Incidence Of Syphilis Research Articles

Genomic Epidemiology of Treponema pallidum and Circulation of Strains With Diminished tprK Antigen Variation Capability in Seattle, 2021-2022.

The incidence of syphilis continues to increase in the United States, yet little is known about Treponema pallidum genomic epidemiology within American metropolitan areas. We performed whole-genome sequencing and tprK deep sequencing of 28 T. pallidum-containing specimens, collected mostly from remnant Aptima swab specimens from 24 individuals from Seattle Sexual Health Clinic during 2021-2022. All 12 individuals infected with Nichols-lineage strains were men who have sex with men, while a specific SS14 cluster (mean, 0.33 single-nucleotide variant) included 1 man who has sex with women and 5 women. All T. pallidum strains sequenced were azithromycin resistant via 23S ribosomal RNA A2058G mutation. Identical T. pallidum genomic sequences were found in pharyngeal and rectal swab specimens taken concurrently from the same individuals. The tprK sequences were less variable between patient-matched specimens and between epidemiologically linked clusters. We detected a 528-base pair deletion in the tprK donor site locus, eliminating 9 donor sites, in T. pallidum genomes of 3 individuals with secondary syphilis, associated with diminution of TprK diversity. We developed an end-to-end workflow for public health genomic surveillance of T. pallidum from remnant Aptima swab specimens. tprK sequencing may assist in linking cases beyond routine T. pallidum genome sequencing. T. pallidum strains with deletions in tprK donor sites currently circulate and are associated with diminished TprK antigenic diversity.

The Syphilis Epidemic Among Heterosexuals Is Accelerating: Evidence From King County, Washington.

We characterized the rapid increase in syphilis among cisgender women in King County, Washington, and compared it with trends among cisgender men who have sex with men. We used surveillance data from King County, 2007 to 2022, to describe incidence trends stratified by syphilis stage, gender, and gender of sex partners; trends in pregnant cases and congenital syphilis; and trends in rapid plasma reagin titer at diagnosis among late/unknown duration cases. We used joinpoint regression to analyze trends. Among cisgender women, all-stage syphilis incidence remained stable from 2007 to 2010 but then increased by 16.3% per year (95% CI, 12.0%-20.7%) from 2010 to 2020 and 90.1% per year (95% CI, 26.4%-185.9%) from 2020 to 2022. Early syphilis rates rose gradually from 2007 to 2017 (18% per year; 95% CI, 7.4%-29.6%) and then rapidly from 2017 to 2022 (62.5% per year; 95% CI, 24.1%-112.9%). In contrast, the increase in late/unknown duration syphilis incidence was delayed. Among cisgender men who have sex with women, all-stage syphilis remained stable from 2007 to 2014 and increased 25.0% per year (95% CI, 14.0%-37.0%) from 2014 to 2022. Syphilis incidence increased steadily among men who have sex with men, with all-stage incidence increasing 7.0% per year (95% CI, 4.8%-9.2%) from 2007 to 2022. Median rapid plasma reagin titer among late/unknown duration cases increased significantly over the analysis period. An explosive epidemic of syphilis is ongoing in King County. The delayed increase in asymptomatic late/unknown duration cases relative to early symptomatic cases suggests that there is a large and growing reservoir of recently acquired undiagnosed syphilis in women. New clinical and public health activities are urgently needed to control the growing epidemic.

