Syphilis Patients Research Articles

Association of Interleukin-10 promoter polymorphisms with neurosyphilis

Interleukin 10 (IL-10) is a potent anti-inflammatory cytokine. Increased production of IL-10 has been found in late syphilis, presumably creating favorable conditions for bacteria persistence. Single-nucleotide polymorphisms (SNPs) within the promoter of IL-10 gene have been found to influence IL-10 production. We investigated whether SNPs in the IL-10 gene promoter are associated with cerebrospinal fluid (CSF) levels of IL-10 and neurosyphilis.Polymorphisms in the gene for IL-10 (G→A mutation at the position −1084 and C→A mutation at the position −592) were sought in 35 patients with syphilis and 24 healthy volunteers. CSF examination (i.e. routine laboratory tests and IL-10 levels) was performed in all syphilis patients. Neurosyphilis was defined as reactive CSF VDRL test or CSF white blood cells⩾5/μL and CSF protein concentration⩾45mg/dL.Overall, 31% of patients with syphilis had neurosyphilis. CSF IL-10 levels were significantly higher in patients with neurosyphilis when compared to those with syphilis but not neurosyphilis. −1082 GG and −592 CC genotypes were significantly associated with higher CSF IL-10 levels. Moreover, these genotypes were found to be more frequent in individuals with neurosyphilis in comparison to those without neurosyphilis.Anti-inflammatory immune response seems to be important in pathogenesis of neurosyphilis. Our data suggest that host-related factors, such as SNPs of immune regulatory genes may influence the susceptibility to neurosyphilis.

Ocular syphilis in patients with Human Immunodeficiency Virus infection

As Acquired Immunodeficiency Disease (AIDS) turns thirty-years old, much progress has been made. 56,000 new cases of the Human Immunodeficiency Virus (HIV) infection are expected in Americans this year. At least half or more will be in African Americans. Reports of the association between syphilis and HIV infection are well documented. We present a case of bilateral optic neuritis and panuveitis as the initial presentation in a previously undiagnosed patient with human immunodeficiency virus (HIV) and syphilis.

Secondary Syphilis in Patients Treated at the City Institute for Skin and Venereal Diseases in Belgrade from 2010 to 2014

Abstract The aim of this study was to analyze the characteristics and clinical manifestations of secondary syphilis among patients registered at the City Institute for Skin and Venereal Diseases in Belgrade, during the period from 2010 to 2014. The study was designed as a case-note review. In the five-year period, a total of 62 patients with secondary syphilis were registered. The average patient age was 32 years. There were 45 (72.6%) HIV-negative, and 17 (27.4%) HIV-positive patients. The incidence of HIV–positive patients was significantly different from random distribution (p = 0.016). All HIV-positive patients were unmarried men. A significant percentage of HIV-positive patients were unemployed (p < 0.001), reported unknown source of infection (p = 0.002) and were all homosexuall (p = 0.026). More than 25% of all patients with syphilis had a history of chancres, and it was still present at the time of examination in 11.3% of all patients. The majority of cases (87.1%) had a rash, and lymphadenopathy was found in 20% of patients. However, syphilitic alopecia was detected only in HIV-positive cases (p = 0.004). There were no statistically significant differences between HIV-positive and HIV-negative patients in regard to other clinical manifestations, such as mucous patches and condylomata lata. Being a great imitator, secondary syphilis may manifest in a myriad of diverse morphological entities and clinical manifestations. We review a range of cutaneous manifestations of secondary syphilis and skin diseases it may mimic. Clinicians must be vigilant and consider syphilis in differential diagnosis, and maintain a high index of suspicion, especially when assessing vulnerable populations, such as men who have sex with men and HIV-infected individuals.

Duration of the determination of specific Igm antibodies in primary syphilis patients after treatment

It was carried out a study with ALISAIgM of 341 samples of the blood, obtained from the patients with the early forms of syphilis 3-36 months later the end of adequate antibacterial therapy with the purpose for studying the duration of circulation in the blood of specific antibodies IgM to the antigens T. pallidum after the treatment. It was shown gradual reduction of the levels of the anti-treponema antibodies of the class M in the blood with an increase of the period of observation and their total elimination to the period of 36 months. It was not established reliable differences within the dynamics of a decrease in the levels of specific IgM and the periods of negativation of the ALISAIgM results depending on the adequate method of antibacterial therapy.

