Serologic Tests For Syphilis Research Articles

Multiple liver metastases of unknown origin: A case report

BACKGROUND The liver is the most common site of digestive system tumor metastasis, but not all liver metastases can be traced back to the primary lesions. Although it is unusual, syphilis can impact the liver, manifesting as syphilitic hepatitis with inflammatory nodules, which might be misdiagnosed as metastasis. CASE SUMMARY This case report involves a 46-year-old female who developed right upper abdominal pain and intermittent low fever that persisted for more than three months. No definitive diagnosis of a tumor had been made in the past decades, but signs of multiple liver metastases were recognized after a computed tomography scan without evidence of primary lesions. With positive serological tests for syphilis and a biopsy of the liver nodules, a diagnosis of hepatic syphilis was made and confirmed with follow-up nodule reduction after anti-syphilis therapy. CONCLUSION Clinicians must be aware of the possibility that syphilis can cause hepatic inflammatory masses, especially when liver metastasis is suspected without evidence of primary lesions. A definitive diagnosis should be established in conjunction with a review of the patient’s medical history for accurate therapeutic intervention.

Performance Validation and Blood Donation Analysis in Nagqu, Tibet, One of the Highest Cities in the World.

Due to the unique geographical and climatic conditions in Nagqu (Tibet), the blood station laboratory was only fully established and accredited by 2020. This study validated the performance of the laboratory's blood screening system and analyzed recent trends in blood donation and screening effectiveness. Various serum samples were used to assess the performance of hepatitis B, hepatitis C, HIV, and syphilis tests, both serological and nucleic acid tests. Donation data were also collected and analyzed. Serological testing demonstrated excellent sensitivity, specificity, and reproducibility (all 100%), with detection limits for HBsAg, HCV Ab, HIV-1 Ab, HIV-1 p24, and TP Ab of 0.2 IU/mL, 0.013 NCU/mL, 0.25 NCU/mL, 1.25 U/mL, and 1.5 mIU/mL, respectively. Nucleic acid testing systems also achieved 100% reproducibility with precision below 5%. PROBIT analysis revealed the 95% detection limits for HBV DNA, HCV RNA, and HIV-1 RNA as 8.29, 97.14, and 40.52 IU/mL, respectively. The study also found a high rate of unqualified donations for local markers such as ALT, HBsAg, syphilis, and HBV DNA. The validation confirmed the screening system's high sensitivity, specificity, and reproducibility, highlighting the importance of effective predonation checks to ensure a safe blood supply in high-altitude areas.

Syphilitic aortitis: from the past to the present (view of a dermatovenerologist)

In order to improve the diagnosis and treatment of syphilitic aortitis, an analysis of known data on the clinical manifestations, course and diagnosis of this pathology was conducted, illustrating our own observations with the subsequent implementation of recommendations in clinical practice. The problem of syphilitic aortitis - the most frequent manifestation of late syphilis - was considered. Current data on clinical manifestations, possibilities and problems of diagnosing this pathology were presented. Modern methods of serological research used in the diagnosis of syphilitic aortitis were analyzed in detail; the course, complications and prognosis of this pathology were separately considered. All these aspects were illustrated by our own observations of clinical cases of syphilitic aortitis, which are of interest due to their rarity in clinical practice and demonstrate the importance of correct diagnosis and appropriate treatment. Serological tests for syphilis, ultrasound examination of the heart, extracardiac vessels and internal organs; X-ray examinations were used when examining patients. It was concluded that lesions of the cardiovascular system are currently among the most common forms of visceral syphilis. Syphilitic aortitis with symptoms of cardiovascular damage, which are caused by aortic valve insufficiency, narrowing of the ascending coronary arteries, aneurysmal dilatation of the ascending part and aortic arch, occurs in the late stages of syphilitic infection. Even in patients with syphilis who have been treated in the past with penicillin drugs, cardiovascular damage may occur, namely aortitis with aortic valve insufficiency. The most informative methods for detecting late cardiovascular damage are: enzyme-linked immunosorbent assay, passive hemagglutination reaction, immunoblotting and computed tomography of the heart and echocardiography. Special attention is paid to the fact that the uniqueness of the above observations lies in the fact that complicated forms of aortitis began to occur more often and also in treated syphilis patients who had previously been treated with water-soluble penicillin. Aortitis also occurs against the background of seroconversion (positivity) of non-treponemal tests, which were previously negative after treatment.

