Syphilis Serology Research Articles

P071 Cost efficacy savings on serological follow up for syphilis at an urban sexual health clinic

<h3>Background/introduction</h3> General Practitioners (GPs) in Lothian are requesting syphilis serology in 65% of individuals being tested for HIV. Adding syphilis to the remaining 35% would cost around £7000. In Edinburgh full serology (IgG, RPR, TPPA, IgM) is performed in all with a previous syphilis diagnosis. HIV positive individuals are tested 6 monthly. BASHH 2015 Syphilis Guidelines recommend RPR follow up and annual monitoring in HIV positive individuals. The aim was to evaluate if full serological screening was appropriate and whether cost savings could be made. <h3>Methods</h3> One hundred individuals with full serological testing for syphilis, 30/9/15 to 29/10/15. Age, risk group, HIV status, stage of infection, PCR, treatment, symptoms, follow up and infection risks were collated. <h3>Results</h3> 88 male, 12 female. Twenty one early infection (all positive RPR), 4 re infection (all rise in RPR), 7 late latent and 54 treated infection. Forty seven HIV positive. Of these 14 (21%) had no ongoing risks and 16 (34%) had ongoing risks, longstanding RPR 0. Forty HIV negative. Twenty four (60%) were MSM with treated STS, and a longstanding RPR 0. <h3>Recommendations</h3> Testing should be annual RPR in HIV positive individuals with no ongoing risks. In those with ongoing risks RPR alone sufficient for monitoring. All with re infection would have been picked up on RPR. In HIV negative individuals, most had ongoing risks but a longstanding RPR 0. Monitoring with RPR only would have diagnosed all re infections. <h3>Discussion</h3> It was difficult to vary testing based on risk assessment and concerns that RPR only may miss prozone. However, there was agreement that IgM should no longer be performed. At £3.77/test approximately £377/month would be saved in this group alone. This would apply to all other testing with considerable cost savings

P233 A Case of CMV (Cancer Mimicking Virulence)

Background/introduction Generalised lymphadenopathy and fatigue have a broad differential diagnosis ranging from curable infections to lymphoma. Certain diagnoses can be delayed or missed altogether when patients do not present to sexual health clinics. Aim(s)/objectives Highlight secondary syphilis as a cause of lymphadenopathy amongst non-sexual health colleagues. Expand syphilis testing beyond sexual health clinics, even in the absence of classical risk factors. Methods Case report of secondary syphilis which was misdiagnosed despite numerous investigations in primary and secondary care. Results A 23 year Caucasian lady was referred to lymphoma clinic by her GP with a three month history of lymphadenopathy and fatigue. She was diagnosed with a primary CMV infection and lost to follow up after her symptoms resolved. One year later she attempted to donate blood. Positive syphilis serology with a low RPR was detected on routine blood screening by the transfusion service. The patient was referred to Bristol Sexual Health Centre where sexual history taking revealed she had a bi sexual partner at the time of her illness who also tested positive for syphilis. An archived blood sample from the time of her illness revealed active syphilis infection with a high RPR. Discussion/conclusion Secondary syphilis can mimic numerous illnesses. However syphilis testing remains uncommon outside of sexual health clinics for a variety of reasons. A change of culture is required to ensure medical professionals are prepared for routine sexual enquiry and consider syphilis as a potential cause for lymphadenopathy.

P226 Reattendance, retesting and test positivity among patients initially treated for chlamydia or gonorrhoea in a large inner city clinic: Abstract P226 Table 1

Background/introduction Reinfection with a bacterial sexually transmitted infection following treatment is common. National guidelines recommend retesting for chlamydia three to six months after treatment in Aim(s)/objectives To review reattendance, retest and positivity rates in patients with chlamydia or gonorrhoea at a large inner-city clinic. Methods Patients diagnosed with chlamydia or gonorrhoea were identified in our electronic patient records (March-September 2015). Proportion reattending, retesting and test positivity two to four months after treatment of the initial infection were recorded. Results The minority of patients treated for chlamydia and gonorrhoea reattended and retested for infection (Table 1). Positivity was high in those who retested, especially in MSM. Two HIV diagnoses and 89 syphilis serology positive results were found in those retesting. Discussion/conclusion Retesting rates following treatment for chlamydia and gonorrhoea are low. Those who did reattend and retest experienced high rates of infections and represent an important group to target for active recall.

