Treponema Pallidum Hemagglutination Research Articles

Sexually Transmitted Diseases and Associated Risk Factors Among Transgenders in Peshawar

Background: Transgenders, male to female, are exceptionally predominant in India-Pakistan, dreaded to be alarming for sexually transmitted diseases. The objective of this study was to determine the frequency of sexually transmitted diseases and their associated risk factors among transgenders.
 Methodology: This cross-sectional study was conducted amongst transgenders at Institute of Paramedical Sciences (IPMS), Khyber Medical University Peshawar from January to July,2021. About two ml of venous blood was collected in a gel tube under aseptic conditions among 100 individuals to check for HBsAg, anti-HCV, HIV and syphilis by ICT rapid strip method. Positive samples of HBsAg and anti-HCV were confirmed by Polymerase Chain Reaction (PCR), while positive cases of syphilis were confirmed by Treponema Pallidum Hemagglutination (TPHA). Chi-square test was applied to determine the association between sexually transmitted disease and associated risk factors.
 Results: Out of 100, seven (7%) samples were positive for HBsAg, five (5%) for anti-HCV and nine (9%) were positive for syphilis while there were no positive cases of HIV. HBV infection was significantly associated with blood transfusion, a drug injection history and some surgical procedure (p<0.05). For syphilis, the data were significantly associated with a history of blood transfusion and drug injection (p<0.05).
 Conclusion: Frequency of HBV, HCV and syphilis infections are high in transgenders with common associated risk factors to be sexual activities, drug injection, unsafe blood transfusion and surgical procedures.
 Keywords: Chromatography, Hepatitis B surface antigen, Hepatitis C Antibodies, HIV, Syphilis, Transgenders

Secondary syphilis mimicking mid-borderline leprosy in HIV-positive patient

Background: Syphilis increases the risk of HIV transmission. Coinfection of both infectious diseases potentially changes the presentation of mucocutaneous lesions and accelerates disease progression, complicating the diagnosis and treatment with standard regimens. In the case study, we present a case of secondary syphilis in an HIV-positive patient with clinical manifestations resembling mid-borderline leprosy. Case presentation: A 23-year-old male patient was referred to the emergency care unit of Dr. Soetomo General Hospital with red spots on the palms of the hands and soles of the feet for the past four months. The skin manifestation first appeared as a single spot, grew over time with itch and pain. The patient had lost 15 kg of body weight in the last three months which was confirmed as HIV-positive. He was also treated for leprosy based on the skin manifestations ever since. There was no history of direct contact with leprosy patients. The patient admitted that he had sex with men in the last 3-4 years. The laboratory examination showed negative results for Mycobacterium leprae through skin biopsy and negative for IgM and IgG of anti-phenolic glycolipid-1 (PGL-1). The patient however was positive for syphilis due to high titers of venereal disease research laboratory/rapid plasma regain (VDRL/RPR) and treponema pallidum hemagglutination (TPHA), supported by histological findings. The patient’s condition improved after receiving penicillin benzathine G, the definitive treatment for syphilis. Conclusion: Secondary syphilis is a great imitator to mid-borderline leprosy, especially in HIV patients. To avoid misdiagnosis and mistreatment, a careful physical and laboratory examination, including serology and histopathology, should be carried out.

Ocular Syphilis: Our Experience in Selayang Hospital, Malaysia.