Prospective evaluation of non-invasive saliva specimens for the diagnosis of syphilis and molecular surveillance of Treponema pallidum.

The promising diagnostic performance of molecular testing for syphilis using saliva and urine samples has been reported; however, further evaluation of its possible application for diagnosis and molecular surveillance is required. In addition, the development of a rapid and easy-to-perform molecular test for syphilis is important for its use in the clinical setting. We comprehensively evaluated the diagnostic and surveillance performance of two novel loop-mediated isothermal amplification (LAMP) assays using saliva and urine samples. Saliva, urine, and whole blood were collected from patients who underwent serological testing for syphilis at outpatient clinics. Treponema pallidum DNA in specimens was detected using quantitative PCR (qPCR), nested PCR, and novel LAMP assays. T. pallidum genotyping was conducted by multi-locus sequence typing (MLST). Of the 163 patients recruited, 98 were diagnosed with syphilis (primary: n = 35; secondary: n = 40; latent: n = 23). qPCR showed the highest sensitivity among the molecular tests performed with a sensitivity of 54.1% and 30.3% for all syphilis patients using saliva and urine samples, respectively. A novel method of LAMP combined with dry reagents and crude DNA extraction (Dry-LAMP) showed a probit detection limit of 37.4 copies/reaction within 45 min. The agreement rate between Dry-LAMP and qPCR for saliva was 95.7% (κ coefficient 0.90). The T. pallidum genotype was identified in 48 patients by MLST using saliva samples. Molecular analysis of saliva could be used as a supplementary diagnostic test for syphilis and molecular surveillance of the T. pallidum genotype. Dry-LAMP is expected to be helpful in the clinical diagnosis of syphilis.

Sexually Transmitted Infections in Pre-Exposure Prophylaxis Patients

Background: Pre-exposure Prophylaxis (PrEP) has revolutionized HIV prevention, but concerns exist about its potential impact on other Sexually Transmitted Infections (STIs). This study aimed to assess the prevalence and patterns of STIs among PrEP users at a single urban clinic. Methods: We conducted a retrospective analysis of 100 patients on PrEP, evaluating STI diagnoses over a 12-month period. Comprehensive STI screening was performed quarterly, including nucleic acid amplification tests for chlamydia and gonorrhea at multiple anatomical sites, and serological testing for syphilis. Results: Of the 100 participants (mean age 32.5 years, 82% men who have sex with men), 42% were diagnosed with at least one STI during the study period. The most common infections were chlamydia (28%), gonorrhea (18%), and syphilis (8%). Among chlamydia and gonorrhea cases, 60.9% were rectal infections. Fifteen percent of patients experienced multiple STI diagnoses. Factors independently associated with STI diagnosis included age <30 years (OR 2.1, 95% CI: 1.3-3.4), ≥5 sexual partners in the past 6 months (OR 2.8, 95% CI: 1.7-4.6), and inconsistent condom use (OR 1.9, 95% CI: 1.2-3.0). Conclusion: This study demonstrates a high prevalence of STIs among PrEP users, emphasizing the need for comprehensive STI prevention, frequent screening, and prompt treatment in this population. While PrEP effectively prevents HIV transmission, it must be implemented as part of a holistic approach to sexual health to address the risk of other STIs.

Uveítis sifilítica en pacientes VIH-positivos. Perspectiva actual desde un caso clínico

