Treatment Of Syphilis Research Articles

Clinical efficacy and tolerability of 1.5 g/day oral amoxicillin therapy without probenecid for the treatment of syphilis

ObjectivesIntramuscular benzathine penicillin G is not available in certain countries. In a previous report, 3 g/day amoxicillin with probenecid was shown to be effective in treating syphilis in patients with...

The treatment outcome and predictors of serological response in syphilis in a sexually transmitted infections center, China.

Serology is the mainstay for syphilis treatment monitoring. Baseline rapid plasma reagin (RPR) titre, HIV status, and syphilis stage have been found to be associated with the time to serological response among syphilis patients. This study mainly aims to evaluate the time to serological response, and to identify factors affecting the serological outcome. Medical records of syphilis cases diagnosed in Peking Union Medical College Hospital (PUMCH) between 2008 and 2018 were retrospectively reviewed. Kaplan-Meier analysis was performed to evaluate the median time to serologic response and cumulative probability of serologic response over time according to different variables. Cox regression model was conducted to find factors associated with serological response. There were 984 patients diagnosed with primary, secondary, or latent syphilis cases and receiving injections of benzathine penicillin G (BPG) as initial treatment at the Peking Union Medical College Hospital (PUMCH) between 2008 and 2018. Finally, data on 571 patients, including 49 (8.6%) primary syphilis, 261 (45.7%) secondary syphilis, and 261 (45.7%) latent syphilis, were used for analysis. It took longer time to achieve serological response for subjects aged ≥45years than younger individuals (89days versus 58days; p=0.008). Males achieved serological response more quickly than females (71days versus 83days; p = 0.011). There was a significant difference in the time to serological response according to different syphilis stages (p < 0.001), with 55days (95% CI, 43-67days) for primary, 57days (95% CI, 51-63days) for secondary, and 117days for latent syphilis. In addition, patients with lower baseline RPR titre had longer period to achieve serological response (252days [95% CI, 129-375days] for RPR titre ≤1:8, 78days [95% CI, 63-93days] for RPR titres from 1:16 to 1:32, and 53days [95% CI, 49-57days] for RPR titres ≥1:64, respectively; p<0.001). However, no significant difference in time to serological response to treatment was found according to HIV coinfection status. The result of multivariate Cox regression analysis showed that being older than 45years with latent syphilis, HIV coinfection, or with baseline RPR titre ≤1:8 was associated with slow response. Among patients followed for at least 1year or seroreverted, 128 (36.9%) had seroreverted within a year, and 219 (63.1%) still had a positive RPR after 1year. For multiple logistical regression, being female and HIV coinfection were significantly associated with the failure of seroreversion (OR, 0.42 [95% CI, 0.26-0.68]; p <0.001). This study revealed that younger age, higher initial RPR titre, early syphilis stage, and HIV-negative status were associated with faster serological cure. Female sex, individuals with HIV coinfection, and latent syphilis were significantly associated with the failure of seroreversion.

Characteristics of Pregnant Women With Syphilis and Factors Associated With Congenital Syphilis at a Chicago Hospital.

BackgroundCongenital syphilis incidence has more than tripled in recent years, in parallel with the resurgence of syphilis among reproductive-aged women. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis through prenatal diagnosis and treatment. We aimed to describe factors associated with maternal syphilis and congenital syphilis at a public medical center in Chicago, Illinois.MethodsMaternal syphilis diagnoses were identified using a database for local health department reporting. Medical records were reviewed for infant congenital syphilis diagnoses, sociodemographic information, medical history, and other behavioral factors. Maternal characteristics associated with congenital syphilis were assessed using logistic regression.ResultsOf 106 maternal syphilis diagnoses between 2014 and 2018, 76 (72%) had a known pregnancy outcome; of these, 8 (11%) delivered an infant with congenital syphilis. Women with psychiatric illness and noninjection substance use each had a >5-fold increased odds of having an infant with congenital syphilis. Cases with congenital syphilis were more likely to have late or scant prenatal care and initiated treatment nearly 3 months later in pregnancy. None were human immunodeficiency virus positive or reported incarceration, intravenous substance use, sex work, or having sex with men who have sex with men.ConclusionsMaternal psychiatric illness and substance use may have complicated prenatal care and delayed syphilis treatment, describing a population in need of public health intervention. Women experiencing such barriers to care may benefit from closer follow-up after a prenatal syphilis diagnosis to prevent congenital transmission.