Seroconversion of serological test for syphilis in infants born to mothers with syphilis serofast reaction

Objective To explore the influence of anti-syphilis treatment to pregnant women with lower titer seroresistance on infantile serum, so as to provide the guidance for clinical diagnosis and treatment. Methods Totally 134 cases of pregnant women with lower titer syphilis serofast reaction were divided into treatment group(75 cases) and untreated group(59 cases) according to whether received anti-syphilis treatment during their pregnancy.The change of syphilis serology toluidine red unheated serum test (TRUST) and Treponema pallidum particle assay(TPPA) for the two groups mothers and babies were compared. Results (1)The first detection of TRUST titers between the two groups of pregnant women did not show statistically significant difference (χ2=0.520, P>0.05). (2)Among the 134 neonates, 20 cases(14.9%) were negetive for both TRUST and TPPA, 23 cases(17.2%) were Treponema pallidum particle assay(TPPA) positive only, 91 cases(67.9%) were positive for both TRUST and TPPA and showed lower or equivalent TRUST titers compared to their mothers, without significant differences between the two groups(χ2=0.892, P>0.05). (3)In the two groups of babies with the same TRUST titers, the seroreversion time of TRUST showed no significant differences(P=0.229, 0.309, 1.000). The negative time of TRUST in infants with neonatal higher titer was later than those with neonatal lower titer in the two groups(all P<0.05). The infant with TRUST+ showed longer duration than those with neonatal TRUST- in TPPA seroreversion(all P<0.05). The seroreversion time of TPPA in infants with neonatal TRUST titer of 1: 4 in untreated group was later than that in treatment group[(14.1±1.4)months vs.(12.5±1.1)months, t=2.900, P=0.010]. Conclusion The treatment for mothers with lower titer seroresistance in pregnant period had no influence in the positive rate of TRUST and TPPA in the neonates and seroreversion time of TRUST in infant.It may have certain effect to shorten the seroreversion time of TPPA in infant with high TRUST titer by the treatment. Key words: Syphilis; Pregnancy; Infant; Syphilis serodiagnosis; Seroresistance

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China.

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40–49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%–2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%–0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.

Vertigo and sensorineural hearing loss due to syphilis: differential diagnosis and treatment

Objective:To analyze the etiology of repeatedly attacks of intractable vertigo and some types of sensorineural deafness whose clinical manifestation were not in conformity with the known spectrum diseases，and explore the screening method to prevent missed diagnosis or misdiagnosis, then provide references for clinical diagnosis and treatment for rare etiology. Method:The authors retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis from 4 cases of vertigo sufferers and 2 cases of hearing impairment sufferers whose serological tests were positive for syphilis. All these 6 cases were treated with large doses of penicillin aqueous solutions (24 million U/d), multi-times intravenous infusion, the course of the treatment was 14 d. Result:The clinical manifestations of these 6 patients were lack of characteristic, as well as the results of hearing and vestibular function, imaging diagnosis. Positive syphilis detection of serology and cerebrospinal fluid tests were the main diagnostic basis. After anti-syphilis treatment, 5 cases got satisfied clinical symptoms improvement, 1 case suffered from low-tone sensorineural hearing loss, whose hearing fluctuated recurrently. Conclusion:Syphilis infection may damage the Ⅷ cranial nerve and then lead to vertigo and hearing loss, through chronic syphilitic osteitis of temporal bone, atrophy of organ of corti, osteolytic lesion surrounding the endolymphatic duct, and neurosyphilis. For patients presented with intractable vertigo, and those whose clinical manifestations are not in conformity with the known diseases of unilateral ear or bilateral ears rapidly progressive deafness, syphilis serology screening and validation tests are recommended in case of missed diagnosis or misdiagnosis.

