Syphilis Rapid Plasma Reagin Research Articles

The role of VDRL in phirang rog

A perfect scientific medical science by the name of Ayurveda is a gift given by our ancestors which deals with our daily activities to annual activities which help us to maintain our physical and mental health. Many diseases and their treatment have been described by them, some of which are not present today and some still exist. As new diseases arrived in the Indian subcontinent during the period, they came to India through invaders or traders, they were described by our ancestors with their pathogenesis, signs and symptoms, complication, prognosis and treatment. One of them is Phirang rog, which came from Europe, was not found in our scriptures before 16th century. Presently its compatibility with the Syphilis disease can be seen. Timely diagnosis and treatment is necessary to prevent the spreading of disease and the development of irreversible tissue damage. In Syphilis RPR (Rapid Plasma Reagin), VDRL (Venereal Disease Reasearch Laboratory Test), FTA-ABS (Fluorescent Treponemal Antibody Absorption), TP-PA (Treponema Pallidum Particle Agglutination assay), Darkfield microscopy are advised for diagnosis. This study has been done to prove the usefulness of VDRL in the diagnosis of Phirang rog.

Changes in the Syphilis Rapid Plasma Reagin Titer Between Diagnosis and Treatment.

We compared the rapid plasma reagin (RPR) titer on the day of initial presentation with that on the day of syphilis treatment to inform clinical practice as to whether a repeated RPR test should be recommended. We undertook a retrospective study between 1 March 2011 and 31 December 2020 at the Melbourne Sexual Health Centre in Australia among individuals who underwent syphilis serology on the day of initial presentation and the day of treatment, if the latter were within 14 days after initial presentation. We calculated the percentage of individuals with a ≥4-fold change in RPR titer, stratified by the time between initial presentation and treatment and by syphilis stage. Among the 766 included syphilis cases, the median duration between initial presentation and treatment was 6 days (interquartile range, 5-7 days). Of these cases, 14.8% (n = 113) had a ≥4-fold increase or decrease during this interval. The number of cases with a ≥4-fold increase or decrease in RPR titer increased with increasing time between initial presentation and treatment, from 5.7% (n = 6) 1-3 days after initial presentation to 26.2% (n = 27) at 10-14 days (Ptrend < .001). There was no significant difference in the number of cases with a ≥4-fold increase or decrease in RPR titer between syphilis stages (P = .66). Our data support the recommendation of repeating the RPR titer if the day of initial presentation and the day of treatment are different, even when treatment is within a few days after initial presentation.

Syphilis-related rapidly progressive glomerulonephritis: a case presentation

BackgroundSyphilis is a multisystemic infection that causes a wide variety of symptoms and thus has been dubbed one of the great medical mimickers. Due to recent global re-emergence of syphilis, it has become important to recognize its various presentations. Relative to the kidney, syphilitic infections generally present themselves with nephrotic range proteinuria, and are most often associated with pathological features of a membranous glomerulonephritis with subepithelial immune complex deposition. However, other rare renal presentations have been reported. One of these includes a rapidly progressive glomerulonephritis picture. All described cases have been successfully resolved with the treatment of the underlying syphilis infection.Case presentationThe patient was an elderly woman of Caribbean descent who presented with lower extremity weakness, anasarca and proteinuria, hematuria with progressive renal failure. On kidney biopsy, she was found to have a pauci-immune crescentic glomerulonephritis pattern and a concomitant acute tubulointerstitial nephritis. She had a positive Treponema pallidum particle agglutination test and a negative syphilis rapid plasma reagin test with clinical evidence of polyneuropathy suggestive chronic syphilis infection.Conclusion and discussionIt is important in the context of pauci-immune crescentic glomerulonephritis to explore all differential diagnoses. Given the positive syphilis serologies, clinical context and presence of tubulointerstitial nephritis, she was determined to have syphilitic glomerulonephritis that resolved with a course of both penicillin and steroids.

Why we need pre-exposure prophylaxis: incident HIV and syphilis among men, and transgender women, who have sex with men, Bangkok, Thailand, 2005-2015.

We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer ≥1:8) and confirmatory anti- Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the seroconversion interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4-5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 ( p < 0.01) (Poisson with RCS function, p = 0.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9-4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok.

The Great Imitator Strikes Again: Syphilis Presenting as "Tongue Changing Colors".

