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Zhang Q, Peng L, Yuan Y, Hu Z, Zeng Y, Zeng W, Chen J, Chen W, Liu P. High rates of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis co-infection in people with HIV: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2025; 44:1-15. [PMID: 39466544 DOI: 10.1007/s10096-024-04966-w] [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] [Received: 08/27/2024] [Accepted: 10/16/2024] [Indexed: 10/30/2024]
Abstract
PURPOSE People living with HIV (PWH) experience a disproportionate burden of sexually transmitted infections (STIs), leading to more severe health outcomes and increasing the risk of HIV transmission. The presence of untreated STIs can accelerate HIV disease progression, while HIV infection can complicate STI diagnosis and treatment. Despite this interconnectedness, comprehensive data on the global prevalence of specific STIs among PWH remain limited. This systematic review aims to synthesize existing data to provide a more accurate picture of the prevalence of co-infection with Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis in PWH, while also identifying critical knowledge gaps and informing future research priorities. METHODS We searched databases for eligible studies reporting the prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis among PWH, published from January 1, 2000, to February 1, 2023. From 22,290 identified articles, 127 independent studies meeting the inclusion criteria were included in this meta-analysis. RESULTS The overall global co-infection prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis in PWH, was 4.8% (95%CI: 4.7-5.0%), 0.8% (95%CI: 0.6-0.9%), 2.5% (95%CI: 2.2-2.7%), and 3.0% (95%CI: 2.7-3.3%), respectively. The global prevalence of these four STIs in PWH is high, especially in Africa and Southeast Asia and in MSM and TGW populations. Based on the subgroup analyses, we further found that there was a high prevalence of Treponema pallidum and Chlamydia trachomatis in Southeast Asia and a high infection of Trichomonas vaginalis in the whole of Africa. Treponema pallidum infection was more common in males than females, and Chlamydia trachomatis and Trichomonas vaginalis infections were more common in females than males. Besides, high infection rates of Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis were detected in men who have sex with men (MSM) + transgender women (TGW), while high infection rates of Trichomonas vaginalis were found in sex workers and pregnant women. CONCLUSION The study confirmed high prevalence of four sexually transmitted pathogens in PWH, noting regional, gender, and subpopulation-specific differences. It offered insights for targeted interventions and healthcare strategies. The research underscored the necessity for enhanced data collection and expanded screening/treatment for vulnerable populations and regions.
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Affiliation(s)
- Qinyi Zhang
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Linyuan Peng
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Yuan Yuan
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Zongnan Hu
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Ying Zeng
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Weijia Zeng
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Jiaxin Chen
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China
| | - Wenxin Chen
- Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hengyang, Hunan, 421001, China.
| | - Peng Liu
- Institute of Pathogenic Biology, Basic Medical School, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, Hengyang, Hunan, 421001, China.
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Yu LJ, Ji PS, Ren X, Wang YH, Lv CL, Geng MJ, Chen JJ, Tang T, Shan CX, Lin SH, Xu Q, Wang GL, Wang LP, Hay SI, Liu W, Yang Y, Fang LQ. Inter-city movement pattern of notifiable infectious diseases in China: a social network analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2025; 54:101261. [PMID: 39759426 PMCID: PMC11700286 DOI: 10.1016/j.lanwpc.2024.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 11/09/2024] [Accepted: 11/29/2024] [Indexed: 01/07/2025]
Abstract
Background Co-existence of efficient transportation networks and geographic imbalance of medical resources greatly facilitated inter-city migration of patients of infectious diseases in China. Methods To characterize the migration patterns of major notifiable infectious diseases (NIDs) during 2016-2020 in China, we collected migratory cases, who had illness onset in one city but were diagnosed and reported in another, from the National Notifiable Infectious Disease Reporting System, and conducted a nationwide network analysis of migratory cases of major NIDs at the city (prefecture) level. Findings In total, 2,674,892 migratory cases of NIDs were reported in China during 2016-2020. The top five diseases with the most migratory cases were hepatitis B, tuberculosis, hand, foot and mouth disease (HFMD), syphilis, and influenza, accounting for 79% of all migratory cases. The top five diseases with the highest proportions of migratory cases were all zoonotic or vector-borne (37.89%‒99.98%). The network analysis on 14 major diseases identified three distinct migration patterns, where provincial capitals acted as key node cities: short distance (e.g., pertussis), long distance (e.g., HIV/AIDS), and mixed (e.g., HFMD). Strong drivers for patient migration include population mobility and labor flow intensities between cities as well as the economic development level of the destination city. Interpretation Collaborative prevention and control strategies should target cities experiencing frequent patient migration and cater to unique migration patterns of each disease. Addressing disparity in healthcare accessibility can also help alleviate case migration and thereby reduce cross-regional transmission. Funding National Key Research and Development Program of China.
