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Gutierrez-Lanz E, Smith LB, Perry AM. Syphilis in Hematopathology Practice: A Diagnostic Challenge. Arch Pathol Lab Med 2024; 148:633-641. [PMID: 37535664 DOI: 10.5858/arpa.2023-0078-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT.— Syphilis, a reemerging disease caused by the spirochete Treponema pallidum, is becoming more frequent in surgical pathology and hematopathology practices. Hematopathologists typically receive lymph node biopsies from patients with syphilis who have localized or diffuse lymphadenopathy. Occasionally, syphilis infection in the aerodigestive tract can show a prominent lymphoplasmacytic infiltrate and mimic lymphoma. Besides the varying and occasional atypical morphology, the fact that clinical suspicion tends to be low or absent when histologic evaluation is requested adds to the importance of making this diagnosis. OBJECTIVE.— To summarize histologic features of syphilitic lymphadenitis and syphilis lesions in the aerodigestive tract, and to review differential diagnosis and potential diagnostic pitfalls. DATA SOURCES.— Literature review via PubMed search. CONCLUSIONS.— Characteristic histologic findings in syphilitic lymphadenitis include thickened capsule with plasma cell-rich inflammatory infiltrate, reactive follicular and paracortical hyperplasia with prominent lymphoplasmacytic infiltrate, and vasculitis. Lymph nodes, however, can show a number of other nonspecific histologic features, which frequently makes the diagnosis quite challenging. In the aerodigestive tract, syphilis is characterized by plasma cell-rich infiltrates. Immunohistochemistry for T pallidum is the preferred method for detecting spirochetes; however, this immunohistochemical stain shows cross-reactivity with other treponemal and commensal spirochetes. Differential diagnosis of syphilis in lymph nodes and the aerodigestive tract is broad and includes reactive, infectious, and neoplastic entities. Pathologists should be aware of the histologic features of syphilis and keep this challenging entity in the differential diagnosis.
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Mussa A, Jarolimova J, Ryan R, Wynn A, Ashour D, Bassett IV, Philpotts LL, Freyne B, Morroni C, Dugdale CM. Syphilis Prevalence Among People Living With and Without HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Sex Transm Dis 2024; 51:e1-e7. [PMID: 38180840 PMCID: PMC10922304 DOI: 10.1097/olq.0000000000001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Syphilis is a curable sexually transmitted infection that, untreated, is associated with significant morbidity and mortality. In people living with HIV (PLWH), syphilis carries greater risks of disease progression. We estimated syphilis prevalence among PLWH in the general population in sub-Saharan Africa and compared the prevalence among PLWH and without HIV. METHODS We searched for studies published January 1, 2011, to March 28, 2022, reporting syphilis prevalence among PLWH in sub-Saharan Africa (PROSPERO No. CRD42020167328). We excluded studies in high-risk subpopulations. We estimated pooled syphilis prevalence among PLWH using random-effects modeling and compared the prevalence with people without HIV when included in the same study. We examined influences of region, study setting, and test type in subgroup analyses. RESULTS We identified 926 studies; 53 were included in the meta-analysis. Pooled syphilis prevalence among PLWH was 7.3% (95% confidence interval [CI], 6.3%-8.5%). Prevalence differed by region: 3.1% (95% CI, 2.2%-4.0%) in Southern, 5.5% (95% CI, 2.3%-9.3%) in West/Central, and 10.5% (95% CI, 8.0%-13.1%) in Eastern Africa. Prevalence also differed by study setting: 13.8% (95% CI, 5.7%-23.0%) in sexual and reproductive health/sexually transmitted infection care, 8.7% (95% CI, 5.0%-12.8%) in HIV care, 7.1% (95% CI, 5.8%-8.5%) in antenatal care, and 3.8% (95% CI, 2.0%-5.8%) in household/community-based settings. Syphilis prevalence was higher among PLWH than without HIV (relative risk, 3.5; 95% CI, 2.8-4.5). CONCLUSIONS Syphilis is highly prevalent among PLWH in sub-Saharan Africa and is more common among PLWH than without HIV. Integration of syphilis screening and management into HIV care may reduce complications of HIV-syphilis coinfection among PLWH in sub-Saharan Africa.
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Affiliation(s)
- Aamirah Mussa
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jana Jarolimova
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Adrianne Wynn
- University of California, San Diego; Division of Infectious Diseases and Global Public Health; La Jolla, CA, USA
| | - Dina Ashour
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ingrid V Bassett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, MA, USA
| | - Bridget Freyne
- Department of Paediatric Infectious Diseases, Children’s Health Ireland, Dublin, Ireland
- Department of Women and Children’s Health, University College Dublin, Dublin, Ireland
- Department of Paediatrics, Kamuzu University of Health Sciences, Malawi
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Caitlin M Dugdale
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ramchandani MS, Cannon CA, Marra CM. Syphilis. Infect Dis Clin North Am 2023; 37:195-222. [PMID: 37005164 DOI: 10.1016/j.idc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Syphilis is an important public health problem in the U.S. and many high-income nations. The rates of syphilis continue to increase and there is an urgent need for medical providers of a variety of backgrounds to recognize this disease. In this review, we cover the key clinical findings of syphilis and provide an overview of the diagnosis and management of this disease in adults.
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Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study. J Clin Med 2022; 11:jcm11247499. [PMID: 36556115 PMCID: PMC9781386 DOI: 10.3390/jcm11247499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Syphilis infection does not confer definitive and protective immunity against reinfection, and crucial aspects of repeated episodes of syphilis are far from being understood, especially among people living with HIV (PLWH). Methods: In order to explore the burden of syphilis in a large cohort of HIV-negative patients and PLWH, this retrospective study describes the demographics, clinical presentation and treatment outcome of patients with syphilis treated at our clinic from 2013 to 2021. Results: Within the study period, 1859 syphilis episodes (827, 44.5% first infections and 1032, 55.5% reinfections) were recorded. A total of 663 patients, of whom 347 (52%) had PLWH, were considered. Syphilis was mostly diagnosed in males (77%) and European (79%) patients. More than half of syphilis episodes were recorded during the late latent stage (64%) or during follow-up/screening visits for other diseases, while symptomatic stages led to a diagnosis in almost half of HIV-negative patients (p < 0.001). PLWH with syphilis infection were predominantly homo/bisexual (p < 0.001). A significantly higher rate of syphilis reinfection was observed in PLWH, who also demonstrated a higher range of subsequent episodes. The serofast state was found to be similar at the 6- and 12-month follow-up visits. The multivariate analysis carried out in the HIV-positive group showed that an RPR titre >1:16 was an independent predictor for serological non-response. Conclusions: Syphilis reinfections are predominantly diagnosed in HIV-positive MSM. The high rate of asymptomatic presentation among PLWH supports the role of periodical syphilis screening. In PLWH, the only baseline factor associated with an increased risk of non-response was an RPR titre >1:16, while assessment at 12 months after treatment increased the possibility of detecting a serological response, indicating that PLWH have a slower serological response to treatment.
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Benslama L. Oral and maxillofacial manifestations of human immunodefficiency virus infection. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:622-633. [PMID: 35618625 DOI: 10.1016/j.jormas.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Oral manifestations occur at all stages of human immunodeficiency virus (HIV) infection. Their clinical expressions and severity depend on the evolution of the infection and become critical at the stage of acquired immunodeficiency (AIDS). They are essentially infectious, tumoral, and, starting a few years ago, iatrogenic. Infections are mostly fungal (candidiasis), viral (herpes, zoster, human papillomavirus infections, etc.), and less frequently bacterial (streptococcemia). Cases of sexually transmitted diseases, particularly syphilis, are multiplying preoccupyingly. The most frequently observed tumors are Kaposi's sarcoma. Drug intolerance is common; the symptoms are mostly dermatological, but also oral (Stevens-Johnson syndrome and toxic epidermal necrolysis) when sulfonamides and certain antiretrovirals are used. The advent of prolonged Highly Active Anti-Retroviral Therapies (HAARTs) has led to a decline in the incidence of most opportunistic conditions, infections and tumors (except for multiple oral warts and zoster). HAARTs also provoke adverse reactions such as lipodystrophy syndromes (signs of peripheral atrophy and central hypertrophy, associated in varying degrees with metabolic syndromes). Extended survival and the new methods for prophylaxis of opportunistic infections have gradually modified diagnostic and therapeutic strategies for oral manifestations of HIV infections.