48 Congenital Syphilis in Canada: Findings of a Canadian Paediatric Surveillance Program Study

Abstract Background Since 2015, the incidence of congenital syphilis (CS) in Canada has increased significantly. Vertical transmission of syphilis can be prevented through timely treatment of infected pregnant persons; however, difficulty engaging in prenatal care can preclude diagnosis, and consequently treatment. Canadian data on sociobehavioural risk factors associated with poor engagement in prenatal care is limited, yet needed to inform prevention efforts. Objectives Our primary objective is to identify sociobehavioural risk factors of mothers with infants affected by syphilis, as well as describe the screening and treatment they receive. Our secondary objective is to describe the presentation and management of affected infants in Canada. Design/Methods Cases of confirmed and probable CS were elicited from paediatricians through the Canadian Paediatric Surveillance Program between June 2021 and October 2022. Survey responses were analyzed using descriptive statistics. Results In total, 143 cases were reported: 78% originated from the prairies (Alberta n=39, Saskatchewan n=50, Manitoba n=23) and 34% resided rurally. The median age was 27 years (range 17-39). Among the 143 women, 94 (66%) reported substance use, 42 (29%) child protection involvement with a previous child, and 25 (17%) housing insecurity; however, “unknown” responses were frequent for many variables. Of those reporting substance use, methamphetamines (n=46/94, 49%) and opioids (n=34/94, 36%), were the most common. Most women (n=73/143, 51%) had no known sexually transmitted co-infection, but among those who did, chlamydia was the most common (n=38/70, 54%). Only 22% (n=32/143) reported at least one prenatal visit per trimester. Of the 85/143 mothers known to have a positive syphilis screen, 22% (n=19/85) did not receive treatment. Of the 28 cases where specific barriers to accessing prenatal care were reported, 8 reported substance use, 6 reported housing insecurity, and 6 reported attitudinal barriers. Most affected infants had no physical exam findings of CS (n=83/143, 58%), but among those who did, rash and hepatomegaly were the most common findings (n=17/143, 12% and n=15/143, 11% respectively). Of the 136 with long bone x-rays completed, 70% (n=95) were normal. Most cases (138/143, 96%) were identified within the first month of life, and 89% (n=127/143) began antibiotic treatment within a week of life. Conclusion Substance use during pregnancy is common in mothers of children with CS; however, the presence of other sociobehavioural risk factors is often not known by reporting paediatricians. Most affected infants are asymptomatic but are diagnosed and treated early. Findings will inform public health strategies for preventing CS and combatting the current epidemic.

Congenital syphilis in Switzerland: a marker of inequality? A mini-review.

Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.

Doxycycline PEP can induce doxycycline resistance in Klebsiella pneumoniae in a Galleria mellonella model of PEP.

Four randomized controlled trials have now established that doxycycline post exposure (sex) prophylaxis (PEP) can reduce the incidence of chlamydia and syphilis in men who have sex with men. These studies have concluded that the risk of selecting for antimicrobial resistance is low. We evaluated this risk in vitro and in vivo using a Galleria mellonella infection model. We evaluated how long it took for doxycycline resistance to emerge during passage on doxycycline containing agar plates in 4 species - Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae and Neisseria subflava. We then assessed if K. pneumoniae could acquire resistance to doxycycline (and cross resistance to other antimicrobials) during intermittent exposure to doxycycline in a Galleria mellonella model of doxycycline PEP. In our passage experiments, we found that resistance first emerged in K. pneumoniae. By day 7 the K. pneumoniae MIC had increased from 2 mg/L to a median of 96 mg/L (IQR 64-96). Under various simulations of doxycycline PEP in the G. mellonella model, the doxycycline MIC of K. pneumoniae increased from 2 mg/L to 48 mg/L (IQR 48-84). Ceftriaxone and ciprofloxacin MICs increased over ten-fold. Whole genome sequencing revealed acquired mutations in ramR which regulates the expression of the AcrAB-TolC efflux pump. Doxycycline PEP can select for doxycycline, ceftriaxone and ciprofloxacin resistance in K. pneumoniae in a G. mellonella model. The emergent ramR mutations were similar to those seen in circulating strains of K. pneumoniae. These findings suggest that we need to assess the effect of doxycycline PEP on resistance induction on a broader range of bacterial species than has hitherto been the case.

Estimating the real burden of gestational syphilis in Brazil, 2007–2018: a Bayesian modeling study

Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.