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Affiliation(s)
- Lin-Jie Yu
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
- Center for Disease Control and Prevention (Health Inspection Office) of Yuhang District, Hangzhou, Zhejiang, PR China
| | - Peng-Sheng Ji
- Department of Statistics, Franklin College of Arts and Science, University of Georgia, GA, United States
| | - Xiang Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Yan-He Wang
- The 968th Hospital of Joint Logistics Support Force of PLA, Jinzhou, Liaoning, PR China
| | - Chen-Long Lv
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Meng-Jie Geng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jin-Jin Chen
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Tian Tang
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Chun-Xi Shan
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Sheng-Hong Lin
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Qiang Xu
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Guo-Lin Wang
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Li-Ping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Simon I. Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Science, University of Georgia, GA, United States
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, PR China
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Zeng Q, Yang Y, Zhang L, Yan J, Wang J, Nie J, Wang Q, Luo Y, Li G. The impact of the National Syphilis Prevention Program on the prevalence of syphilis among people living with HIV in China: a systematic review and meta-analysis. J Int AIDS Soc 2025; 28:e26408. [PMID: 39763073 PMCID: PMC11705538 DOI: 10.1002/jia2.26408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION In 2010, China launched the 10-year National Syphilis Prevention and Control Program to curb the spread of syphilis by integrating syphilis screening and treatment with HIV services. Herein, we aimed to evaluate changes in the prevalence of syphilis among people living with HIV (PLHIV) in China. METHODS We conducted this systematic review and meta-analysis by searching the PubMed, Embase, Web of Science, China Biomedical Literature, China National Knowledge Infrastructure, Wanfang and CQVIP databases from inception to 1 June 2024 to obtain relevant articles. A total of 75 studies were ultimately included. We used a DerSimonian‒Laird random effects model to estimate the prevalence and 95% confidence interval of syphilis among PLHIV. RESULTS The overall prevalence of syphilis among PLHIV in China was 18.6% (95% CI 16.5-21.0). Regional differences (R2 = 15.29%) were observed in the prevalence rates: 22.2% (18.9-25.8) in the eastern region, 19.0% (15.1-23.8) in the central region and 14.0% (11.1-17.5) in the western region. The prevalence decreased from 22.8% (18.4-27.9) before 2010 to 17.0% (14.6-19.6) in 2010 and thereafter (R2 = 5.82%). Among PLHIV via homosexual transmission, the prevalence of syphilis was 24.9% (21.3-28.9), which significantly declined from 33.8% (27.5-40.8) to 21.4% (18.3-24.9) in 2010 and thereafter (R2 = 22.35%). The prevalence of syphilis was significantly higher in men living with HIV than in women living with HIV (pooled odds ratio 1.67, 95% CI 1.29-2.15), with the highest prevalence in the eastern region (2.55, 95% CI 1.80-3.59). DISCUSSION The prevalence of syphilis among PLHIV, particularly in cases of homosexual transmission, has declined. There was a correlation between the prevalence of syphilis and regional economic conditions, with a greater burden in developed eastern coastal areas. Additionally, the risk of syphilis differed across sexes, with men living with HIV having a higher risk. CONCLUSIONS There has been preliminary success in the control of syphilis among PLHIV, but there is still a long way to go to meet the WHO's 2030 syphilis prevention and control goal. Syphilis prevention measures should be integrated into broader health policies and development plans, particularly in high-burden regions and populations.
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Affiliation(s)
- Qingling Zeng
- Department of CardiovascularXinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yuhui Yang
- School of NursingArmy Medical UniversityChongqingChina
| | - Limin Zhang
- Department of CardiovascularXinqiao HospitalArmy Medical UniversityChongqingChina
| | - Jiangyu Yan
- Clinical Research CenterChongqing Public Health Medical CenterChongqingChina
| | - Jian Wang
- Center for Disease Control and Prevention of Central Theater Command of Chinese People's Liberation ArmyBeijingChina
| | - Jingmin Nie
- Department of Infectious DiseasePeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Qingmei Wang
- Department of Nursing, The First Medical CenterChinese PLA General HospitalBeijingChina
| | - Yu Luo
- School of NursingArmy Medical UniversityChongqingChina
| | - Gaoming Li
- Center for Disease Control and Prevention of Central Theater Command of Chinese People's Liberation ArmyBeijingChina
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Campo JJ, Romeis E, Oberai A, Pablo JV, Hung C, Teng AA, Shandling AD, Phan A, Haynes AM, Giacani L. A novel pan-proteome array for high-throughput profiling of the humoral response to Treponema pallidum. iScience 2024; 27:110618. [PMID: 39262771 PMCID: PMC11387709 DOI: 10.1016/j.isci.2024.110618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/08/2024] [Accepted: 07/26/2024] [Indexed: 09/13/2024] Open
Abstract
Given the resurgence of syphilis, research endeavors to improve current assays for serological diagnosis and management of this disease are a priority. A proteome-scale platform for high-throughput profiling of the humoral response to Treponema pallidum (T. pallidum) proteins during infection could identify antigens suitable to ameliorate the performance and capabilities of treponemal tests for syphilis. Additionally, because infection-induced immunity is partially protective, profiling the response to T. pallidum outer membrane proteins (OMPs) could help select vaccine candidates. Therefore, we developed a pan-proteome array (PPA) based on the Nichols and SS14 strain complete proteomes and used it to define the immunoglobulin M (IgM) and IgG humoral response to T. pallidum proteins in sera collected longitudinally from long-term infected rabbits and from rabbits that were infected, treated, and re-infected. We identified antigens that could facilitate early diagnosis and immunity to a core set of OMP that could explain protection upon reinfection.
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Affiliation(s)
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Amber Phan
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Reid GA, Halmagyi GM, Whyte C, McCluskey PJ. Ocular vs neurosyphilis. are they the same? A guide to investigation and management. Eye (Lond) 2024; 38:2337-2349. [PMID: 38914721 PMCID: PMC11306553 DOI: 10.1038/s41433-024-03150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/26/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
This article reviews key concepts in the epidemiology, clinical features, diagnosis and management of ocular syphilis. It is not a systematic review or meta-analysis, but highlights the critical clinical features and investigations in patients with ocular syphilis. It reviews the overlap and interplay between ocular and neuro syphilis and provides practical guidance to diagnose and manage patients with ocular syphilis.
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Affiliation(s)
- Gerard A Reid
- Ophthalmology Department, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Gabor Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, University of Sydney, Specialty of Neurology, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Claudia Whyte
- Department of Infectious Diseases Prince of Wales Hospital, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
| | - Peter J McCluskey
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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He L, Pan X, Yang J, Zheng J, Luo M, Cheng W, Chai C. Current syphilis infection in virally suppressed people living with HIV: a cross-sectional study in eastern China. Front Public Health 2024; 12:1366795. [PMID: 38962784 PMCID: PMC11220119 DOI: 10.3389/fpubh.2024.1366795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Background Antiretroviral therapy (ART) has been shown to reduce human immunodeficiency virus (HIV) viral replication and ultimately achieve viral suppression and eliminate HIV transmission. However, little is known about the impact of viral suppression on high-risk behaviors and sexually transmitted infections (STIs). Objective This study aimed to assess the rates of current syphilis infection in virally suppressed people living with HIV (PLWH) and whether with the duration of ART can reduce the current syphilis infection in eastern China. Method We conducted a cross-sectional survey of PLWH in Zhejiang Province, China, in 2022. PLWH who were on ART >6 months and were virally suppressed (viral load <50 copies/mL) were included in the study. Data were collected from the National Epidemiological Database of Zhejiang Province and all participants were tested for viral load and current syphilis. Multivariable logistic regression was used to identify risk factors associated with current syphilis infection. Result A total of 30,744 participants were included in the analysis. 82.7% of participants were male, the mean age was 44.9 ± 14.1 years, 84.9% had received ART in a hospital setting, the mean time on ART was 5.9 ± 3.1 years and 5.6% of participants were infected with current syphilis. Multivariable logistic regression showed that being male [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.69-2.66], high level of education (aOR: 1.23, 95% CI: 1.02-1.49), homosexual route of HIV infection (aOR: 1.80, 95% CI: 1.60-2.04), non-local registered residence (aOR: 1.29, 95% CI: 1.11-1.51), had history of STIs before HIV diagnosis (aOR: 1.95, 95 % CI: 1.75-2.18) and treatment provided by a municipal hospital (aOR: 2.16, 95% CI: 1.31-3.55) were associated with increased risk of current syphilis infection. Being married (aOR: 0.67, 95% CI: 0.58-0.76) was associated with a decreased risk of current syphilis infection. Conclusion Our findings revealed a high rate of current syphilis infection among virally suppressed PLWH in eastern China. Duration of ART did not reduce the prevalence of current syphilis infection. Targeted interventions to reduce current syphilis infection should be prioritized for subgroups at higher risk.