Objectives: This study aims to describe the demographic features, clinical profile, Human Immunodeficiency Virus (HIV) status, and visual outcome after completing treatment in patients diagnosed with uveitic syphilis. Methods: A retrospective review was conducted of all cases diagnosed with ocular syphilis from January 2014 to December 2019 at the ophthalmology clinic of Selayang Hospital, Selangor, Malaysia. A total of 31 cases were reviewed, and the collected data included demographic features, history of high-risk behavior, ocular symptoms and signs, visual acuity at presentation and after completing treatment, treatment received, complications, and HIV status. Serology tests to confirm the diagnosis were also included, such as the rapid plasma reagin (RPR), venereal disease research laboratory test (VDRL) titer, and treponema pallidum hemagglutination (TPHA) tests, and some cases also included the VDRL cerebrospinal fluid (CSF) test. Results: A total of 31 patients with ocular syphilis were identified within the study period. Male patients comprised the majority with 27 cases. Nineteen patients were below the age of 50. The majority were ethnic Malay (21 patients). Seventeen patients were identified to have HIV co-infection. Twenty patients reported high-risk behaviors, and among them, six cases were HIV-infected homosexuals. The commonest symptom was blurring of vision (61%), followed by eye redness (16%), floaters (13%), and incidental findings (10%). There were 18 bilateral cases and 13 unilateral cases. The larger share presented as panuveitis (14 cases), followed by intermediate uveitis (nine cases), anterior uveitis (four cases), posterior uveitis (two cases), endophthalmitis (one case), and branch retinal vein occlusion (one case). RPR and TPHA tests were done for all patients. Only 12 patients consented to lumbar puncture for a CSF VDRL test, and one tested positive. All patients received intravenous (IV) administration of 3.0 to 4.0 million units of benzylpenicillin every four hours for 14 days. All cases reported a good outcome with an improvement in visual acuity of at least two Snellen lines after treatment. Conclusion: Early detection and treatment of ocular syphilis will usually preserve visual acuity and ocular function. This study highlights the need for a high degree of suspicion of HIV co-infection, as the majority of our patients were discovered to be HIV-seropositive. Thus, HIV screening is mandatory in all patients presenting with syphilitic uveitis.

Correlation of Treponemal Chemiluminescent Microparticle Immunoassay Screening Test Signal Strength Values With Reactivity of Confirmatory Testing.

Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio ≥10.4. When the S/Co ratios were ≥7.2 and ≥10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio <10.4, and negative TPHA and RPR. We propose a potentially cost-effective reverse screening algorithm with a treponemal CMIA S/Co ratio ≥10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation.

Penile porokeratosis mimicking annular lichen planus

Sir, Porokeratosis is a group of cutaneous diseases presented by epidermal keratinization [1]. Herein, we report the case of a patient with porokeratosis who responded well to carbon dioxide (CO2) laser therapy. A 22-year-old Vietnamese male visited our department with an asymptomatic plaque on the penis present for three months. He denied a family history of similar lesions. A cutaneous examination of the penis revealed an annular, well-circumscribed plaque with slightly raised borders with scales (Fig. 1a). Other mucocutaneous lesions were absent. Fungal microscopy, a rapid plasma reagin (RPR) test, and a Treponema pallidum hemagglutination (TPHA) test were negative. Histological findings revealed a hyperkeratotic lesion with a discrete parakeratotic column. There was the presence of a cornoid lamella, which was a parakeratotic column overlying a small vertical zone of dyskeratotic and vacuolated cells within the epidermis (Fig. 2a). There was also a focal loss of the granular layer. A mild lymphocytic infiltrate could be seen around an increased number of capillaries in the underlying dermis (Fig. 2b). CO2 laser removal was performed. There was no recurrence after a twelve-month follow-up (Fig. 1b). However, a hypopigmented scar was seen. Porokeratosis is an uncommon disorder of keratinization with clinical variants, such as classical porokeratosis of Mibelli, disseminated superficial actinic porokeratosis, linear porokeratosis, and porokeratosis palmaris et plantaris disseminata [2]. Porokeratosis involving the genital areas and other adjacent sites is rare [2]. Genital porokeratosis was first described by Helfman in 1985 [3]. More than 69 cases have been reported in the literature [1]. The pathophysiology of genital porokeratosis remains unknown. It has been supposed that porokeratosis is linked to repeated minor frictional trauma. A benign lesion may transform into squamous cell carcinoma or basal cell carcinoma [4]. However, no malignant transformation of genital porokeratosis has been noted in the literature. Genital porokeratosis manifests itself clinically as classic or plaque-type porokeratosis of Mibelli [2]. Histological findings revealed a cornoid lamella with the absence of a granular layer and dyskeratotic cells in the upper spinous zone [2]. Our case may mimic some annular lesions, such as secondary syphilis, fungal infection, and annular lichen planus. Because a fungal examination and syphilis serology were negative, we could exclude fungal infection and annular secondary syphilis. The distinctive histology of porokeratosis such as a cornoid lamella with a decreased granular layer may help to differentiate between porokeratosis and annular lichen planus [4]. Numerous therapeutic methods of treatment exist, including surgical excision, CO2 laser, cryotherapy, topical retinoids, 5% 5-fluorouracil, vitamin D3 analogs, imiquimod cream, and 3% diclofenac gel [2,5].