Number of Sexual Partners and Sexual Activity Effect on Incidence of Syphilis in Women Sex Workers Commercial in Medan City

Syphilis is an infectious disease caused by treponema pallidum. Syphilis is still a health problem in the world and even syphilis is still a major cause of perinatal morbidity and mortality in many countries. Syphilis infects around 12 million people worldwide every year. The prevalence of syphilis in the female population of sex workers (WPS) infected with HIV is 16.7 percent while in WPS that is not infected with HIV 9.47 percent. The purpose of this study was to analyze the effect of the number of sexual partners and sexual activity on the events of syphilis in WPS in Medan. This research design case control with a total sample of 76 consists of 38 cases and 38 controls. The results showed that there was the influence of the number of sexual partners (p <0.001) and sexual activity (p <0.003) on the events of syphilis in WPS. In the number of sexual partners with the value of OR = 17.077 means that WPS suffering from syphilis has 17.077 times it is likely to have more than four customers per week compared to WPS who do not suffer from syphilis. Whereas in sexual activity, the value of OR = 4,429 means that WPS suffering from syphilis 4.429 times the possibility of using sexual activity more than or equal to two categories compared to WPS that does not suffer from syphilis. Suggestions This study to the Indonesian Family Planning Association (PKBI) is expected to carry out health education about the use of condoms and loyal to one partner to WPS and sex customers so that syphilis transmission does not increase.

Congenital Syphilis-An Illustrative Review.

Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing all over world with 700,000 to 1.5 million cases reported annually between 2016 and 2023. Despite the widespread availability of Penicillin, 2677 cases were reported in 2021 in the US. Clinical manifestations at birth can vary widely ranging from asymptomatic infection to stillbirth or neonatal death. Low birth weight, rash, hepatosplenomegaly, osteolytic bone lesions, pseudoparalysis, central nervous system infection, and long-term disabilities have been reported in newborns with congenital syphilis. Prevention of congenital syphilis is multifaceted and involves routine antenatal screening, timely treatment of perinatal syphilis with penicillin, partner tracing and treatment, and health education programs emphasizing safe sex practices and strategies to curb illicit drug use. Neonatal management includes risk stratification based on maternal syphilis history, evaluation (nontreponemal testing, complete blood counts, cerebrospinal fluid, and long-bone analysis), treatment with penicillin, and followup treponemal testing. Public health measures that enhance early detection during pregnancy and treatment with penicillin, especially in high-risk mothers, are urgently needed to prevent future cases of congenital syphilis.

Incidence, risk factors, and clinical findings of syphilis among men living with HIV in Croatia during the COVID-19 pandemic

We conducted a nationwide longitudinal observational study to estimate the incidence of syphilis in a cohort of male persons living with HIV (MLWH) in Croatia in the pre-COVID-19 and COVID-19 years. Data were reviewed and extracted from the clinical database. We analyzed 1187 MLWH (≥ 18 years) in care in Croatia from 2018 to 2021 and used Poisson regression to calculate rates. We observed a 91.4% increase in incidence between 2019 and 2020; the overall rate was 6.0/100 person-years, and the annual rate ranged from 3.3/100 person-years in 2018 to 9.3/100 person-years in 2021. We found higher rates in men who have sex with men, MLWH with a baseline history of syphilis, MLWH with a more recent HIV diagnosis, and a lower rate in those who had clinical AIDS. The rate of syphilis serological testing was 3.5% lower in 2020 compared to 2019. Recurrent syphilis was more likely asymptomatic compared to the first episodes. In conclusion, during the COVID-19 epidemic years, there was a huge increase in syphilis. Results highlight the need for enhanced and novel prevention interventions.

Doxycycline post exposure prophylaxis could select for cross-resistance to other antimicrobials in various pathogens: An in silico analysis.