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Affiliation(s)
- L Benslama
- Department of stomatology and maxillofacial surgery, AP-HP, DHU FAST, GH Pitié- Salpêtrière- Charles Foix, Paris F-75013, France.
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Tiecco G, Degli Antoni M, Storti S, Marchese V, Focà E, Torti C, Castelli F, Quiros-Roldan E. A 2021 Update on Syphilis: Taking Stock from Pathogenesis to Vaccines. Pathogens 2021; 10:pathogens10111364. [PMID: 34832520 PMCID: PMC8620723 DOI: 10.3390/pathogens10111364] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
In 2021 the scientific community’s efforts have been focused on solving the back-breaking challenge of the COVID-19 pandemic, but sexually transmitted infections (STI) are still one of the most common global health problems. Syphilis is a systemic disease caused by the spirochaete Treponema pallidum (TP) and is one of the oldest known diseases. Its incidence has increased in the last few years and syphilis still remains a contemporary plague that continues to afflict millions of people worldwide. Despite research improvements, syphilis pathogenesis is not completely clear; clinical presentation is very heterogeneous and the diagnosis can sometimes be difficult. Furthermore, few therapeutic options are available, and a vaccine has not been found yet. In this review, we describe the most recent evidence concerning the clinical manifestation, diagnosis, treatment and vaccine prospectives for this disease.
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Affiliation(s)
- Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Melania Degli Antoni
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Samuele Storti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Valentina Marchese
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
- Correspondence: ; Tel.: +39-(030)-399-5677
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Adriaansens EH, van Winden MEC, van Wijngaarden P. Localised cervical lymphadenopathy: a rare presenting sign of syphilis. BMJ Case Rep 2021; 14:14/6/e243195. [PMID: 34167988 DOI: 10.1136/bcr-2021-243195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recognising syphilis can be challenging due to enormous variability in disease presentation. We present a case of 56-year-old female patient, without any medical history, with unilateral cervical lymphadenopathy and night sweats since 3 weeks. Initial differential diagnosis consisted of infectious disease, lymphoproliferative disease and autoimmune disease. Despite considerable diagnostic efforts, including serological tests for common infectious diseases, a CAT scan and histologic examination, no diagnosis was found. After reconsideration, serologic testing for syphilis was performed and was positive. Hereby, the final diagnosis of syphilis was made. Neurosyphilis and HIV coinfection were ruled out before treatment with benzylpenicillin was initiated. After which our patient made a full recovery. Treatment delay could have been considerably diminished if the localised lymphadenopathy was recognised as possible syphilitic disease. In future cases this could not only prevent further dissemination and potential morbidity in the individual patient as well as further emergence within the population.
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Ren M, Dashwood T, Walmsley S. The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management. Curr HIV/AIDS Rep 2021; 18:280-288. [PMID: 34091858 PMCID: PMC8180186 DOI: 10.1007/s11904-021-00564-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To 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 Findings HIV 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. Summary The intersection of HIV and syphilis infections continues to pose new and unique challenges in diagnosis, treatment, and prevention.
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Affiliation(s)
- Melody Ren
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Dashwood
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Room 13EN214, Toronto, ON, M5G2C4, Canada.
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Affiliation(s)
| | | | | | - Alain Brassard
- Correspondence to: Alain Brassard, MD, FRCPC, Department of Dermatology, University of California, Davis, 3301 C St., Suite 1400, Sacramento, CA 95816.
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Hamze H, Ryan V, Cumming E, Lukac C, Wong J, Muhammad M, Grennan T. Human Immunodeficiency Virus Seropositivity and Early Syphilis Stage Associated With Ocular Syphilis Diagnosis: A Case-control Study in British Columbia, Canada, 2010-2018. Clin Infect Dis 2021; 71:259-266. [PMID: 31420644 DOI: 10.1093/cid/ciz794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of syphilis has been increasing worldwide in the last 20 years, disproportionately impacting those living with human immunodeficiency virus (HIV). Alongside this increase, several jurisdictions have reported increasing incidences of syphilis-related complications, including ocular syphilis. We sought to characterize ocular syphilis cases in British Columbia (BC), Canada. METHODS This case-control study compared ocular syphilis cases, matched (1:4) to syphilis controls, that were diagnosed in BC between January 2010 and December 2018. Multivariable logistic regression was used to identify potential correlates of ocular syphilis, where variables were included in the final model if significant (P ≤ .05). RESULTS During the study period, there were 6716 syphilis diagnoses, including 66 (0.98%) ocular syphilis cases. The median age of cases was 49.5 years (interquartile range 39-59). Most (87.8%) patients were male, where 54.6% identified as men who have sex with men. The most common ophthalmologic diagnosis was panuveitis (42.4%). Of ocular syphilis patients, 48.5% were living with HIV at the time of their syphilis diagnosis, compared to 26.4% of controls (P = .001). The proportion of syphilis cases with ocular syphilis increased from 0.48% in 2010 to 0.83% in 2018. The final multivariable model demonstrated correlates between ocular syphilis and early syphilis stage, including primary/secondary (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.86-13.24) and early latent (OR 4.29, 95% CI 1.62-11.34) stages, and HIV serostatus (OR 2.16, 95% CI 1.14-4.09). CONCLUSIONS Ocular syphilis increased over the study period, both in absolute numbers and as a proportion of all syphilis cases, a finding consistent with other jurisdictions. These findings highlight the importance of vigilance for ocular syphilis, to avoid diagnostic and treatment delays.
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Affiliation(s)
- Hasan Hamze
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Venessa Ryan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Emma Cumming
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Christine Lukac
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
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Klein M, Angstwurm K, Esser S, Hahn K, Maschke M, Scheithauer S, Schoefer H, Sturzenegger M, Wildemann B, Weber J. German guidelines on the diagnosis and treatment of neurosyphilis. Neurol Res Pract 2020; 2:33. [PMID: 33225223 PMCID: PMC7669305 DOI: 10.1186/s42466-020-00081-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction In view of the importance of neurosyphilis and the difficulties encountered in diagnosing it, the S1 guideline "Neurosyphilis" has been published by the German Society for Neurology (DGN) in accordance with the stipulations of the Association of the Scientific Medical Societies in Germany (AWMF). The present article is an abridged translation of that German guideline. Main recommendations (a) Neurosyphilis can manifest as early neurosyphilis (meningitis, meningovascular neurosyphilis or syphilitic gummas) or late neurosyphilis (tabes dorsalis, general paresis). (b) The following diagnostic criteria help to establish the presence of probable neurosyphilis (always point iv, accompanied by any two of points i to iii): (i) subacute or chronic neuro-psychiatric symptoms; (ii) increased cerebrospinal fluid (CSF) cell count or signs of blood-CSF barrier disruption; (iii) positive effect of anti-neurosyphilis antibiotic therapy on clinical course and CSF findings; (iv) positive TPHA/TPPA or FTA test in serum. (c) The diagnosis of neurosyphilis is confirmed by the subsequent detection of intrathecal production of antibodies against Treponema pallidum. (d) In neurosyphilis, treatment with intravenous penicillin or ceftriaxone for 14 days is recommended. (e) The following parameters can be used to assess a therapeutic effect: clinical findings, serum VDRL, and CSF cell count. Conclusion The German guideline on the diagnosis and treatment of neurosyphilis is a practical tool to support clinicians in diagnosing and treating patients with neurosyphilis. This article is an abridged translation of this guideline (Klein MW, J.; Angstwurm, K.; Esser, S.; Hahn, K.; Matschke, M.; Scheithauer, S.; Schoefer, H.; Sturzenegger, M.; Wildemann, B. Neurosyphilis, S1-Leitlinie. Deutsche Gesellschaft für Neurologie, Leitlinien für Diagnostik und Thearpie in der Neurologie 2020).