The Distribution of Syphilis Among Inpatients in Wenzhou, China: A Hospital Based Study.

BackgroundThe high prevalence of syphilis among inpatients is an important concern in clinical settings. Thus, a better understanding of the serological test would be valuable.ObjectivesWe analyzed the serological test results for syphilis among the inpatients in Wenzhou central hospital, China, to estimate the distribution of syphilis this Chinese population.Patients and MethodsThe blood samples of 81946 inpatients at the hospital from January 2010 to December 2012 were collected and retrospectively analyzed. Syphilis testing was conducted using a Treponema pallidum enzyme-linked immunosorbent assay (TP-ELISA) and a TP particle agglutination (TPPA) assay. A toluidine red unheated serum test (TRUST) was then used to determine the titer of TP antibody in the TP- ELISA-positive samples.ResultsIn total, 1618 of the 81946 inpatients showed positive syphilis serology; the positive rates in 2010, 2011, and 2012 were 2.27%, 1.58%, and 2.11%, respectively. Males had a significantly higher positive rate when compared to females. Surprisingly, the highest positive rate was observed among patients older than 80 years, followed by patients younger than 19 years, while patients aged 20 - 39 years had the lowest positive rate. The TRUST titer of most TP-positive cases was less than 1:8. Patients aged 20 - 39 years showed the highest percentage of TRUST titer values ≥ 1:8, while patients older than 80 years showed the lowest percentage; the differences between these two groups were statistically significant.ConclusionsThe serological characteristics of syphilis varied with gender and age. Syphilis screening and control should be conducted for young patients and pregnant women, but special attention should also be paid to elderly inpatients. The TRUST assay is better used in syphilis screening and for judgment of curative effects, but the diagnosis needs specific methods, such as the TP-ELISA and the TPPA test.

Resultados de sorologia para casos de sífilis em campanha de município no norte do Brasil

The World Health Organization estimates that approximately 12 million new cases of syphilis occur per year in the world. The aim of this study was to evaluate results in a campaign of active search of syphilis cases in the City of Belem, Para State, Brazil, entitled no controle da sifilis (Belem in syphilis control). This campaign was aimed at the population of reproductive age, above 15 years old. Twelve Municipal Health Centers were selected based on the target audience and positive cases of Belem Health Districts. From October 24, 2013 to October 30, 2013, samples for serology were collected and 630 tests were conducted by Rapid Check Syphilis. The results of the campaign showed that the positive serology for syphilis in the sampled population was 6%, corresponding to 40 cases with positive diagnosis. The most prevalent age group was 21-40 years old in females and 31-50 years old in males. The campaign demonstrated efficacy in syphilis diagnosis, improving the principles of health promotion and disease prevention that focus on maternal and fetal mortality. It is recommended that health services participate actively in the diagnostic campaigns offered by health networks, and continually make available the rapid testing to users and treatment for positive cases.

