Stage Of Syphilis Infection Research Articles

Phase II trial evaluating the clinical efficacy of cefixime for treatment of active syphilis in non-pregnant women in Brazil (CeBra)

BackgroundSyphilis is a sexually and vertically transmitted infection caused by the bacteria Treponema pallidum for which there are few proven alternatives to penicillin for treatment. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. Recent shortages, national level stockouts as well as other barriers to penicillin use call for the urgent identification of alternative therapies to treat pregnant women infected with syphilis.MethodsThis prospective, randomized, non-comparative trial will enroll non-pregnant women aged 18 years and older with active syphilis, defined as a positive rapid treponemal and a positive non-treponemal RPR test with titer ≥1:16. Women will be randomized in a 2:1 ratio to receive the oral third generation cephalosporin cefixime at a dose of 400 mg two times per day for 10 days (n = 140) or benzathine penicillin G 2.4 million units intramuscularly based on the stage of syphilis infection (n = 70). RPR titers will be collected at enrolment, and at three, six, and nine months following treatment. Participants experiencing a 4-fold (2 titer) decline by six months will be considered as having an adequate or curative treatment response.DiscussionDemonstration of efficacy of cefixime in the treatment of active syphilis in this Phase 2 trial among non-pregnant women will inform a proposed randomized controlled trial to evaluate cefixime as an alternative treatment for pregnant women with active syphilis to evaluate prevention of congenital syphilis.Trial registrationTrial identifier: www.Clinicaltrials.gov, NCT03752112. Registration Date: November 22, 2018.

Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia.

IntroductionOcular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia.MethodologyThis was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed.ResultsA total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes.ConclusionsPosterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.

Evaluation of the Elecsys Syphilis Immunoassay for Detection of Syphilis in Populations at Risk of Disease in the US and Argentina.

The Elecsys® syphilis immunoassay is an automated, qualitative immunoassay that uses a double-antigen sandwich format to detect antibodies to Treponema pallidum in human serum and plasma. We aimed to validate performance of the immunoassay in various populations at risk for syphilis infection in the US and Argentina. Samples were obtained for a number of study cohorts, including participants from routine syphilis testing at high or low risk for syphilis, HIV-positive patients, pregnant women, and patients in various stages of syphilis infection. The primary objective was to validate the Elecsys syphilis immunoassay by comparing it with a composite testing algorithm using US Food and Drug Administration (FDA)-approved tests, including the predicate IMMULITE 2000 syphilis screening assay, the rapid plasma reagin, and the T. pallidum particle agglutination assay. Complete algorithm testing was performed on all 2660 collected samples. Acceptable precision was demonstrated in all samples. Comparison of the Elecsys syphilis immunoassay with the final syphilis status for all samples yielded a diagnostic sensitivity of 99.5% (95% CI, 98.21-99.94) and a diagnostic specificity of 99.2% (95% CI, 98.69-99.49). Overall, the lower limit of the 95% CIs for sensitivity and specificity met the expected performance of ≥95%. This is the first study that confirms the high sensitivity and specificity of the Elecsys syphilis immunoassay in US and Argentinian cohorts and highlights the assay's usefulness as an alternative to current tests for the diagnosis of syphilis infection in a broad range of participant cohorts.

Missed opportunities to diagnose syphilis prior to the development of sight-losing uveitis

The incidence of syphilis in the UK is rapidly rising. Uveitis (intraocular inflammation) usually occurs in the secondary or later stages of syphilis infection and is sight-threatening. Methods A retrospective analysis of the demographics, presentation, diagnosis, treatment and outcomes of patients with syphilitic uveitis managed in Newcastle from 2005-2016 was carried out. Results Ten males (19 eyes) with syphilitic uveitis had a generally good visual and serological response to penicillin treatment. In eight of the patients there had been a failure to test for syphilis during assessments by various medical practitioners for unexplained symptoms that were attributable to syphilis prior to the eye involvement. Conclusion Uveitis associated with syphilis can be sight-threatening but responds well to treatment. In our case series there were multiple missed opportunities to diagnose syphilis prior to presentation with eye disease, with a general failure of healthcare professionals to take an adequate sexual history.

Identifying and interpreting spatiotemporal variation in diagnoses of infectious syphilis among men, England: 2009 to 2013

ObjectivesSpatial clusters and variations in the trajectory of local epidemics were explored in relation to sexual orientation, demographic factors, stage of syphilis infection and HIV serostatus.MethodsKulldorff's scan statistics (SaTScan) was...

Clinical and epidemiological characteristics of patients with early syphilis from three academic centres in Poland, Germany and Ireland: initial findings from the POETS study

ObjectivesSyphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the...