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Affiliation(s)
- Matthias Klein
- Department of Neurology, LMU Klinikum Muenchen, Marchioninistr. 15, 81377 Munich, Germany
| | - Klemens Angstwurm
- Department of Neurology, Universitaetsklinik Regensburg, Universitaetsstr. 84, 93042 Regensburg, Germany
| | - Stefan Esser
- Department of Dermatology, Universitaetsklinikum Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Kathrin Hahn
- Department of Neurology, Charite Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Matthias Maschke
- Department of Neurology, Krankenhaus der Barmherzigen Brueder Trier, Nordallee 1, 54292 Trier, Germany
| | - Simone Scheithauer
- Institute for Hygiene and Infectiology, Universitaet Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Helmut Schoefer
- Dr. Horst Schmidt Kliniken, Aukamm-Allee 33, 65191 Wiesbaden, Germany
| | - Matthias Sturzenegger
- Department of Neurology, Inselspital Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Brigitte Wildemann
- Department of Neurology, Universitaetsklinik Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Jörg Weber
- Department of Neurology, Klinikum Klagenfurt, Feschnigstraße 11, 9020 Klagenfurt am Wörthsee, Austria
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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Enhancing the Control of Syphilis Among Men Who Have Sex With Men by Focusing on Acute Infectious Primary Syphilis and Core Transmission Groups. Sex Transm Dis 2020; 46:629-636. [PMID: 31356529 PMCID: PMC6887624 DOI: 10.1097/olq.0000000000001039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The syphilis epidemic among men who have sex with men (MSM) has been increasing steadily. Many syphilis control programs focus on assuring treatment of all persons diagnosed with early syphilis without prioritizing acute primary syphilis or specific subgroups. Acute primary syphilis is highly infectious and contributes to a high proportion of new cases. Surveillance data show that among MSM with incident syphilis (primary or secondary) only about 35% are identified in the primary stage, indicating that most primary cases are missed and untreated. Patients with primary syphilis and large numbers of sex partners may play a major role in maintaining syphilis transmission. Considering those issues, sexually transmitted disease (STD) programs should consider increasing their focus on primary syphilis by assigning primary cases the highest priority, expanding client and clinician health education, and increasing the detection of primary syphilis through increased serologic screening frequency among high-risk MSM. Furthermore, syphilis control programs should implement steps to identify asymptomatic high-probable occult primary cases based on low titer (≤1:8) and recent seroconversion. Finally, to address core transmission groups, programs should implement periodic risk assessment to identify persons with a high number of sex partners and offer these individuals risk-reduction counseling, case management, and selective syphilis preexposure or postexposure doxycycline chemoprophylaxis. Although reprioritizing prevention efforts might be challenging, the Centers for Disease Control and Prevention, community advocacy groups, university STD research centers, and national STD prevention training centers can assist by providing support for consensus discussions and direction in developing operational guidance, some of which may be best delivered through STD and human immunodeficiency virus program partnerships.
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Diagnosis and Management of Syphilis in Patients With HIV Co-infection. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Lee TH, Yang TH, Chang YS, Chang IJ. Granulomatous secondary syphilis with a facial annular sarcoidosis-like clinical and histopathological pattern. Australas J Dermatol 2020; 61:e364-e365. [PMID: 32020601 DOI: 10.1111/ajd.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tsai-Hsien Lee
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ting-Hua Yang
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yin-Shuo Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - I-Jing Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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17
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Grillová L, Noda AA, Lienhard R, Blanco O, Rodríguez I, Šmajs D. Multilocus Sequence Typing of Treponema pallidum subsp. pallidum in Cuba From 2012 to 2017. J Infect Dis 2020; 219:1138-1145. [PMID: 30325448 DOI: 10.1093/infdis/jiy604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The increased prevalence of syphilis in Cuba prompted us to map the circulating Treponema pallidum subsp. pallidum allelic profiles in this geographic region. METHODS Samples were collected from 2012 to 2017, from 83 male patients with ulcers or skin lesions, and were examined using multilocus sequence typing. Additionally, we analyzed the 23S rDNA and 16S rDNA regions for the presence of possible mutations leading to macrolide and tetracycline resistance. RESULTS Among 94% of fully typed strains, we found 7 different allelic profiles, of which 4 had not been previously described. More than 87% of patients were infected with the T. pallidum SS14-like group and only 8.2% with T. pallidum Nichols-like group. As in other countries, the 1.3.1 allelic profile (ie, SS14-like) was the most common. In addition, 1 of the newly described allelic profiles represents T. pallidum strains that arose by recombination events between members of different T. pallidum subgroups. More than 90% of patients were infected with treponemes harboring the A2058G mutation. However, we found no potential tetracycline-resistant T. pallidum mutations. CONCLUSIONS Our results suggest that, in Cuba, tetracycline antibiotics could be used to treat syphilis in penicillin-allergic patients instead of macrolides.
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Affiliation(s)
- Linda Grillová
- Department of Biology, Masaryk University, Brno, Czech Republic
| | - Angel A Noda
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Reto Lienhard
- Department of Bacteriology and Serology, Analyses and Diagnostics Medical Microbiology, La Chaux-de-Fonds, Switzerland
| | - Orestes Blanco
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Islay Rodríguez
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - David Šmajs
- Department of Biology, Masaryk University, Brno, Czech Republic
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18
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Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol 2019; 20:423-442. [PMID: 30806959 DOI: 10.1007/s40257-019-00422-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antiretroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.
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Affiliation(s)
- Khatiya Chelidze
- Weill Cornell Medical College, Massachusetts General Hospital, 1300 York Avenue, New York, NY, 10021, USA
| | - Cristina Thomas
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA
| | - Aileen Yenting Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Esther Ellen Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA.
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
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Serigado J, Lewis E, Kim G. Rectal bleeding caused by a syphilitic inflammatory mass. BMJ Case Rep 2019; 12:12/1/e226595. [PMID: 30696637 DOI: 10.1136/bcr-2018-226595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 47-year-old man presented with fatigue, decrease appetite, abdominal pain and rectal bleeding. His colonoscopy revealed a single, firm, raised, centrally ulcerated mass at the anorectal junction. During this same admission, he was diagnosed with HIV and syphilis, found to have multiple hepatic lesions and positive cerebrospinal fluidvenereal disease research laboratory test (VDRL). Biopsies from both the hepatic lesions and rectal ulcer showed spirochaetes by immunostaining. The initial presentation was felt to be secondary to a rectal inflammatory mass caused by syphilis.
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Affiliation(s)
- Joao Serigado
- Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Eugene Lewis
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Grace Kim
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
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20
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Khaw C, Richardson D, Matthews G, Read T. Looking at the positives: proactive management of STIs in people with HIV. AIDS Res Ther 2018; 15:28. [PMID: 30577866 PMCID: PMC6302453 DOI: 10.1186/s12981-018-0216-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023] Open
Abstract
Patients who are HIV-positive and co-infected with other sexually transmitted infections (STIs) are at risk of increased morbidity and mortality. This is of clinical significance. There has been a dramatic increase in the incidence of STIs, particularly syphilis, gonorrhoea, Mycoplasma genitalium and hepatitis C virus (HCV) in HIV-positive patients. The reasons for this are multifactorial, but contributing factors may include effective treatment for HIV, increased STI testing, use of HIV pre-exposure prophylaxis and use of social media to meet sexual partners. The rate of syphilis-HIV co-infection is increasing, with a corresponding increase in its incidence in the wider community. HIV-positive patients infected with syphilis are more likely to have neurological invasion, causing syndromes of neurosyphilis and ocular syphilis. HIV infection accelerates HCV disease progression in co-infected patients, and liver disease is a leading cause of non-AIDS-related mortality among patients who are HIV-positive. Since several direct-acting antivirals have become subsidised in Australia, there has been an increase in treatment uptake and a decrease in HCV viraemia in HIV-positive patients. The incidence of other sexually transmitted bacterial infections such as Neisseria gonorrhoeae and M. genitalium is increasing in HIV patients, causing urethritis, proctitis and other syndromes. Increasing antimicrobial resistance has also become a major concern, making treatment of these infections challenging. Increased appropriate testing and vigilant management of these STIs with data acquisition on antimicrobial sensitivities and antimicrobial stewardship are essential to prevent ongoing epidemics and emergence of resistance. Although efforts to prevent, treat and reduce epidemics of STIs in patients living with HIV are underway, further advances are needed to reduce the significant morbidity associated with co-infection in this patient setting.