Chronic skin ulcers in a patient returning from Mexico

A 27-year-old Chilean man presented with a 3 month history of cutaneous ulcers accompanied by intermittent fever, night sweats, dry cough, and weight loss. He had recently returned from a 10-month stay at the Yucatan Peninsula, Mexico, where his clinical problems had started with a skin lesion on his forehead, which he related to an insect bite. Samples of this lesion had been diagnosed in Mexico as cutaneous leishmaniasis. Shortly before returning to Chile, he was tested and found to be positive for HIV. On admission, he had various small maculopapular lesions on his chest and several skin ulcers on his shoulder and face (fi gure, A). CT scans showed several pulmonary nodular lesions and hepatosplenomegaly. His CD4 count was 75 cells per μL and his HIV viral load was 110 000 copies per mL; serology for toxoplasmosis, syphilis, Chagas disease, and Cryptococcus neoformans antigen were negative. Scrapings of the lateral margins of a skin ulcer were taken to confi rm the previous suspicion of cutaneous leish maniasis. Giemsa stains showed numerous intracellular and extracellular oval structures with a diameter of 2–4 μm (fi gure, B). Because kinetoplasts (densely stained rod-shaped structure representing mitochondrial DNA), which are pathognomonic for Leishmania spp parasites, were absent, histoplasmosis was suspected. This suspicion was verifi ed by Grocott-Gomori methenamine silver stain showing several numerous darkly stained yeast-like elements (fi gure, C). With antifungal treatment (amphotericin B, itraconazole) the fever subsided and the patient recovered; skin ulcers healed with scarring (fi gure, D). Oral itraconazole was continued for 12 months. Currently, the patient is still on his fi rst-line antiretroviral regimen (abacavir, lamivudine, raltegravir) and has undetectable viral loads. Although his CD4 count is maintained below 100 cells per μL, he is clinically stable and asymptomatic. Histoplasma capsulatum is an endemic fungal agent causing pulmonary infection after inhalation of spores. Immuno compromised patients might have life-threatening systemic infections, including cutaneous manifestations, which are more frequently reported from Latin America. Microscopic examination of tissue samples permits rapid diagnosis and initiation of therapy. However, in specimens of chronic skin ulcers, H capsulatum cells might easily be misdiagnosed as leishmania amastigotes because both microorganisms present as intracellular objects of the same size and shape.

Prevalence and risk factors of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other sexually transmissible infections among women attending antenatal clinics in three provinces in Papua New Guinea: a cross-sectional survey.

A cross-sectional bio-behavioural survey to investigate the epidemiology of CT, NG, TV and other STIs among pregnant women in three provinces of PNG was undertaken. Women aged 18-35 years attending their first antenatal clinic visit were invited to participate. Participants completed a short interview and provided self-collected vaginal specimens for CT, NG and TV laboratory-based nucleic acid amplification tests and a venepuncture specimen for laboratory testing for syphilis and Herpes simplex virus type-2 (HSV-2) serology. Routine antenatal assessment was conducted according to national guidelines, including HIV counselling and testing and point-of-care syphilis screening. A total of 765 women were enrolled. Overall, 43% (95% confidence interval (CI): 39.2-46.4) had one or more of CT, NG or TV infection. CT was the most prevalent STI (22.9%, 175/765; 95% CI: 19.9-25.9), followed by TV (22.4%, 171/765; 95% CI: 19.4-25.4), and NG (14.2%, 109/765; 95% CI: 11.7-16.7). The prevalence of active syphilis was 2.2% (17/765; 95% CI: 1.2-3.3), HSV-2 was 28.0% (214/765; 95% CI: 24.8-31.2) and HIV, 0.8% (6/765; 95% CI: 0.2-1.4). Prevalences were highest among primigravid women, women aged <25 years, and among those in Central Province. High prevalences of curable genital STIs were observed among women attending routine antenatal clinic services in PNG. These infections have been associated with adverse pregnancy outcomes and could be important contributors to poor maternal and neonatal health in this setting.

UK national guidelines on the management of syphilis 2015.

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

Prenatal diagnosis of congenital syphilis presenting with transient pleural effusion in the fetus: a case report and rising incidence of congenital syphilis in South Korea

Congenital syphilis is preventable and curable if maternal infection is detected early, and pregnant women in Korea are screened routinely for this disease. Nevertheless, the incidence of congenital syphilis is not decreasing. Prenatal diagnosis of congenital syphilis is difficult and treatment is usually based on maternal syphilis serology. Prenatal ultrasonographic examination may sometimes reveal abnormal features suggesting congenital infection. The authors report a case of congenital syphilis that was diagnosed in both fetus and asymptomatic mother following detection on prenatal ultrasonography of transient fetal pleural effusion. The case is noteworthy for its sonographic presentation as fetal pleural effusion rapidly resolved spontaneously.

