Syphilis Patient Research Articles

A RARE CLINICAL SYPHILIS ORAL MANIFESTATION DUE TO SEXUALLY TRANSMITTED DISEASE AMONG HOMOSEXUAL: CASE REPORT

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum, often found in Human Immunodeficiency Virus (HIV) patients and homosexuals. The oral manifestations are chancres, mucous patches, focal epithelial hyperplasia (FEH) and papilloma/condyloma. FEH is a rare oral mucosa disorder that occurs in immunocompromised patient. Objective: To present a rare oral manifestation in syphilis patient due to sexually transmitted infections. Case: A 25-year-old homosexual male came to Oral Medicine Department complaining of sores on the palate for 3 weeks and 2 weeks later a painless lump appeared. He was an HIV patient and had been taking ARVs since 6 months ago. Pain when opening the mouth, itching on his face and genital area. Intraoral revealed a soft, pedunculated, non-bleeding, mobile mass at the palate with a diameter about 2 cm, had the same color as the surrounding tissue. There was a reddish band-like area on the maxillary anterior gingival margin, suspected as Linear Gingival Erythema (LGE). Case management: 0.2% Chlorhexidine gluconate mouthwash was administered to prevent secondary infection and he was referred to Dermatovenereology and Periodontology Department. HBsAg Immunochromatography (negative), VDRL titer (reactive), TPHA titer (reactive) therefore diagnosis of syphilis was made and he was treated with a single dose Benzathine penicillin G 2.4 million units intramuscular. The oral lesions healed after 1 month therapy. Conclusion: FEH is a rare oral mucosa disorder in syphilis patients. Knowledge of the signs and symptoms of the disease is needed to make a diagnosis and a multidisciplinary approach to achieve successful treatment. Keywords: Oral manifestation, Sexual transmission, Syphilis, Treponemal infection

Intrathecal nonspecific immunoglobulin synthesis in syphilitic infection

Intrathecal Ig synthesis is one of the characteristic laboratory features of neurosyphilis (caused by Treponema pallidum subspecies pallidum able to affect the central nervous system (CNS), but a persisting pathogen-driven immune response is problem of scar effect. This long-term Ig production within the CNS compartment even after timely and proper treatment remains unexplored. We hypothesized that a long-term current chronic inflammation in the CNS caused by syphilitic infection can be a trigger of nonspecific humoral immune response and the scar effect may result from non-specific B cell activation within the CNS in the absence of antigens. The MRZ reaction is a laboratory tool for detection of intrathecal nonspecific humoral immune reaction, which is poorly investigated in syphilis patient. The MRZ reaction (MRZR) is used as a marker of intrathecal nonspecific humoral immune response and is composed of the three antibody indices (AI) against neurotropic viruses: measles, rubella and varicella zoster virus. A positive MRZR, defined as an elevated AIs ( 1.5) against at least one or more viral agents, confirms diagnosis of a chronic or autoimmune disease involving CNS recently declared as a highly specific marker of multiple sclerosis. Insufficient data on neuroinfections motivated us to examine a hypothesis that a long-term chronic inflammation within the CNS compartment caused by syphilitic infection may be a trigger of intrathecal nonspecific humoral immune response. We assessed prevalence of positive MRZR in 147 patients with later-stage syphilis seropositive for MRZ viruses. Study group included 43 patients with first-time diagnosed neurosyphilis, 16 patients with a follow-up visit after neurosyphilis treatment, 88 patients with excluded neurosyphilis. There were no significant differences between categories of patients examined, and presence of positive MRZR was not associated with any demographic, clinical and laboratory characteristics. To sum up, our study (n = 147) showed that 27 patients (18%, 95% CI: 1225% ) were positive for intrathecal Ig production against one, two or three of the M, R, Z viruses, and bi- and tri-specific MRZR was present in 7 of 147 patients (5%, 95% CI: 210%). The data obtained evidence that frequency of the MRZR for syphilitic infection matches that of found in general population and a long-term current syphilitic infection affecting CNS seems to not be a trigger of a nonspecific intrathecal immune response. Among our patients, we also selected 43 patients with previously treated syphilitic infection without any neurological symptoms and excluded neurosyphilis diagnosis, so these patients can be considered as an apparently healthy group.

Proportion of syphilis and hepatitis B and C virus infections among the Integrated Counselling and Testing Centre attendees of a tertiary care hospital.

