Syphilis Research Articles

Performance Assessment of Treponemal and Nontreponemal Tests for the Diagnosis of Acquired Syphilis.

There are a variety of nontreponemal test (NTT) and treponemal test (TT) kits for the serologic diagnosis of syphilis. Because of the complexity of the infection (multiple clinical stages) and the different antigens used in these kits, a systematic evaluation of the accuracy of the currently available commercial tests is warranted. Our objective was to evaluate the performance of commercially available tests for the diagnosis of syphilis infection. In this study, we analyzed one NTT (Venereal Disease Research Laboratory [VDRL] test, Wiener Laboratories, Rosario, Argentina) and two TTs (fluorescent treponemal antibody absorption [FTA-ABS] test, Euroimmun, Lübeck, Germany, and syphilis recombinant ELISA v. 4.0 test [ELISA], Wiener Laboratories, Rosario, Argentina) using a panel of 187 samples, including serum samples from 31 individuals with primary syphilis, 77 with secondary syphilis, and 79 with latent syphilis. An additional 192 samples from uninfected individuals and 323 serum samples from individuals with other diseases were included. The sensitivities of the VDRL, ELISA, and FTA-ABS tests were 97.9%, 100%, and 96.3%, respectively. The VDRL and ELISA tests showed a specificity of 100%, and the FTA-ABS test showed a specificity of 99.5%. Accuracy was 98.9% for the VDRL test, 100% for the ELISA, and 97.9% for the FTA-ABS test. For primary, secondary, and latent syphilis, the ELISA achieved a diagnostic performance of 100%, whereas the sensitivity for the VDRL and FTA-ABS tests ranged from 96.8% to 98.7% and 93.7% to 98.7%, respectively. No difference was observed when the tests were used as traditional or reverse algorithms. In general, all three tests are able to discriminate positive and negative samples for syphilis, regardless of the diagnostic algorithm.

Epidemiological characteristics of syphilis in mainland China, 2004 to 2019.

Syphilis is a globally prevalent sexually transmitted infection. This study aimed to elucidate the epidemiological characteristics of syphilis in China from 2004 to 2019. Incidence data for syphilis across 31 provinces in mainland China were obtained from the Data Center of China Public Health Science for the period from 2004 to 2019. Epidemiological methods and the Chi-squared test were used to analyze the temporal, regional, and disease stage distributions of syphilis. In total, 5,527,399 syphilis cases were reported in China from 2004 to 2019, with an average annual prevalence of 25.7063 per 100,000 population and overall increasing trend. In terms of regional distribution, high-incidence provinces included Shanghai, Zhejiang, Fujian, Guangxi, Guangdong, Xinjiang, Ningxia, and Qinghai. The proportion of latent syphilis increased from 20.41% in 2004 to 82.95% in 2019, with an upward trend each year. Syphilis incidence exhibited an overall increasing trend in China, and latent syphilis was predominant. Syphilis incidences considerably varied among regions, and syphilis was detected from coastal to inland provinces. Thus, syphilis prevention and control programs should be tailored according to the specific epidemiological characteristics of each region.

ORAL MANIFESTATION OF SECONDARY SYPHILIS IN A PATIENT WITH IMMUNOSUPPRESSION ASSOCIATED WITH HIV/AIDS - CASE REPORT

ORAL MANIFESTATION OF SECONDARY SYPHILIS IN A PATIENT WITH IMMUNOSUPPRESSION ASSOCIATED WITH HIV/AIDS - CASE REPORT

Treponema Pallidum rapid syphilis compared diagnostic algorithm syphilis in men who have sex with men (MSM).