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Affiliation(s)
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Li J, Yang Y, Huang B, Zeng J. Epidemiological characteristics of syphilis in mainland China, 2004 to 2019. J Int Med Res 2024; 52:3000605241258465. [PMID: 38886868 PMCID: PMC11184993 DOI: 10.1177/03000605241258465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Syphilis is a globally prevalent sexually transmitted infection. This study aimed to elucidate the epidemiological characteristics of syphilis in China from 2004 to 2019. METHODS Incidence data for syphilis across 31 provinces in mainland China were obtained from the Data Center of China Public Health Science for the period from 2004 to 2019. Epidemiological methods and the Chi-squared test were used to analyze the temporal, regional, and disease stage distributions of syphilis. RESULTS In total, 5,527,399 syphilis cases were reported in China from 2004 to 2019, with an average annual prevalence of 25.7063 per 100,000 population and overall increasing trend. In terms of regional distribution, high-incidence provinces included Shanghai, Zhejiang, Fujian, Guangxi, Guangdong, Xinjiang, Ningxia, and Qinghai. The proportion of latent syphilis increased from 20.41% in 2004 to 82.95% in 2019, with an upward trend each year. CONCLUSIONS Syphilis incidence exhibited an overall increasing trend in China, and latent syphilis was predominant. Syphilis incidences considerably varied among regions, and syphilis was detected from coastal to inland provinces. Thus, syphilis prevention and control programs should be tailored according to the specific epidemiological characteristics of each region.
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Affiliation(s)
- Jingyi Li
- Department of Dermatology, Huizhou First Hospital, China
| | - Yuanchao Yang
- Department of Dermatology, Huizhou First Hospital, China
| | - Biran Huang
- Department of Dermatology, Huizhou First Hospital, China
| | - Jiaqi Zeng
- Department of Dermatology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), China
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Haynes AM, Konda KA, Romeis E, Siebert J, Vargas SK, Reyes Diaz M, Phan A, Caceres CF, Giacani L, Klausner JD. Evaluation of a minimal array of Treponema pallidum antigens as biomarkers for syphilis diagnosis, infection staging, and response to treatment. Microbiol Spectr 2024; 12:e0346623. [PMID: 38095465 PMCID: PMC10782976 DOI: 10.1128/spectrum.03466-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE This manuscript explores the host humoral response to selected antigens of the syphilis agent during infection to evaluate their potential use as diagnostic tests and markers for treatment.
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Affiliation(s)
- Austin M. Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Kelika A. Konda
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | | | - Silver K. Vargas
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Reyes Diaz
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Amber Phan
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Carlos F. Caceres
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, Harborview Medical Center, University of Washington, Seattle, Washington, USA
- Department of Global Health, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Jeffrey D. Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Shi Q, Liu WS, Liu F, Zeng YX, Chen SF, Chen KL, Yu JT, Huang YY. The Etiology of Rapidly Progressive Dementia: A 3-Year Retrospective Study in a Tertiary Hospital in China. J Alzheimers Dis 2024; 100:77-85. [PMID: 38848185 DOI: 10.3233/jad-240079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background Rapidly progressive dementia (RPD), characterized by a rapid cognitive decline leading to dementia, comprises a diverse range of disorders. Despite advancements in diagnosis and treatment, research on RPD primarily focuses on Western populations. Objective This study aims to explore the etiology and demographics of RPD in Chinese patients. Methods We retrospectively analyzed 323 RPD inpatients at Huashan Hospital from May 2019 to March 2023. Data on sociodemographic factors, epidemiology, clinical presentation, and etiology were collected and analyzed. Results The median onset age of RPD patients was 60.7 years. Two-thirds received a diagnosis within 6 months of symptom onset. Memory impairment was the most common initial symptom, followed by behavioral changes. Neurodegenerative diseases accounted for 47.4% of cases, with central nervous system inflammatory diseases at 30.96%. Autoimmune encephalitis was the leading cause (16.7%), followed by Alzheimer's disease (16.1%), neurosyphilis (11.8%), and Creutzfeldt-Jakob disease (9.0%). Alzheimer's disease, Creutzfeldt-Jakob disease, and frontotemporal dementia were the primary neurodegenerative causes, while autoimmune encephalitis, neurosyphilis, and vascular cognitive impairment were the main non-neurodegenerative causes. Conclusions The etiology of RPD in Chinese patients is complex, with neurodegenerative and non-neurodegenerative diseases equally prevalent. Recognizing treatable conditions like autoimmune encephalitis and neurosyphilis requires careful consideration and differentiation.
