15 experts, including internists, ophthalmologists and a rheumatologist and are based on a review of the literature with regard to effectiveness of investigations and the results of the ULISSE study, which is the first prospective study assessing the efficiency of a standardized strategy for the etiological diagnosis of uveitis. Children, immunocompromised patients, severe retinal vasculitis and specific ophthalmological entities are excluded from these recommendations. ResultsInvestigations should be first guided by the history and physical examination. Serological screening for syphilis is the only test appropriate in all forms of uveitis. If no diagnosis is made after this stage, we propose investigations guided by the anatomic characteristics of uveitis. It includes HLA B27 testing (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin converting enzyme, interferon-gamma release assay and chest CT (chronic uveitis), cerebral MRI and anterior chamber tap with IL10 analysis (intermediate or posterior uveitis in patients over 40 years). Investigations ordered in the absence of orientation are almost always unhelpful. ConclusionsWe propose a strategy for the etiologic diagnosis of uveitis. The recommendations should be updated regularly. The efficiency of more invasive investigations has yet to be evaluated.

Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee.

Diagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis. Recommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only. Diagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients >40years-old). Other investigations prescribed in the absence of orientation are usually unhelpful. A strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.

P17: Value of the addition of a treponemal test (FTA-Abs) in the routine serologic screening for syphilis in an HIV-infected cohort

P17: Value of the addition of a treponemal test (FTA-Abs) in the routine serologic screening for syphilis in an HIV-infected cohort

Comparison Between Screening and Confirmatory Serological Assays in Blood Donors in a Region of South Italy

Screening assays are needed in order to guarantee safety of donated blood, but a significant number of safe donations are removed from blood supply because of reactive screening results. It is important to evaluate the positive predictive value (PPV) of screening assays in order to modulate confirmatory algorithm and implement an adequate counseling. An analysis of 17,912 blood donations has been conducted at Transfusion Medicine at Second University Naples, Italy, in 2009-2012. Serological screening for syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) was performed by ARCHITECT (Abbott Diagnostics, Wiesbaden, Germany); repeatedly reactive (RR) samples were checked by respective confirmatory tests. The relationship between sample/cutoff and confirmed seropositivity were analyzed. RR rates were low as expected in blood donors: 0.47% for syphilis, 0.42% for HBV, 0.50% for HCV, and 0.15% for HIV. The specificity on RR + gray zone (GZ) was 99.67%, 99.79%, 99.77%, and 99.88%, respectively; due to the low prevalence, PPV value was 30.6% for syphilis, 50.7% for HBV, 42.2% for HCV, and 18.5% for HIV. These values increased substantially reaching a plateau of 89.3% for syphilis, 94.6% for HBV, 85.7% for HCV, and 100% for HIV at the threshold established by receiver operating characteristics curve analysis. Supplemental testing on samples with high signal by screening assays seems to add little information. GZ settings and confirmatory testing for positive screening results should be designed taking in account several factors, including difference in the natural history among blood-borne infections, the characteristics of first- and second-level tests, and, when available, the results of nucleic acid amplification testing.

Prevalence of Treponema pallidum DNA among blood donors with two different serologic tests profiles for syphilis in São Paulo, Brazil.

The presence of Treponema pallidum DNA was assessed by real-time PCR in samples of blood donors with reactive serologic tests for syphilis. Treponema pallidum DNA was detected in two (1·02%) of 197 samples of VDRL>8, EIA+ and FTA-ABS+ donors, and in no sample from 80 VDRL−, EIA+ and FTA-ABS+ donors. Donors VDRL−, EIA+ and FTA-ABS+ lack demonstrable T. pallidum DNA in their blood and are unlike to transmit syphilis. Donors VDRL>8, EIA+ and FTA-ABS+ carry the risk of syphilis infectivity even in concomitance to antibodies detection. Serologic screening for syphilis may still play a role to prevent its transfusion transmission.

O08.6 Do You Have an STI? Findings from a Dedicated Men’s Sexual Health Clinic in Alexandra Township, South Africa

BackgroundA walk-in weekly men’s sexual health clinical service, provided by a male clinical team, was established in 2006.MethodsWe analysed new patient episodes at a dedicated men’s sexual health clinic in...

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.

State laws regarding prenatal syphilis screening in the United States

Objective The purpose of this study was to assess the frequency and pattern of state laws or regulations regarding prenatal syphilis serologic screening in the United States in 2001. Study design We surveyed the United States for existing laws and regulations regarding serologic screening for syphilis during pregnancy. Testing was compared with 2000 state rates of syphilis in women and newborn infants, with states that had syphilis high morbidity areas, and with national 2000 and 2010 objectives for rates of syphilis. Results Forty-six of the 50 states (90%) and the District of Columbia have laws regarding antenatal syphilis screening. Thirty-four of the 46 statutes (76%) mandate one prenatal test, usually at the first prenatal visit or early in pregnancy. Twelve laws (26%) include third-trimester testing for all or high-risk women. The presence of high morbidity areas, incidence of early syphilis in women, and rates of congenital syphilis are associated with increasing frequency of legislated antepartum screening. Conclusion Only 90% of states have statutes that require antepartum syphilis screening, and there is variation in the content of the statutes about the number and timing of tests. States with a heavy burden of infectious syphilis in women tend to require more prenatal testing.

Strategies for syphilis prevention: findings from surveys in a high-incidence area.

The persistence of syphilis in the United States suggests that a better understanding is needed of the potential for various public health approaches to prevent the spread of the disease. The authors conducted surveys of 92 persons with early syphilis, 56 uninfected sexual contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area. The surveys collected information regarding sexual behavior, access to and use of healthcare services, encounters at sites at which serologic screening for syphilis could be done, and exposure to interventions designed to prevent HIV infection. All groups reported high-risk sexual behavior. Cases and contacts were more likely than controls to report two or more sex partners in the previous year, but the three groups were similar in the percentage reporting five or more sex partners. Cases had poor access to health care and by some measures this access was less than that of controls. The potential screening site visited most frequently by cases was the public hospital emergency room (40%). Cases were less likely to have been exposed to programs designed to prevent HIV infection than uninfected contacts and controls combined (odds ratios, 0.51-0.66). Persons with syphilis were not unlike others in their neighborhoods, suggesting that syphilis is a sentinel event that indicates an entire neighborhood is at risk. Improvements in access to health care for sexually transmitted disease-related symptoms, screening in sites such as public hospital emergency rooms, and emphasizing sexual risk-reduction interventions may limit the spread of syphilis in these neighborhoods. To prevent syphilis in the long term, public health programs should also try to better understand and change other community-level socioeconomic factors that influence sexual behavior.

Serological screening for syphilis during pregnancy in a multiethnic Asian population.

Out of 14,841 women who were serologically examined for syphilis at the antenatal booking clinic, University Hospital, Kuala Lumpur in Malaysia, 1.78% were VDRL positive and 1.05% TPHA positive with significant differences between the Malays, Indians and Chinese. These rates are higher than published series and were attributed to childhood yaws infection among the Malays. As differentiation between yaws and syphilitic infection in the clinic is difficult, all TPHA-reactive women were treated as for syphilis. Congenital syphilis was not diagnosed in those women who had been effectively treated before delivery.

The relationship of smiling, sociability and motor status to cognitive development in Down Syndrome infants: Implications for assessment

Diagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis.Recommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only.Diagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients > 40 years-old). Other investigations prescribed in the absence of orientation are usually unhelpful.A strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.