Syphilis infection can be asymptomatic and difficult to diagnose based on clinical symptoms. Early detection and treatment are critical for preventing and controlling syphilis as well as long-term serious complications. A serological examination based on the diagnostic algorithm was used to confirm the diagnosis of syphilis. Syphilis is frequent in high-risk groups, such as men who have sex with men (MSM). Treponema pallidum (TP) rapid can be used for early syphilis detection. The diagnostic value of TP rapid with diagnostic algorithm (RPR-TPHA) utilizing whole blood in MSM should be studied. To determine the diagnostic value of TP rapid syphilis test compared to a diagnostic algorithm (RPR-TPHA) among MSM. A diagnostic test with a cross-sectional design at Dr Mohammad Hoesin Palembang General Hospital from November 2022 to January 2023. The sampling method was consecutive sampling with a total sample of 83 MSM based on inclusion and exclusion criteria. All samples were tested for RPR, TPHA, and TP rapid. The diagnostic value of TP rapid was evaluated with RPR-TPHA as a diagnostic algorithm for syphilis. The sensitivity and specificity value of the TP rapid compare diagnostic algorithm as gold standard were 95.8% and 96.6% respectively. Other metrics: positive predictive value (PPV) 92%, negative predictive value (NPV) 98%, positive likelihood ratio (PLR) 28.27, negative likelihood ratio (NLR) 0.04, accuracy 96% and AUC 0.962. The TP rapid test has a high diagnostic value and can be used to establish an early diagnosis of syphilis in MSM.

Secondary syphilis with tuberculosis co-infection: A rare case

Secondary syphilis with tuberculosis co-infection: A rare case

Letter in response to “Frequency of asymptomatic neurosyphilis in patients with latent syphilis: A 4-year retrospective study from a tertiary care center”

Letter in response to “Frequency of asymptomatic neurosyphilis in patients with latent syphilis: A 4-year retrospective study from a tertiary care center”

Clinical Updates in Sexually Transmitted Infections, 2024.

Sexually transmitted infections (STIs) continue to increase in the United States with more than 2.5 million cases of gonorrhea, chlamydia, and syphilis reported to the Centers for Disease Control and Prevention in 2022. Untreated STIs in women can lead to adverse outcomes, including pelvic inflammatory disease, infertility, chronic pelvic pain, and pregnancy complications such as ectopic pregnancy, early pregnancy loss, stillbirth, and neonatal transmission. STI-related guidelines can be complex and are frequently updated, making it challenging to stay informed on current guidance. This article provides high-yield updates to support clinicians managing STIs by highlighting changes in screening, diagnosis, and treatment. One important topic includes new guidance on syphilis screening, including a clarified description of high community rates of syphilis based on Healthy People 2030 goals, defined as a case rate of primary or secondary syphilis > 4.6 per 100,000. Reproductive aged persons living in counties above this threshold should be offered syphilis screening. Additionally, American College of Obstetricians & Gynecologists now recommends syphilis screening three times during pregnancy regardless of risk-at the first prenatal visit, during the third trimester, and at delivery. In addition, new guidance to support consideration for extragenital screening for gonorrhea and chlamydia in women at sites such as the anus and pharynx is discussed. Other topics include the most recent chlamydia, gonorrhea, trichomoniasis, and pelvic inflammatory disease treatment recommendations; screening and treatment guidance for Mycoplasma genitalium; genital herpes screening indications and current diagnostic challenges; and the diagnosis and management of mpox in women and during pregnancy.

Determination of molecular types and resistance to macrolides in <i>Treponema pallidum</i> isolates isolated in the Russian Federation

Background. The number of syphilis cases in the Russian Federation increased significantly in 2022. Control of heterogeneity of Treponema pallidum subtypes is important to monitor the emergence and spread of antibiotic-resistant strains Aims. To determine molecular subtypes and resistance to macrolides in T. pallidum isolates isolated in the Russian Federation in 2022. Methods. We analyzed DNA isolated from 49 samples of clinical material obtained from patients from dermatovenerological treatment and prevention facilities in three federal districts (CFD, SFD, SCFD) of the Russian Federation in 2022 with diagnoses of primary syphilis and secondary syphilis. T. pallidum DNA isolation and confirmation of the presence of genetic material were performed according to the existing algorithms. To search for genetic determinants of resistance to macrolides, a fragment of the 23S rRNA gene was analyzed. Primary decoding of nucleotide sequences was performed in Sequencing Analysis 5.3.1. Mega 11 program was used to align the analyzed fragments of target genes to T. pallidum reference sequences. Results. In 2022, three subtypes of T. pallidum were identified in the territory of the represented federal districts of the Russian Federation: 14d/f, 14d/g, 14d/d with continued dominance of subtype 14d/f. The macrolide-resistant subtype 14d/d was identified in two federal districts, which is new for the Russian Federation. Conclusions. The population of T. pallidum continues to expand in the Russian Federation, including the emergence of azithromycin-resistant strains. The data obtained confirm the need for continuous monitoring of circulating strains and may facilitate understanding of their geographic distribution.