High-dose oral amoxicillin plus probenecid is highly effective for syphilis in patients with HIV infection.

Intramuscular benzathine penicillin G (BPG) is widely used for the treatment of syphilis. However, BPG is not available in some countries. This study examined the effectiveness and safety of high-dose oral amoxicillin plus probenecid for the treatment of syphilis in patients with human immunodeficiency virus type 1 (HIV-1). This retrospective observational study included 286 HIV-infected male patients with syphilis (median age, 36 years; median CD4 count, 389 cells/µL) who were treated with oral amoxicillin 3 g plus probenecid. Syphilis was diagnosed by both serum rapid plasma reagin (RPR) titers ≥8 and positive Treponema pallidum hemagglutination test. Patients with neurosyphilis diagnosed by cerebrospinal fluid examination were excluded. Successful treatment was defined as a at least 4-fold decrement in RPR titer. The overall treatment efficacy was 95.5% (95% confidence interval [CI], 92.4%-97.7%; 273/286 patients), and efficacy for primary, secondary, early latent, late latent, and unknown duration syphilis was 93.8% (95% CI, 68.1%-99.8%; 15/16), 97.3% (95% CI, 92.9%-99.2%; 142/146), 100% (95% CI, 90.5%-100%; 37/37), 85.7% (95% CI, 58.6%-96.4%; 18/21), and 92.4% (95% CI, 81.9%-97.3%; 61/66), respectively. Treatment duration was mostly 14-16 days (49.7%) or 28-30 days (34.3%), with efficacy of 94.4% (134/142) and 95.9% (94/98), respectively; 96.3% of successfully treated patients achieved a ≥4-fold decrement in RPR titer within 12 months. Adverse events were noted in 28 (9.8%) patients, and 25 of these (89.3%) were successfully treated. Only 6% of patients underwent lumbar puncture. The combination of oral amoxicillin 3 g plus probenecid was highly effective and tolerable for the treatment of syphilis in patients with HIV-1 infection.

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.

High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis

The preferred drugs for the treatment of syphilis, benzathine and procaine penicillin, have not been available in Shanghai for many years, and currently, the incidence of syphilis is increasing. Alternative antibiotics for patients with syphilis during the benzathine and procaine penicillin shortage include macrolides. The failure of macrolide treatment in syphilis patients has been reported in Shanghai, but the reason for this treatment failure remains unclear. We used polymerase chain reaction technology to detect a 23S rRNA A2058G mutation in Treponema pallidum in 109 specimens from syphilis patients. The use of azithromycin/erythromycin in the syphilis patients and the physicians' prescription habits were also assessed based on two questionnaires regarding the use of macrolides. A total of 104 specimens (95.4%) were positive for the A2058G mutation in both copies of the 23S rRNA gene, indicating macrolide resistance. A questionnaire provided to 122 dermatologists showed that during the penicillin shortage, they prescribed erythromycin and azithromycin for 8.24±13.95% and 3.21±6.37% of their patients, respectively, and in the case of penicillin allergy, erythromycin and azithromycin were prescribed 15.24±22.89% and 7.23±16.60% of the time, respectively. A second questionnaire provided to the syphilis patients showed that 150 (33.7%), 106 (23.8%) and 34 (7.6%) individuals had used azithromycin, erythromycin or both, respectively, although the majority did not use the drugs for syphilis treatment. Our findings suggest that macrolide resistance in Treponema pallidum is widespread in Shanghai. More than half of the syphilis patients had a history of macrolide use for other treatment purposes, which may have led to the high prevalence of macrolide resistance. Physicians in China are advised to not use azithromycin for early syphilis.

Natural Killer Cell Immunophenotypic Abnormalities in Secondary Syphilis Patients

Natural Killer Cell Immunophenotypic Abnormalities in Secondary Syphilis Patients

Syphilis: Is it making resurgence?