Does performance and operational superiority of point-of-care test make it the investigation of choice in confirming syphilis?

According to the World Health Organization, 6 million cases of syphilis occur every year. Serological tests for syphilis form the mainstay of diagnosis for syphilis. We evaluated the performance of point-of-care test (POCT) against other specific treponemal test for confirming the diagnosis of syphilis. Does performance and operational superiority of POCT make it the investigation of choice in confirming syphilis? Retrospectively, data were analyzed of 599 serum samples from Apex Regional sexually transmitted disease centre, Safdarjung Hospital, New Delhi, received for testing by syphilis treponemal assays (both nontreponemal reactive and nonreactive). These samples underwent treponemal testing for syphilis by the Treponema pallidum hemagglutination (TPHA), fluorescent treponemal antibody absorption test (FTA-ABS), and POCT. Performance characteristics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy), and operational characteristics of POCT and TPHA were evaluated against the gold standard FTA-ABS. A total of 599 samples were evaluated, of which 61.76% were positive by FTA-ABS. On analysis, the sensitivity was 91.08% and 91.89%, specificity was 89.08% and 87.34%, PPV was 93.09% and 92.14%, NPV was 86.08% and 86.96%, and diagnostic accuracy was 90.32% and 90.15% for POCT and TPHA, respectively. The lower cost, shorter turnaround time, lesser infrastructure and workforce need, and easy availability make the POCT operationally superior to TPHA. Owing to its operational superiority and higher specificity POCT can replace TPHA for confirming the diagnosis of Syphilis. POCT are affordable, equipment free, have room temperature storage, and yield result within 15 minutes, enabling same day testing and treatment. It can be used in a resource limited setting, for community setup or even self-testing.

A Comparative Status of HBsAg, HCV, HIV, TPHA &amp; MP Test Results Among General Blood Donors in a Tertiary Care Hospital in Bangladesh

Background: Today blood transfusion is most frequently used of a life-saving therapeutic procedure in treatment arena. But in some times its becomes revers like life threatening rather than lifesaving. Specially for the blood receivers may have the threat of transfusion transmitted infections (TTIs) because of transmitting virus, bacteria or parasitic, microorganisms through blood transfusion procedures. Specially hepatitis B and C virus, human immunodeficiency virus (HIV) and syphilis (Treponema pallidum) bear the risk of transmission by blood transfusion. For this reason, Hepatitis B surface antigen (HBsAg), anti- Hepatitis C Virus (HCV), anti- human immunodeficiency virus (HIV), syphilis antibody TPHA (Treponema pallidum haemagglutination) and MP (Malarial Parasite) are routinely controlled in all donated blood samples. Aim of the study: The aim of this study was to analyze the status of HBsAg, HCV, HIV, TPHA &amp; MP test results among general blood donors. Methods: This was a comparative observational study which was conducted in the Department of Blood Transfusion Medicine, National Institute of Cancer Research and Hospital(NICRH), Mohakhali, Dhaka, Bangladesh during the period from January 2018 to December 2020. In total 14,625 general blood donors were enrolled as the study population. This study was approved by the ethical committee of the mentioned hospital. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version 20 as per need. Result: In this study 70.5% blood donors were male and 29.5% were female. So male was dominating in number and the male vs female ratio was 2.39:1. The highest number of donors were from 18-30 years’ age group which was 67.3%. Then 28.6% and 4.1% donors were from 31-34 years 41-50 years’ age groups respectively Finally, in analyzing the positive .........