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Affiliation(s)
- Carole Khaw
- Adelaide Sexual Health Centre (Clinic 275), Infectious Diseases Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide, SA 5000 Australia
- School of Medicine, University of Adelaide, Adelaide, SA Australia
| | - Daniel Richardson
- Department of Sexual Health and HIV Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Sexual Health and HIV Medicine, Brighton and Sussex University NHS Trust, Brighton, UK
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW Australia
| | - Tim Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC Australia
- Central Clinical School, Monash University, Melbourne, VIC Australia
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21
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Kufa T, Maseko VD, Nhlapo D, Radebe F, Puren A, Kularatne RS. Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: A cross sectional study. Medicine (Baltimore) 2018; 97:e12575. [PMID: 30278565 PMCID: PMC6181585 DOI: 10.1097/md.0000000000012575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe knowledge of human immunodeficiency virus (HIV) status, correct report of HIV status and antiretroviral therapy (ART) use among sexually transmitted infection (STI) service attendees in South Africa.An anonymous questionnaire was administered and serological HIV testing done. Proportions of attendees reporting knowledge of HIV status and HIV status consistent with laboratory results and ART use (among HIV positives) were determined as were factors associated with knowledge and inconsistent report of HIV status.Of 1054 attendees, 288 (27.3%) were HIV positive and 830 (78.8%) self-reported knowledge of HIV status. Not knowing one's HIV status was associated with male gender [adjusted Odds Ratio (aOR) 2.66 (95% confidence interval (CI) 1.70-4.18] medical circumcision [aOR 0.48 (95% CI 0.24-0.95)] and site [Gauteng Province (GP)-aOR 6.20 (95% CI 3.51-10.95), Eastern Cape (EC)-aOR 17.29 (95% CI 10.08- 29.66) versus Free State (FS)/Western Cape (WC) sites]. Of 219 HIV positive attendees with knowledge of HIV status, 136 (62.1%) self-reported being HIV positive, of whom 80 (58.8%) reported taking ARVs in the preceding 3 days. Inconsistent report of status was associated with males [aOR 2.26 (95%CI 1.05-4.87)], prior STI treatment [aOR 0.33 (95% CI 0.16-0.69)], recent HIV testing (6months) [aOR 3.20 (95% CI 1.62-6.36)] and site [GP-aOR 6.89 (95% 3.21-14.82), EC-aOR 5.08 (95% CI 2.15-11.64) versus FS/WC sites]. Knowledge of HIV status was lower than targeted. HIV testing and linkage to care services are essential in STI-related care and validation of self-reported indicators in this population maybe necessary.
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Affiliation(s)
- Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases
- The School of Public Health
| | - Venessa D. Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Duduzile Nhlapo
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Frans Radebe
- Centre for HIV and STIs, National Institute for Communicable Diseases
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases
- Division of Virology, School of Pathology
| | - Ranmini S. Kularatne
- Centre for HIV and STIs, National Institute for Communicable Diseases
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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22
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Marks M, Lawrence D, Kositz C, Mabey D. Diagnostic performance of PCR assays for the diagnosis of neurosyphilis: a systematic review. Sex Transm Infect 2018; 94:585-588. [PMID: 30061192 DOI: 10.1136/sextrans-2018-053666] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/26/2018] [Accepted: 07/07/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Syphilis continues to be a major public health problem and the recent resurgence in syphilis in high-income settings has seen an accompanying increase in cases of neurosyphilis. While the introduction of PCR has had a significant impact on the diagnosis of early syphilis, cerebrospinal fluid (CSF) serological assays remain the most commonly used tests to diagnosis neurosyphilis. We reviewed data on the performance of CSF-PCR for the diagnosis of neurosyphilis. METHODS We searched Pubmed, Medline, EMBASE and the grey literature for references on PCR in neurosyphilis. We calculated the sensitivity and specificity of PCR compared with reference testing for the diagnosis of neurosyphilis. RESULTS We identified 66 articles of which seven met the study inclusion criteria. The sensitivity of PCR for definite neurosyphilis varied between 40% and 70% and specificity between 60% and 100% across the studies. The most commonly used PCR assay targeted Tp47 which had an overall sensitivity of 68% and a specificity of 91.9%. DISCUSSION The sensitivity of PCR was low compared with CSF-serological assays but the challenges of evaluating a diagnostic test in the absence of a clear gold standard make definitive interpretation challenging. Most studies were small and not adequately powered highlighting the need for multicentre, multicountry trials to provide adequate statistical power in evaluations of new tests the diagnosis of neurosyphilis.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK .,Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
| | - David Lawrence
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Christian Kositz
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
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Lang R, Read R, Krentz HB, Peng M, Ramazani S, Vu Q, Gill MJ. A retrospective study of the clinical features of new syphilis infections in an HIV-positive cohort in Alberta, Canada. BMJ Open 2018; 8:e021544. [PMID: 29991630 PMCID: PMC6082489 DOI: 10.1136/bmjopen-2018-021544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Syphilis is a global health concern with an estimated 12 million infections occurring annually. Due to the increasing rates of new syphilis infections being reported in patients infected with HIV, and their higher risk for atypical and severe presentations, periodic screening has been recommended as a routine component of HIV care. We aimed to characterise incident syphilis presentation, serological features and treatment response in a well-defined, HIV-infected population over 11 years. METHODS Since 2006, as routine practice of both the Southern Alberta Clinic and Calgary STI programmes, syphilis screening has accompanied HIV viral load measures every 4 months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were reinfected as evidenced by a fourfold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed. RESULTS We identified 249 incident syphilis infections in 194 different individuals infected with HIV; 72% were initial infections whereas 28% were reinfections. Half (50.8%) of the infections were asymptomatic and identified only by routine screening. Symptomatic syphilis was more common when RPR titres were higher (p=0.03). In patients with recurrent syphilis infection, a trend was noted favouring symptomatic presentation (62%, p=0.07). All 10 patients with central nervous system (CNS) syphilis involvement presented with an RPR titre ≥1:32. Following syphilis infection, a decline of 42 cells/mm3 in CD4 (p=0.004) was found, but no significant changes in viral load occurred. No association was found with the stage of syphilis or symptoms at presentation and antiretroviral therapy use, CD4 count or virological suppression. CONCLUSION Routine screening of our HIV-infected population identified many asymptomatic syphilis infections. The interaction of HIV and syphilis infection appears to be bidirectional with effects noted on both HIV and syphilis clinical and serological markers.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ron Read
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hartmut B Krentz
- S Alberta HIV Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Mingkai Peng
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Soheil Ramazani
- S Alberta HIV Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Quang Vu
- S Alberta HIV Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- S Alberta HIV Clinic, Alberta Health Services, Calgary, Alberta, Canada
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24
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Bjekić M, Šipetić-Grujičić S, Begović-Vuksanović B, Rafailović N, Vlajinac H. Syphilis Resurgence in Belgrade, Serbia, in the New Millennium: An Outbreak in 2014. Cent Eur J Public Health 2018; 25:277-281. [PMID: 29346849 DOI: 10.21101/cejph.a4525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A worldwide syphilis incidence increase was recorded at the beginning of the new millennium, occurring primarily among men who have sex with men (MSM). The aim of this study was to analyse the epidemiological situation of syphilis in the Belgrade population between 2005 and 2014 and to examine the characteristics of an early syphilis outbreak among MSM in Belgrade in 2014. METHOD Reporting of syphilis is compulsory in Serbia. Routinely reported data were analysed along with data collected from patients' charts. RESULTS During the period observed, syphilis incidence increased from 1.07 per 100,000 in 2005 to 4.1 per 100,000 in 2014 (383.2%). From 2005 to 2009, syphilis rates in Belgrade were low, around 1 case per 100,000 people. The first outbreak was registered in 2010. The new incidence increase happened in 2012, and again in 2014 when it was the highest. These incidence changes were registered mainly in men, where the frequency of syphilis was much higher than in women. In 2014, primary syphilis was diagnosed in 20 cases, secondary syphilis in 42, and early latent syphilis in 9 patients. Fifty-seven were MSM, 10 were heterosexual men and 4 were women. Twenty-four cases, all MSM were co-infected with HIV. Majority of patients acquired infection in Belgrade, while in 42/71 cases oral sex was the only risk factor. In comparison with HIV negative, HIV positive syphilis patients were older, more frequently unemployed and MSM. They also more frequently had sex with unknown partners and were diagnosed in the secondary stage of infection. CONCLUSIONS Study results underline the need for coordinated and expeditious surveillance, partner services, enhanced screening of population at risk, health education, as well as early diagnosis and treatment.