Syphilis, the "great imitator", presents with a wide range of mucocutaneous and systemic manifestations, which can mimic many more diseases. Though there has been a rising prevalence of viral sexually transmitted infections (STIs), syphilis is not an uncommon diagnosis. To study the recent trend of acquired syphilis in the patients attending STI clinic. Retrospective analysis of all the syphilis patients registered with STI clinic of our institute from January 2013 to December 2014 was done. Thorough sociodemographic, clinical, and investigational data were assessed and compared with the annual incidence of last 4 years. Of the total 1010 STI patients who attended the STI clinic, 110 cases were diagnosed as syphilis. There were 78 (70.9%) males and 32 (29.1%) females. Twenty-five (22.7%) patients were men who have sex with men (MSM). Primary syphilis was diagnosed in 28 (25.5%), secondary in 47 (42.7%), and latent in 35 (31.8%) cases. Lymphadenopathy was present in 55 (50%) patients with syphilis. Mixed infection was diagnosed in 29 (26.4%) patients of whom genital herpes was the most common. Twenty-seven (24.5%) patients were human immunodeficiency virus (HIV) reactive. Incidence of syphilis has shown a rising trend over past few years. The major risk factors considered are the HIV infection and homosexual behavior.

Syphilis: Is it making resurgence?

Background:Syphilis, the “great imitator”, presents with a wide range of mucocutaneous and systemic manifestations, which can mimic many more diseases. Though there has been a rising prevalence of viral sexually transmitted infections (STIs), syphilis is not an uncommon diagnosis.Aims:To study the recent trend of acquired syphilis in the patients attending STI clinic.Materials and Methods:Retrospective analysis of all the syphilis patients registered with STI clinic of our institute from January 2013 to December 2014 was done. Thorough sociodemographic, clinical, and investigational data were assessed and compared with the annual incidence of last 4 years.Results:Of the total 1010 STI patients who attended the STI clinic, 110 cases were diagnosed as syphilis. There were 78 (70.9%) males and 32 (29.1%) females. Twenty-five (22.7%) patients were men who have sex with men (MSM). Primary syphilis was diagnosed in 28 (25.5%), secondary in 47 (42.7%), and latent in 35 (31.8%) cases. Lymphadenopathy was present in 55 (50%) patients with syphilis. Mixed infection was diagnosed in 29 (26.4%) patients of whom genital herpes was the most common. Twenty-seven (24.5%) patients were human immunodeficiency virus (HIV) reactive.Conclusion:Incidence of syphilis has shown a rising trend over past few years. The major risk factors considered are the HIV infection and homosexual behavior.

Screening, treatment, and follow-up of syphilis patients: Issues, concerns and efforts to improve current paradigms.

Screening, treatment, and follow-up of syphilis patients: Issues, concerns and efforts to improve current paradigms.

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

ABSTRACT Objective To report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test ( Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008. Methods A total of 14 639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened. Results Among the 14 639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008. Conclusions Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

High seroprevalence of Borrelia miyamotoi antibodies in forestry workers and individuals suspected of human granulocytic anaplasmosis in the Netherlands.

Substantial exposure to Borrelia miyamotoi occurs through bites from Ixodes ricinus ticks in the Netherlands, which also transmit Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum. Direct evidence for B. miyamotoi infection in European populations is scarce. A flu-like illness with high fever, resembling human granulocytic anaplasmosis, has been attributed to B. miyamotoi infections in relatively small groups. Borrelia miyamotoi infections associated with chronic meningoencephalitis have also been described in case reports. Assuming that an IgG antibody response against B. miyamotoi antigens reflects (endured) infection, the seroprevalence in different risk groups was examined. Sera from nine out of ten confirmed B. miyamotoi infections from Russia were found to be positive with the recombinant antigen used, and no significant cross-reactivity was observed in secondary syphilis patients. The seroprevalence in blood donors was set at 2.0% (95% CI 0.4–5.7%). Elevated seroprevalences in individuals with serologically confirmed, 7.4% (2.0–17.9%), or unconfirmed, 8.6% (1.8–23%), Lyme neuroborreliosis were not significantly different from those in blood donors. The prevalence of anti-B. miyamotoi antibodies among forestry workers was 10% (5.3–16.8%) and in patients with serologically unconfirmed but suspected human granulocytic anaplasmosis was 14.6% (9.0–21.8%); these were significantly higher compared with the seroprevalence in blood donors. Our findings indicate that infections with B. miyamotoi occur in tick-exposed individuals in the Netherlands. In addition, B. miyamotoi infections should be considered in patients reporting tick bites and febrile illness with unresolved aetiology in the Netherlands, and other countries where I. ricinus ticks are endemic.