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Affiliation(s)
- Qin Shi
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
- Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
| | - Wei-Shi Liu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fang Liu
- Shandong Xiehe University, Jinan, Shandong, China
| | - Yi-Xuan Zeng
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shu-Fen Chen
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ke-Liang Chen
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Yuan Huang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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Tantalo LC, Lieberman NAP, Pérez-Mañá C, Suñer C, Vall Mayans M, Ubals M, González-Beiras C, Rodríguez-Gascón A, Canut A, González-Candelas F, Mueller J, Tapia K, Greninger AL, Giacani L, Mitjà O. Antimicrobial susceptibility of Treponema pallidum subspecies pallidum: an in-vitro study. THE LANCET. MICROBE 2023; 4:e994-e1004. [PMID: 37827185 PMCID: PMC10686905 DOI: 10.1016/s2666-5247(23)00219-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The increasing incidence of syphilis and the limitations of first-line treatment with penicillin, particularly in neurosyphilis, neonatal syphilis, and pregnancy, highlight the need to expand the therapeutic repertoire for effective management of this disease. We assessed the in-vitro efficacy of 18 antibiotics from several classes on Treponema pallidum subspecies pallidum (T pallidum), the syphilis bacteria. METHODS Using the in-vitro culture system for T pallidum, we exposed the pathogen to a concentration range of each tested antibiotic. After a 7-day incubation, the treponemal burden was evaluated by quantitative PCR targeting the T pallidum tp0574 gene. The primary outcome was the minimum inhibitory concentration (MIC) at which the quantitative PCR values were not significantly higher than the inoculum wells. We also investigated the susceptibility of macrolide-resistant strains to high concentrations of azithromycin, and the possibility of developing resistance to linezolid, a proposed candidate for syphilis treatment. FINDINGS Amoxicillin, ceftriaxone, several oral cephalosporins, tedizolid, and dalbavancin exhibited anti-treponemal activity at concentrations achievable in human plasma following regular dosing regimens. The experiments revealed a MIC for amoxicillin at 0·02 mg/L, ceftriaxone at 0·0025 mg/L, cephalexin at 0·25 mg/L, cefetamet and cefixime at 0·0313 mg/L, cefuroxime at 0·0156 mg/L, tedizolid at 0·0625 mg/L, spectinomycin at 0·1 mg/L, and dalbavancin at 0·125 mg/L. The MIC for zoliflodacin and balofloxacin was 2 mg/L. Ertapenem, isoniazid, pyrazinamide, and metronidazole had either a poor or no effect. Azithromycin concentrations up to 2 mg/L (64 times the MIC) were ineffective against strains carrying mutations associated to macrolide resistance. Exposure to subtherapeutic doses of linezolid for 10 weeks did not induce phenotypic or genotypic resistance. INTERPRETATION Cephalosporins and oxazolidinones are potential candidates for expanding the current therapeutic repertoire for syphilis. Our findings warrant testing efficacy in animal models and, if successful, clinical assessment of efficacy. FUNDING European Research Council.
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Affiliation(s)
- Lauren C Tantalo
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Nicole A P Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol, Badalona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Suñer
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Marti Vall Mayans
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Maria Ubals
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Camila González-Beiras
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology, and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain
| | - Andrés Canut
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain; Microbiology Service, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
| | - Fernando González-Candelas
- Joint Research Unit Infection and Public Health, FISABIO-Universitat de València, València, Spain; Institute for Integrative Systems Biology, Universitat de València-CSIC, Paterna, Spain; CIBER Epidemiology and Public Health, Madrid, Spain
| | - John Mueller
- Innoviva Specialty Therapeutics, Waltham, MA, USA
| | - Kenneth Tapia
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Oriol Mitjà
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya, Vic, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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11
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Zhang Y, Wang K, Zhu J, Wu J. A network suspected infectious disease model for the development of syphilis transmission from 2015 to 2021 in Hubei province, China. J Appl Microbiol 2023; 134:lxad311. [PMID: 38130214 DOI: 10.1093/jambio/lxad311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
AIMS Understanding the transmission mode of syphilis is essential to prevent and predict its future prevalence and to develop effective control measures. This study aimed to develop a network suspected infectious disease model to simulate the syphilis transmission. METHODS AND RESULTS The number of syphilis cases in Wuhan's Fourth Hospital, Hubei province, China, from October 2015 to July 2021 was collected. The simulation was carried out by interpersonal network-SI (suspected infectious) model based on temporal exponential family random graph models. Late latent syphilis and tertiary syphilis are predicted by December 2025. The validity of simulated value and real data was tested, including determination coefficient (R2), root means square error (RMSE), and means relative error (MRE). Moreover, we developed an online app that can more easily predict the number of syphilis infections in different scenarios by setting different parameters. Results showed that R2, RMSE, and MRE were 0.995, 36.19, and 6.31, respectively. Speed from latent infection to primary syphilis, primary syphilis to secondary syphilis, and susceptible group to latent infection decreased rapidly. The speed of transformation from secondary syphilis to early incubation period and early latent to late latent experienced a process from increase to decreased. Late latent to tertiary syphilis patients increased steadily. The number of late latent patients, early latent, invisible infection, primary syphilis, and secondary syphilis all increased at first and turn to decreased. However, tertiary syphilis continuously kept rising in the whole process. To better make use of the transmission model, an online application was developed (https://alanwu.shinyapps.io/MD-shiny/). CONCLUSIONS Based on the simulation that late latent and tertiary syphilis were steadily increasing, the prevention and treatment for syphilis were imperative.
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Affiliation(s)
- Yue Zhang
- School of Public Health, Department of Epidemiology, Shanxi Medical University, Key Laboratory of Coal Environmental Pathogenicity and Prevention, Ministry Education, Taiyuan 030001, China
| | - Kai Wang
- Department of Public Health, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Junjie Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Dali University, Dali 671000, China
| | - Jinyi Wu
- Department of Public Health, Wuhan Fourth Hospital, Wuhan 430000, China
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12
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Jingxian F, Yun W, Le W, Ke L, Yizhu C, Quan S, Feng W. Epidemiological characteristics and risk factors of syphilis among blood donors in Huzhou. Transfus Clin Biol 2023; 30:426-429. [PMID: 37604304 DOI: 10.1016/j.tracli.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To investigate the epidemiological characteristics and risk factors for syphilis in Huzhou City, and to provide data to support the design of more effective health counselling and screening measures for blood donors. METHODS A retrospective study was conducted to analyse the demographic characteristics and seropositivity of syphilis among blood donors from 2019 to 2021. The differences in the serological status of syphilis among different populations under different demographic factors were compared, and conditional logistic regression analysis was used to identify the risk factors for syphilis. RESULTS The seropositivity rate of syphilis among blood donors in Huzhou City was 133/100,000, which decreased year by year. There were significant differences in the syphilis seropositivity rate among different groups in terms of age, education level, occupation, household registration, marital status and blood donation history (P < 0.05). The multivariate logistic regression model showed that all six factors, including age, education level, occupation, household registration, marital status and blood donation history, had significant effects on syphilis infection (P < 0.01), with OR values and 95% CIs of 2. 387 (1.381-4.127), 3.607 (1.609-8.086), 2.784 (1.657-4.679), 5.074 (1.865-13.804), 11.177 (3.481-35.888), and 11.244 (3.940-32.091), respectively. CONCLUSION There is room for improvement in pre-donation health counselling and screening of high-risk populations. Timely monitoring and updating of demographic data for specific high-risk populations is essential.