BIOCHEMICAL, IMMUNOLOGICAL, SEROLOGICAL INDICATORS FOR SERORESISTANT SYPHILIS, CORRECTION IN TREATMENT

In recent years, the world has seen a significant increase in the incidence of sexually transmitted infections, including syphilis. Despite the progress made in venereology, the problem of syphilis is an urgent problem of our time, and this especially concerns serological resistance in syphilis. Among practitioners and scientists involved in the treatment of syphilis, it is widely believed that there is an increase in the number of cases of seroresistance among patients treated for syphilis.

The "China rhizome" in Galenic medicine and pharmacology

Smilacaceous Chinese herbs with the commercial name of "the China rhizome" were first imported to Europe as an alternative drug for syphilis treatment at the beginning of the 16th century. Its primary properties in Galenic medicine and pharmacology were designated as hot and dry, its secondary properties were believed removing, cleansing and relieving for inducing urination and perspiration, healing ulcers, and relieving numbness. Its reason for syphilis treatment was believed to be the property of discharging obsolete body fluid by intense sweating. Its processing method was mainly decoction, which had been normally used among western physicians since the 1st century. The interventions with it were medication and dietary therapies, considering the Galenic humoralism with the six "non-naturals elements" and other elements, such as the duration of diseases. It was believed to be neither "a drug for specific effects" nor a "panacea" based on the suppositions in Galenic medicine and pharmacy in terms of a variety of its usages. It was not highly praised by conventional medicine, demonstrating the influence of the debate on exotic drugs during the Period of Renaissance in Europe. The thinking about its usages almost fully came from classic western medicine. This embodies the conflicts between pharmaceutical practice and medical theory.

Space-time risk cluster and time trends of congenital syphilis in Brazil: an ecological study.

Congenital syphilis (CS) is a problem of great concern for public health, especially in Brazil. The aim of this study was to analyse the time trends and the space-time dynamics of morbidity and mortality from CS in Brazil. An ecological and time series study, which included all cases and deaths from CS recorded in a national Brazilian database from 2013 to 2019 was performed. Time trends in CS incidence and mortality were assessed using segmented linear regression. Univariate global and local Moran indices and space-time scan statistics were used in the space and space-time analyses. A total of 183171 cases and 2401 deaths from CS were recorded in Brazil, with the highest number of cases being observed in the Southeast Region (n=82612 [45.1%]). Only 21.1% of pregnant mothers with syphilis received adequate treatment. There was an upward trend in CS rates among mothers ages 20-29y (average annual percent change [AAPC] 1.4 [95% confidence interval {CI} 1.0 to 1.7]) and with <8y of schooling (AAPC 6.6 [95% CI 5.3 to 7.9]). The primary space-time cluster involved 338 municipalities in the Southeast Region (relative risk 3.06, p<0.001) and occurred between 2017 and 2019. To reduce the trends in CS rates, it is necessary to develop actions to improve the quality of prenatal care and expand early diagnosis and adequate treatment of syphilis in pregnant women and their sexual partners, especially in groups with upward trends (mothers ages 20-29y and <8y of schooling) and living in higher-risk regions (Southeast, North and Northeast).

Management Ocular Syphilis in Human Immunodeficiency Virus (HIV) Patients

Introduction: Ocular syphilis is a rare manifestation of syphilis. Ocular syphilis manifestations vary and can occur at all stages of the disease. Syphilis can affect all eye structures, the main complaint is blurred vision, accompanied by non-specific symptoms such as pain in the eye, and does not respond to steroids. Case: The male patient, 54 years old, presents with complaints of both eyes slowly getting worse with a history of sexual multi-partners. Visual acuity in both eyes were light perception bad projection, ophthalmological examination showed cloudy lens, cloudy vitreous, cell (+) flare (+) right eye optic nerve, hyperemia, and left eye optic nerve, pale at temporal. VDRL results: reactive&gt; 1: 512 and TPHA: reactive&gt; 1: 5120. The patient was diagnosed with late latent syphilis and neurosyphilis observation from the Dermatology and Venereology Department and received benzathine penicillin injection therapy. From the Neurology Department the patient was diagnosed with neuro-syphilis and was consulted to VCT department with pre-HAART Stage IV HIV infection (WHO). After receiving penicillin therapy and topical steroids, the patient was experienced improvement in visual acuity. Conclusion: In HIV patients without antiretroviral therapy, Treponema pallidum infection is more common and has manifestations such as ocular syphilis and neurosyphilis. Treatment of ocular syphilis using topical steroids to reduce inflammation and penicillin as the main antibiotic.

