Treatment Of Syphilis Research Articles

High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study.

Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians. Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy. Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy. This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.

Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review.

Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.

Penicillin Treatment Failure in Rabbit Syphilis Due to the Persistence of Treponemes (Treponema paraluisleporidarum Ecovar Cuniculus) in the Focus of Infection.

Rabbit venereal spirochetosis, a disease caused by Treponema paraluisleporidarum ecovar Cuniculus (TPeC), affects both wild and pet rabbits, and is transmitted sexually and via direct contact among animals. Treatment of syphilis in pet rabbits requires administration of antibiotics, including penicillin G, chloramphenicol, or fluoroquinolones. The aim of this work was to elucidate the cause of penicillin treatment failure in rabbit syphilis in a pet rabbit treated in Brno, Czech Republic, and to assess the phylogenetic relatedness of the agent to previously characterized pathogenic treponemes. Following amputation of the infected digits, the second round of penicillin treatment using the same dosage and application route resulted in the disappearance of clinical symptoms within a period of two weeks. The bacterium was successfully isolated from the claws, propagated in three experimental rabbits, and the resulting TPeC strain was designated as Cz-2020. Analysis of four genetic loci revealed that the Cz-2020 strain was similar but also clearly distinct from the only TPeC strain, which had been characterized in detail to date, i.e., the Cuniculi A strain, which was isolated in North America. The strain Cz-2020 represents the first available viable TPeC strain of European origin. DNA sequences encoding five penicillin-binding proteins of the strain Cz-2020 were compared to those of Cuniculi A, which is known to be sensitive to penicillin. The sequences differed in six nucleotides resulting in single amino acid changes in Penicillin-binding protein 1, 2, and 3. Since the second round of treatment was successful, we conclude that the penicillin treatment failure in the first round resulted from the presence of infection foci in claws where treponemes persisted.

The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management.

Purpose of ReviewTo highlight recent trends in the epidemiology of HIV and syphilis, the impact of the COVID epidemic, our approach to care of co-infected patients, and our views on important next steps in advancing the field.Recent FindingsHIV and syphilis co-infection has been on the rise in recent years although since the COVID pandemic there is a decrease in new diagnoses—it remains unclear if this represents a true decline or inadequate testing or under-reporting. Standard HIV care should include regular syphilis serology .Treatment and serological follow-up of syphilis in HIV positive and negative patients can be conducted similarly. Challenges remain in the diagnosis and management of neurosyphilis. New models for testing and prevention will be crucial next steps in controlling co-infection.SummaryThe intersection of HIV and syphilis infections continues to pose new and unique challenges in diagnosis, treatment, and prevention.

Evolution of syphilis incidence in Sibiu county (Romania) over a period of 10 years (2009-2018).

Syphilis is the most common sexually transmitted disease that mainly affects socially active people, with a fluctuating worldwide incidence over the years. A retrospective study was conducted over a period of 10 years (2009-2018) that included 396 patients with syphilis diagnosed and monitored by Sibiu County Emergency Clinical Hospital, Romania. During this period (2009-2018), we observed a decrease in the new cases of syphilis by 35.90%, and the average syphilis incidence was 9.90 new cases per 100,000 inhabitants. Syphilis was diagnosed more frequently in men with an average age of 35.39 years, from urban areas, with and educational level of grades 9-12, unmarried, workers, or without occupation. Out of the 396 patients with syphilis, about 6% were HIV coinfected. Over half of the HIV coinfected cases were declared MSM (men who have sex with men), and 40% of these cases were registered in 2018. The most common clinical stage of syphilis was the latent form (67.93%). Regarding the syphilis treatment regimen, we noted the transition from the classic regimen with benzathine-penicillin G (100% in 2009) to alternative therapies (mainly with cephalosporins) in 2018 (56.86%). Our findings showed that in the last 10 years in our county, the incidence of syphilis had a downward trend, but with an increase in syphilis-HIV co-infection and neurosyphilis cases.

Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada.

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts. All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches. Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10-9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271). Public health- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

Detection of Treponema pallidum DNA in Oropharyngeal Swabs and Whole Blood for Syphilis Diagnosis.