Human Immunodeficiency Virus (HIV) affects the immune system of the body, causing a breakdown in its normal defenses and leaving it vulnerable to a host of life-threatening diseases. High-risk behaviors and routes of transmission for sexually transmitted infections such as syphilis, hepatitis B and hepatitis C are identical with HIV. This study was conducted to assess the proportion of syphilis and hepatitis B and C virus infections in HIV-positive and HIV-negative individuals, and their association with socioeconomic and other factors in Integrated Counselling and Testing Centre (ICTC) attendees, and to determine the association of absolute CD4+ T-lymphocyte count with these co-infections in HIV-positive individuals. The study was conducted in the Department of Microbiology of a tertiary care hospital. It included 100 HIV-positive individuals and 100 matched HIV-negative controls attending the ICTC. HIV-positive patients on antiretroviral therapy and patients with history of current/past treatment for chronic hepatitis infection were excluded from the study. Blood samples were tested for HIV, syphilis, and hepatitis B and C infections. The prevalence of syphilis, hepatitis B, and hepatitis C was observed in 3.5%, 2%, and 10% of patients, respectively. The frequency of hepatitis B virus (HBV) infection in HIV-positive and HIV-negative individuals was 1% and 3%, respectively. Hepatitis C virus (HCV) infection among HIV-positive and HIV-negative patients was 16% and 4%, respectively. Syphilis was seen in 7% of the HIV-infected patients. The mean CD4+ count for the HIV-positive patients with either syphilis, HBV, or HCV infections was 252 ± 137.5 cells/μl. Significant associations between HIV infection and education below high school, IV drug abuse, and multiple sexual partners were observed. The HIV-infected patients were observed to be at an increased risk of acquiring syphilis and HCV co-infections through the shared routes of transmission. Routine screening of these patients for concurrent syphilis and viral hepatitis may aid in prompt diagnosis and treatment with improved outcomes, which in turn may decrease the further spread of these infections.

B Flach! B Flach!

B Flach! B Flach!

In Vitro Transformation and Selection of Treponema pallidum subsp. pallidum.

Although the isolation of Treponema pallidum subsp. pallidum (T. pallidum) from a syphilis patient dates to 1912, for the duration of the 20th century, this pathogen has remained an exceedingly difficult organism to study due to the lack of a system to support its viability in vitro. This limitation, in turn, has precluded the application of genetic engineering techniques via transformation and subsequent selection of T. pallidum transformants. A recently described method for in vitro cultivation of T. pallidum, however, has made it possible for us to experiment with transformation and selection methods. Here we describe the approach that we adopted to successfully transform T. pallidum with foreign DNA and select the resulting recombinant strain using kanamycin. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Transformation of T. pallidum Support Protocol 1: Quantification of T. pallidum in suspensions using dark-field microscopy Support Protocol 2: Counting cells using a hemacytometer Basic Protocol 2: Selection, initial passaging, and expansion of transformed cultures Basic Protocol 3: Isolation of a clonal strain through limiting dilution.

Risk Factors for Syphilis at a Large Urban Emergency Department.

The prevalence of syphilis is increasing in the United States. The emergency department (ED) is an important setting to screen and treat underserved populations. To tailor testing protocols to the local population, we aimed to identify risk factors for syphilis positivity in ED patients. We performed a retrospective analysis of ED patients who were screened for syphilis between November 2018 and August 2020. Patients were screened for Treponema pallidum antibody using a multiplex flow immunoassay, and positive results were confirmed by rapid plasma reagin or T. pallidum particle agglutination. Risk factors for new syphilis diagnoses were identified using multiple logistic regression. We screened 1974 patients for syphilis (mean age, 37 ± 16 years; 56% female). We identified 201 patients with new infections without previous treatment. Independent risk factors for a new diagnosis of syphilis included housing status (undomiciled, 23% [60 of 256]; domiciled, 9% [133 of 1559]; adjusted odds ratio [aOR], 1.9 [95% confidence interval {CI}, 1.2-3.0]), history of HIV (positive, 44% [28 of 63]; negative, 9% [173 of 1893]; aOR, 5.8 [95% CI, 3.0-11.2]), tobacco use (positive, 15% [117 of 797]; negative, 4% [29 of 665]; aOR, 2.4 [95% CI, 1.5-3.9]), and illicit drug use (positive, 14% [112 of 812]; negative, 8% [52 of 678]; aOR, 2.2 [95% CI, 1.0-2.5]). Undomiciled housing status, history of HIV, history of tobacco use, and history of illicit drug use were independently associated with a new diagnosis of syphilis in the ED. Broadening targeted syphilis screening algorithms beyond sexually transmitted disease-related complaints could help identify new syphilis cases for treatment.