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Affiliation(s)
| | - Wang Yun
- Huzhou Central Blood Station, China
| | - Wang Le
- Huzhou Central Blood Station, China
| | - Lv Ke
- Huzhou Central Blood Station, China
| | | | - Sun Quan
- Huzhou Central Blood Station, China
| | - Wang Feng
- Huzhou Central Blood Station, China.
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13
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Wu H, Xue M, Wu C, Lu Q, Ding Z, Wang X, Fu T, Yang K, Lin J. Scaling law characteristics and spatiotemporal multicomponent analysis of syphilis from 2016 to 2022 in Zhejiang Province, China. Front Public Health 2023; 11:1275551. [PMID: 37965512 PMCID: PMC10642232 DOI: 10.3389/fpubh.2023.1275551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
Background Syphilis has caused epidemics for hundreds of years, and the global syphilis situation remains serious. The reported incidence rate of syphilis in Zhejiang Province has ranked first in the province in terms of notifiable infectious diseases for many years and is the highest in China. This study attempts to use the scaling law theory to study the relationship between population size and different types of syphilis epidemics, while also exploring the main driving factors affecting the incidence of syphilis in different regions. Methods Data on syphilis cases and affected populations at the county level were obtained from the China Disease Control and Prevention Information System. The scaling relationship between different stages of syphilis and population size was explained by scaling law. The trend of the incidence from 2016 to 2022 was tested by the joinpoint regression. The index of distance between indices of simulation and observation (DISO) was applied to evaluate the overall performance of joinpoint regression model. Furthermore, a multivariate time series model was employed to identify the main driving components that affected the occurrence of syphilis at the county level. The p value less than 0.05 or confidence interval (CI) does not include 0 represented statistical significance for all the tests. Results From 2016 to 2022, a total of 204,719 cases of syphilis were reported in Zhejiang Province, including 2 deaths, all of which were congenital syphilis. Latent syphilis accounted for 79.47% of total syphilis cases. The annual percent change (APCs) of all types of syphilis, including primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis, were - 21.70% (p < 0.001, 95% CI: -26.70 to -16.30), -16.80% (p < 0.001, 95% CI: -20.30 to -13.30), -8.70% (p < 0.001, 95% CI: -11.30 to -6.00), -39.00% (p = 0.001, 95% CI: -49.30 to -26.60) and - 7.10% (p = 0.008, 95% CI: -11.20 to -2.80), respectively. The combined scaling exponents of primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis based on the random effects model were 0.95 (95% CI: 0.88 to 1.01), 1.14 (95% CI: 1.12 to 1.16), 0.43 (95% CI: 0.37 to 0.49), 0.0264 (95% CI: -0.0047 to 0.0575) and 0.88 (95% CI: 0.82 to 0.93), respectively. The overall average effect values of the endemic component, spatiotemporal component and autoregressive component for all counties were 0.24, 0.035 and 0.72, respectively. The values of the autoregressive component for most counties were greater than 0.7. The endemic component of the top 10 counties with the highest values was greater than 0.34. Two counties with value of the spatiotemporal component higher than 0.1 were Xihu landscape county and Shengsi county. From 2016 to 2022, the endemic and autoregressive components of each county showed obvious seasonal changes. Conclusion The scaling exponent had both temporal trend characteristics and significant heterogeneity in the association between each type of syphilis and population size. Primary syphilis and latent syphilis exhibited a linear pattern, secondary syphilis presented a superlinear pattern, and tertiary syphilis exhibited a sublinear pattern. This suggested that further prevention of infection and transmission among high-risk populations and improvement of diagnostic accuracy in underdeveloped areas is needed. The autoregressive components and the endemic components were the main driving factors that affected the occurrence of syphilis. Targeted prevention and control strategies must be developed based on the main driving modes of the epidemic in each county.
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Affiliation(s)
- Haocheng Wu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory for Vaccines and Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Ming Xue
- Hangzhou Centre for Disease Control and Prevention, Hangzhou, China
| | - Chen Wu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Qinbao Lu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Zheyuan Ding
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Xinyi Wang
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Tianyin Fu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Ke Yang
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Junfen Lin
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory for Vaccines and Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
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14
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Zhu Y, Lin S, Dong S, Zhang C, Shi L, Ren X, Li Z, Wang L, Fang L. Incidence and trends of 17 notifiable bacterial infectious diseases in China, 2004-2019. BMC Infect Dis 2023; 23:273. [PMID: 37131164 PMCID: PMC10152418 DOI: 10.1186/s12879-023-08194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Certain bacterial infectious diseases are categorized as notifiable infectious diseases in China. Understanding the time-varying epidemiology of bacterial infections diseases can provide scientific evidence to inform prevention and control measures. METHODS Yearly incidence data for all 17 major notifiable bacterial infectious diseases (BIDs) at the province level were obtained from the National Notifiable Infectious Disease Reporting Information System in China between 2004 and 2019. Of them 16 BIDs are divided into four categories, respiratory transmitted diseases (RTDs, 6 diseases), direct contact/fecal-oral transmitted diseases (DCFTDs, 3 diseases), blood-borne/sexually transmitted diseases (BSTDs, 2 diseases), and zoonotic and vector-borne diseases (ZVDs, 5 diseases), and neonatal tetanus is excluded in the analysis. We characterized the demographic, temporal, and geographical features of the BIDs and examined their changing trends using a joinpoint regression analysis. RESULTS During 2004‒2019, 28 779 thousand cases of BIDs were reported, with an annualized incidence rate of 134.00 per 100 000. RTDs were the most commonly reported BIDs, accounting for 57.02% of the cases (16 410 639/28 779 000). Average annual percent changes (AAPC) in incidence were - 1.98% for RTDs, - 11.66% for DCFTDs, 4.74% for BSTDs, and 4.46% for ZVDs. Females had a higher incidence of syphilis than males, and other BIDs were more commonly reported in males. Among 0-5-year-olds, the diseases with the largest increases in incidence were pertussis (15.17% AAPC) and scarlet fever (12.05%). Children and students had the highest incidence rates of scarlet fever, pertussis, meningococcal meningitis, and bacillary dysentery. Northwest China had the highest incidence of RTDs, while South and East China had the highest incidences of BSTDs. Laboratory confirmation of BIDs increased from 43.80 to 64.04% during the study period. CONCLUSIONS RTDs and DCFTDs decreased from 2004 to 2019 in China, while BSTDs and ZVDs increased during the same period. Great attention should be paid to BSTDs and ZVDs, active surveillance should be strengthened, and timely control measures should be adopted to reduce the incidence.