A number of randomized controlled trials have found that doxycycline post exposure prophylaxis (PEP) can reduce the incidence of gonorrhoea, chlamydia and syphilis in men who have sex with men (MSM). If tetracycline resistance is associated with resistance to other antimicrobials in a range of bacterial species, then doxycycline PEP could have the unintended effect of selecting for resistance to other antimicrobials in these bacterial species. Antimicrobial susceptibility data were retrieved from two sources: pubMLST (https://pubmlst.org/) and Pathogenwatch (https://pathogen.watch/) for the following bacterial pathogens: Klebsiella pneumoniae, Salmonella enterica subsp. Enterica serovar Typhi, Campylobacter jejuni, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes. We assessed if tetracycline resistance was associated with resistance to six relevant antimicrobials. We found evidence of cross resistance to various antimicrobials in all six bacterial species assessed. Cross resistance was found in 4 of 5 antimicrobials for K. pneumoniae, 1 of 2 for C. jejuni, 3 of 5 for S. enterica subsp. Enterica serovar Typhi, 5 of 5 for S. aureus, 5 of 6 for S. pneumoniae and 2 of 3 for S. pyogenes. These associations include a higher prevalence of methicillin resistance in tetracycline resistant S. aureus, penicillin resistance in S. pneumoniae, macrolide and clindamycin resistance in S. pyogenes, fluoroquinolone resistance in S. enterica subsp. Enterica serovar Typhi and third-generation cephalosporin resistance in K. pneumoniae. These results suggest that studies evaluating the effects of doxycycline PEP should include the effects of doxycycline on resistance not only to doxycycline but also to other antimicrobials and in a broader array of bacterial species than has been included in doxycycline PEP studies thus far.

Evaluating the introduction of HIV pre-exposure prophylaxis as abenefit of statutory health insurance (EvE-PrEP) : Highly effective protection against HIV without an increase in sexually transmitted infections

We investigated the impact of HIV pre-exposure prophylaxis (PrEP) as anew service of the statutory health insurance (SHI) on the incidence of HIV and other sexually transmitted infections (STIs) in Germany. In addition, PrEP needs and access barriers were analyzed. The following data were evaluated as part of the evaluation project: HIV and syphilis notification data and extended surveillance by the Robert Koch Institute (RKI), pharmacy prescription data, SHI routine data, PrEP use in HIV-specialty care centers, Checkpoint, the BRAHMS and PrApp studies, as well as acommunity board. The majority of PrEP users were male (98-99%), primarily aged between 25-45years, and predominantly of German nationality or origin (67-82%). The majority were men who have sex with men (99%). With regard to HIV infections, PrEP proved to be highly effective. There were only isolated cases of HIV infections (HIV incidence rate 0.08/100 person years); in most cases the suspected reason was low adherence. The incidences of chlamydia, gonorrhea, and syphilis did not increase but remained almost the same or even decreased. Aneed for information on PrEP for people in trans*/non-binary communities, sex workers, migrants, and drug users emerged. Needs-based services for target groups at increased risk of HIV are necessary. PrEP proved to be avery effective HIV prevention method. The partly feared indirect negative influences on STI rates were not confirmed in this study. Due to the temporal overlap with the containment measures during the COVID-19 pandemic, alonger observation period would be desirable for aconclusive assessment.

Congenital Syphilis in the Medicaid Program: Assessing Challenges and Opportunities Through the Experiences of Seven Southern States.

Rates of congenital syphilis cases are increasing, particularly among lower socioeconomic populations within the southern United States. Medicaid covers a significant portion of these births, which provides an opportunity to improve birth outcomes. This project sought to collect information from key stakeholders to assess facilitators of and barriers to Medicaid funding of prenatal syphilis screening and to provide insight into improving screening and lowering incidence through the Medicaid program. Seven southern states (Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee) were identified for this assessment. Researchers conducted a legal and policy analysis for each state to gather information on factors affecting congenital syphilis prevention, identify knowledge gaps, and inform the development of interview guides. Seventeen structured interviews with 29 participants were conducted to gather information on facilitators and barriers to receiving timely prenatal syphilis screening through the Medicaid program. Interview transcripts were analyzed and compared to identify key themes. Barriers to timely prenatal syphilis screening include varied laws among the states on the timing of screening, Medicaid reimbursement policies that may not adequately incentivize testing, Medicaid enrollment issues that affect both enrollment and continuity of care, and lack of clear understanding among providers on recommended testing. This work provides insight into systemic issues that may be affecting rates of prenatal syphilis screening and incidence among Medicaid enrollees and others in the U.S. South. To address rising congenital syphilis cases, policymakers should consider requiring third trimester syphilis screening, adopting policies to enhance access to prenatal care, adapting Medicaid payment and incentive models, and promoting collaboration between Medicaid and public health agencies.