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Affiliation(s)
- Milan Bjekić
- City Institute for Skin and Venereal Diseases, Belgrade, Serbia
| | | | | | | | - Hristina Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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25
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Neurosyphilis in Africa: A systematic review. PLoS Negl Trop Dis 2017; 11:e0005880. [PMID: 28859081 PMCID: PMC5597251 DOI: 10.1371/journal.pntd.0005880] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Neurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of HIV co-infection on clinical neurosyphilis remains unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore it might be expected that neurosyphilis would be an important and not uncommon manifestation of syphilis in Africa and frequently occur in association with HIV co-infection; yet few data are available on neurosyphilis in Africa. The aim of this study is to review data on neurosyphilis in Africa since the onset of the HIV epidemic. Methods We searched the literature for references on neurosyphilis in Africa for studies published between the 1st of January 1990 and 15th February 2017. We included case reports, case series, and retrospective and prospective cohort and case-control studies. We did not limit inclusion based on the diagnostic criteria used for neurosyphilis. For retrospective and prospective cohorts, we calculated the proportion of study participants who were diagnosed with neurosyphilis according to the individual study criteria. Depending on the study, we assessed the proportion of patients with syphilis found to have neurosyphilis, and the proportion of patients with neurological syndromes who had neurosyphilis. Due to heterogeneity of data no formal pooling of the data or meta-analysis was undertaken. Results Amongst patients presenting with a neurological syndrome, three studies of patients with meningitis were identified; neurosyphilis was consistently reported to cause approximately 3% of all cases. Three studies on stroke reported mixed findings but were limited due to the small number of patients undergoing CSF examination, whilst neurosyphilis continued to be reported as a common cause of dementia in studies from North Africa. Ten studies reported on cases of neurosyphilis amongst patients known to have syphilis. Studies from both North and Southern Africa continue to report cases of late stage syphilis, including tabes dorsalis and neurosyphilis, in association with ocular disease. Discussion This is the first systematic review of the literature on neurosyphilis in Africa since the beginning of the HIV epidemic. Neurosyphilis continues to be reported as a manifestation of both early and late syphilis, but the methodological quality of the majority of the included studies was poor. Future well-designed prospective studies are needed to better delineate the incidence and clinical spectrum of neurosyphilis in Africa and to better define interactions with HIV in this setting. Involvement of the central nervous system is an important manifestation of syphilis which may be more common in patients co-infected with HIV. As most cases of syphilis and HIV are seen in Africa it might be anticipated that neurosyphilis was common there. We reviewed all published material on neurosyphilis in Africa since 1990. There were few well designed studies of neurosyphilis. A small number of studies suggested that syphilis remains a cause of meningitis in Africa. Our data suggest that neuosyphilis remains an important disease in Africa but better prospective studies are needed to understand its epidemiology.
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26
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Practice Bulletin No. 167: Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus. Obstet Gynecol 2017; 128:e89-e110. [PMID: 27661659 DOI: 10.1097/aog.0000000000001707] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. For information on screening guidelines, refer to the American College of Obstetricians and Gynecologists' Committee Opinion No. 596, Routine Human Immunodeficiency Virus Screening (2).
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The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus. Case Rep Med 2017; 2017:2481961. [PMID: 28400821 PMCID: PMC5376408 DOI: 10.1155/2017/2481961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/05/2017] [Accepted: 02/28/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction. The incidence of syphilis continues to rise in the United States over the past 15 years. This disease process is classified into stages and may present with a coinfection of Human Immunodeficiency Virus (HIV). Case Report. We present a case of a 32-year-old African American male who presented with cutaneous manifestations of secondary syphilis and transaminitis. A workup revealed that the transaminitis was secondary to underlying syphilitic hepatitis in the presence of HIV coinfection. The patient had a reactive rapid plasma reagin (RPR) of 1 : 64 TU and reactive Treponema pallidum particle agglutination assay (TPPA). Lab findings showed alkaline phosphate (ALP) of 648 unit/L, aspartate aminotransferase (AST) of 251 unit/L, and alanine aminotransferase (ALT) of 409 unit/L. Conclusion. Syphilitic hepatitis is a recognized entity in the medical literature. It is a manifestation of secondary syphilis and it is more commonly seen in coinfected patients with both syphilis and HIV. Therefore, primary care physicians should keep infectious etiologies (e.g., syphilis and HIV) in the differential diagnosis of patients who present with unexplained liver dysfunction in a cholestatic pattern.
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28
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Ghanem KG. Syphilis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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Hernandez I, Johnson A, Reina-Ortiz M, Rosas C, Sharma V, Teran S, Naik E, Salihu HM, Teran E, Izurieta R. Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador. Am J Mens Health 2016; 11:823-833. [PMID: 27923971 PMCID: PMC5675307 DOI: 10.1177/1557988316680928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.
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Affiliation(s)
| | | | - Miguel Reina-Ortiz
- 2 University of South Florida, Tampa, FL, USA.,3 Fundación Raíces, Esmeraldas, Ecuador
| | - Carlos Rosas
- 4 Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Eknath Naik
- 2 University of South Florida, Tampa, FL, USA
| | | | - Enrique Teran
- 4 Universidad San Francisco de Quito, Quito, Ecuador
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Schöfer H, Weberschock T, Bräuninger W, Bremer V, Dreher A, Enders M, Esser S, Hamouda O, Hagedorn HJ, Handrick W, Krause W, Mayr C, Münstermann D, Nast A, Ochsendorf F, Petry U, Potthoff A, Prange H, Rieg S, Schneede P, Sing A, Weber J, Wichelhaus TA, Brockmeyer N. S2k guideline* "Diagnosis and therapy of syphilis"--short version. J Dtsch Dermatol Ges 2016; 13:472-80. [PMID: 25918100 DOI: 10.1111/ddg.12574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helmut Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital Frankfurt, Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Burchell AN, Allen VG, Grewal R, MacPherson PA, Rachlis A, Walmsley S, Mishra S, Gardner SL, Raboud J, Cooper C, Gough K, Rourke SB, Rousseau R, Salit I, Tan DHS. Enhanced syphilis screening among HIV-positive men (ESSAHM): a study protocol for a clinic-randomized trial with stepped wedge design. Implement Sci 2016; 11:8. [PMID: 26772390 PMCID: PMC4715363 DOI: 10.1186/s13012-016-0371-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current syphilis epidemic among urban men who have sex with men (MSM) has serious implications for those co-infected with human immunodeficiency virus (HIV). Routine and frequent syphilis screening has the potential to ensure early detection and treatment, minimize disease burden, and help control the ongoing spread of syphilis and HIV. We aim to enhance syphilis screening among HIV-positive men by conducting a clinic-based intervention that incorporates opt-out syphilis testing into routine HIV laboratory evaluation for this population. Trial objectives are to determine the degree to which the intervention (1) increases the detection rate of untreated syphilis, (2) increases screening coverage, (3) increases screening frequency, and (4) reaches men at highest risk according to sexual behaviors. METHODS/DESIGN The trial is a pragmatic, stepped wedge cluster-randomized controlled trial that introduces the intervention stepwise across four urban HIV clinics in Ontario, Canada. The intervention includes standing orders for syphilis serological testing whenever a male in HIV care undergoes HIV viral load testing, which typically occurs every 3-6 months. The control condition is the maintenance of current, provider-initiated syphilis testing practice. Approximately 3100 HIV-positive men will be followed over 30 months. Test results will be obtained from the centralized provincial laboratory in Ontario and will be supplemented by a standardized clinical worksheet and medical chart review at the clinics. Detailed clinical, psychosocial, and behavioral data is available for a subset of men receiving HIV care who are also participants of the province-wide Ontario HIV Treatment Network Cohort Study. Process evaluation plans include audit and feedback of compliance of the participating centers to identify potential barriers to the introduction of this type of practice into routine care. Health economic components include evaluation of the impact and cost-effectiveness of the intervention. DISCUSSION This trial will be the first of its kind in Canada and will provide evidence regarding the feasibility, clinical effectiveness, and cost-effectiveness of a clinic-based intervention to improve syphilis screening among HIV-positive men. Involvement of knowledge users in all stages of trial design, conduct, and analysis will facilitate scale-up should the intervention be effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02019043.