The management of isolated positive syphilis enzyme immunoassay results in HIV-negative patients attending a sexual health clinic

An unconfirmed positive treponemal enzyme immunoassay (enzyme immunoassay positive, Treponema pallidum particle agglutination negative and rapid plasma reagin negative) presents a clinical challenge to distinguish early syphilis infection from false-positive results. These cases are referred for syphilis line assay (INNO-LIA) and recalled for repeat syphilis serology. We performed a retrospective audit to establish the proportion of HIV-negative cases with unconfirmed positive enzyme immunoassay results, the proportion of these cases that received an INNO-LIA test and repeat syphilis serology testing and reviewed the clinical outcomes; 0.35% (80/22687) cases had an unconfirmed positive treponemal enzyme immunoassay result. Repeat syphilis serology was performed in 80% (64/80) cases, but no additional cases of syphilis were identified. Eighty-eight per cent (70/80) received an INNO-LIA test; 14% (5/37) unconfirmed enzyme immunoassay-positive cases with no prior history of syphilis were confirmed on INNO-LIA assay, supporting a diagnosis of latent syphilis. As a confirmatory treponemal test, the INNO-LIA assay may be more useful than repeat syphilis serological testing.

Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study

BackgroundChancres, the hallmark of primary syphilis, are classically described as single, painless ulcers at the site of Treponema pallidum inoculation. We aimed to determine the frequency of painful or multiple...

P11.11 High rates of co-occurring sexually transmissible infections among men who have sex with men attending high-caseload general practice and sexual health services in victoria

Introduction Sexually transmissible infection (STI) screening and treatment is a health priority for gay, bisexual and other men who have sex with men (GBM). Current Australian guidelines recommend frequent syphilis serology and screening for pharyngeal, anorectal and urogenital chlamydia and gonorrhoea infection, in addition to routine HIV testing. However, evidence from recent community surveys that many Australian GBM access only some of these tests suggests concurrent infections may remain undetected. Methods To better understand the epidemiology of co-occurring curative STIs, we calculated the proportion of positive tests for one or more STI among GBM attending two sexual health services and two gay-friendly high-caseload general practices in Victoria between 2007 and 2013. Among positive tests for chlamydia or gonorrhoea, we calculated the proportion positive at multiple anatomical sites. We examined demographic and risk behaviour associations with co-occurring STIs and positivity at multiple anatomical sites using adjusted logistic regression. Results There were 70977 test events between 2007 and 2013; 8316 (11.7%) were positive for at least one STI and of these, 792 (9.5%) were positive for more than one STI. Younger age (16–29 years) (aOR = 1.7, 95% CI = 1.1–2.7), being HIV-positive (aOR = 2.2, 95% CI = 1.5–3.1) and reporting inconsistent condom use (aOR = 1.3, 95% CI = 1.0–1.6) were associated with testing positive for co-occurring infections. Of 7584 test events positive for chlamydia or gonorrhoea, 1028 (13.6%) were positive for either infection at multiple sites. Being aged 16–29 (aOR = 2.9, 95% CI = 1.8–4.6) or 30–39 (aOR = 2.4, 95% CI = 1.5–3.9) was associated with testing positive for either infection at multiple sites. Conclusion The high prevalence of co-occurring STIs and infection at multiple anatomical sites supports national guidelines for frequent comprehensive testing for GBM. These results support the promotion of comprehensive STI testing for GBM, including in lower-caseload settings alongside taking appropriate sexual histories, and underline the importance of structural efforts to maximise access to comprehensive testing for GBM. Disclosure of interest statement All authors have no conflicts to declare. The authors gratefully acknowledge patients and participating clinics and laboratories for the ongoing data contribution. The authors acknowledge Drs Norm Roth and BK Tee for their ongoing support of surveillance work at the Burnet Institute. The Victorian Department of Health funds ongoing surveillance projects within the Burnet Institute. The authors would like to acknowledge the NHMRC who provide funding to Anna Wilkinson as a public health scholarship recipient. Mark Stoove is supported by an NHMRC Career Development Fellowship. The authors gratefully acknowledge the contribution to this work of Victorian Operational Infrastructure Support Program received by the Burnet Institute.