Addressing Racial/Ethnic Healthcare Disparities and the Rising Incidence of Syphilis

Some sexually transmitted infections have posed a particular epidemiologic problem for some communities, in that racial/ethnic disparities have been demonstrated. Syphilis represents a specific example of such an infection, compounding the medical problem further by adding to the serious consequences of its vertical perinatal transmissibility to the neonate, in addition to its sexual, or horizontal, transmission. The recently rising incidence of syphilis in the pregnant woman and the potential for the rising incidence of congenital syphilis should be a cause for global concern. However, what may be concluded as a problem within communities of color, may actually be a problem relating more closely with a socioeconomic disparity. Multiple deliberate measures may be needed to affect its eradication, which is naturally possible, given the longtime availability of the simple curable medical compound of penicillin.

IMPACT IN NOTIFIED SYPHILIS DIAGNOSIS DURING THE COVID-19 PANDEMIC IN BRAZIL

Objective This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. Study Design In this descriptive study, data were extracted from a SUS public disease notification database. Results There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. Conclusion The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures. FAPEMIG, CNPq, CAPES. This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. In this descriptive study, data were extracted from a SUS public disease notification database. There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures.

Sexualized drug use and STD and HIV incidence among men who have sex with men in Amsterdam, the Netherlands.

We assessed the association between sexualized drug use (SDU), and incident sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). We used data from the MS2 cohort study, conducted at the STI Outpatient Clinic of the Public Health Service of Amsterdam, the Netherlands, in 2014-2019. Eligible participants were adult HIV-negative MSM with ≥2 STDs in the preceding year and MSM living with HIV and ≥1 STD. Participation encompassed 3-monthly visits including STD screening and questionnaires on drug use. Primary outcomes were incident HIV, anal chlamydia/gonorrhoea, and syphilis. We studied the association between SDU of individual drugs and incident HIV and STDs, using Poisson regression. Analyses were adjusted for age and HIV-status. 131 HIV-negative MSM and 173 MSM living with HIV were included for analysis. SDU with GHB/GBL (aIRR = 7.2, 95% CI = 1.4-35.5) in the 3months before testing was associated with incident HIV. SDU with GHB/GBL (aIRR = 1.2, 95% CI = 1.0-1.4), ketamine (aIRR = 1.3, 95% CI = 1.0-1.6) or methamphetamine (aIRR = 1.3, 95% CI = 1.0-1.6) was associated with incident anal chlamydia/gonorrhoea. We found no association between SDU with specific drug types and syphilis incidence. SDU with GHB/GBL, ketamine and methamphetamine among MSM was associated with incident HIV and anal chlamydia/gonorrhoea. HIV-negative MSM engaging in SDU should be advised to use HIV pre-exposure prophylaxis, and all MSM engaging in SDU should be advised to have STD screening regularly. We suggest counselling on STDs among MSM engaging in SDU.

Predicting congenital syphilis cases: A performance evaluation of different machine learning models.