Syphilis diagnosis relies on serological tests, which may be falsely nonreactive or may be reactive but not reflect current syphilis. Polymerase chain reaction for detection of T. pallidum DNA was performed on 123 oropharyngeal swabs, 120 whole bloods, and 46 lesion exudate swabs from 123 untreated individuals with syphilis (cases); oropharyngeal swabs from 148 at-risk controls without syphilis; and 73 oropharyngeal swabs and 36 whole bloods from 73 individuals recently treated for syphilis. Most (90.2%) cases had early syphilis. T. pallidum DNA was detected in 33 (26.8%) of 123 oropharyngeal swabs, 32 (26.7%) of 120 bloods, and 30 (65.2%) of 46 lesion exudate swabs. T. pallidum DNA was detected in 49 (40.8%) of 120 individuals in whom both oropharyngeal swabs and blood were tested. T. pallidum was more likely to be amplified from oropharyngeal swabs when it was amplified from blood than when it was not (15 of 32 [46.9%] vs. 17 of 88 [19.3%], P = 0.003). For each 2-fold increase in serum rapid plasma reagin titer, the odds of detection of T. pallidum DNA in oropharyngeal swabs increased by 1.44 (95% confidence interval, 1.14-1.82, P = 0.003). T. pallidum DNA was not detected in oropharyngeal samples from controls, but it was detected in 3 (8.3%) of 36 bloods from individuals recently treated for syphilis: 2 at 1 day and 1 at 5 days after initiation of syphilis treatment. Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.

A case series with literature review on adjunctive usage of intravitreal ceftazidime in ocular syphilis with human immunodeficiency virus infection.

Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24h after the adjunctive intravitreal ceftazidime injection. Case Series. In case 1, there was significant improvement in the vision and vitritis after 24h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1week after a single intravitreal ceftazidime injection. The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.

Ceftriaxone treatment of syphilis

The article presents literature data on the use of antibacterial drugs for the treatment of patients with syphilis, where the main focus is on ceftriaxone. Based on the materials of national and foreign studies, data on the effectiveness of ceftriaxone in the treatment of patients with various forms of syphilis have been analyzed, and information characterizing the pharmacological and pharmacokinetic features of ceftriaxone has been presented. Based on the scientific and clinical experience accumulated over previous years, both in Russia and abroad, some results of the use of ceftriaxone in the treatment of syphilis have been summed up. To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.

Treponema pallidum detection in lesion and non-lesion sites in men who have sex with men with early syphilis: a prospective, cross-sectional study

Syphilis transmission is increasing, and precisely how Treponema pallidum is transmitted sexually from person to person is unclear. We aimed to determine the frequency of T pallidum shedding from potentially asymptomatic sites and the stage of infection at which shedding is most frequent in men who have sex with men (MSM), who have been disproportionately affected by syphilis. We did a prospective, cross-sectional study in MSM recruited from Melbourne Sexual Health Centre (Melbourne, VIC, Australia). Men were eligible if they were aged 18 years or older, reported sex with men during the past 12 months, and had laboratory confirmed primary, secondary, or early latent syphilis, consistent with Australian definitions. Primary and secondary syphilis lesions were swabbed and non-lesion samples were collected via oral rinse, oral cavity swab, anal canal swab, urine, and semen. Samples were tested for T pallidum using PCR assays targeting polA (lesion and non-lesion samples) and 47 kDa (non-lesion samples only) gene targets. The primary outcome was the proportion of men with T pallidum detected from potentially asymptomatic sites-namely, the mouth, anus, urethra, and semen. Between Nov 30, 2015, and May 23, 2019, 246 MSM were screened for inclusion, of whom 200 had serologically confirmed early syphilis and were included in the study: 54 (27%) of 200 had primary syphilis, 93 (47%) had secondary syphilis, and 53 (27%) had early latent syphilis. T pallidum DNA was detected in 48 (24%; 95% CI 18·3-30·5) of 200 men by oral rinse or oral lesion swab, or both, of whom 24 had no oral lesions. Oral T pallidum detection was most frequent in those with secondary syphilis compared with those at other stages of disease (41 [44%] of 93 vs seven [7%] of 107; p<0·0001), and in men with rapid plasma reagin titres of 1/64 or higher compared with those with lower titres (37 [32%] of 117 vs 11 [13%] of 83; p=0·0026). T pallidum was detected by anal canal swab or anal lesion swab, or both, in 45 (23·0%; 95% CI 17·3-29·5) of 196 men with available samples, of whom ten had no anal lesion. Furthermore, T pallidum was detected in urine samples of 12 (6·1%, 3·2-10·3) of 198 men and in semen samples from six (12·0%, 4·5-24·3) of 50 men who provided samples. Among the 93 men with secondary syphilis, 69 (74%) had T pallidum detected at any site, and 24 (26%) had detection at two or more separate sites. Among the 54 men with primary syphilis, 49 (91%) had T pallidum detected at any site, and 11 (20%) had detection at two or more separate sites. Among the 53 men with early latent syphilis, four (8%) had T pallidum detected at any site and none had T pallidum detected at two or more separate sites. Unrecognised oral and anal shedding of T pallidum occurs in MSM with early syphilis, most frequently in those with secondary syphilis, suggesting secondary syphilis is the most infectious stage and that earlier detection and treatment of syphilis to prevent progression to the secondary stage might improve syphilis control. Future research is needed to ascertain the contribution of shedding of T pallidum from non-lesion sites to transmission of syphilis. Australian National Health and Medical Research Council.