Lethal Complication in a Very Preterm Infant with Congenital Syphilis

Introduction: Congenital syphilis is a multi-organ infection caused by Treponema pallidum and transmitted from mother to fetus through uteroplacental circulation. Congenital syphilis is one of the main contributors to neonatal deaths in the United States. Case: A male infant was born by cesarean delivery from a G1P0 mother at 28 weeks of gestational age because of premature rupture of the membrane and anhydramnion. The mother had an untreated latent syphilis infection. The birthweight was 1,400 grams, the head circumference was 25 cm, and the body length was 35 cm. His APGAR score was 3-3-5 with severe asphyxia and respiratory distress syndrome. Multiple abnormalities were found, and the VDRL titre was 1/128. Cardiac-pulmonary resuscitation started immediately with 0.15 mg epinephrine through an intraendotracheal tube and continued with 0.02 mg epinephrine through intravenous access every 3 minutes. The baby was declared dead after 30 minutes of resuscitation. Conclusion: Congenital syphilis can cause lethal complications due to untreated latent syphilis suffered by his mother. The mother should undergo antenatal screening to prevent congenital syphilis.

Annular Secondary Syphilis with Histopathologic Features of Granuloma Annulare

Syphilis is one of the most common sexually transmitted diseases in the world. It is known as “the great mimicker” due to its varied cutaneous presentations, which can make it challenging to diagnose. We report a case of a 20-year-old female presenting with a nonhealing, pruritic, annular plaque on the left malar area of 3-month duration. She was initially treated as a case of tinea faciei. The lesion was unresponsive to topical antifungals and steroids with continued increase in size and number. Skin biopsy revealed secondary syphilis with histopathologic features of granuloma annulare. Degenerated collagen, not a feature of secondary syphilis, was seen, prompting further studies to confirm the diagnosis of secondary syphilis. Alcian blue stain was negative, which helped rule out granuloma annulare. She was then given benzathine penicillin G 2.4 million U, which led to a significant decrease in the size of the lesion noted 1 week posttreatment. Only postinflammatory hyperpigmentation was noted after 1 month of treatment. Clinically, secondary syphilis may present as an annular lesion that can mimic tinea. This can also present with atypical histopathologic features and an in-depth investigation is needed to further confirm the diagnosis.

Evaluation of HIV and Syphilis Co-infected Cases, Data from a University Hospital.

HIV and syphilis are sexually transmitted infections with overlapping risk factors, potentially leading to increased HIV transmission and treatment challenges. Understanding the clinical management of syphilis co-infection among people living with HIV is crucial for public health interventions. This retrospective cohort study aimed to assess the prevalence of syphilis co-infection, clinical characteristics, treatment response, and public health implications among people living with HIV in southern Turkey. Records of 1352 people living with HIV 18 years and older, followed at a tertiary infectious diseases clinic between 2013 and 2023, were analyzed. Data on demographics, clinical stage of syphilis and HIV/AIDS, laboratory parameters, treatment response, and co-infections were collected. Statistical analyses were performed using SPSS 20.0 software. Among the people living with HIV, 103 (7.6%) were diagnosed with syphilis. Most cases were male (97.1%), with a median age of 33 (IQR 28-49) years. Heterosexual transmission was predominant (60.2%), with a history of condomless sexual intercourse in 90.3% of cases. The majority (88.3%) were asymptomatic with latent syphilis. Syphilis was diagnosed concurrently with HIV in 77.7% of cases. Serological response to syphilis treatment was observed in 46.8% of patients, while 53.2% showed a serofast reaction. Neurosyphilis was rare, diagnosed in only one patient. Co-infections with hepatitis B and C were detected in 3.9% and 1.9% of patients, respectively. Syphilis co-infection among people living with HIV is a significant public health concern in southern Turkey. Routine screening for syphilis, along with comprehensive education on sexually transmitted infection prevention, is essential for early detection and optimal management. Further research is needed to improve treatment outcomes and address emerging challenges in HIV-syphilis co-infection management.