Syphilitic uveitis, caused by Treponema pallidum, has experienced a worrying coexistence with HIV infection in recent years. It has been observed that this coinfection has a significant prevalence in men, especially during the fifth decade of life. Identifying this association promptly is crucial due to similarities in transmission routes and epidemiological risks. We present the case of a 56-year-old male patient with HIV, referred for possible optic neuritis, who experienced progressive loss of vision in both eyes. The findings revealed intermediate uveitis in both eyes, vitreous and positive serological tests for syphilis and HIV. Intravenous administration of crystalline penicillin led to significant improvements in visual acuity. The resurgence of syphilis cases in recent decades underlines the importance of understanding its ocular manifestations. Syphilitic uveitis, especially the middle layer of the eye, can occur in various forms, with anterior uveitis being the most common. The diagnosis of ocular syphilis involves specific tests such as EIA, TPHA, FTA-ABS, VDRL and RPR. Intravenous crystalline penicillin is the standard treatment, although they are considered alternatives for patients allergic to penicillin. In addition, the use of systemic steroids is analyzed in selected cases. The rise of syphilis and its connection to HIV poses challenges in timely diagnosis and treatment. Education about these diseases becomes essential. Ocular syphilis requires a multidisciplinary approach to prevent irreversible damage to vision.

Three dermatologists who were nominated for a Nobel Prize: Albert Neisser, Erich Hoffmann, and Aaron B. Lerner

During the past 125 years, three dermatologists have been nominated for the Nobel Prize in Physiology or Medicine: Albert Neisser (1855-1916), Erich Hoffmann (1868-1959), and Aaron B. Lerner (1920-2007). Neisser was nominated 22 times for his discovery of the gonococcus and for his work on the serologic testing for syphilis through complement fixation. Hoffmann was nominated three times for his role in the discovery of Treponema pallidum. Lerner was nominated twice, once for his work on melanocyte-stimulating hormone and a second time for his work on melatonin. Although neither Neisser, Hoffmann, nor Lerner won the Nobel Prize, it is still a notable accomplishment that each of them was nominated multiple times for this prestigious award. This contribution highlights the lives and careers of these three distinguished dermatologists, including the landmark discoveries they made that led to their being nominated for a Nobel Prize.As of 2023, there were 114 Nobel Prizes in Physiology or Medicine awarded to 227 individuals, none of whom were dermatologists. There were, however, three distinguished dermatologists who were nominated for this illustrious prize: Albert Neisser (1855-1916), Erich Hoffmann (1868-1959), and Aaron Bunsen Lerner (1920-2007) (Figures 1-3). Although these three dermatologists failed to win the Nobel Prize, it remains a signal accomplishment for each of them to have been nominated for such a prestigious award on multiple occasions in recognition of their outstanding discoveries that have had a significant impact on modern-day medicine. This Fun Facts About Dermatology presentation highlights the lives and careers of Neisser, Hoffmann, and Lerner and the important scientific contributions that led to their nominations for medicine's most coveted award: the Nobel Prize.

Syphilis infection and related factors among HIV-infected patients in Zhejiang Province

Objective: To investigate syphilis infection and related factors among HIV-infected patients being followed up for more than one year in Zhejiang Province. Methods: Data were collected from the China Disease Control and Prevention Information System, and information such as demographic characteristics, viral load levels, and syphilis serologic test results was collected from HIV-infected persons who were diagnosed with HIV more than 1 year, aged ≥15 years with a current address in Zhejiang Province through December 31, 2022. The logistic regression model analyzed the prevalence of syphilis and the related factors. The SPSS 19.0 software was used for statistical analysis. Results: A total of 33 734 HIV-infected patients, with the prevalence of syphilis was 5.6% (1 879/33 734). Among the syphilis cases, the prevalence of syphilis was 6.4% (1 774/27 934) of males, 7.5% (640/8 543) of 25-34 years old age group, 7.6% (1 025/13 423) of unmarried, 8.3% (1 239/14 862) of homosexual transmission, 6.9% (214/3 080) with a non-local registered residence and 9.6% (602/6 267) with a history of STD before the HIV diagnosis. Multivariate Logistic regression analysis showed that participants who were male (aOR=2.19, 95%CI:1.77-2.72), 25-34 years old age group (aOR=1.80, 95%CI:1.47-2.20), homosexual transmission (aOR=1.67, 95%CI:1.49-1.88), with other provinces registered residence (aOR=1.26, 95%CI:1.09-1.47), and with a history of sexually transmitted disease (STD) before the HIV diagnosis (aOR=1.98, 95%CI:1.78-2.20) were associated with increased risk of syphilis. Being married (aOR=0.79, 95%CI:0.68-0.92) was associated with a decreased risk of syphilis. Conclusions: Syphilis infections were high in HIV-infected patients followed up more than one year in Zhejiang Province. It is recommended that syphilis surveillance and screening frequency should be strengthened among HIV-infected persons with characteristics such as male, homosexual transmission, and STD history.