Panorama of congenital syphilis in school hospital of the hospital of the South region of city of São Paulo

Introduction: Congenital syphilis is an infectious disease that has the etiological agent Treponema pallidum. Its transmission is vertical hematogenous, transplacental, of infected pregnant untreated or inadequately treated for its concept. It divides into two periods: early to the second year of life, and after the second year of life, late. Detection during prenatal care is performed by screening the third trimester of pregnancy with preterm labor, as early as in the maternity ward. The detection of Treponema pallidum through non-treponemal test (VDRL), presents little specificity, high sensitivity, low cost and fast negativation in response to the treatment avoiding that the concept is born with sequels. Thus, prenatal care is an important tool in the control of the disease, and it is necessary to improve care quality, since 70% of the mothers in Brazil are prenatal, not all of them are diagnosed or have the appropriate treatment of syphilis. Objective: To establish an epidemiological panorama of the incidence of Congenital Syphilis in the socioeconomic and cultural context in which the School Hospital of the Southern Region of the city of São Paulo is inserted. Patients and Methods: This is an individualized, observational, cross-sectional study carried out by means of a medical records survey of the Hospital Infection Control Service of Hospital Escola da Região Sul in the city of São Paulo. The survey of data referring to the form with questions of interest to the mother and the newborns diagnosed with Congenital Syphilis in the period from 2012 to 2016 was developed. This project was submitted and approved by the Ethics Committee of the Santo Amaro University - SP (Plataforma Brasil - CAAE: 68103317.6.3001.5447). Results: A total of 183 cases of Congenital Syphilis were registered in the Hospital Infection Control Service of the São Paulo School Hospital from 2012 to 2016, and among these, 126 medical records were reinforced. Prenatal performance (p = 0.0060), schooling (p = 0.5107) and schooling (p = 0.8603) did not influence disease screening by showing insignificant statistical data. Success occurred with companion treatment (p = 0.0451), which showed the highest incidence in 2014 (48.1%) and 2016 (58.3) when compared to the others. Conclusion: In the presented scenario, it was verified that although prenatal and maternal treatment were performed, they were inefficient to prevent pregnant women from transmitting the disease. This is probably related to the inefficiency of the treatment of the companions, who although in the year 2014 and 2016 presented a higher incidence of accomplishment, coincided with the increase of notifications in those same years. There were no statistically significant differences in relation to other factores, a fact that causes concern in the field of Public Health.

A co-infection model for HPV and syphilis with optimal control and cost-effectiveness analysis