Communicable diseases represent a huge economic burden for healthcare systems and for society. Sexually transmitted infections (STIs) are a concerning issue, especially in developing and underdeveloped countries, in which environmental factors and other determinants of health play a role in contributing to its fast spread. In light of this situation, machine learning techniques have been explored to assess the incidence of syphilis and contribute to the epidemiological surveillance in this scenario. The main goal of this work is to evaluate the performance of different machine learning models on predicting undesirable outcomes of congenital syphilis in order to assist resources allocation and optimize the healthcare actions, especially in a constrained health environment. We use clinical and sociodemographic data from pregnant women that were assisted by a social program in Pernambuco, Brazil, named Mãe Coruja Pernambucana Program (PMCP). Based on a rigorous methodology, we propose six experiments using three feature selection techniques to select the most relevant attributes, pre-process and clean the data, apply hyperparameter optimization to tune the machine learning models, and train and test models to have a fair evaluation and discussion. The AdaBoost-BODS-Expert model, an Adaptive Boosting (AdaBoost) model that used attributes selected by health experts, presented the best results in terms of evaluation metrics and acceptance by health experts from PMCP. By using this model, the results are more reliable and allows adoption on a daily usage to classify possible outcomes of congenital syphilis using clinical and sociodemographic data.

Comparing 7-Day Versus 6–8-Day Penicillin Treatment Intervals Among Pregnant People With Syphilis of Late or Unknown Duration: No Difference Found in Incidence of Congenital Syphilis

Abstract Background Guidelines recommend that pregnant patients with syphilis of late/unknown duration be treated with benzathine penicillin G, dosed as 3 weekly intramuscular injections (BPGx3) given ideally at strict 7-day intervals. Given limited pharmacokinetic data, it is unknown whether more flexible BPG treatment intervals might be effective in preventing congenital syphilis (CS). Methods We used California surveillance data to identify birthing parent/infant dyads wherein the pregnant parent had syphilis of late/unknown duration between January 1, 2016 – June 30, 2019. We divided the dyads into 3 groups based on prenatal treatment: (1) BPGx3 at strict 7-day intervals, (2) BPGx3 at 6-8 day intervals, and (3) no/inadequate treatment. We then compared CS incidence among infants in each group. Results We analyzed 1,092 parent/infant dyads: 607 (55.6%) in the 7-day treatment group, 70 (6.4%) in the 6–8 day treatment group, and 415 (38.0%) in the no/inadequate treatment group. The incidence proportion of infants meeting CS criteria in each group was, respectively, 5.6%, 5.7%, and 36.9%. Compared with BPGx3 at 7-day intervals, the odds of CS were 1.0 [95% CI 0.4–3.0] in the 6–8 day group and 9.8 [95% CI 6.6–14.7] in the no/inadequate treatment group. Conclusions Prenatal BPGx3 at 6–8 days was no more likely to lead to CS in infants than 7-days. These findings hint that 6-8-day intervals might be adequate to prevent CS among pregnant people with syphilis of late/unknown duration. Consequently, it is possible that CS evaluation beyond an RPR at delivery may be unnecessary in asymptomatic infants whose parents received BPGx3 at 6–8 days.

Modern trends of the incidence of syphilis in the areas of Ural Federal District

BACKGROUND: The incidence of syphilis is an indicator of social disadvantage in society as a whole and in particular regions, and is mostly determined by medical, social, biological and economic factors.
 AIM: To study modern clinical and epidemiological aspects and assess epidemic trends of syphilis in the population of the Ural Federal District for the period from 2014 to 2022 in order to determine further preventive epidemic control measures.
 MATERIALS AND METHODS: The object of the study are the data of statistical forms No. 9 and No. 34 on the number of registered cases of syphilis in the Ural Federal District for the period from 2014 to 2021, the data of statistical materials "Resources and activities of medical organizations of dermatovenerological profile. Incidence of sexually transmitted infections, contagious skin diseases and skin diseases" and operational data for 6 months of 2021 and 2022 years. Intensive and extensive morbidity rates are calculated and their analysis using descriptive statistics is presented.
 RESULTS: The main patterns of the course of syphilitic infection in six subjects (which are parts of the Ural Federal District) of the Russian Federation have been studied. Modern clinical and epidemiological features and trends have been established: variability of morbidity indicators, its clinical structure and territorial dynamics; variability in the age-associated characteristics of patients, the emergence of high-risk groups have been noted. Target indicators characterizing the epidemiological situation of syphilis in the region have been determined. The necessity of interdisciplinary interaction of doctors of various specialties on early detection of patients with syphilis is indicated.
 CONCLUSIONS: During the analyzed period from 2014 to 2022, in certain areas of the Ural Federal District, the current trends of syphilitic infection prevalence is characterized by multi-directional dynamics and levels of morbidity, an increase in early and late forms of syphilis in the structure of clinical forms of the disease; an increase in the registration of late latent forms of infection, cases of congenital syphilis, an increase in the incidence rate among adolescents, foreign citizens and pregnant women in the territory of the Ural Federal District.