P3.433 Cost-Effectiveness of Enhanced Syphilis Screening Among HIV-Positive Men Who Have Sex with Men

BackgroundSyphilis co-infection has increased substantially among HIV-positive men who have sex with men (MSM). Screening rates in this population remain below recommended guidelines for screening frequency. We evaluated the cost-effectiveness...

P43 RPR titres following syphilis treatment: does HIV status affect the magnitude or rate of response?

AimsCo-infection with HIV has been shown to alter the serological response to, and the course of, infection with Treponema pallidum. We aimed to determine whether the rate or magnitude of...

Characterization and Serologic Analysis of theTreponema pallidumProteome

Treponema pallidum subsp. pallidum is the causative agent of syphilis, a sexually transmitted disease characterized by widespread tissue dissemination and chronic infection. In this study, we analyzed the proteome of T. pallidum by the isoelectric focusing (IEF) and nonequilibrating pH gel electrophoresis (NEPHGE) forms of two-dimensional gel electrophoresis (2DGE), coupled with matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis. We determined the identity of 148 T. pallidum protein spots, representing 88 T. pallidum polypeptides; 63 of these polypeptides had not been identified previously at the protein level. To examine which of these proteins are important in the antibody response to syphilis, we performed immunoblot analysis using infected rabbit sera or human sera from patients at different stages of syphilis infection. Twenty-nine previously described antigens (predominantly lipoproteins) were detected, as were a number of previously unidentified antigens. The reactivity patterns obtained with sera from infected rabbits and humans were similar; these patterns included a subset of antigens reactive with all serum samples tested, including CfpA, MglB-2, TmpA, TmpB, flagellins, and the 47-kDa, 17-kDa, and 15-kDa lipoproteins. A unique group of antigens specifically reactive with infected human serum was also identified and included the previously described antigen TpF1 and the hypothetical proteins TP0584, TP0608, and TP0965. This combined proteomic and serologic analysis further delineates the antigens potentially useful as vaccine candidates or diagnostic markers and may provide insight into the host-pathogen interactions that occur during T. pallidum infection.

Evaluation in Laboratory Practice

EVALUATION as a laborat,ory tool is basically a means of communication. It is used to compare test efficiency against a standard (patient groups of diseases and conditions) and as a means of conveying information between technologists within a laboratory and also between laboratories. Evaluation studies have been conducted and their results have been transmitted locally, regionally, nationally, and internationally. Three other points about evaluations in labora,tory practice should be remembered: * Evaluation studies are a necessary and effective means of gathering information. * They are a means rather than an end and as such are, or at least should be, part of a more broadly defined endeavor. * Evaluations should be properly designed to reach the desired objectives. Evaluation studies of serologic tests for syphilis have been conducted in the United States by the Public Health Service since 1935. The first Public Health Service evaluation study (1) was made to determine the reliability of several serologic tests foir syphilis then in use in this country. All authors of tests or those who had modified preexisting procedures were invited to participate. When a test-author had originated two procedures, one test was performed by his designee in a laboratory in a different city. More than 1,200 blood and spinal fluid specimens were distributed to the participants. The donors included patients in several stages of syphilis infection and presumably nonsyphilitic persons with and without other diseases or specified conditions. Results were evaluated as to specificity and sensitivity in each of the several disease categories. This study was considered successful since (a) it allowed all testing to be performed by the test-author under nearly idea,l conditions, (b) the relative efficiencies of several tests authored in this country were determined for the first time, and (C) data acquired indicated that the most efficient flocculation-type tests were as efficient as complement fixa,tion tests for testing either blood or spinal fluid. Some tests did not fare well in this study and many are no longer used. Test names such as Brem, Johns, Lufkin-Rytz, Ruediger, and Williams may not be remembered by many. T'he report of this study had wide distribution and probably had an effect on tests that were later adopted by laboratories. Thus the study was a contribution as a means of communication and effective in gathering pertinent and needed information in an unbiased manner. Had these results been all that had been expected of this evaluation study, it would haze stopped here. The real objective of the major endeavor in which this study was a small but significant part was to attain and maintain the high level of efficiency in serologic testing in all laboratories in the United States that would be needed to support,an effective syphilis control program. Finding that test X did well in the hands of the author did not indicate that it would necessarily be performed with equal efficiency by others. It was therefore necessary to evaluate the performance of these tests in other laboratories. Mr. Harris is director, Venereal Disease Research Laboratory, Communicable Disease Center, Public Health Service, Atlanta, Ga. This paper is based on one presented at the Florida Public Health Association meeting, Jacksonville, October 6,1961.