A co-infection model for human papillomavirus (HPV) and syphilis with cost-effectiveness optimal control analysis is developed and presented. The full co-infection model is shown to undergo the phenomenon of backward bifurcation when a certain condition is satisfied. The global asymptotic stability of the disease-free equilibrium of the full model is shown not to exist when the associated reproduction number is less than unity. The existence of endemic equilibrium of the syphilis-only sub-model is shown to exist and the global asymptotic stability of the disease-free and endemic equilibria of the syphilis-only sub-model was established, for a special case. Sensitivity analysis is also carried out on the parameters of the model. Using the syphilis associated reproduction number, [Formula: see text], as the response function, it is observed that the five-ranked parameters that drive the dynamics of the co-infection model are the demographic parameter [Formula: see text], the effective contact rate for syphilis transmission, [Formula: see text], the progression rate to late stage of syphilis [Formula: see text], and syphilis treatment rates: [Formula: see text] and [Formula: see text] for co-infected individuals in compartments [Formula: see text] and [Formula: see text], respectively. Moreover, when the HPV associated reproduction number, [Formula: see text], is used as the response function, the five most dominant parameters that drive the dynamics of the model are the demographic parameter [Formula: see text], the effective contact rate for HPV transmission, [Formula: see text], the fraction of HPV infected who develop persistent HPV [Formula: see text], the fraction of individuals vaccinated against incident HPV infection [Formula: see text] and the HPV vaccine efficacy [Formula: see text]. Numerical simulations of the optimal control model showed that the optimal control strategy which implements syphilis treatment controls for singly infected individuals is the most cost-effective of all the control strategies in reducing the burden of HPV and syphilis co-infections.

Fetüslerin Sifilizden Zarar Görmemesi: Antenatal Bakım, Maternal ve Neonatal Sonuçlar

Objective: Syphilis is a disease as old as human history.Untreated syphilis during pregnancy can cause serious prenatal adverse outcomes, including stillbirth, and congenital syphilis. World Health Organization, obstetrics and gynecology societies recommends screening syphilis at the first antenatal care visit. In this present study, it was aimed to discuss antenatal follow-up, maternal and neonatal outcomes of patients having syphilis infection during pregnancy. Material and Method: Patients diagnosed with syphilis during pregnancy were included in the study. Patients were screened by a Non-Treponomal test and positive results were confirmed by the Treponemal test. Patients data including antenatal examinations, maternal and neonatal results, syphilis treatment, newborn examination findings, syphilis treatment follow-up were obtained and evaluated retrospectively through the hospital registry system and telephone interviews. Results: The total number of patients who were screened with RPR in the first antenatal visit of the pregnancy over two and a half years period was 24427. Ten patients were diagnosed with syphilis by Treponemal test (TP-PA) confirmation. All patients were treated by three doses of Penicillin Benzathine G 2.4 million units via intramuscular route each at a one-week interval. All women gave birth at term without complication. Forty percent of patients diagnosed gestational diabetes mellitus. No congenital syphilis occurred. None of the patients had concomitant HIV and HCV infection. Conclusion: Eradication is possible for syphilis. Early detection at the first antenatal visit and adequate treatment with penicillin would prevent maternal and congenital syphilis, and recover babies from adverse outcomes of syphilis.

Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series

BackgroundDespite an otherwise robust national antenatal clinic program, maternal and congenital syphilis remains an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with congenital syphilis in Lusaka, Zambia.Case presentationsThe cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using rapid plasma reagin test. From a cohort of 214 mother–infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, four (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive rapid plasma reagin test result. The mean age at diagnosis was 4.5 months (1.3 months standard deviation), and the common presenting features included coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and underweight (5/7). Three of the seven infants were exposed to human immunodeficiency virus. Following diagnosis, all seven cases received standard treatment according to national treatment guidelines. That is, 6/7 cases received inpatient care with benzylpenicillin for 10 days, while 1/7 was treated as an outpatient and received daily procaine penicillin for 10 days.ConclusionThese findings suggest that, though screening for syphilis is part of the standard antenatal care in Zambia, it is not offered optimally. There is urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms, regardless of the mother’s human immunodeficiency virus status.