P09.20 Trend of stis prevalence among women and men in morocco between 1999 to 2011

<h3>Background</h3> The Ministry of Health in Morocco conducted several studies to determine the prevalence of STIs in the Moroccan population. Two studies in 1999 and 2011, among women consultants in family planning units (FPU) for studied the aetiology and for follow the trends of genital tract infections and two studies in 2001 and 2009 to determine the aetiological profile of urethral discharge (UD). <h3>Methods</h3> A samples of 760 (1999) and 256 (2011) women who consult in the maternal and infant health units (MIHU) and in the FPU were recruited and samples of 422 (2001) and 171 (2009) men complaining of UD were recruited in basic health services. <i>Neisseria gonorrhoeae</i> (GC) identification was performed by culture and PCR and <i>Chlamydia trachomatis</i> (CT) was detected by PCR. HIV and Syphilis status was determined for all the patients. <h3>Results</h3> Results showed that cervical infection due to GC and CT increased respectively from 0,7% to 0,9% and 4,02% to 4,4% from 1999 to 2011. Urethral discharge caused by GC and CT extend respectively from 41,6% in 2001 to 62,8% in 2009 and from 6,3% in 2001 to 10,4% in 2009. Syphilis serology decreased in women and men and no case for the HIV was detected. <h3>Conclusion</h3> The increase of cervical infections and urethral discharges with GC and CT showed that the asymptomatic infections in women and the UD are a serious problem for the Moroccan population. These studies has allowed the Ministry of Health (MOH) to update the data on the aetiology of STIs in women and men and therefore to strengthen primary prevention of STIs and regularly monitor trends in prevalence of these infections among the general population and also among vulnerable groups in particular. <h3>Disclosure of interest statement</h3> We declare that none of the authors has conflicts of interest relevant to this work and no pharmaceutical grants were received in the development of these studies.

P09.35 Eradication of syphilis?—not there yet ongoing public health response to a syphilis outbreak in the northern territory, australia

Introduction An extensive outbreak of infectious syphilis in the Northern Territory (NT) was identified in Central Australia and Katherine regions in 2014. The NT Centre for Disease Control (CDC) launched an outbreak response to contain it. Methods A multi-disciplinary outbreak response team was formed to drive the response. Comprehensive testing and treatment data were regularly collected and used to monitor the outbreak and to guide the response measures. Opportunistic testing was proactively promoted in affected regions. In areas with high numbers of cases and untraceable contacts, a community-wide screen using a point-of-care test (PoCT) for syphilis was conducted for those aged 12–30 years. Local guidelines were followed in treatment and contact tracing. Updates on the outbreak response were communicated to the affected communities regularly. Results As of 7 April 2015, 112 cases (60 females and 52 males) of infectious syphilis were detected, consisting of 74 and 38 confirmed and probable cases, respectively. Their ages ranged from 12 to 37 years (median: 17; inter-quartile range: 15–20.5). Community-wide screening was conducted in 2 remote Aboriginal communities with combined population coverage of 62.7% and a prevalence of 8.4% in the targeted age group (12–30 years). All positive PoCT results were confirmed by normal syphilis serology tests. Conclusion Effective syphilis outbreak control requires up-to-date surveillance on testing and treatment as well as an outbreak response team capable of adopting the best disease control measures in a timely fashion to the different stages and needs of the outbreak. In particular, using PoCT for community screening is proving to be an extremely useful case finding method, shortening the time to treatment and thus the period of infectiousness in communities most affected. Further control of the outbreak will require inter-jurisdictional collaboration. Disclosure of interest statement There are no conflicts of interest

Subsequent pregnancies in women with previous gestational syphilis.