Syphilis is known as the great imitator, making its diagnosis in the emergency department difficult. A 29-year-old male presented with the chief complaint of “my tongue is changing colors.” A syphilis rapid plasma reagin (RPR) test resulted as positive. In primary syphilis, the chancre is the characteristic lesion. While chancres are frequently found on the external genitalia or anus, extragenital chancres arise in 2% of patients. With oral involvement, the chancre is commonly found on the lip or tongue. The patient was treated for secondary syphilis with 2.4 million units of long acting penicillin intramuscularly. On follow-up a month later, the patient's symptoms had resolved.

Incidence and risk factors for the prozone phenomenon in serologic testing for syphilis in a large cohort.

The prozone phenomenon is known to be associated with high antibody titers; other associations, such as host factors, have not been elucidated. A retrospective analysis was conducted to evaluate the incidence of the prozone phenomenon of the syphilis rapid plasma reagin (RPR) test among 46 856 clinical samples, between June 2010 and June 2013. Logistic regression was used to analyze the risk factors of the prozone phenomenon. Our results showed that the incidence of the prozone phenomenon was low (0.83%) and could occur during any clinical phase, particularly during primary and secondary syphilis. Pregnancy and neurosyphilis were associated with the prozone phenomenon; sex, age, and whether the patient had been treated were not. The results also revealed that the prozone phenomenon not only occurred in patients with a high titer but also could occur in patients with a moderate/low titer. In fact, almost 31% of the patients with the prozone phenomenon had titers ≤1:16. The prozone phenomenon in the RPR test was associated with the phase of syphilis, pregnancy, and neurosyphilis as well as a range of RPR titers between 1:8 and 1:512. This latter finding is in contrast to previous reports that the prozone phenomenon is associated with very high RPR titers.

Nephrogenic Diabetes Insipidus Secondary to Syphilis Infection

Nephrogenic diabetes insipidus (NDI) is caused by partial or complete renal resistance to the effects of antidiuretic hormone. Acquired NDI can be caused by electrolyte imbalances (eg, hypercalcemia), renal/extrarenal diseases (eg, chronic pyelonephritis), and drugs (eg, lithium toxicity). Syphilis has never been reported to cause NDI. The aim of this study was to report the case of a 56-year-old man with NDI secondary to syphilis. The 56-year-old patient presented with polyuria and polydipsia lasting more than 40 days. His urine specific gravity was 1.002. He had no history of chronic kidney disease or contact with toxicants. He had normal blood glucose levels. A water-deprivation test and vasopressin administration indicated NDI. His rapid plasma reagin titer was 1:128. The serum Treponema pallidum-particle agglutination test was positive. He reported engaging in unprotected, extramarital sex 6 months before polydipsia onset and thereafter developing a skin lesion on the external genitalia and arthralgia, both of which resolved spontaneously. Examination of renal biopsy specimens showed abundant plasmacytic and lymphocytic infiltration of the interstitium and low and flat tubular epithelial cells, indicating renal tubular injury. Silver staining revealed T. pallidum-like organisms. Immunohistochemical analysis with T. pallidum-specific antibody confirmed the presence of treponemes. The patient received 2.4 million U of benzathine penicillin im once a week for 3 weeks. His urine output gradually reduced; he recovered 1 month later. His urine specific gravity was 1.026, and his syphilis rapid plasma reagin titer was 1:8. Syphilis can cause NDI. The manifestations of syphilis and causes of acquired NDI are diverse.

The great medical imitator: a case of syphilitic osteitis in the setting of HIV infection

A 44-year-old man with well-controlled HIV presented with low-grade fever, pharyngitis, frontal headache, abdominal and shin pain, and abnormal liver function tests 8 weeks after switching from zidovudine to abacavir (while continuing nevirapine and lamivudine). An abacavir reaction was the working diagnosis and thus his antiretroviral regimen was returned to the previously tolerated combination and he received 10 days of oral penicillin (500mg twice daily) for presumptive tonsillitis with significant improvement. A whole-body bone scan demonstrated multiple foci of increased patchy osteoblastic activity of the long bones and skull. Six months later during routine screening, a syphilis rapid plasma reagin (RPR) titre of 128 was detected. Retrospective testing on stored samples demonstrated a first positive RPR at the time of symptomatic presentation. He received three injections of 1.8g benzathine penicillin on a weekly basis with a subsequent decrease in RPR titre and normalisation of the bone scan. Although syphilitic osteitis is rare, this case re-emphasises the importance of considering syphilis when HIV-infected patients present with unusual symptoms. The use of bone scan in this setting and treatment options are discussed.