Frequent chlamydia and gonorrhoea but very infrequent syphilis among men who have sex with men using HIV pre-exposure prophylaxis in West Africa

ObjectivesAlthough oral pre-exposure prophylaxis (PrEP) for HIV is being rolled out in West Africa, data on sexually transmitted infections (STIs) in PrEP users are scarce. We assessed the prevalence, incidence...

Clinical characteristics and aetiology of uveitis in a viral haemorrhagic fever zone

Background/ObjectivesStudies on uveitis in Sierra Leone were conducted prior to the Ebola Virus Disease epidemic of 2013–16, which was associated with uveitis in 20% of survivors. They did not include imaging or investigation of tuberculosis and used laboratory services outside the country. We performed a cross-sectional study on patients presenting with uveitis to establish their clinical characteristics and identify the impact of in-country laboratory diagnoses.MethodsWe invited uveitis cases presenting to Eye Clinics in Sierra Leone from March to September 2022 to participate in the study. They underwent a diagnostic work-up, including fundus and ocular coherence tomography imaging. Active uveitis cases underwent further investigations including serology and immunological tests for syphilis, tuberculosis, herpetic viruses and HIV and chest radiographs.ResultsWe recruited 128 patients. The median age was 34 (IQR 19) years and there was an equal gender split. Panuveitis was the predominant anatomical uveitis type (n = 51, 40%), followed by posterior uveitis (n = 36, 28%). Bilateral disease affected 40 patients (31%). Active uveitis was identified in 75 (59%) cases. ICD 11 definition of blindness with VA < 3/60 occurred in 55 (33%) uveitis eyes. Aetiology of uveitis from clinical and laboratory assessment demonstrated that most cases were of undifferentiated aetiology (n = 66, 52%), followed by toxoplasmosis (n = 46, 36%). Trauma contributed to eight (6%) cases, syphilis to 5 (4%) cases and Ebola to 2 (2%).ConclusionsUveitis was associated with high levels of visual impairment. Posterior and panuveitis contributed to the highest proportion of uveitis cases. Laboratory studies helped differentiate syphilis as a significant aetiology of uveitis.

Chronic myeloid leukemia presenting with disc edema: A case report

The aim is to report a case of chronic myeloid leukemia (CML) in a 20-year-old female who initially presented with bilateral optic disc edema and headaches, and to raise awareness of uncommon causes of disc edema that could potentially be life-threatening. The patient first presented in June 2022 with blurry vision in the left eye, headache, and neck pain of 6 months duration. Initial examination revealed a young woman in no acute distress, with a blood pressure of 100/60 mm Hg and a body mass index of 26.98. Her pinhole visual acuity was 6/9 in both eyes, extraocular motility was full bilaterally, and both pupils were briskly reactive. However, she had bilateral optic disc edema. Both brain and orbital magnetic resonance imaging (MRI) revealed normal findings. Serological tests for syphilis and human immunodeficiency virus were negative. Based on these and the clinical features, an initial diagnosis of idiopathic intracranial hypertension was made, and the patient was started on acetazolamide tablets. She was followed up for approximately 1 year without resolution of symptoms. At a follow-up visit in December 2023, she was found to have developed dilated tortuous vessels with discrete retinal lesions. A peripheral blood film result showed that the patient had CML. In conclusion, a high index of suspicion should be entertained when managing a patient with unexplained bilateral disc swelling with normal brain MRI study. A complete blood workup, including a peripheral blood film, should be included as a part of the routine investigation of these patients so that diagnosis and treatment could be instituted early.