Molecular typing of Treponema pallidum in the Czech Republic during 2011 to 2013: increased prevalence of identified genotypes and of isolates with macrolide resistance.

From January 2011 to December 2013, a total of 262 samples, from 188 patients suspected of having syphilis were tested for the presence of treponemal DNA by PCR amplification of five chromosomal loci, including the polA (TP0105), tmpC (TP0319), TP0136, TP0548, and 23S rRNA genes. Altogether, 146 samples from 103 patients were PCR positive for treponemal DNA. A set of 81 samples from 62 PCR-positive patients were typeable, and among them, nine different genotypes were identified. Compared to a previous study in the Czech Republic during 2004 to 2010, the number of genotypes detected among syphilis patients in a particular year increased to six in both 2012 and 2013, although they were not the same six. The proportion of macrolide-resistant clinical isolates in this 3-year study was 66.7%.

Increased interleukin-17 in peripheral blood and cerebrospinal fluid of neurosyphilis patients.

Background Treponema pallidum infection evokes vigorous immune responses, resulting in tissue damage. Several studies have demonstrated that IL-17 may be involved in the pathogenesis of syphilis. However, the role of Th17 response in neurosyphilis remains unclear.Methodology/Principal FindingsIn this study, Th17 in peripheral blood from 103 neurosyphilis patients, 69 syphilis patients without neurological involvement, and 70 healthy donors were analyzed by flow cytometry. The level of IL-17 in cerebrospinal fluid (CSF) was quantified by ELISA. One-year follow up for 44 neurosyphilis patients was further monitored to investigate the role of Th17/IL-17 in neurosyphilis. We found that the frequency of Th17 cells was significantly increased in peripheral blood of patients with neurosyphilis, in comparison to healthy donors. IL-17 in CSF were detected from 55.3% neurosyphilis patients (in average of 2.29 (0–59.83) pg/ml), especially in those with symptomatic neurosyphilis (61.9%). CSF IL-17 was predominantly derived from Th17 cells in neurosyphilis patients. Levels of IL-17 in CSF of neurosyphilis patients were positively associated with total CSF protein levels and CSF VDRL (Venereal Disease Research Laboratory) titers. Notably, neurosyphilis patients with undetectable CSF IL-17 were more likely to confer to CSF VDRL negative after treatment.ConclusionsThese findings indicate that Th17 response may be involved in central nervous system damage and associated with clinical symptoms in neurosyphilis patients. Th17/IL-17 may be used as an alternative surrogate marker for assessing the efficacy of clinical treatment of neurosyphilis patients.

Detection of polA gene in whole blood samples and preliminary observations with molecular subtyping of Treponema pallidum

To detect Treponema pallidum (T.pallidum) DNA with polymerase chain reaction (PCR) in whole blood samples of syphilis patients and analyze their features of sub-genotypes. The clinical data of patients were collected from July 2012 to February 2013. And polA gene of syphilis was detected by PCR. The arp and tpr genes of polA gene-positive samples were analyzed by the established genotyping system.Statistical analyses were performed to compare different clinical courses and features to examine their correlations. The common treponemal gene target (polA) of 35 samples were detected in whole blood by PCR in 181 samples. A total of 24 cases (35.8%) were positive in 67 patients with newly diagnosed non-latent syphilis untreated patients;26 cases of latent syphilis were negative;7 cases (9.7%) were positive in 72 subsequent visit patients;4 cases (25.0%) were positive in 16 patients with sero-resistant. There were 4 subtypes of 14a (n = 7), 14b (n = 10), 13c (n = 4) and 14d (n = 14). Among those positive samples, there were 4 sero-resistant samples of 3 subtypes 14d and 1 subtype 14b. The feasibility of peripheral blood is confirmed. Although the positive rate of whole blood detection of T.pallidum gene is low, the method is both simple and reliable for patients with sero-resistant syphilis.