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Affiliation(s)
- Yuliang Zhu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China
- Central People's Hospital of Zhanjiang, Zhanjiang, China
- Field Epidemiology Training Program, China CDC, Beijing, China
| | - Shenghong Lin
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, China
| | - Shuaibing Dong
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive medicine, Beijing, China
| | - Cuihong Zhang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China
- Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Lusha Shi
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China
- Complex Systems Research Center, School of Mathematics Sciences, Shanxi University, Taiyuan, China
| | - Xiang Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China
| | - Liping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, China CDC, 155 Changbai Road, Changping District, Beijing, China.
| | - Liqun Fang
- The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, China.
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15
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Carter A, McManus H, Ward JS, Vickers T, Asselin J, Baillie G, Chow EPF, Chen MY, Fairley CK, Bourne C, McNulty A, Read P, Heath K, Ryder N, McCloskey J, Carmody C, McCormack H, Alexander K, Casey D, Stoove M, Hellard ME, Donovan B, Guy RJ. Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019. Med J Aust 2023; 218:223-228. [PMID: 36854387 PMCID: PMC10952992 DOI: 10.5694/mja2.51864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health. DESIGN, SETTING Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS). PARTICIPANTS First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019. MAIN OUTCOME MEASURES Positive infectious syphilis test rate; change in annual positive test rate. RESULTS 180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years. CONCLUSION The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.
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Affiliation(s)
- Allison Carter
- The Kirby InstituteSydneyNSW
- Australian Human Rights InstituteSydneyNSW
| | | | | | | | - Jason Asselin
- Centre for Population HealthBurnet InstituteMelbourneVIC
| | | | - Eric PF Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Marcus Y Chen
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
| | - Christopher K Fairley
- The Kirby InstituteSydneyNSW
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Christopher Bourne
- New South Wales Ministry of HealthSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
| | - Anna McNulty
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
- University of New South WalesSydneyNSW
| | - Phillip Read
- The Kirby InstituteSydneyNSW
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Kevin Heath
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Nathan Ryder
- Hunter New England Sexual Health Pacific ClinicNewcastleNSW
| | | | | | | | - Kate Alexander
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | - Dawn Casey
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | | | | | - Basil Donovan
- The Kirby InstituteSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
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Romeis E, Lieberman NAP, Molini B, Tantalo LC, Chung B, Phung Q, Avendaño C, Vorobieva A, Greninger AL, Giacani L. Treponema pallidum subsp. pallidum with an Artificially impaired TprK antigenic variation system is attenuated in the Rabbit model of syphilis. PLoS Pathog 2023; 19:e1011259. [PMID: 36940224 PMCID: PMC10063172 DOI: 10.1371/journal.ppat.1011259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/30/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The TprK protein of the syphilis agent, Treponema pallidum subsp. pallidum (T. pallidum), undergoes antigenic variation in seven discrete variable (V) regions via non-reciprocal segmental gene conversion. These recombination events transfer information from a repertoire of 53 silent chromosomal donor cassettes (DCs) into the single tprK expression site to continually generate TprK variants. Several lines of research developed over the last two decades support the theory that this mechanism is central to T. pallidum's ability for immune avoidance and persistence in the host. Structural and modeling data, for example, identify TprK as an integral outer membrane porin with the V regions exposed on the pathogen's surface. Furthermore, infection-induced antibodies preferentially target the V regions rather than the predicted β-barrel scaffolding, and sequence variation abrogates the binding of antibodies elicited by antigenically different V regions. Here, we engineered a T. pallidum strain to impair its ability to vary TprK and assessed its virulence in the rabbit model of syphilis. PRINCIPAL FINDINGS A suicide vector was transformed into the wild-type (WT) SS14 T. pallidum isolate to eliminate 96% of its tprK DCs. The resulting SS14-DCKO strain exhibited an in vitro growth rate identical to the untransformed strain, supporting that the elimination of the DCs did not affect strain viability in absence of immune pressure. In rabbits injected intradermally with the SS14-DCKO strain, generation of new TprK sequences was impaired, and the animals developed attenuated lesions with a significantly reduced treponemal burden compared to control animals. During infection, clearance of V region variants originally in the inoculum mirrored the generation of antibodies to these variants, although no new variants were generated in the SS14-DCKO strain to overcome immune pressure. Naïve rabbits that received lymph node extracts from animals infected with the SS14-DCKO strain remained uninfected. CONCLUSION These data further support the critical role of TprK in T. pallidum virulence and persistence during infection.