Late-onset mania as a manifestation of neurosyphilis: A Case Report

IntroductionThe evaluation of manic behavior with later onset is crucial, as various organic factors such as medications, infections, metabolic disturbances, tumors, and epilepsy can serve as potential etiological causes. While not universally observed, most studies indicate a connection between late-onset mania and neurological disorders like neurosyphilis.ObjectivesOur study aims to investigate the relationship between late-onset mania and neurosyphilis.MethodsIn this paper, we present a case of neurosyphilis presenting exclusively with symptoms of mania.ResultsA 72-year-old Tunisian woman with no prior medical or psychiatric history was referred to the psychiatric emergency room due to alterations in her mental state and behavior over the past ten days. During the psychiatric assessment, she displayed increased motor activity, fluctuating emotions, and rapid flow of ideas. The general physical examination yielded no notable findings. The serum Venereal Disease Research Laboratory (VDRL) test returned a strongly positive result (+++), and the TPHA examination confirmed a positive result at a titer of 1/60. In the serologic analysis of cerebrospinal fluid, VDRL was also positive, thereby confirming the diagnosis of neurosyphilis (NS). The diagnosis of mania secondary to a medical condition was established. The patient was treated with ceftriaxone and antimanic medications, resulting in a significant improvement in her psychiatric symptoms within a few days.ConclusionsThis case underscores the importance of conducting serologic testing for syphilis in patients who present with manic symptoms, experience a late-onset mental disorder, and have no prior history or family history of affective disorders.Disclosure of InterestNone Declared

A pilot program of HIV pre-exposure prophylaxis in Thai youth.

There are gaps in knowledge and experience of antiretroviral pre-exposure prophylaxis (PrEP) delivery in adolescents. This pilot study enrolled Thai adolescents 14-20 year-old without HIV who reported risk behaviour. All participants were offered daily tenofovir/emtricitabine (TDF-FTC) and followed for 24 weeks. HIV testing, renal function, bone density scan, and sexually transmitted infection (STI) testing including syphilis serology and urine molecular testing for gonorrhoea and C. trachomatis were performed at baseline and weeks 12 and 24. Adherence was evaluated through intracellular tenofovir diphosphate (TFV-DP) levels in dried blood spots. Of the 61 enrolled adolescents, median age 18.1 (IQR: 14.8-20.9) years, 46 (75.4%) were males and 36 (59%) were MSM. Retention to week 24 was 80.3%. One third (36%) had TFV-DP levels consistent with taking ≥6 pills/week at week 12 and 29% at week 24. The factors associated with taking ≥6 pills/week were being MSM (adjusted odds ratio [aOR]: 53.2, 95% CI: 1.6-1811; p = 0.027), presence of STI at baseline (aOR: 9.4, 95% CI: 1.5-58.5; p = 0.016), and self-report of decreased condom use while taking PrEP (aOR: 8.7, 95% CI: 1.4-56.6; p = 0.023). 31% had an STI at baseline and this declined to 18% at week 24. No renal or bone toxicity was observed and there were no HIV seroconversions. Daily oral PrEP with FTC-TDF in high-risk Thai adolescents is feasible, accepted, well-tolerated, and had no increased risk compensation; however, low adherence was a major challenge. Adolescent-specific PrEP strategies including long-acting modalities are needed for successful HIV prevention.

Evaluation of Automated Processing of Electronically Reported Serological Tests for Syphilis Using Current and Historical Syphilis Results Compared With Traditional Reactor Grid Processing in Florida.

Syphilis in Florida increased 49% from 2016 to 2020. Moreover, many serological tests for syphilis (STS) do not indicate current infection. Traditionally, syphilis surveillance systems used reactor grids, a method for prioritizing STS for investigation based on age, nontreponemal titer, and/or sex. In 2022, Florida's sexually transmitted disease surveillance system implemented an automated method for processing electronically reported STS (eSTS), expanding upon the reactor grid, using an individual's current STS (treponemal and nontreponemal), treatment history, and historical STS results aiming for more efficiently processing eSTS. We compared the new method of processing eSTS results against the reactor grid and determined potential value in time/cost savings of this change. All eSTSs (n = 4144) from January 2, 2023 to January 8, 2023, were compared by how the logic-based method processed test results versus how the reactor grid processed test results. Each method was compared using measurements of accuracy (e.g., sensitivity/specificity). Time and cost savings in eSTS processing were estimated. Using the surveillance case definition as reference, the accuracy of the logic-based method for processing eSTS was nearly double (82.3% vs. 43.6%), had greater specificity (79.0% vs. 33.0%), and increased positive predictive value (47.5% vs. 22.0%) when compared with the reactor grid method. Sensitivity (99.5% vs. 98.6%) and negative predictive value (99.9% vs. 99.2%) remained similar. The logic-based method is estimated to save 7783 hours annually (~$185,000). Processing eSTS based on current and historical STS results is significantly more accurate than using a reactor grid. Moreover, these improvements save time and resources that can be better allocated to other program prevention activities.