Early syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin

Benzathine penicillin G is the treatment of choice for syphilis, but doxycycline and tetracycline are effective second-line treatments. The objective of this study was to assess the serological response to treatment for early syphilis with benzathine penicillin compared with doxycycline or tetracycline. We examined rapid plasma regain (RPR) serological test results of all first-time early syphilis patients in Peking Union Medical College Hospital between 2000 and 2011, comparing treatment with two doses of penicillin to 14-day course of oral doxycycline (100 mg twice daily) or oral tetracycline (500 mg 4 times a day). Of the 641 early syphilis cases with available treatment outcome data, 606 (94.5%) received penicillin and 35 (5.5%) received doxycycline/tetracycline. More than half (52.1%) had secondary syphilis, 13.4% had primary syphilis, and 34.5% had early latent syphilis. A statistically similar serological treatment success rate (p = 0.157) was observed in penicillin-treated patients 91.4% (554/606), when compared with patients treated with doxycycline/tetracycline 82.9% (29/35). Doxycycline/tetracycline had a similar serological treatment success rate when compared to penicillin in the treatment of early syphilis.

Psychology and behavior investigation of student nurses in contact with syphilis patients

Objective To investigate the psychological and behavioral change of student nurses after contacting with syphilis patients and to seek the measures to improve the awareness of related knowledge , in order to help them overcome the psychological fear and to strengthen their protection awareness .Methods A self-designed questionnaire on syphilis-related knowledge was used to randomly survey 100 student nurses who were in clinical practice at our hospital .Results In the 100 questionnaires , most of student nurses had poor-mastering knowledge on syphilis .84% student nurses were afraid of being infected with syphilis , and 92%student nurses would wash hands and disinfection after caring of syphilis patients .Conclusions The student nurses have relatively poor knowledge on syphilis , so the education on syphilis should be paid much more attention, as well as the education of professional ethics .Thus, the student nurses can improve the awareness of self-protection , and provide syphilis patients with better meticulous nursing care . Key words: Student,nursing; Syphilis; Psychology; Behavior

Soroprevalência de sífilis em pacientes submetidos à fertilização assistida

ObjectiveTo determine the seroprevalence of syphilis in patients undergoing assisted reproduction. MethodRetrospective descriptive study conducted from january to december 2011 in patients undergoing assisted reproduction of low and high complexity at the Hospital and Clinic Fertility Diagnostics in Goiania. The test used for the diagnosis of syphilis was not treponemal test and treponemal. ResultsIn the Hospital das Clinicas found 320 women. Negative not treponemal test were found in 253 of these patients and 67 were not screened. In Fertile Diagnostics were selected in 1,942 patients, 896 women and 728 are men. Of this total, 318 did not perform serology necessary to start treatment, and then collected data from 1,624 patients. ConclusionThe overall prevalence of syphilis in patients undergoing assisted reproduction is 0.11%, and considering the female sample was 0% public and private female sample was 0.11%, and the sample was male private 0.14%.

Production and evaluation of the clinical efficacy of the recombinant T. pallidum antigen Tp0453 for syphilis diagnosis

Goal. Production of a recombinant T. pallidum antigen Tp0453 and the evaluation of the efficacy of its clinical use for syphilis diagnosis. Materials and methods. To produce the target recombinant T. pallidum antigen, a Tp0453 protein coding fragment of the DNA of the causative agent of syphilis, was cloned into the pET28а vector. Heterological expression of the recombinant T. pallidum antigen was performed in the E. coli BL21 (DE3) strain. The recombinant Tp0453 six-histidine-tagged protein was purified by the metal-chelate affinity chromatography. The resulting homogenous recombinant T. pallidum Tp0453 protein was used to reveal specific IgG antibodies in the serum of syphilis patients using a microarray technology. Results and conclusion. The use of the resulting recombinant protein enabled authors to reveal anti- T. pallidum antibodies in the blood serum of patients suffering from syphilis (primary, secondary, early and late latent syphilis). None of the uninfected controls had a significant reactivity to the recombinant Tp0453. These data allow to propose, that the recombinant protein Tp0453 show promise for laboratory diagnosis of syphilis. The introduction of Tp0453 antigen into the test systems for diagnosis of syphilis (ELISA, immunoblotting or microarray) increases the potential of serodiagnosis of this disease due to the broader range of the revealed antitreponemal antibodies.