Jarisch-Herxheimer reaction in a pregnant woman with gestational syphilis

The Jarisch-Herxheimer reaction is a feverish inflammatory reaction witch may occur after the treatment of patients for syphilis at all stages. Commonly begin between in the first 12 hours after treatment. In pregnant women the reaction may end up in prematurity and fetal death, especially when the fetus is infected. It’s necessary to be aware of all the patient’s complaints and take a look at to group them in a single medical diagnosis whenever possible. And it’s principal that obstetricians always have Jarisch-Herxheimer reaction as a medical diagnosis for febrile syndromes in pregnant women with syphilis.

"Sex in the Time of COVID": Clinical Guidelines for Sexually Transmitted Disease Management in an Era of Social Distancing.

"Sex in the Time of COVID": Clinical Guidelines for Sexually Transmitted Disease Management in an Era of Social Distancing.

USE OF TPHA AND VDRL IN THE DIAGNOSIS OF SYPHILIS

INTRODUCTION: Venereal Disease Research Laboratory (VDRL) test is performed by the physicians to screen patients for syphilis and is still the most commonly used test all over the world for screening. Three basic methods has been described in screening for syphilis. These include direct observation of the T. pallidum by dark field microscopy, and nontreponemal and treponemal serologic antibody studies. Nonspecific (non tremonemal) tests like Venereal Disease Research Laboratory (VDRL) test use lipoidal antigens containing cardiolipin, lecithin, and cholesterol, that flocculate with IgM and IgG. Positive tests occur from 21 days of exposure till about up to 6 weeks after infection. Serologic tests in syphilis only provide indirect evidence of syphilis and may be reactive in the absence of clinical or epidemiologic evidence of syphilis. The reactivity in these cases is usually in low dilutions (<1:8), however, in exceptional cases false reactivity is shown in very high titers up to 1:256. False-positive reactions can also also be seen with treponemal tests.
 MATERIAL AND METHODS: A total of 10253 patients were tested for syphilis by VDRL as a screnning test during study period. Both the the qualitative and quantitative VDRL tests were done as per the manufacturer's instructions. TPHA was performed on all the sera demonstrating reactivity with VDRL test. VDRL test was based on the principle that after syphilis infection, host develops nontreponemalantilipoidal antibodies in response to the release of lipoidal material from the damaged host cells. Also host produces antibodies against T. pallidum. In TPHA Agglutination of cells shows a positive reaction. In the absence of antibody i.e. in negative cases cells settled down to form a compact button in the well which constituted a negative reaction.
 RESULTS: In this study a total of 10253 patients were screened for syphilis by VDRL of which 98 were reactive. In a sample of 98 VDRL reactive patients, 33(34%) were males and 65(66%) females. The age of patients who tested VDRL positive in our study ranged from youngest being 21 years to eldest being 66 years. Majority of patients i.e. 88.8% belonged to 20-50 years of age group, with majority of patients 37.75% belonging to age group 30 – 40.
 CONCLUSION: VDRL test is the best screening test for the diagnosis of syphilis but whenever the patient is serologically reactive it should be confirmed by the more specific TPHA test.

Analysis of host cell binding specificity mediated by the Tp0136 adhesin of the syphilis agent Treponema pallidum subsp. pallidum.