Efficiency of Immunoblot While Determination of Antibodies to Treponema Pallidum in Cerebrospinal Fluid

BACKGROUND: A decrease in the incidence of syphilis has been observed in the world and in Ukraine in recent years. At the same time, an increase in cases of neurosyphilis is recorded. Diagnosis of neurosyphilis is quite difficult and based on the correct interpretation of the complex of various diagnostic tests. OBJECTIVES: The paper is aimed to determine diagnostic potential of treponemal tests (TTs) and evaluate effectiveness of Treponema pallidum immunoblot (TPI) while research on cerebrospinal fluid (CSF) in differential diagnosis of neurosyphilis. MATERIALS AND METHODS: The research object was CSF of patients with late forms of syphilis. The regulated serological and immunological methods in accordance with current guidelines and orders of the Ministry of Healthcare of Ukraine were used for laboratory diagnosis of neurosyphilis: Enzyme immunoassays (EIA), fluorescent treponemal antibody (FTA), T. pallidum hemagglutination assay (TPHA), and TPI. RESULTS: Effectiveness of TTs in the diagnosis of neurosyphilis while research on 23 samples of CSF was carried out by the following methods: EIA (Immunoglobulin [Ig]M + IgG), FTA, andTPHA. The above-mentioned TTs used in serological diagnosis of CSF do not always meet the problem of confirming neurosyphilis diagnosis. According to these investigations, both positive and false positive results were obtained. In order to verify the diagnosis, a study on positive and false positive samples of CSF by TPI method was carried out. Positive results were obtained in 13 samples with the established duration of the disease. CONCLUSIONS: TPI is an optimal treponemal immunological method of examination of CSF to diagnose neurosyphilis with a high degree of reliability. The use of TPI while research on CSF makes it possible to verify the diagnosis of neurosyphilis by differentiated detection of antibodies to the most immunogenic antigens of T. pallidum eliminating the subjective factor of the reaction and simplifies diagnostic procedure.

Screening of Syphilis Using the Reverse Algorithm and its Trends Among Healthy/Asymptomatic Blood Donors: A Regional Transfusion Centre Study from Northern Pakistan

Objective: To determine the syphilis trends by using the reverse algorithm in healthy/asymptomatic blood donors from Northern Pakistan. Study Design: Perspective longitudinal study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan, from Jan to Sep 2022. Methodology: After taking a complete history from potential donors, an appointed blood bank doctor performed a general physical examination. Potential donors’ blood samples were tested for syphilis by the Chemiluminescent Microparticle Immunoassay (CMIA) method followed by reflexively testing of CMIA reactive blood samples with Rapid Plasma Reagin (RPR), and results were interpreted as positive or negative. Results: A total of 56122 donors donated blood over nine months, including 55742(99.3%) males and 380(0.7%) females. Blood donors ranging from 18-65 years with a mean age of 28.82±7.1 were included in the study. Out of 56122 blood donor samples submitted, 487(0.87%) turned out to be syphilis positive by CMIA method, comprising 485(99.59%) males and 02(0.41%) females. Of 487 CMIA-positive serum samples, 216(44.3%) were RPR-positive, all male donors. Conclusion: A higher latent syphilis trend was observed in replacement non-voluntary young male donors between 18 and 40 years of age. The majority of the syphilis positives donors were male, while females made up a negligible percentage.

Syphilitic Stomatitis: Raising Awareness on an Often-Overlooked Presentation of Secondary Syphilis.

Syphilis is a resurgent infection with increasing prevalence, and its manifestations in the secondary stage of the disease are general and non-specific, being able to affect every organ system.The oral mucosa may be involved at any stage of the disease and the tongue, often a neglected organ, can be particularly affected and should be routinely observed.The internist, integrating a cornerstone speciality able to manage and diagnose systemic diseases, must be aware of the individual aspects of the physical examination, notably the appreciation and interpretation of each clue and sign found.

Secondary recurrent syphilis in a patient with HIV infection. Clinical case

Relevance. HIV infection is a chronic sexually transmitted infectious disease. Given the single route of transmission, quite often HIV-infected patients develop a syphilitic infection. At the same time, syphilis against the background of HIV infection has its own clinical characteristics. It is important for doctors of various specialties to know these features.Description of the case. A clinical case of secondary syphilis and early neurosyphilis in a 52-year-old patient with HIV infection is presented.Discussion. Patients with HIV infection are characterized by unusual clinical manifestations of syphilis in the form of its malignity, atypical, severe course with the development of various complications. In the article, the authors describe atypical manifestations of papular syphilide of the palms and soles. The effectiveness of specific treatment has been shown.Conclusions. Doctors’ knowledge of the clinical features of syphilis against the background of HIV infection will allow them to avoid diagnostic errors leading to late treatment and the development of complications.