This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.

002.3 Are rapid point-of-care tests for syphilis useful in outbreak settings in remote australia? – an experience from the northern territory

<h3>Introduction</h3> A rapid point-of-care test (PoCT) for syphilis was used in two community-wide screens as part of an outbreak response in remote Northern Territory (NT) in 2014. This paper reports the results and evaluation for using PoCT as a tool for outbreak management. <h3>Methods</h3> A community-wide screen for people aged 12–30 years was conducted in two remote communities in the NT with high numbers of new cases and contacts, using the OnSite Syphilis Ab Combo Rapid Test. Preparatory work included devising a screening protocol, community engagement, clinical staff training and mobilisation of resources. <h3>Results</h3> The two screens were conducted in September to December 2014 in the two communities. The combined population of residents in the targeted age group was 545. A total of 326 individuals (including 57 non-residents) were tested with the PoCT (44.5% males and 55.5% females). The age range was from 12 to 30 years (median: 18, interquartile range: 14–23). Of these, 30 tested positive (13 males and 17 females), giving a combined prevalence among those tested of 9.2% (9.0% in males, 9.4% in females). All positive PoCT results were confirmed positive by normal syphilis serology tests, with 14 and 10 of them categorised as confirmed and probable infectious syphilis cases respectively. Treatment was given on the spot for these cases and contact tracing initiated immediately. Of the 296 tested negative, 5 (1.7%) were found to be false negative later due to past history of infection. Staff reported excellent acceptability of the test method for specimen collection. <h3>Conclusion</h3> With prior community engagement, updated population lists, screening protocols, and staff training, using PoCT for syphilis can be an effective for case detection in an outbreak setting in remote Indigenous communities in Australia. However, given the reported sensitivity of the PoCT used, retesting in 3 months is important. <h3>Disclosure of interest statement</h3> No potential conflicts of interest are identified.

S04.1 Haemophilus ducreyiin “YAWS” ulcers in papua new guinea

Skin infections with ulceration are a major health problem in the South Pacific countries. Yaws, diagnosed by the presence of cutaneous ulcers (CU) and a reactive syphilis serology, is one important cause, but this can be confused clinically with ulcers due to other aetiologies. In a prospective cohort study in yaws-endemic villages of a Papua New Guinean (PNG) island we showed that Haemophilus ducreyi is the leading cause of chronic CU in children; nearly 60% of patients with ulcers had detectable lesional H. ducreyi DNA, while 35% were Treponema pallidum subsp. pertenue positive. Similar findings were reported from yaws endemic communities in the Solomon Islands, Vanuatu and Ghana. Unlike yaws, H. ducreyi lesions appear to be restricted to the skin and, if left untreated, do not result in inflammatory lesions of the bones. Whole-genome sequencing studies have shown that CU strains of H. ducreyi are remarkably similar to class I genital ulcer (GU) strains with an overall sequence similarity of 99.98%, and that CU strains diverged from class I strains ≈0.18mya which supports the idea that CU with H. ducreyi preceded syndromic management of GU. A single oral dose of azithromcycin (AZ, 30 mg/Kg) is effective for treatment of yaws and, cutaneous strains of H. ducreyi have been shown to be susceptible to macrolides. In the context of new efforts to eradicate yaws, the use of mass treatment with azithromycin in PNG reduced the absolute prevalence of yaws CU from 2.4 to 0.3 percent at 12 months after treatment, and H. ducreyi CU from 2.7% to 0.6%. The persistence of skin ulcers in the population raises the possibility that the bacteria may exist in an environmental reservoir or are so infectious that MDA at less than 100% above coverage rate fails to eradicate the diseases from a community.