English

BACKGROUND Sexually transmitted infections (STI) are ancient and are as old as human existence. They are closely interlinked with the human sexual behaviour. Syphilis well known for its systemic complications in the pre-antibiotic era is described as the ‘great imitator’ by Sir William Osler, the father of modern medicine. In the present era of human immuno deficiency virus disease / acquired immuno deficiency syndrome, STI control has been made as first priority, because of their close association and interaction. Syphilis caused by Treponema pallidum is diagnosed most often on clinical suspicion supplemented by laboratory diagnosis, where serological tests for syphilis play a key role / main role. METHODS This study is a hospital based cross sectional study that consisted of 416 cases among which, 276 were females, 140 were males who had attended the STI / RTI clinic. The study period was from July 2011 to September 2012. Blood samples were drawn from all the patients (who were willing to be included in the study) attending the RTI / STI clinic, GGH, Guntur after taking consent. All the sera were tested by rapid plasma reagin (RPR) test and the sera was screened simultaneously for human immunodeficiency virus (HIV). Those sera which were tested reactive for RPR were further tested in dilutions to know the titres. Later the sera tested reactive for RPR were further tested by a specific test, Treponema pallidum haemagglutination (TPHA). RESULTS Of the total 19 (4.56 %) persons tested reactive for RPR, males were 10 (7.14 %), females were 9 (3.26 %), and these were further tested for TPHA. Of the 19 tested for TPHA, a total of 16 (84.21 %) were positive for TPHA of which males were 9 (90 %) and females were 7 (77.78 %). Among the 16 patients, positive for serological test for syphilis (STS), 13 (81.25 %) fall in the age group of 21 - 40, 2 (12.50 %) in the age group of ≤ 20, and 1 (6.25 %) is above 60 years of age. CONCLUSIONS In this study it was seen that out of the 16 syphilis cases, 9 were HIV reactive, 3 were non-reactive for HIV and 4 were of unknown status, showing that the rate was more among the HIV reactive group. The prevalence rate of syphilis among the 66 tested patients belonging to the high-risk group was 6.06 % and in nonhigh-risk group was 3.12 %, showing that it was more in people belonging to high risk group. KEYWORDS Serological Profile, Syphilis, Treponema pallidum, Sexually Transmitted Infections (STI), People Living with HIV / AIDS (PHLA)

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.

Biological False Positive Venereal Disease Research Laboratory in Hepatitis B and C Infections in a Tertiary Care Hospital, Delhi, India

Introduction: Venereal Disease Research Laboratory (VDRL) test is commonly used for screening of syphilis. In India in some centres, the diagnosis of syphilis is based on VDRL test without confirmation by specific treponemal test resulting in Biological False Positives (BFPs) due to non specific nature of antigen used. Both hepatitis and syphilis are sexually transmitted diseases which are widely prevalent in India. Diagnosing syphilis aptly is important due to its association with various complications and social stigmas. Aim: To demonstrate the false-positivity of VDRL test in patients with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Materials and Methods: This was a cross-sectional observational study in which 420 hepatitis B positive and 208 hepatitis C positive serum samples of patients &gt;18 years of age were tested for syphilis by VDRL and Treponema pallidum Haemagglutination (TPHA). VDRL reactive and TPHA negative samples were considered as BFPs. Sera of 90 healthy individuals, which were negative for both Hepatitis B and C were included as control group. The data entry and analysis was done in the Microsoft Excel spreadsheet. Results: Out of 420 hepatitis B reactive samples, 64 (15.23%) and out of 208 hepatitis C reactive samples, 24 (11.5%) were observed to be BFPs. Of these 64 hepatitis B reactive patients, 46 (71.88%) were females and 18 (28.12%) were males with BFP VDRL test. Similarly, out of the 24 hepatitis C reactive patients, 18 (75%) were females and 6 (25%) were males with BFP VDRL test. BFP was observed to be 1.1% in control group. Conclusion: The study highlights that HBV and HCV infection are associated with increased chances of obtaining a BFP-VDRL test. If VDRL test is reactive, then reflex testing should be done with a specific treponemal test for a confirmatory diagnosis.

Coinfection of High-Risk and Low-Risk Human Papillomavirus in Urethra Condylomata Accuminata

Background: Condylomata accuminata (CA) is a sexually transmitted infection caused by the Human Papillomavirus (HPV), which has more than 40 subtypes classified into high and low risks. The incidence of coinfection involving HPVs in genitalia varies between 2%–71%. Coinfection events increase in immunosuppressed patients. Purpose: To know the types of HPV in CA lesions and the risk factors of a high and low-risk HPV coinfection. Case: A 45-year-old woman presented with genital warts appeared three weeks before. The patient had a breast cancer history and undergone chemotherapy. The examination revealed multiple papules with verrucous surface, firm borders, with whitish color around the urethra and on the vaginal wall. Acetowhite test was positive. The biopsy examination showed squamous epithelium arranged to form papils and foci suspected as koilocytes suggesting CA. The Human Immunodeficiency Virus (HIV) rapid test, VDRL (Venereal Disease Research Laboratory) and TPHA (Treponema Pallidum Haemagglutination) examinations showed non-reactive results. The HPV deoxyribonucleic acid (DNA) genotyping test showed positive results for HPV type 56 (High-Risk Genotypes) and HPV type 6 (Low-Risk Genotypes). She was treated with electrosurgery and consulted to the urology department. Discussion: Coinfection of HPVs might cause a persistent HPV infection for a longer duration, as well as the risk of developing into cancerous lesion. The mechanism of high-risk and low-risk HPV coinfection in immunosuppressed individuals might be due to faster replication of the virus or reactivation of a latent infection. Conclusion: Coinfection of 2 types of HPV could happen in immunosuppression condition such as in patient undergone chemotherapy.