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Affiliation(s)
- Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Nicole A. P. Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Barbara Molini
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Lauren C. Tantalo
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Benjamin Chung
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Quynh Phung
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Carlos Avendaño
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
| | - Anastassia Vorobieva
- VIB-VUB Center for Structural Biology, VIB, Brussels, Belgium
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Romeis E, Lieberman NAP, Molini B, Tantalo LC, Chung B, Phung Q, Avendaño C, Vorobieva A, Greninger AL, Giacani L. Treponema pallidum subsp. pallidum with an Artificially Impaired TprK Antigenic Variation System is Attenuated in the Rabbit Model of Syphilis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.18.524629. [PMID: 36711914 PMCID: PMC9882362 DOI: 10.1101/2023.01.18.524629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The TprK protein of the syphilis agent, Treponema pallidum subsp. pallidum ( T. pallidum ), undergoes antigenic variation in seven discrete variable (V) regions via non-reciprocal segmental gene conversion. These recombination events transfer information from a repertoire of 53 silent chromosomal donor cassettes (DCs) into the single tprK expression site to continually generate TprK variants. Several lines of research developed over the last two decades support the theory that this mechanism is central to T. pallidum 's ability for immune avoidance and persistence in the host. Structural and modeling data, for example, identify TprK as an integral outer membrane porin with the V regions exposed on the pathogen's surface. Furthermore, infection-induced antibodies preferentially target the V regions rather than the predicted β-barrel scaffolding, and sequence variation abrogates the binding of antibodies elicited by antigenically different V regions. Here, we engineered a T. pallidum strain to impair its ability to vary TprK and assessed its virulence in the rabbit model of syphilis. Principal findings A suicide vector was transformed into the wild-type (WT) SS14 T. pallidum isolate to eliminate 96% of its tprK DCs. The resulting SS14-DC KO strain exhibited an in vitro growth rate identical to the untransformed strain, supporting that the elimination of the DCs did not affect strain viability in absence of immune pressure. In rabbits injected intradermally with the SS14-DC KO strain, generation of new TprK sequences was impaired, and the animals developed attenuated lesions with a significantly reduced treponemal burden compared to control animals. During infection, clearance of V region variants originally in the inoculum mirrored the generation of antibodies to these variants, although no new variants were generated in the SS14-DC KO strain to overcome immune pressure. Naïve rabbits that received lymph node extracts from animals infected with the SS14-DC KO strain remained uninfected. Conclusion These data further support the critical role of TprK in T. pallidum virulence and persistence during infection. Author Summary Syphilis is still endemic in low- and middle-income countries, and it has been resurgent in high-income nations, including the U.S., for years. In endemic areas, there is still significant morbidity and mortality associated with this disease, particularly when its causative agent, the spirochete Treponema pallidum subsp . pallidum ( T. pallidum ) infects the fetus during pregnancy. Improving our understanding of syphilis pathogenesis and T. pallidum biology could help investigators devise better control strategies for this serious infection. Now that tools to genetically manipulate this pathogen are available, we can engineer T. pallidum strains lacking specific genes or genomic regions known (or believed) to be associated with virulence. This approach can shed light on the role of the ablated genes or sequences in disease development using loss-of-function strains. Here, we derived a knockout (KO) T. pallidum mutant (SS14-DC KO ) impaired in its ability to undergo antigenic variation of TprK, a protein that has long been hypothesized to be central in evasion of the host immune response and pathogen persistence during infection. When compared to the WT isolate, which is still capable of antigenic variation, the SS14-DC KO strain is significantly attenuated in its ability to proliferate and to induce early disease manifestations in infected rabbits. Our results further support the importance of TprK antigenic variation in syphilis pathogenesis and pathogen persistence.
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Xie JW, Wang M, Zheng YW, Lin Y, He Y, Lin LR. Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis. Front Public Health 2023; 11:1105847. [PMID: 36817920 PMCID: PMC9932918 DOI: 10.3389/fpubh.2023.1105847] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Nontreponemal and treponemal tests for analyzing cerebrospinal fluid to confirm the existence of neurosyphilis have been widely used, so we aim to evaluate and compare their performance on the cerebrospinal fluid in the diagnosis of neurosyphilis. Methods We conducted a systematic literature search on five databases and utilized a bivariate random-effects model to perform the quantitative synthesis. Results Nontreponemal tests demonstrated a pooled sensitivity of 0.77 (95% CI: 0.68-0.83), a pooled specificity of 0.99 (95% CI: 0.97-1.00), and a summary AUC of 0.97 (95% CI: 0.95-0.98). The pooled sensitivity, pooled specificity, and summary AUC of treponemal tests were 0.95 (95% CI: 0.90-0.98), 0.85 (95% CI: 0.67-0.94), and 0.97 (95% CI: 0.95-0.98), respectively. The pooled specificity of all nontreponemal tests varied minimally (ranging from 0.97 to 0.99), with TRUST (0.83) having a higher pooled sensitivity than VDRL (0.77) and RPR (0.73). Among all treponemal tests, EIA has outstanding diagnostic performance with a pooled sensitivity of 0.99 and a pooled specificity of 0.98. Conclusion Nontreponemal tests exhibited a higher pooled specificity, and treponemal tests exhibited a higher pooled sensitivity in diagnosing neurosyphilis on cerebrospinal fluid. TRUST may be a satisfactory substitute for VDRL. EIA is a prospective diagnostic tool that deserves further study in the future. Our study may be useful to clinical laboratories in selecting appropriate serological tests on the cerebrospinal fluid for the diagnosis of neurosyphilis.
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Affiliation(s)
- Jia-Wen Xie
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Mao Wang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Ya-Wen Zheng
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yun He
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China,*Correspondence: Li-Rong Lin ✉
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Zhu X, Zhu Z, Gu L, Zhan Y, Gu H, Yao Q, Li X. Spatio-temporal variation on syphilis from 2005 to 2018 in Zhejiang Province, China. Front Public Health 2022; 10:873754. [PMID: 36117594 PMCID: PMC9480496 DOI: 10.3389/fpubh.2022.873754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023] Open
Abstract
Background Syphilis has spread throughout China, especially in Zhejiang Province which endangers the health and lives of people. However, the spatial and temporal epidemiological studies of syphilis in Zhejiang are not thorough enough. The temporal and spatial variation and the relevant factors of syphilis incidence should be analyzed for more effective prevention and control in Zhejiang, China. Methods Data on confirmed cases of syphilis in Zhejiang Province from 2005 to 2018 was used and the spatio-temporal distributions were described. The spatial autocorrelation analysis and SaTScan analysis were performed to identify spatio-temporal clusters. A Bayesian spatial Conditional Autoregression (CAR) model was constructed to explore the relationships between syphilis incidence and common social and natural indicators. Results 474,980 confirmed cases of syphilis were reported between 2005 and 2018 with a large peak in 2010. Farmers and unemployed people accounted for the largest proportion of confirmed cases. And the significant spatial clusters of syphilis were concentrated in the north of Zhejiang Province, especially in more economically developed regions. Seven spatio-temporal clusters were identified and the main three high-risk areas were located in Hangzhou (RR = 1.62, P < 0.05), Zhoushan and Ningbo (RR = 1.99, P < 0.05), and Lishui (RR = 1.68, P < 0.05). The findings showed that the morbidity of syphilis was positively correlated with the Gross Domestic Product (GDP) per capita, the number of health technicians per 10,000 people, the proportion of the elderly and air temperature were negatively correlated with the proportion of the urban population, the proportion of men and precipitation. Conclusions The spatio-temporal analysis revealed that the prevalence of syphilis was still serious in Zhejiang Province. Syphilis high-risk areas were mainly located in the more developed coastal regions where more targeted intervention measures were required to be implemented. The study highlighted the need to strengthen Sexually Transmitted Diseases (STD) screening and health education for high-risk groups and improve the coverage of syphilis testing to reduce hidden syphilis cases.