Latent Syphilis Unresponsive to Doxycycline and Azithromycin

Background. Syphilis management is based on the syphilis stage classification. The main treatment for syphilis is currently benzathine penicillin. However, patients allergic to penicillin antibiotics or who are not willing to be injected can be given doxycycline or erythromycin antibiotics.&#x0D; Case presentation. We present a case of a female with latent syphilis. Patient was previously treated with oral antibiotics, such as doxycycline for 30 days and followed by azithromycin for 30 consecutive days. Clinical laboratory examinations show increase of TPHA and VDRL, and the case was considered as unresponsive case. Later, the patients received benzathine penicillin G for three weeks and showed clinical improvement.&#x0D; Conclusion. For patient who refuse to be treated with penicillin injection, the alternative treatments are oral antibiotics. However, there is a reduced number of successful treatments for patients treated with oral antibiotics.

Pregnancy with Early Latent Syphilis, a reality in 21st century: a case report and literature review

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. It is of special concern during pregnancy because can lead to adverse pregnancy outcomes and congenital syphilis. We retrospectively included female patient with laboratory-confirmed syphilis in East Java. Demographic, pregnancy record, clinical, radiological, laboratory, and treatment data were reviewed from medical record and health of both mother and child book. Clinical characteristics and outcome of patient were described. The patient was 40-year-old multiparous pregnant women was referred to the hospital at 40 weeks of gestation due to early latent syphilis. The patient was diagnosed during the last trimester and had not been treated, but no vulvar and anal genital wart was found. Patient was scheduled to urgent section caesarean but 1 hour after admitted to the hospital, patient had spontaneous delivery. A healthy son was born (3400 g /50 cm, 10 points Apgar score). Due to the lack of documentation regarding treatment of maternal syphilis, crystalline penicillin was administered to the newborn. Screening and early penicillin treatment are the most important factors that can eliminate complications related to the prenatal contagion with Treponema pallidum. Yet despite the lack of treatment or its inappropriate administration, the pregnancy complicated with maternal syphilis may end in a completely different way.

Seroreduction of syphilis non-treponemal titers during pregnancy for women with and without HIV co-infection.

To evaluate the effect of HIV co-infection on non-treponemal titers during pregnancy in women with syphilis. This is a secondary analysis of pregnant women with syphilis in the prospective, observational Zambian Preterm Birth Prevention Study (ZAPPS). Treponemal (Treponema pallidum particle agglutination) and non-treponemal (rapid plasma reagin; RPR) testing were performed on serum biospecimens, resulting in 47 participants with serologically confirmed syphilis (27 HIV-positive, 20 HIV-negative). The primary outcome, achievement of RPR titer seroreduction during pregnancy, was analyzed by logistic regression. Secondary outcomes included overall titer reduction, seroreduction rate, serologic cure, and adverse pregnancy outcomes. Seroreduction of RPR titer occurred in 78% (21/27) of women with HIV versus 45% (9/20) of women without (adjusted odds ratio 4.66; 95% confidence interval [CI] 1.14-19.08). Overall RPR titer reduction, rate of seroreduction per week, and the proportion achieving serologic cure each trended higher among women with HIV compared with those without HIV. There was a trend toward decreased stillbirth incidence in participants achieving seroreduction (odds ratio 0.15, 95% CI 0.01-1.58). HIV co-infection in this cohort of Zambian women with syphilis was associated with greater odds of RPR titer seroreduction during pregnancy. Pregnant women with syphilis and HIV may not be at increased risk for a delayed syphilis treatment response compared with women without HIV.

Outcomes of infectious syphilis in pregnant patients and maternal factors associated with congenital syphilis diagnosis, Alberta, 2017–2020

Background: Congenital syphilis (CS) is a significant public health challenge, requiring early diagnosis and treatment to improve infant outcomes. The aim of this study is to describe public health outcomes of infectious syphilis cases among pregnant patients and factors associated with a CS diagnosis for their infant. Methods: We conducted a retrospective review of demographic and clinical characteristics of infectious syphilis cases diagnosed during pregnancy and resulting infant outcomes in Alberta from 2017 to 2020 from the provincial communicable disease database. Adequate maternal treatment was defined as receiving at least one dose of Benzathine penicillin G-LA 2.4 million units IM at least 28 days before delivery. Univariate and multivariate analysis was performed to determine factors associated with CS diagnosis using SPSS version 25. Results: A total of 374 cases of infectious syphilis were diagnosed in pregnancy, with two patients being diagnosed twice in a single pregnancy. The majority (79.1%; n=296) of women had a live birth, followed by therapeutic abortion (9.4%; n=35), stillbirth (7.5%; n=28) and spontaneous abortion (4.0%; n=15). Infant records (n=265) were available for review (n=117 CS cases and 148 non-cases). Correlates associated with CS were screening time in third trimester (adjusted odds ratio [AOR] 8.4, 95% confidence interval [CI], 2.9–24.6) and fewer than 28 days before delivery (AOR 8.1, 1.4–47.8 [vs. first and second trimester] and inadequate treatment (AOR 86.1, CI, 15.9–466.5). Among the CS cases, 23.1% (n=27) were stillborn compared with one (0.7%) stillbirth in the non-CS infants (p&lt;0.001). Conclusion: The early identification and treatment of syphilis in pregnancy is crucial to preventing poor infant outcomes.

Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

BackgroundCongenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.MethodsBetween May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.ResultsGaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.ConclusionsCongenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.

Ineffective penicillin treatment and absence of partner treatment may drive the congenital syphilis epidemic in Brazil

BACKGROUND:Reducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity.OBJECTIVE:We hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission.STUDY DESIGN:Data on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression.RESULTS:Nearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35–8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77–23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07–4.58), and maternal nontreponemal titers ≥1:64 (1.09–1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59–1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02–1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17–1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55–0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection.CONCLUSION:Public health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.

Significant and memorable dates in the field of epidemiology and prevention of infectious diseases 2022

The staff of the Department of the History of Medicine of the N.A. Semashko National Research Institute of Public Health has prepared a list and description of significant and memorable dates in the field of epidemiology and prevention of infectious diseases, timed to 2022. The material is presented in three sections: “historical and medical events”, “publication of works” and “personalities”. Historical and medical events, the round dates of which are celebrated in 2022, are associated with the prevention of infectious diseases relevant in the 19th and 20th centuries — tuberculosis, plague, rabies, brucellosis, malaria, etc. Scientific works published 75-255 years ago are devoted to the problems of epidemiology, treatment and prevention of syphilis, plague, typhus. During this period, such periodicals as “Hygiene and Epidemiology”, “Preventive Medicine”, “Bulletin of Epidemiology and Microbiology” were founded, which became the prototypes of modern specialized scientific journals. The section “personalities” contains a list of round dates from the birth and death of prominent figures in the field of epidemiology, parasitology, infectious diseases and a description of the main milestones of their lives and activities.

Retrospective Cohort Study of the Incidence and Outcomes of Jarisch-Herxheimer Reactions After Treatment of Infectious Syphilis in Late Pregnancy.

Of 39 pregnant women at ≥20 weeks' gestation treated with benzathine penicillin G for infectious syphilis, we identified only 2 mild Jarisch-Herxheimer reactions. There were no immediate fetal sequelae. Data from our study do not support the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy.

A Primary Care Intervention to Increase HIV Pre-Exposure Prophylaxis (PrEP) Uptake in Patients with Syphilis.

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018.

This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.

A Case of Successful Treatment of Congenital Syphilis in an Extremely Preterm Baby With Severe Respiratory Distress

A Case of Successful Treatment of Congenital Syphilis in an Extremely Preterm Baby With Severe Respiratory Distress

Pharmacobotanical study of Croton floribundus stem bark

Abstract Croton floribundus, Euphorbiaceae, popularly known as “capixingui” is a native tree of the Atlantic Forest. In folk medicine, the tea of C. floribundus stem bark is used for the treatment of leukemia, tumors, and syphilis. The aim of this work was to describe the morphological and anatomical characteristics of C. floribundus stem bark and to establish parameters for its quality control. Accordingly, different analyses were performed, including organoleptic, morphological, anatomical, and histochemical analysis of the samples, plus the characterization of druse crystals by energy-dispersive X-ray spectroscopy. The sample showed menthol and camphor odor, and bitter taste. The main macroscopic characteristic was the presence of a thin periderm with striations. The main distinctive microscopic features of the species were: dense gelatinous fibers, phenolic idioblasts, sclereids, numerous crystalline idioblasts with druses located in the cortex and abundantly in the parenchymal rays of the phloem, and absence of laticifers in the mature stem bark. These analyses made possible to describe the morpho-anatomy of that species, contributing to phytochemical and pharmacognostic future studies of C. floribundus.

Sensitivity and Specificity of Two Investigational Point of Care Tests for Syphilis and HIV (PoSH Study) for the Diagnosis and Treatment of Infectious Syphilis in Canada: A Cross Sectional Study

Sensitivity and Specificity of Two Investigational Point of Care Tests for Syphilis and HIV (PoSH Study) for the Diagnosis and Treatment of Infectious Syphilis in Canada: A Cross Sectional Study