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Affiliation(s)
- Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, Canada.
| | - Ramandip Grewal
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Anita Rachlis
- Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Hospital, University Health Network, Toronto, Canada.
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Sandra L Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Ontario HIV Treatment Network, Toronto, Canada.
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Toronto General Research Institute, University Health Network, Toronto, Canada.
| | | | - Kevin Gough
- Department of Medicine, University of Toronto, Toronto, Canada.
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.
| | - Sean B Rourke
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Ontario HIV Treatment Network, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, Toronto, Canada.
- Poz Prevention Working Group, Gay Men's Sexual Health Alliance, Toronto, Canada.
| | - Irving Salit
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Hospital, University Health Network, Toronto, Canada.
| | - Darrell H S Tan
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Research Institute, University Health Network, Toronto, Canada.
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.
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Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, McBrien B, Tipple C, Turner A, Sullivan AK, Radcliffe K, Cousins D, FitzGerald M, Fisher M, Grover D, Higgins S, Kingston M, Rayment M, Sullivan A. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2015; 27:421-46. [PMID: 26721608 DOI: 10.1177/0956462415624059] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
Abstract
These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.
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Affiliation(s)
- M Kingston
- Manchester Centre for Sexual Health, Manchester, UK
| | - P French
- Mortimer Market Centre, London, UK
| | - S Higgins
- North Manchester General Hospital, Manchester, UK
| | - O McQuillan
- Manchester Centre for Sexual Health, Manchester, UK
| | - A Sukthankar
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Stott
- Manchester Centre for Sexual Health, Manchester, UK
| | - B McBrien
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Tipple
- Jefferiss Wing Centre for Sexual Health, Imperial College Health Care NHS Trust, London, UK
| | - A Turner
- The Public Health England/Clinical Virology Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Keith Radcliffe
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Darren Cousins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Mark FitzGerald
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Martin Fisher
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Deepa Grover
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Stephen Higgins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Margaret Kingston
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Michael Rayment
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Ann Sullivan
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
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Tayal S, Shaban F, Dasgupta K, Tabaqchali MA. A case of syphilitic anal condylomata lata mimicking malignancy. Int J Surg Case Rep 2015; 17:69-71. [PMID: 26555060 PMCID: PMC4701813 DOI: 10.1016/j.ijscr.2015.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022] Open
Abstract
Condylomata lata are a cutaneous manifestation of secondary syphilis and can be misdiagnosed as condylomata acuminata (warts caused by human papillomavirus), anal cancer, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. Condylomata lata are flesh coloured or hypo pigmented, macerated papules or plaques. We present a case of a 49-years-old gentleman who initially presented to primary care with perianal pain and peri-anal skin changes who was referred to the colorectal clinic under the two-weeks rule with suspected anal cancer. The diagnosis was confirmed by biopsy and positive standard tests for syphilis. Once condylomata lata is suspected or diagnosed, refer promptly to sexual health clinic for further investigations, treatment, contact tracing and follow up. Early treatments with intramuscular benzathine benzylpenicillin prevent serious neurological and cardiac complication.
Introduction Condylata lata in secondary syphilis is well known presentation and needs to be considered in differential diagnosis of perianal lesions. In England between 2013 and 2014 the overall incidence of infectious syphilis increased by 33% and is mainly seen in men who have sex with men. Presentation of case We report the management of a 49-years-old Caucasian homosexual man with perianal lesions that were suspicious of malignancy. After biopsies, colonoscopy, staging with computed tomography, magnetic resonance imaging and syphilis serology anal cancer was excluded and a diagnosis of syphilis was confirmed. He was referred to the sexual health clinic for the appropriate investigations and treatment. Discussion This case highlights the consideration of treatable infectious syphilis pathology. The main differential diagnosis of perianal growths to consider is condylomata acuminata (warts caused by human papillomavirus), anal cancer, syphilis, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. To differentiate a biopsy is needed for histopathological examination. A dense plasma cell infiltrate and numerous spirochetes visualised by immunostaining confirms condylomata lata. Conclusion In UK, it is important for colorectal surgeons to be aware of syphilitic condylomata lata and consider this when dealing with perianal lesions. It is advisable to refer patients suspected of or diagnosed with syphilis to sexual health clinics to help improve outcome. In sexual health clinics additional investigations and treatment are available in addition to partner notification and follow-up can be offered.
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Affiliation(s)
- Sarup Tayal
- Virgin Care, Sexual Health Teesside, Lawson Street Health Centre, Lawson Street, Stockton TS18 1HU UK.
| | - Fadlo Shaban
- Department of Colorectal surgery, University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE,UK.
| | - Kaushik Dasgupta
- Department of Histopathology, University Hospital of North Tees, Hardwick, Stockton on Tees TS19 8PE, UK.
| | - Mohamed A Tabaqchali
- Department of Colorectal surgery, University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, UK.
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Malisiewicz B, Schöfer H. [Diagnosis and therapy of genitoanal ulcers of infectious etiology]. Hautarzt 2015; 66:19-29. [PMID: 25523404 DOI: 10.1007/s00105-014-3551-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted. Besides frequent causative infections rare but relevant diseases in the differential diagnosis are discussed in detail. MATERIAL AND METHODS A Pubmed literature search was carried out, guidelines from different task groups and clinical experiences are presented. RESULTS Infections with herpes simplex virus (first) and syphilis (second) are still the most common causes of infectious genital ulcers. An endemic occurrence, previously rare in Europe, has been observed in recent years. Particular risk groups, such as men who have sex with men (MSM), sex workers or sex tourists are affected. Even less common locations, such as the mouth or the rectum, lymphogranuloma venereum (LGV) and atypical clinical symptoms (e.g. pelvic pain in pelvic lymphadenopathy with LGV) must be considered in the differential diagnosis. CONCLUSION In recent years sexually transmitted infections (STI) have shown a significant increase in western industrialized nations. In all cases with unclear findings in the genital and anal areas (and also in the oral cavity) STI diseases must be reconsidered in the differential diagnosis.
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Affiliation(s)
- B Malisiewicz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Goethe-Universität Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland
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Merins V, Hahn K. Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid. Eur J Med Res 2015; 20:81. [PMID: 26445822 PMCID: PMC4596308 DOI: 10.1186/s40001-015-0175-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients. Methods We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant. Results Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %. Discussion Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.
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Affiliation(s)
- V Merins
- Group Practice Family Physicians, Alt-Buckow 9-11, 12349, Berlin, Germany.
| | - K Hahn
- Department of Neurology, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Germany.
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Towns JM, Leslie DE, Denham I, Azzato F, Fairley CK, Chen M. Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study. Sex Transm Infect 2015; 92:110-5. [PMID: 26378262 DOI: 10.1136/sextrans-2015-052219] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chancres, the hallmark of primary syphilis, are classically described as single, painless ulcers at the site of Treponema pallidum inoculation. We aimed to determine the frequency of painful or multiple anogenital lesions of primary syphilis among men, whether there was concurrent herpes simplex virus (HSV) infection and whether HIV status altered clinical presentations. METHODS This study was conducted among men with T. pallidum PCR-positive lesions, attending a clinic in Melbourne, Australia, between 2009 and 2014. Lesions were also tested with HSV PCR, and syphilis serology undertaken. RESULTS 183 men with T. pallidum PCR-positive primary anogenital lesions were included. 89% were men who have sex with men, and 10.9% were heterosexual. 38 men (20.8%) were HIV positive. Anal lesions were more common in HIV-positive men (34.2%) than in HIV-negative men (11.6%). Primary lesions were frequently painful (49.2%) or multiple (37.7%), and infrequently associated with HSV (2.7%). Of 37 men with both painful and multiple primary lesions, only 8% had concurrent HSV. Presentation was not significantly altered by HIV status. CONCLUSIONS Primary syphilis lesions are often painful and/or multiple in the absence of herpes coinfection, and may be clinically misdiagnosed.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia Central Clinical School, Monash University, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians. RECENT FINDINGS Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern. SUMMARY Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.