Importance of Serological Tests in the Diagnosis of Asymptomatic Congenital Syphilis in Neonates: A Case Report

Introduction: Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests. Case Presentation: The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests. Conclusions: It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.

Seroprevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, and syphilis among human immunodeficiency virus-infected people at a university hospital, Turkey

IntroductionInfections such as viral hepatitis and syphilis that share similar transmission routes with human immunodeficiency virus (HIV) may adversely affect the course of the disease. We aimed to determine the seroprevalence of viral hepatitis and syphilis among HIV-infected people at the initial stage of diagnosis.Material and methodsThe medical records of 336 HIV-infected people aged 18 years and older, who were followed up between 2005 and 2018 at a university hospital in Samsun, Turkey, were evaluated retrospectively in terms of initial serological markers for viral hepatitis and syphilis.ResultsHepatitis B surface antigen (HBsAg) was positive in 13 (4.2%) of 303 patients, antibody to HBs antigen (anti-HBs) in 117 (39.2%) of 298 patients, antibody to hepatitis C virus (anti-HCV) in 3 (0.9%) of 301 patients, total antibody to hepatitis B core antigen (anti-HBc total) in 70 (29.2%) of 239 patients and total antibody to hepatitis A virus (anti-HAV total) in 224 (84.5%) of 265 patients. Hepatitis B virus (HBV) deoxyribonucleic acid (DNA) was detected in one (12.5%) of eight patients with isolated anti-HBc. Of 224 patients who were examined for syphilis, 34 (15.1%) were positive for Treponema pallidum hemagglutination (TPHA).ConclusionsIn our study, high seroprevalence of syphilis and low immunity to HBV were detected. Health care facilities that follow up HIV-infected people should determine the serological profiles initially once the patients are diagnosed. It should be kept in mind that due to behavioral risk factors among HIV-infected people prevalence of coinfections may be higher than the rate in the community.

Clinical manifestations and outcomes of ocular syphilis in Asian Indian population: Analysis of cases presenting to a tertiary referral center.

Purpose:To describe disease manifestations and outcomes of ocular syphilis in Asian Indian population.Methods:Retrospective analysis of patients diagnosed with ocular syphilis at a tertiary referral center in India. Demographics, history, extraocular and ocular manifestations, ocular and systemic investigations, treatment and visual acuity outcomes were noted. All patients were diagnosed after necessary laboratory investigations including HIV ELISA (Human immunodeficiency virus, enzyme-linked immunosorbent assay), VDRL (venereal disease research laboratory), and TPHA (treponema pallidum hemagglutination).Results:Totally, 20 patients with mean age at presentation 38.25 ± 9.76 were analyzed. 9/20 patients had bilateral involvement. 8/20 had concurrent HIV at presentation with an average CD4 counts of 592.25 ± 411.34 cells/microliter. The mean duration of symptoms at time of presentation was 15.45 ± 35.15 weeks. VDRL test was reactive in 45% (9/20) patients whereas, all patients had a reactive TPHA test. Clinical manifestations included outer retinal placoid chorioretinitis lesions (8/20, 40%), followed by retinitis mimicking acute retinal necrosis as the second most common phenotype (4/20, 20%). Other presenting manifestations noted were panuveitis, miliary retinitis lesions, retinal vasculitis, intermediate uveitis, and anterior uveitis. The clinical phenotypes in immunocompromised included panuveitis, acute retinal necrosis and isolated anterior uveitis. Mean follow up duration was 6.32 ± 6.15 months. An improvement in mean best corrected visual acuity (BCVA) of (0.63 LogMAR, approximately 6 Snellen lines, P < 0.02) was noted at last follow-up.Conclusion:Phenotypic manifestations of ocular syphilis are varied. Non-treponemal tests like VDRL may be unreliable when compared with treponemal tests in diagnosing ocular syphilis. Syphilitic uveitis is considered equivalent to neurosyphilis and is treated similar to neurosyphilis.