HIV Infection Modifies the Role of Prior Treponema pallidum Infection in the Clinical Presentation of Early Syphilis Among Adult Patients From Sexually Transmitted Infection Clinics in Peru.

We aimed to compare the clinical presentations (symptomatic vs. asymptomatic) with prior Treponema pallidum infection status (first infection vs. reinfection) among people with early syphilis. We used data from PICASSO, a cohort study in Peru that enrolled people with active syphilis from May 2019 to August 2021. Study participants had early syphilis and a prior syphilis serological test result within the prior 12 months to determine prior T. pallidum infection status. We calculated prevalence ratios (PRs) of symptomatic clinical presentation (primary or secondary syphilis) by prior T. pallidum infection status, stratified by HIV infection status. In addition, we explored the association of prior T. pallidum infection status and lesion presentation, stratified by primary and secondary syphilis cases, using the Fisher exact test. We include 84 T. pallidum reinfection cases and 61 first infection cases. We found increased frequency of symptomatic clinical presentation among first-infection cases (39% vs. 20%; PR, 1.94; P = 0.014). This association was stronger among persons living without HIV infection (38% vs. 7%; adjusted PR, 6.63; P = 0.001) in comparison to those living with HIV infection (45% vs. 34%; adjusted PR, 1.38; P = 0.458). Among secondary syphilis cases, more participants from the reinfection group reported that their lesions improved 1 week after treatment (100% vs. 29%, P = 0.045) compared with those with a first infection. Among the primary syphilis cases, all participants reported that their lesions improved 1 week after treatment. Prior syphilis was associated with a decreased prevalence of symptomatic reinfection, especially among persons not living with HIV infection.

Unilateral Syphilitic Optic Neuritis without Uveitis

This report describes a case of case of unilateral syphilitic optic neuritis without uveitis. A 56-year-old man presented with complaints of four days history of decreasing vision in his left eye. At the initial visit, the patient’s best corrected visual acuity was 1.2 and 0.03 in the right and left eye, respectively. A relative afferent pupillary defect was observed in the left eye. Slit-lamp examination revealed no cells, flare or keratic precipitates in the anterior segment either eye. Fundoscopy revealed diffuse optic disc swelling with peripapillary hemorrhage in the left eye. Goldmann visual field testing identified central absolute scotoma and an enlarged blind spot in the left eye. On serological evaluation for syphilis, serum rapid plasma reagin (RPR) and treponema pallidum hemagglutination assay (TPHA) were positive (RPR 52.5, TPHA 740.0). In addition, IgM fluorescent Treponemal antibody absorbance (FTA-ABS) was positive. In contrast, cerebrospinal fluid showed negative RPR and positive TPHA (TPHA 11.8). Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and increased protein content and glucose. Magnetic resonance imaging showed a swollen enhanced lesion in the left optic nerve. The patient was diagnosed with syphilitic optic neuritis and received the currently recommended treatment with intravenous penicillin G (PCG). Twenty-four million units per day of PCG were administered for 2 weeks. After 2 weeks of therapy, his left visual acuity improved to 0.3 in 2 months. However, the optic disc looked diffusely pale in the left eye. At 6-month visit, the patient was clinically stable. RPR turned out negative and there was a reduction in serological TPHA reactivity. We consider that it is essential to perform serological tests for syphilis in every patient with optic neuritis, which makes it possible to initially treat syphilitic optic neuritis with PCG.