BackgroundSyphilis affects approximately 11 million people each year globally, and is the third most prevalent sexually transmitted bacterial infection in the United States. Inability to independently culture and genetically manipulate Treponema pallidum subsp. pallidum, the causative agent of this disease, has hindered our understanding of the molecular mechanisms of syphilis pathogenesis. Here, we used the non-infectious and poorly adherent B314 strain of the Lyme disease-causing spirochete, Borrelia burgdorferi, to express two variants of a known fibronectin-binding adhesin, Tp0136, from T. pallidum SS14 and Nichols strains. Using this surrogate system, we investigated the ability of Tp0136 in facilitating differential binding to mammalian cell lines offering insight into the possible role of this virulence factor in colonization of specific tissues by T. pallidum during infection.Principal findingsExpression of Tp0136 could be detected on the surface of B. burgdorferi by indirect immunofluorescence assay using sera from a secondary syphilis patient that does not react with intact B314 spirochetes transformed with the empty vector. Increase in Tp0136-mediated adherence of B314 strain to human epithelial HEK293 cells was observed with comparable levels of binding exhibited by both Tp0136 alleles. Adherence of Tp0136-expressing B314 was highest to epithelial HEK293 and C6 glioma cells. Gain in binding of B314 strain expressing Tp0136 to purified fibronectin and poor binding of these spirochetes to the fibronectin-deficient cell line (HEp-2) indicated that Tp0136 interaction with this host receptor plays an important role in spirochetal attachment to mammalian cells. Furthermore, preincubation of these cell lines with fibronectin-binding peptide from Staphylococcus aureus FnbA-2 protein significantly inhibited binding of B314 expressing Tp0136.ConclusionsOur results show that Tp0136 facilitates differential level of binding to cell lines representing various host tissues, which highlights the importance of this protein in colonization of human organs by T. pallidum and resulting syphilis pathogenesis.

Increases in Ocular Syphilis-North Carolina, 2014-2015.

Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease. We reviewed syphilis cases reported to North Carolina during 2014-2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics. Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment. In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.

Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster.

The abrupt onslaught of the syphilis pandemic that started in the late fifteenth century established this devastating infectious disease as one of the most feared in human history1. Surprisingly, despite the availability of effective antibiotic treatment since the mid-twentieth century, this bacterial infection, which is caused by Treponema pallidum subsp. pallidum (TPA), has been re-emerging globally in the last few decades with an estimated 10.6 million cases in 2008 (ref. 2). Although resistance to penicillin has not yet been identified, an increasing number of strains fail to respond to the second-line antibiotic azithromycin3. Little is known about the genetic patterns in current infections or the evolutionary origins of the disease due to the low quantities of treponemal DNA in clinical samples and difficulties in cultivating the pathogen4. Here, we used DNA capture and whole-genome sequencing to successfully interrogate genome-wide variation from syphilis patient specimens, combined with laboratory samples of TPA and two other subspecies. Phylogenetic comparisons based on the sequenced genomes indicate that the TPA strains examined share a common ancestor after the fifteenth century, within the early modern era. Moreover, most contemporary strains are azithromycin-resistant and are members of a globally dominant cluster, named here as SS14-Ω. The cluster diversified from a common ancestor in the mid-twentieth century subsequent to the discovery of antibiotics. Its recent phylogenetic divergence and global presence point to the emergence of a pandemic strain cluster.

P181 Do we need to routinely re-screen heterosexual patients for HIV and Syphilis when they reattend GUM/SRH clinics? (Improving clinical practice and service delivery)

Background/introduction In the current financial climate we need to ensure that scarce resources are used efficiently. Heterosexual patients re-attending GUM/SRH services after an initial negative screen for HIV may be at low risk for acquiring new HIV and/or Syphilis and routine testing may not be cost-effective. Aim(s)/objectives Determine the incidence of HIV and Syphilis in heterosexuals re-attending GUM/SRH services after previous negative HIV testing. Establish potential savings. Methods Case note review of heterosexual patients attending a mixture of Inner London Integrated and Sexual Health clinics in 2014 and re-testing for HIV and/or Syphilis within 12 months. Data extracted includes patient demographics, tests performed and outcomes. Cost of HIV POCT £2.64, HIV serology £18.75, Syphilis screen £10.35. Results Of 31,469 patients who tested for HIV in 2014, 4,584 (14.6%) were retested within 12 months. 69% were female and 31% male. The age range was 16–81 years with 27% Discussion/conclusion These results suggest that we need to review our current testing policy.

P3.034 General Practitioners in the Netherlands Miss Opportunities to Test For STI/HIV During STI-Related Consultations

BackgroundWhereas the majority of STI-related consultations in the Netherlands take place in general practise (GP), national surveillance of STI predominantly uses data from STI centres, focussing at trends in high-risk...

O08.1 Assessing the Added Value of Internet Partner Services For Syphilis and HIV

BackgroundInternet partner services (IPS) is the process of notifying named sexual partners to a newly diagnosed syphilis or HIV patient, where the only contact information for that partner is an...