Choriocapillaris Involvement in Acute Syphilis Posterior Placoid Chorioretinitis is Responsible for Functional Impairment and Points towards an Immunologic Mechanism: A Comprehensive Clinicopathological Approach.

Purpose:To evaluate the multimodal imaging of acute syphilitic posterior placoid chorioretinitis (ASPPC) lesions in order to elucidate their pathophysiology which seems to resemble choriocapillaritis as in primary inflammatory choriocapillaropathies such as multifocal choroiditis (MFC) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE).Methods:Charts of patients with ASPPC seen in the Centre for Ophthalmic Specialised Care, Lausanne, Switzerland, were retrieved. Fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and when available, OCT angiography were analyzed and compared to a case of MFC.Results:One woman aged 58 and 2 men aged 50 and 31 with unilateral ASPPC were analyzed. All had positive syphilis serologies (venereal disease research laboratory [VDRL] and treponema Pallidum hemagglutination assay [TPHA]). Two were human immunodeficiency virus (HIV) positive. Mean best corrected visual acuity was 0.2 ± 0.1 at presentation and 1.0 for all patients 6 weeks later, after antibiotic treatment for neurosyphilis. All had central scotomata with a mean defect (MD) of 12.2 ± 2.6. Six weeks later, MD values were 3.9 ± 1.7. Microperimetry had a mean score of 25/560 at presentation and recovered to a mean of 444/560 6 weeks later. Multimodal imaging features consisted of FA tissue staining, ICGA hypofluorescent choriocapillaris non-perfusion, FAF hyperautofluorescence, and loss of the ellipsoid line in the diseased areas. The findings were consistent and identical in ASPPC and a case of MFC and pointed toward the involvement of the choriocapillaris.Conclusions:Similarities seen in multimodal imaging features in ASPPC and choriocapillaritis highlight the role of the choriocapillaris in the pathophysiologic mechanism of both conditions. Inflammatory choriocapillaris non-perfusion triggered by infectious agents seems to be the common pathway through which the eye is reacting.

Leucoderma syphiliticum in a pregnant woman

A 32-year-old woman at 31 weeks’ gestation with a history of premature rupture of membranes presented with asymptomatic hypopigmented macules on her upper back and neck region of 2 months’...

Miliary Retinal Lesions in Ocular Syphilis: Imaging Characteristics and Outcomes

ABSTRACT Purpose: To describe full thickness miliary retinal lesions in ocular syphilis. Methods: Retrospective chart review of patients with serologically confirmed ocular syphilis. Retinal miliary lesions in three cases of Syphilitic uveitis, in immunocompetent individuals are described. Case 1 and case 2 were positive for both VDRL (venereal disease research laboratory) and TPHA (Treponema pallidum hemagglutination), case 3 was VDRL negative but TPHA positive. Results: Miliary lesions were small round to oval, yellow retinal lesions, measuring less than ¼ disc diameter size, with distinct margins, involving complete thickness of retina on OCT, in a pillar like manner, associated with ground glass retinitis, outer retinal placoid lesion or with retinal vasculitis. In cases 1 and 3, these healed with pigmentation. Conclusion: In contrast to similar lesions described, retinal miliary lesions seem to involve full thickness of the retina on OCT and may heal with pigmentation. These lesions may be characteristic of ocular syphilis.