Challenges in The Management of Ocular Syphilis in Human Immunodeficiency Virus Patient: A Case Report

Background: The incidence rate of syphilis has been increasing in recent years. Ocular syphilis can manifest at any stage of syphilis, either with or without Human Immunodeficiency Virus (HIV) co-infection. Case Illustration: A 52-year-old man presented with a complaint of blurred vision persisting for the past 6 months. Visual examination revealed NLP (no light perception) in the right eye and 6/30 in the left eye. Syphilis serology testing was positive. Patient were diagnosed with latent syphilis with ocular syphilis, along with stage I HIV infection. Patient were treated with benzathine penicillin also with antiretroviral therapy for the HIV infection. Conclusion: Syphilis and HIV often occur together and can influence each other. Syphilitic ulcers can serve as the port of entry for HIV infection. In HIV-infected individuals with syphilis, the symptoms of syphilis can be varied due to the immunocompromised state. Benzathine penicillin G is a first-line therapy for ocular syphilis.

A comparative retrospective study on syphilis serology in HIV-positive and negative individuals before and after therapy

Syphilis serological tests are crucial for diagnosing and evaluating syphilis therapy. Human immunodeficiency virus (HIV) infection can alter syphilis serologies, making manifestations more atypical and increasing complications. This study aims to compare treponemal and nontreponemal titers before and after therapy between HIV-positive and negative patients. From January 2018 to December 2021, we retrospectively evaluated patients diagnosed with early and latent syphilis using quantitative nontreponemal and treponemal serologies (VDRL and TPHA) and categorized them as HIV-positive or negative. Baseline and post-therapy (1 month and last follow-up within 2 years) VDRL and TPHA titers were recorded. Twenty-nine HIV-negative and 28 HIV-positive patients met the inclusion criteria. Baseline VDRL and TPHA titers differed significantly between both groups, particularly in early syphilis, with the median baseline VDRL titer higher in the HIV-positive group. At 1-month and the last follow-up after therapy, VDRL titers continued to differ significantly, underscoring the impact of HIV coinfection on treatment response. Notably, TPHA titers exhibited significant differences between the two groups only at the last follow-up in overall syphilis. The HIV-positive group showed a higher percentage of patients failing to achieve a serological cure (60.7% vs. 58.6%). HIV coinfection in syphilis patients affects both nontreponemal and treponemal titers and elevates the treatment failure risk. This study highlights the importance of periodic syphilis serology tests in coinfected individuals to ensure treatment effectiveness, detect reinfection promptly, and prevent complications.

Congenital neurosyphilis in neonatal sepsis by Leclercia adecarboxylata: a case report

Introduction: Sepsis remains a leading cause of morbidity and mortality in neonates. In accordance with the development of diagnostic testing, various pathogens have been found to cause neonatal sepsis, ranging from common to even rarer pathogens. Leclercia adecarboxylata is a Gram-negative bacillus rarely found in neonatal sepsis and was previously found predominantly in environmental settings and the human gastrointestinal tract as commensal bacteria. We describe a rare case of Leclercia adecarboxylata in neonatal sepsis with congenital neurosyphilis. Case Description: We present a male neonate born from a positive syphilis serological test mother, presented with sepsis manifestation. Blood culture reveals growth of Leclercia adecarboxylata. The patient received both therapeutic regimens of antibiotics for sepsis and congenital syphilis. The cerebrospinal fluid analysis also performed revealed suggestive of congenital neurosyphilis. The patient passed away due to multiple organ failure. Conclusion: Neonatal sepsis and congenital neurosyphilis present with identical manifestations; therefore, appropriate recognition and comprehensive management should be done

Influence of infectious diseases on detection of antibodies to treponema pallidum

The problem of the spread of syphilis is becoming acute due to the rapid increase in the number of initially detected cases of the disease. When analyzing and interpreting the obtained laboratory data, there is always the possibility of obtaining contradictory results, both false positive and false negative, which do not coincide with the clinical picture of the patient. Since in practice false positive results of serological tests for syphilis are detected more often than false negative ones, special importance is attached to the identification and study of the causes of their occurrence. At the analysis stage, the cause may be the cross-reactivity of the test system with various ‘particles’ in the analyzed samples, due to the peculiarities of its design and antigenic composition. For this work, sets of reagents Abbott GmbH (CMIA), Mindray (CLIA), as well as reagents produced by Vector-Best (ELISA) were used. During the study, it was found that one of the possible ‘particles’ leading to cross-reactivity of test systems may be IgG antibodies to cytomegalovirus.