Acute monoarthritis in a delayed diagnosis of syphilis patient with persistent rupioid psoriasis-like lesions

BackgroundThe incidence of syphilis is increasing in many parts of the world. Clinicians may have limited experience in the diagnosis when the clinical appearance is unusual. If early diagnosis is not made and prompt treatment not given, then the disease may remain quiescent until more serious symptoms or systemic involvement develops.Case presentationWe report the first case of a delayed diagnosis of syphilis with a ten-year history of persistent rupioid psoriasis-like lesions. Acute monoarthritis and high fever together with aggravation of skin lesions led to a careful clinical examination. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Standard treatment with benzathine penicillin brought a partial and transient improvement. A complete clinical and serological resolution of the disease was achieved by a prolonged and repeated penicillin treatment combined with methylprednisolone. A 7-year follow-up of the patient proved a full recovery.ConclusionOur case highlights the fact that clinical signs of syphilis can be diverse and complicated. Unusual clinical manifestations can happen in an immunocompetent individual. Treatment strategy may need to be adjusted in a difficult case.

Human leukocyte antigen‐C and killer cell immunoglobulin‐like receptor gene polymorphisms among patients with syphilis in a Chinese Han population

Syphilis is a sexually transmitted infection caused by the Treponema pallidum subspecies pallidum spirochete bacterium. The killer cell immunoglobulin-like receptors (KIR), interacting with human leukocyte antigens (HLA), regulate the activations of natural killer (NK) cells and certain T-cell subsets in response to microbe infection. The objective of this study was to explore whether KIR and HLA-C gene polymorphisms were associated with syphilis in a Chinese Han population. Polymerase chain reaction with sequence-specific primers (PCR-SSP) method was used to genotype KIR and HLA-C genes in 231 syphilis patients and 247 healthy controls. Framework genes KIR2DL4, KIR3DL2, KIR3DL3 and KIR3DP1 were present in all individuals. The frequencies of KIR2DS3 and KIR3DS1 were higher in syphilis patients than in healthy controls (p = 0.030 and p = 0.038, respectively), while the frequency of KIR2DS5 was higher in healthy controls than in syphilis patients (p = 0.015; OR = 0.575). The homozygote for HLA-C1 allele (HLA-C1C1) was more common in controls compared with syphilis patients (p = 0.030; OR = 0.667). The frequency of individuals with HLA-C1C1 and KIR2DL3 genotype was higher in control group relative to syphilis patient group (p = 0.018; OR = 0.647). These data indicated that KIR2DS3 and KIR3DS1 were more prevalent in syphilis patients than in controls, and that KIR2DS5, HLA-C1C1 and HLA-C1C1-KIR2DL3 were more prevalent in controls than in syphilis patients, respectively. These will require further investigation using functional studies.

When Syphilis Tests Contradict Each Other

Because of cost and logistics, many labs now screen patients for syphilis with automated treponemal antibody immunoassays and then confirm positive

P1-S2.40 HIV and syphilis coinfection among men who have sex with men, 34 states, USA―2009

BackgroundDuring the early 2000s, reports of the re-emergence of syphilis among men who have with men (MSM) in the USA described a high prevalence of HIV coinfection in different localities,...

Assessing compliance with a county board order for third trimester syphilis screening in Maricopa County, Arizona

Objectives Due to high rates of congenital syphilis, a Maricopa County board order was issued in 2003 to increase prenatal syphilis screening. The provisions of this order included prenatal syphilis screening during the first prenatal visit, to be repeated during the third trimester, and again at delivery. The purpose of the study was to evaluate syphilis screening practices and barriers to screening among obstetric providers. Methods Maricopa County medical providers who delivered at least 21 infants (97.2% of all deliveries) in 2008 according to live birth records were surveyed by telephone. Results A total of 146 surveys were completed representing 76% (319/421) of the delivering providers and 83% of delivered infants for 2008. All of the represented prenatal care providers reported testing their patients for syphilis at the first trimester, and 284 (89%) reported screening again during the third trimester. Conclusions All of the surveyed providers reported screening at least once for syphilis during pregnancy and most reported re-screening during the third trimester as recommended by the Maricopa County board order. Similar public health screening guidance should be considered in areas where congenital syphilis rates are high and/or where syphilis is prevalent among women of childbearing age. A local health order of this type is a simple intervention that can provide practice guidance on emerging health issues.