Pancreatic syphilis mimicking cancer

Since the incidence of syphilis is increasing, the number of pancreatic lesions is expected to increase too. Pancreatic syphilis can be congenital or acquired.
 The pancreas is affected in 10–80% of patients with congenital syphilis. Infection of the pancreas occurs most often during the second half of pregnancy. Morphologically, there are five types of congenital pancreatic syphilis: gummy; diffuse interstitial pancreatitis, which can be combined with multiple miliary gummas and atrophy of the pancreatic parenchyma; indurative fibrous type; with atrophy of the lobules (atrophic type); and with a predominant lesion of the pancreatic ducts —sialangitis pancreatica. In congenital syphilis, the pancreatic head is mostly affected. Early and severe damage to the islets of Langerhans is typical.
 Acquired pancreatic syphilis is less common than congenital syphilis. Morphologically, it has three types: the edematous-infiltrative type, in secondary syphilis; the gummy type (pancreatitis gummosa), in tertiary syphilis; and sclerotic pancreatitis, or pancreatitis sclerotica, or “syphilitic cirrhosis of the pancreas”. The latter type is usually the outcome of the first two morphological types. Clinically acquired pancreatic syphilis proceeds according to the type of recurrent chronic pancreatitis, i.e., with periodic exacerbations (pancreatic attacks), but the pain is rarely intense, and the phenomenon of “deviation” of enzymes into the blood is rarely observed. This clinical type more often corresponds to the edematous-infiltrative morphological type of syphilitic organ damage, and less often to the gummy type. It should be noted that acquired pancreatic syphilis occurs against the background of specific damage to the liver, heart, aorta, kidneys, skin, stomach, central nervous system, etc. The differential diagnosis of gummy pancreatic lesions and pancreatic cancer is especially complicated.
 Antisyphilitic treatment should be administered. Due to a toxic-allergic reaction, the symptoms of pancreatitis may exacerbate at the start of a specific therapy. 

Progression of a large syphilis outbreak in rural North Carolina through space and time: Application of a Bayesian Maximum Entropy graphical user interface.

In 2001, the primary and secondary syphilis incidence rate in rural Columbus County, North Carolina was the highest in the nation. To understand the development of syphilis outbreaks in rural areas, we developed and used the Bayesian Maximum Entropy Graphical User Interface (BMEGUI) to map syphilis incidence rates from 1999-2004 in seven adjacent counties in North Carolina. Using BMEGUI, incidence rate maps were constructed for two aggregation scales (ZIP code and census tract) with two approaches (Poisson and simple kriging). The BME maps revealed the outbreak was initially localized in Robeson County and possibly connected to more urban endemic cases in adjacent Cumberland County. The outbreak spread to rural Columbus County in a leapfrog pattern with the subsequent development of a visible low incidence spatial corridor linking Roberson County with the rural areas of Columbus County. Though the data are from the early 2000s, they remain pertinent, as the combination of spatial data with the extensive sexual network analyses, particularly in rural areas gives thorough insights which have not been replicated in the past two decades. These observations support an important role for the connection of micropolitan areas with neighboring rural areas in the spread of syphilis. Public health interventions focusing on urban and micropolitan areas may effectively limit syphilis indirectly in nearby rural areas.