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Schöfer H, Weberschock T, Bräuninger W, Bremer V, Dreher A, Enders M, Esser S, Hamouda O, Hagedorn HJ, Handrick W, Krause W, Mayr C, Münster-mann D, Nast A, Ochsendorf F, Petry U, Potthoff A, Prange H, Rieg S, Schneede P, Sing A, Weber J, Wichelhaus TA, Brockmeyer N. S2k-Leitlinie* „Diagnostik und Therapie der Syphilis“ - Kurzfassung S2k guideline* “Diagnosis and therapy of syphilis” -- short version. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12574_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Helmut Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum der Goethe-Universität; Theodor-Stern-Kai 7 60590 Frankfurt am Main
| | - Tobias Weberschock
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum der Goethe-Universität; Theodor-Stern-Kai 7 60590 Frankfurt am Main
- Ar-beitsgruppe EbM Frankfurt, Institut für Allgemeinmedizin; Goethe-Universität; Theodor-Stern-Kai 7 60590 Frankfurt am Main
| | | | - Viviane Bremer
- Abteilung für Infektionsepidemiologie; Robert Koch-Institut; Seestraße 10 13353 Berlin
| | - Andreas Dreher
- Ar-beitsgruppe EbM Frankfurt, Institut für Allgemeinmedizin; Goethe-Universität; Theodor-Stern-Kai 7 60590 Frankfurt am Main
| | - Martin Enders
- Labor Prof. Gisela Enders & Kolle-gen MVZ; Rosenbergstraße 85 70193 Stuttgart
| | - Stefan Esser
- Klinik für Dermatologie und Venerologie; Universitätsklinikum Essen; Hufelandstraße 55 45147 Essen
| | - Osama Hamouda
- Abteilung für Infektionsepidemiologie; Robert Koch-Institut; Seestraße 10 13353 Berlin
| | | | - Werner Handrick
- Institut für Medizinische Diagnostik; Am Kleistpark 1 15230 Frankfurt (Oder)
| | - Walter Krause
- Klinik für Dermatologie und Allergologie Universitätsklinikum Gießen und Marburg; Standort Marburg 35033 Marburg
| | - Christoph Mayr
- Medizinisches Versorgungszentrum Ärzteforum Seestraße; Seestraße 64 13347 Berlin
| | | | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Kli-nik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Charitéplatz 1 10117 Berlin
| | - Falk Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum der Goethe-Universität; Theodor-Stern-Kai 7 60590 Frankfurt am Main
| | - Ulrich Petry
- Frauenklinik, Klinikum der Stadt Wolfs-burg; Sauerbruchstraße 7 38440 Wolfsburg
| | - Anja Potthoff
- Fachklinikum Borkum, Haut-klinik; Jann-Berghaus-Straße 49 26757 Borkum
| | - Hilmar Prange
- Neurologische Universi-tätsklinik Göttingen; Robert Koch-Straße 40 37075 Göttingen
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University; Center for Infectious Diseases & Travel Medicine, and IFB-Center for Chronic Immunodefciency, University Hospital; Hugstetter Straße 55 79106 Freiburg
| | - Peter Schneede
- Urologische Klinik, Klinikum Memmingen; Bismarckstraße 23 87700 Memmingen
| | - Andreas Sing
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LG-L); Veterinärstraße 2 85764 Oberschleißheim
| | - Jörg Weber
- Neurologische Abteilung, Kli-nikum Klagenfurt; St. Veiterstraße 47 9020 Klagenfurt Österreich
| | - Thomas A. Wichelhaus
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene; Universitätsklinikum der Goethe-Universität; Paul-Ehrlich-Straße 40 60596 Frankfurt am Main
| | - Norbert Brockmeyer
- Ruhr Universität Bochum, Klinik für Dermatologie, Venerologie und Allergologie; Zentrum für sexuelle Gesundheit und Medizin; St. Joseph-Hospital Bochum; Gu-drunstraße 56 44791 Bochum
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Abstract
A review article is addressed the issue of the diagnosis and treatment of neurosyphilis that is developing against the background of HIV-infection. HIV-infected patients are at higher risk of neurologic, ocular and auricular manifestation of syphilis as well as treatment failures and relapses. Diagnosis of neurosyphilis in HIV-positive patients is complicated because both infections cause similar changes in the cerebrospinal fluid (CSF). The effectiveness of neurosyphilis treatment in patients with HIV co-infection is difficult to estimate, since the normalization of their CSF goes slower comparing to HIV-negatives. The increase in incidence of syphilis and HIV co-infection is anticipated in the coming years. This necessitates a comprehensive study of the problem and requires the development of new approaches to neurosyphilis diagnosis and treatment in co-infected patients.
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Cresswell FV, Fisher M. Management of syphilis in HIV-positive individuals. Sex Health 2015; 12:135-40. [DOI: 10.1071/sh14168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022]
Abstract
Since the turn of the millennium a sustained outbreak of syphilis among men who have sex with men continues, approximately 20–50% of whom have concurrent HIV infection. In this paper we aim to explore the controversies that exist around the management of syphilis in HIV-positive individuals. Not only do HIV-positive people have different clinical manifestations of syphilis they have higher rates of asymptomatic neurological involvement, slower serological response to treatment and higher serological failure than HIV-negative individuals in most studies. Whether long-term clinical outcomes are different or affected by the antibiotic regimen selected remains to be established. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a dearth of randomised controlled trial data. International guidelines state that the antibiotic management of syphilis is the same regardless of HIV status, with early syphilis treated with a single dose of benzathine penicillin G 2.4mU intrmuscularly. In practice, however, the majority of surveyed clinicians do treat HIV-positive people with more intensive antibiotics suggesting a lack of faith in guidelines. Factors which appear to affect the likelihood of developing neurological disease include CD4+ count of <350 cells/μL, absence of antiretroviral therapy, rapid plasma regain (RPR) or venereal diseases reference laboratory titre (VDRL) >1 : 32, late-latent disease or lack of response to standard antibiotic treatment. We recommend a low-threshold for offering antibiotic treatment effective against neurosyphilis in HIV-positive people with syphilis, especially if they exhibit any of the above factors.
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Janier M, Hegyi V, Dupin N, Unemo M, Tiplica G, Potočnik M, French P, Patel R. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2014; 28:1581-93. [PMID: 25348878 DOI: 10.1111/jdv.12734] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/04/2014] [Indexed: 12/30/2022]
Affiliation(s)
- M. Janier
- STD Clinic; Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph; Paris France
| | - V. Hegyi
- Department of Pediatric Dermatovenereology; Comenius University; Bratislava Slovak Republic
| | - N. Dupin
- Syphilis National Reference Center; Hôpital Tarnier-Cochin; AP-HP; Paris France
| | - M. Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections; Department of Laboratory Medicine; Microbiology; Örebro University Hospital; Örebro Sweden
| | - G.S. Tiplica
- 2nd Dermatological Clinic; Carol Davila University; Colentina Clinical Hospital; Bucharest Romania
| | - M. Potočnik
- Department of Dermatovenereology; University Medical Centre; Ljubljana Slovenia
| | - P. French
- Central and North West London NHS Trust and University College; London UK
| | - R. Patel
- Department of Genitourinary Medicine; the Royal South Hants Hospital; Southampton UK
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Tsai JC, Lin YH, Lu PL, Shen NJ, Yang CJ, Lee NY, Tang HJ, Liu YM, Huang WC, Lee CH, Ko WC, Chen YH, Lin HH, Chen TC, Hung CC. Comparison of serological response to doxycycline versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients: a multi-center observational study. PLoS One 2014; 9:e109813. [PMID: 25310367 PMCID: PMC4195693 DOI: 10.1371/journal.pone.0109813] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While doxycycline is recommended as an alternative treatment of syphilis in patients with penicillin allergy or intolerance, clinical studies to compare serological response to doxycycline versus benzathine penicillin in treatment of early syphilis among HIV-infected patients remain sparse. METHODS We retrospectively reviewed the medical records of HIV-infected patients with early syphilis who received doxycycline 100 mg twice daily for 14 days (doxycycline group) and those who received 1 dose of benzathine penicillin (2.4 million units) (penicillin group) between 2007 and 2013. Serological responses defined as a decline of rapid plasma reagin titer by 4-fold or greater at 6 and 12 months of treatment were compared between the two groups. RESULTS During the study period, 123 and 271 patients in the doxycycline and penicillin group, respectively, completed 6 months or longer follow-up. Ninety-one and 271 patients in the doxycycline and penicillin group, respectively, completed 12 months or longer follow-up. Clinical characteristics were similar between the two groups, except that, compared with penicillin group, doxycycline group had a lower proportion of patients with secondary syphilis (65.4% versus 41.5%, P<0.0001) and a higher proportion of patients with early latent syphilis (25.3% versus 49.6%, P<0.0001). No statistically significant differences were found in the serological response rates to doxycycline versus benzathine penicillin at 6 months (63.4% versus 72.3%, P = 0.075) and 12 months of treatment (65.9% versus 68.3%, P = 0.681). In multivariate analysis, secondary syphilis, but not treatment regimen, was consistently associated with serological response at 6 and 12 months of follow-up. CONCLUSIONS The serological response rates to a 14-day course of doxycycline and a single dose of benzathine penicillin were similar in HIV-infected patients with early syphilis at 6 and 12 months of follow-up. Patients with secondary syphilis were more likely to achieve serological response than those with other stages.