Seroconversion in syphilis screening without positive confirmatory tests points at early infection

IntroductionThe chemiluminescence immunoassay (CLIA) is a widely used screening test for syphilis. A CLIA seroconversion in the absence of a positive line immunoassay (LIA) or rapid plasma reagin (RPR) could...

Opt-Out Syphilis Screening at an Urgent Care Center in Atlanta: Evaluation of a Pilot Program.

Human immunodeficiency virus (HIV) and syphilis disproportionately impact communities with low access to primary care, who often utilize urgent care centers (UCCs) for sexual health care. UCC visits represent an opportunity for identification and treatment of syphilis and linkage to HIV testing and prevention services. We describe a universal, opt-out syphilis screening program pilot at an Atlanta UCC. A chart review was performed on patients 18 years and older who were offered opt-out syphilis screening and had a rapid plasma reagin (RPR) test collected from September 1, 2021 to December 31, 2021. Demographic data, syphilis stage and treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a study physician for syphilis staging and treatment, counseling, and referral for HIV preexposure prophylaxis (PrEP) or treatment. From September 1, 2021 to December 31, 2021, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis. Of those with active syphilis, 39 (92.9%) received any treatment, and 35 (83.3%) completed treatment. Patients with late syphilis were less likely to complete syphilis treatment (adjusted odds ratio, 0.03; P = 0.009; 95% confidence interval, 0.002-0.42). Among 955 offered PrEP, 41 (4.3%) expressed interest in PrEP, and 7 (0.7%) completed PrEP clinic intake. Univariate analysis did not identify any factors associated with interest in PrEP. In a UCC setting, routine, opt-out syphilis testing resulted in increased syphilis identification and treatment. It also provided an opportunity for PrEP counseling and referral, although few patients completed PrEP clinic intake.

Neutrophil CD64 index as a potential blood biomarker for the diagnosis of neurosyphilis in secondary and tertiary syphilis: A retrospective study

ObjectiveTo examine the correlation of neutrophil CD64 (nCD64) index with neurosyphilis (NS) across different stages of syphilis. MethodsA total of 1243 syphilis patients at different stages (344 of primary, 385 of secondary, and 514 of tertiary) included in this study were divided into NS and non-NS (NNS). Correlations of nCD64 index with currently used syphilis biomarkers were explored using Spearman correlation test. Relationships between nCD64 index and NS at different stages were investigated by stratified analysis and restricted cubic spline model. The diagnostic performance of nCD64 index for NS was assessed by receiver operating characteristic (ROC) curve. ResultsSignificant statistical correlations of nCD64 index with cerebrospinal fluid (CSF) NS indicators were found in secondary and tertiary syphilis. Increased nCD64 index was associated with increased risk of NS in secondary and tertiary syphilis. ROC analysis values further confirmed the diagnostic potential of nCD64 index for NS. Marked decrease of nCD64 index was observed in NS patients after effective antisyphilitic treatments. ConclusionsThe nCD64 index may help to the diagnosis of NS in secondary and tertiary syphilis.

A Rare Concurrence of Polymorphic Pityriasis Rosea: Two Atypical Variants Along with a Classical Plaque Variant in the Pediatric Age Group

Pityriasis rosea, is an acute self-limiting papulosquamous inflammatory disorder. It usually starts with a herald patch on the trunk and proximal extremities, followed by scaly oval patches that give them a “Christmas tree” appearance. The lesions may be associated with fever a rash. The disease can present as numerous morphologies such as papular, urticarial, lichenoid, and generalized that may be confused with other conditions such as secondary syphilis, seborrheic dermatitis, nummular eczema, pityriasis lichenoides chronica, tinea corporis, viral exanthems, lichen planus, and PR like eruption linked to particular drugs. We report a rare case of polymorphic pityriasis rosea in paediatric age group.

Secondary syphilis presenting with alopecia and leukoderma in a stable HIV-positive patient in a resource-limited setting: a case report

BackgroundSyphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis.Case presentationA virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully.ConclusionThis case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.