Serologic and molecular typing of human T‐lymphotropic virus among blood donors in Maputo City, Mozambique

Screening for human T-lymphotropic virus-1/2 (HTLV-1/2) infection is not performed in blood banks in Mozambique. The aim was to determine the prevalence of HTLV-1/2 among blood donors of the Maputo Central Hospital Blood Bank and measure the coinfection rate of HTLV-1/2 with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis. A total of 2019 consecutive blood donors were screened for HTLV-1/2 antibodies, HIV-1/2 antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis. Specimens reactive on a first HTLV-1/2 enzyme immunoassay (EIA) were retested using a second EIA. Specimens that were dually reactive on both EIAs were further tested using Western blot (WB) and real-time polymerase chain reaction (PCR). All 18 dually reactive specimens (0.89%; 95% confidence interval, 0.48%-1.30%) were positive for the presence of HTLV-1 by WB and real-time PCR. HTLV-2 was not detected. The prevalences of anti-HIV, HBsAg, and reactivity in the RPR test were 5.72, 6.01, and 0.98 percent, respectively. There was no significant association between HTLV-1 infection and demographic variables (age and sex) or serologic markers (HIV, HBsAg, and RPR). For the 17 HTLV-1-positive donors for whom serologic data for HIV, HBsAg, and syphilis RPR were available, 2 showed coinfection with HIV and 1 with HBV. Compared to other infectious agents, HTLV-1 is present at relatively low levels among blood donors in Mozambique. Cost and logistics will present as major challenges for introducing HTLV-1/2 screening in blood banks. In blood banks in Southern Africa where EIA testing is possible, a sequential algorithm of two EIAs may be a cost-efficient option for HTLV-1/2 screening.

Neurosyphilitic gumma in a homosexual man with HIV infection confirmed by polymerase chain reaction

The brain gumma is a rare manifestation of the tertiary stage of syphilis. A case of neurosyphilitic gumma was confirmed by the Treponema pallidum polymerase chain reaction in a 46-year-old HIV-positive homosexual man. The patient presented with a severe headache and was hospitalized. A computed tomography scan was performed which revealed a left frontal lobe mass. Lymphoma was suspected. However, infectious disease diagnostics were performed on the cerebrospinal fluid that included investigations for syphilis and other microbiological agents such as Toxoplasma gondii. This revealed a reactive venereal disease research laboratory test, a reactive syphilis rapid plasma reagin and a reactive T. pallidum particle agglutination test. The patient was treated for syphilis till complete recovery.

A case study of antenatal syphilis screening in South Africa: successes and challenges.

To evaluate the process of providing routine syphilis screening to antenatal care (ANC) clients at primary healthcare clinics in KwaZulu-Natal Province, South Africa. To document the program performance and make recommendations for improving the current program and informing proposals for on-site testing. Nine health facilities were recruited for the study. The methodology used for this case study included: Key informant interviews, inventory, focus group discussions with clients, client flow analysis, exit interviews with clients and observations of consultations. All 51 women attending their first ANC visit had a blood sample taken for a syphilis rapid plasma reagin (RPR) test. Unreliable transport resulted in an average 4 weeks turnaround time to get RPR test results back to clinics. Due to late presentation in the pregnancy for their first ANC visit, 15% would have been unable to complete their treatment before delivery if they had been found positive. Health providers gave minimal information and/or counseling on syphilis, neither did they stress the importance of treatment of positive clients and their partners. There was no strategy to track positive clients who had not been treated or their partners. Providers were unclear on whether partners should be tested before treatment. Although testing was readily available, most of the constraints were centered round logistics of ensuring treatment of women and their partners. These issues must be addressed by sexually transmitted infection managers and policymakers.

HIV infection and asymptomatic sexually transmitted infections in a rural South African community.

The objective was to determine the prevalence of HIV and other sexually transmitted infections (STIs) in a rural community. A population-based survey of adults in 110 homesteads was conducted in 1995. A questionnaire on demographics, sexual practices and history of STDs was administered. Neisseria gonorrhoeae and Chlamydia trachomatis infections were detected using ligase chain reaction (LCR) assay of urine. The seroprevalence of syphilis rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) and HIV infection (ELISA) was determined. Among 259 subjects the prevalence of HIV was 10.5%, N. gonorrhoeae 4.5%, C. trachomatis 6.1% and active syphilis 8.8%. All infections were asymptomatic. Forty per cent of sexually active men had more than one concurrent sexual partner. Only 14% of subjects had ever used condoms. The STI epidemic is being promoted by high levels of asymptomatic infections, high partner concurrency and low condom use.