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Affiliation(s)
- Jen-Chih Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, Tzu-Chi Hospital and Tzu-Chi University College of Medicine, Hua-Lien, Taiwan
| | - Yu-Huei Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ni-Jiin Shen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yuag-Meng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Chi Huang
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
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Hepatic Lesions with Secondary Syphilis in an HIV-Infected Patient. Case Rep Med 2014; 2014:604794. [PMID: 25349616 PMCID: PMC4202275 DOI: 10.1155/2014/604794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Syphilis among HIV-infected patients continues to be a public health concern, especially in men who have sex with men. The clinical manifestations of syphilis are protean; syphilitic hepatitis is an unusual complication that can occur at any stage of the disease. We report a case of an HIV-infected male who presented with systemic symptoms and liver lesions highly suggestive of lymphoma and was proven to have syphilitic hepatitis by liver biopsy. Our case reinforces the importance of recognizing syphilis as a possible cause of unexplained abnormal liver enzymes and/or hepatic lesions in HIV-infected patients.
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Sharma C, Nath K, Kumawat BL, Khandelwal D, Jain D. Erb's paraplegia with primary optic atrophy: Unusual presentation of neurosyphilis: Case report and review of literature. Ann Indian Acad Neurol 2014; 17:231-3. [PMID: 25024583 PMCID: PMC4090858 DOI: 10.4103/0972-2327.132648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/07/2013] [Accepted: 02/12/2014] [Indexed: 11/27/2022] Open
Abstract
Symptomatic neurosyphilis (NS) can have varied syndromic presentations: Meningitis, meningovascular and parenchymatous involvement. Non-tabetic syphilis affecting the spinal cord is rare and only sporadic case reports have been published. The variant of meningomyelitis known as Erb's paraplegia refers to patients of spinal syphilis with very slow progression over many years and predominantly motor signs. Primary optic atrophy occurs twice as frequently in tabes dorsalis as in other types of NS. We describe here a case of a 32-year-old truck driver who presented with Erb's paraplegia with primary optic atrophy. This clinical overlap in NS is extremely rare and to our knowledge is the first case report of its type.
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Affiliation(s)
- Chandramohan Sharma
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Kunal Nath
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Banshi Lal Kumawat
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Dinesh Khandelwal
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Deepak Jain
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Triple Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a0ea85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
HIV and syphilis affect similar patient groups and coinfection is common. All patients presenting with syphilis should be offered HIV testing and vice versa. Syphilis can enhance the transmission of HIV. Detection and treatment of syphilis can probably help to reduce HIV transmission. Syphilis may present with atypical features in the HIV-positive patient, for example, there is a higher rate of asymptomatic primary syphilis, and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurologic and ophthalmic involvement. Diagnosis is generally made with serology, but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen, and alternative therapies should be used with caution. All HIV-positive patients should be considered for the evaluation of neurosyphilis. Relapse is a real concern and careful follow up is required. This review will explore the differences in clinical manifestations in HIV-coinfected individuals, and will discuss data to warrant different management in HIV-coinfected individuals.
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Affiliation(s)
- Usha Rani Karumudi
- Department of Infectious Diseases, SUNY-Downstate Health Science Center, Brooklyn, NY 11203, USA.
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Hamauchi A, Abe T, Nihira A, Mizobuchi M, Sako K, Ito T. [A case of cerebral syphilitic gumma mimicking a brain tumor]. Rinsho Shinkeigaku 2014; 54:738-742. [PMID: 25283829 DOI: 10.5692/clinicalneurol.54.738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of young immunocompetent woman who was presented with a left parieto-temporal mass as the first and single manifestation of syphilis. A 23 year-old woman with no significant past medical history was reffered to our hospital due to 3 month history of headache. She had a single unprotected sexual intercourse with a promiscuous man 6 month before the time of admission. Physical and neurological examinations revealed no obvious abnormalities. A brain tumor was firstly suggested according to the findings of brain magnetic resonance imaging (MRI). However, the serologic and cerebrospinal fluid test of syphilis proved to be positive, syphilitic gumma was most likely suspected. She responded dramatically to benzylpenicillin potassium. Cerebral syphilitic gumma is a rare manifestations of the neurosyphilis. Treponemal invasion of the cerebrospinal fluid occurs in approximately 25 to 60% of patients after the infection, but most cases spend asymptomatic. Cerebral gumma should be considered in differential diagnosis of any intracranial mass lesions, even in the early syphilitic stages.
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Abstract
The agents of human treponematoses include four closely related members of the genus Treponema: three subspecies of Treponema pallidum plus Treponema carateum. T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.
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Affiliation(s)
- Lorenzo Giacani
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Pastuszczak M, Wojas-Pelc A. Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines. Postepy Dermatol Alergol 2013; 30:203-10. [PMID: 24278076 PMCID: PMC3834708 DOI: 10.5114/pdia.2013.37029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 01/15/2023] Open
Abstract
Syphilis continues to be an important epidemiologic problem. For a few years a steady increase in the incidence of this sexually transmitted disease has been observed. Advances in medical science obligate the doctor to use only such diagnostic and therapeutic approaches that are scientifically proven. Based on the European (IUSTI) and U.S. (CDC) guidelines, in this manuscript, we present some selected practical issues concerning diagnosis and treatment of syphilis. We truly hope that the present review will help all doctors taking care of syphilitic patients to systematize the current knowledge.
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Affiliation(s)
- Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland. Head: Prof. Anna Wojas-Pelc MD, PhD
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Psutka R, Dickson N, Azariah S, Coughlan E, Kennedy J, Morgan J, Perkins N. Enhanced surveillance of infectious syphilis in New Zealand sexual health clinics. Int J STD AIDS 2013; 24:791-8. [DOI: 10.1177/0956462413483251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following a rise in cases of infectious syphilis in New Zealand, national enhanced surveillance at sexual health clinics was initiated. All public sexual health clinics reported monthly on the number of cases seen, and completed a coded questionnaire on each case. Monthly reports to routine surveillance were compared and discrepancies reconciled. During 2011, 72 cases of infectious syphilis were reported. The majority (83%) were among men who have sex with men who were mainly infected in New Zealand and had an ethnic profile similar to all New Zealanders. Most heterosexual infections occurred overseas, among people of non-European non-Maori ethnicity. About half the cases had symptoms on presentation. Overall, 18% of men who have sex with men were HIV positive. Resurgent syphilis in New Zealand disproportionally affects men who have sex with men, amongst whom HIV is prevalent. Men who have sex with men should be aware of the risks and symptoms of syphilis and encouraged to have regular sexual health checks including serology testing. Control of syphilis should be included in the strategy to check HIV spread. Syphilis serology should continue to be part of routine immigration and antenatal screening, and where clinically indicated. Enhanced surveillance was easily initiated for an uncommon condition seen at sexual health clinics, and provided valuable information.
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Affiliation(s)
- Rebecca Psutka
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nigel Dickson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sunita Azariah
- Auckland Sexual Health Service, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Edward Coughlan
- Christchurch Sexual Health Service, Addington, Christchurch, New Zealand
| | - Jane Kennedy
- Wellington Sexual Health Service, Te Aro, Wellington, New Zealand
| | - Jane Morgan
- Hamilton Sexual Health, Hamilton, New Zealand
| | - Nicky Perkins
- Auckland Sexual Health Service, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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