Terapi &lt;i&gt;Doxycycline &lt;/i&gt;pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi &lt;i&gt;Human Immunodeficiency Virus&lt;/i&gt;

Background: Re-emergence of syphilis is increasing especially among MSM (men who have sex with men) patients. Syphilis in HIV-infected patients is reported to show faster and higher risk for progression to neurosyphilis. Co-infection of syphilis and human immunodeficiency virus (HIV) is correlated with decrease in CD4 and increase in HIV-RNA. Doxycycline has an antiinflammatory effect associated with decrease of HIV-RNA and increase of CD4 in HIV patients. Case: A 20 years old foreigner MSM man complained about non-itchy red spots throughout his body for 2 days with slight fever. He has a history of more than 10 sexual partners and rarely use condom. Physical examination revealed various sizes of erythematous macules and papules on his trunk and extremities. We found erythematous plaques with regular border but no ulcer on his scrotum and no secrete from his urethra. There was enlargement in the inguinal lymph node. VDRL and TPHA examinations were 1:32 and 1:640, respectively. HIV test was reactive with CD4 value 558 cells/ml. Treatment consists of doxycycline 2x100 mg for 14 days and also ARV (nevirapine, lamivudine and zidovudine). His symptoms were improved after a month accompanied with decreased VDRL to 1:2 and slightly increased CD4 to 570 cells/ml. Discussion: Doxycycline is a second line treatment for syphilis that is known to help decreasing the viral load and increasing CD4 level in syphilis with HIV. A significant decrease in VDRL titer in this patient indicates a successful therapy.

Hope for new antibiotics for syphilis treatment

Syphilis is a multi-stage disease caused by infection with Treponema pallidum subspecies pallidum (T. pallidum). Syphilis is usually transmitted by contact with an infected sexual partner or by passage from an infected pregnant woman to her fetus (congenital syphilis). Globally, an estimated six million new cases of syphilis occur each year in persons aged 15–49 years. In 2016, 661,000 cases of congenital syphilis resulted in over 200,000 fetal and neonatal deaths [1].

Cefixime for Early Syphilis? Not Yet

Intramuscular benzathine penicillin is the recommended treatment for syphilis, although third-generation cephalosporins represent possible alternatives

The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review.

Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10-15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.

English

Embolia cutis medicamentosa is a rare complication of intramuscular injury that leads to varying degrees of necrosis of the skin and subcutaneous tissue. In 1924, embolia cutis medicamentosa or Nicolau syndrome (NS) was first portrayed after an intragluteal injection of bismuth salts was given for the treatment of syphilis but it has now been documented with several drugs. (Murthy et al., 2007)1. According to one hypothesis, embolia cutis medicamentosa occurs when an intramuscular drug is accidentally injected into the arterial lumen or wall, leading to vessel thrombosis, subcutaneous tissue and muscle necrosis (Senel et al., 2010)2. Necrosis develops after hyperemia, skin discoloration usually associated with severe pain and wide inflammatory livedoid dermatitis and haemorrhagic patch at the injection site (Hamilton et al., 2008)3. Severe cases may take an immediate clinical course and anticipate to death.

Clinical and laboratory impact of concomitant syphilis infection during acute HIV.

Cognitive impairment has been reported in people living with HIV-1 (PLWH) with prior syphilis, while PLWH who present with incident syphilis have reduced blood CD4 T-lymphocyte and elevated HIV-1 RNA levels. However, the clinical, virological and neurocognitive effects of syphilis during acute HIV-1 (AHI) remain unknown. Pre-antiretroviral therapy laboratory outcomes and neurocognitive performance in a four-test battery in the SEARCH10/RV254 AHI cohort were compared according to syphilis status, determined by serum Treponema pallidum haemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL) and syphilis treatment history. Impaired cognitive performance was defined as having z-scores ≤-1 in at least two tests or ≤-2 in at least one test. Out of 595 AHI participants (97% male, median age of 26years and estimated duration of HIV-1 infection of 19days), 119 (20%) had history of syphilis (TPHA-positive), of whom 51 (9%) had untreated syphilis (TPHA-positive/VDRL-positive/without prior treatment). Compared with those without syphilis (TPHA-negative), individuals with untreated syphilis had higher CD8 T-lymphocyte levels but not higher plasma HIV-1 RNA or lower CD4 T-lymphocyte levels. Taking into account estimated duration of HIV-1 infection (P<0.001), and later Fiebig stages (III-V) (P<0.001), those with untreated syphilis had higher CD8 T-lymphocyte levels (P=0.049). Individuals with any syphilis (TPHA-positive), but not untreated syphilis, had higher odds of impaired cognitive performance than those without (P=0.002). During AHI, individuals with any history of syphilis (TPHA-positive) had poorer cognitive performance than those without syphilis. However, syphilis was not associated with worsened HIV disease measures as described in chronic infection.