Sero-epidemiology and risk factors of syphilis in Makassar, Indonesia

Abstract Introduction. Syphilis is an infectious disease caused by Treponema pallidum spirochete and is mainly transmitted by sexual contact. Syphilis has the potential to cause serious complications and is closely related to human immunodeficiency virus (HIV) infection thus making syphilis still a major public health problem. In Indonesia, surveys of high-risk populations in 2007 and 2011 reported an increase in the prevalence of syphilis, especially in men who have sexual relationships with other men (MSM). Moreover, studies have described risk factors for HIV transmission including MSM, heterosexual contacts, Intravenous (IV) drug use, and infected partners. Objectives. To assess the epidemiological aspects and risk factors for syphilis in Makassar, as well as the correlation with a coinfection of other sexually transmitted infections. Material and Methods. This study is a multi-centre cross-sectional descriptive study with consecutive sampling. We evaluated cases for eligibility by confirming the diagnosis based on the serological result using rapid plasma reagin assay (RPR), Treponema pallidum haemagglutination (TPHA), and HIV screening kit. The cases were analyzed based on epidemiological features, risk factors and clinical findings, co-infection with other sexually transmitted infection (ST), and stadium of the disease. Results. A total of 79 serologically confirmed syphilis cases were collected between January 2017 and December 2018 in Makassar, the capital city of South Sulawesi province in Indonesia. Of the 63 male subjects (79.7%), 38 (48.1%) were homosexual/MSM, and in 41 cases of HIV-infected subjects, 25 (60.9%) of them were also MSM. Conclusion. Our study showed there was a significant correlation between syphilis and an increased risk of HIV transmission in MSM groups. The higher number of cases of syphilis and HIV co-infection among MSM can increase transmission of both infections and should be considered a major risk factor for syphilis in Makassar.

SURGICAL TREATMENT OF AORTIC REGURGITATION AND BILATERAL CORONARY ARTERY OSTIAL STENOSIS DUE TO CARDIOVASCULAR SYPHILIS

We present the case of a 44-year-old gentleman, hospitalized in Interventional cardiology department with retrosternal pain. Percutaneous coronary investigation(PCI) was performed demonstrating bilateral ostial coronary artery stenosis with moderate aortic regurgitation. The patient was transferred in our department for urgent surgery. Cardiac surgery procedure was performed including: double coronary artery bypass grafting (CABG) combined with aortic valve replacement(AVR) with mechanical valve. The Venereal Disease Research Laboratory test (VDRL) and Treponema pallidum Haemagglutination(TPHA) test were done on admission – both of them being positive. Those results confirmed tertiary cardiovascular syphilis. The patient was discharged on POD 12, and was transferred to Dermatology and sexually transmitted diseases(STD) department for further antibiotic therapy concerning the syphilis infection.

Middle-aged man with symmetrical lesions in his throat

A 51-year-old man infected with HIV for more than 10 years visited our HIV clinic due to lesions in his throat. He had a CD4 T-cell count of >500 cells per μl and a HIV-RNA viral load of <20 copies per mm3. Nearly 3 months before this presentation, the patient participated in oral sex. At the clinic, he presented with a milky and (Fig. 1A ). He did not have any other symptoms on his skin. What is the diagnosis? Answer: Butterfly sign of pharyngeal syphilis. The patient had a history of syphilis 4 years prior to this visit. Although he was treated with amoxicillin 4 years prior, his serological tests for syphilis (STS) titer had remained positive at a low level. Laboratory testing revealed that his rapid plasma reagin (RPR) test result increased from 1:4 to 1:512 (normal value, <1), and his Treponema pallidum hemagglutination (TPHA) level had increased from 1280 to >40,960 (normal value, <1). Co-infections of HIV and syphilis are common [[1]Imahashi M. Izumi T. Watanabe D. Imamura J. Matsuoka K. Ode H. et al.Lack of association between intact/deletion polymorphisms of the APOBEC3B gene and HIV-1 risk.PLoS One. 2014; 9e92861Crossref PubMed Scopus (22) Google Scholar]. Notably, HIV patients often demonstrate prolonged STS positivity even after appropriate treatment. Thus, it is hazardous to diagnose syphilis solely based on a serological test. Pharyngeal syphilis accounts for 7% of syphilis cases [[2]Nishijima T. Teruya K. Shibata S. Yanagawa Y. Kobayashi T. Mizushima D. et al.Incidence and risk factors for incident syphilis among HIV-1-infected men who have sex with men in a large urban HIV Clinic in Tokyo, 2008–2015.PLoS One. 2016; 11e0168642Crossref PubMed Scopus (17) Google Scholar]. Due to the diversification of patients' sexual behaviors, healthcare providers should be aware of the oral manifestation of syphilis [[3]Dybeck Udd S. Lund B. Oral syphilis: a reemerging infection prompting Clinicians' alertness.Case Rep Dent. 2016; 20166295920PubMed Google Scholar]. The patient was treated with amoxicillin for a month, and the symptoms of pharyngeal lesions resolved rapidly. The picture shows the patient's soft palate after 2 months of follow-up (Fig. 1B). The authors disclose no financial or proprietary conflicts of interest with this publication. Consent was obtained and no patient identifiers are evident on the clinical image.