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Affiliation(s)
- Xiaoxia Zhu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhixin Zhu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lanfang Gu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yancen Zhan
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Gu
- Center for Medical Science and Technology Education Development, Hangzhou, China
| | - Qiang Yao
- Department of Disease Prevention Control and Occupational Health, Zhejiang Provincial Health Commission, Hangzhou, China,*Correspondence: Xiuyang Li
| | - Xiuyang Li
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China,Qiang Yao
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20
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Wang R, Li X, Hu Z, Jing W, Zhao Y. Spatial Heterogeneity and Its Influencing Factors of Syphilis in Ningxia, Northwest China, from 2004 to 2017: A Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10541. [PMID: 36078254 PMCID: PMC9518519 DOI: 10.3390/ijerph191710541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Syphilis remains a growing and resurging infectious disease in China. However, exploring the influence of environmental factors on the spatiotemporal distribution of syphilis remains under explore. This study aims to analyze the spatiotemporal distribution characteristics of syphilis in Ningxia, Northwest China, and its potential environmental influencing factors. Based on the standardized incidence ratio of syphilis for 22 administrative areas in Ningxia from 2004 to 2017, spatiotemporal autocorrelation and scan analyses were employed to analyze the spatial and temporal distribution characteristics of syphilis incidence, while a fixed-effect spatial panel regression model identified the potential factors affecting syphilis incidence. Syphilis incidence increased from 3.78/100,000 in 2004 to 54.69/100,000 in 2017 with significant spatial clustering in 2007 and 2009-2013. The "high-high" and "low-low" clusters were mainly distributed in northern and southern Ningxia, respectively. The spatial error panel model demonstrated that the syphilis incidence may be positively correlated with the per capita GDP and tertiary industry GDP and negatively correlated with the number of health facilities and healthcare personnel. Sex ratio and meteorological factors were not significantly associated with syphilis incidence. These results show that the syphilis incidence in Ningxia is still increasing and has significant spatial distribution differences and clustering. Socio-economic and health-resource factors could affect the incidence; therefore, strengthening syphilis surveillance of migrants in the economically developed region and allocating health resources to economically underdeveloped areas may effectively help prevent and control syphilis outbreaks in high-risk cluster areas of Ningxia.
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Affiliation(s)
- Ruonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Xiaolong Li
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Zengyun Hu
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi 830011, China
| | - Wenjun Jing
- School of Statistics, Shanxi University of Finance and Economics, Taiyuan 030006, China
| | - Yu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
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Prevalence of Transfusion-Transmitted Infections (HCV, HIV, Syphilis and Malaria) in Blood Donors: A Large-Scale Cross-Sectional Study. Pathogens 2022; 11:pathogens11070726. [PMID: 35889972 PMCID: PMC9321235 DOI: 10.3390/pathogens11070726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022] Open
Abstract
Blood plays a major role in transmitting infectious diseases such as hepatitis C virus (HCV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), syphilis, malaria, and many others. Thus, this study sought to evaluate the distribution of HCV, HIV, syphilis, and malaria among blood donors in Yemen. This is a cross-sectional study, conducted on blood donors at the national center in Yemen. Blood donors’ specimens were serologically tested for the presence of anti-HCV and anti-HIV antibodies, as well as anti-Treponema pallidum, anti-Plasmodium falciparum, and anti-Plasmodium vivax. A total of 16,367 donors were included in this study. Based on the donor’s occupation, the study showed that the relative seroprevalence of anti-HCV Ab among the donors was statistically significant, and relatively high prevalence was found among military donors (2.8%). Positive HIV antibody tests were only reported in 33 male donors (0.2%), who were mostly manual workers. A remarkably high prevalence of anti-Treponema pallidum was observed among manual workers (3.1%). There was a statistically significant difference in the distribution of anti-malaria Ab based on residency and age groups. This study revealed that the prevalence of HCV, HIV, syphilis, and malaria among donors was 2.0%, 0.2%, 2.4%, and 0.7%, respectively. Further genotyping studies are necessary to provide a complete picture of the prevalence of transfusion-transmitted infections (TTIs).
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22
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Molini B, Fernandez MC, Godornes C, Vorobieva A, Lukehart SA, Giacani L. B-Cell Epitope Mapping of TprC and TprD Variants of Treponema pallidum Subspecies Informs Vaccine Development for Human Treponematoses. Front Immunol 2022; 13:862491. [PMID: 35422800 PMCID: PMC9001972 DOI: 10.3389/fimmu.2022.862491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Several recent studies have focused on the identification, functional analysis, and structural characterization of outer membrane proteins (OMPs) of Treponema pallidum (Tp). The Tp species encompasses the highly related pallidum, pertenue, and endemicum subspecies of this pathogen, known to be the causative agents of syphilis, yaws, and bejel, respectively. These studies highlighted the importance of identifying surface-exposed OMP regions and the identification of B-cell epitopes that could be protective and used in vaccine development efforts. We previously reported that the TprC and TprD OMPs of Tp are predicted to contain external loops scattered throughout the entire length of the proteins, several of which show a low degree of sequence variability among strains and subspecies. In this study, these models were corroborated using AlphaFold2, a state-of-the-art protein structure modeling software. Here, we identified B-cell epitopes across the full-length TprC and TprD variants using the Geysan pepscan mapping approach with antisera from rabbits infected with syphilis, yaws, and bejel strains and from animals immunized with refolded recombinant TprC proteins from three syphilis strains. Our results show that the humoral response is primarily directed to sequences predicted to be on surface-exposed loops of TprC and TprD proteins, and that the magnitude of the humoral response to individual epitopes differs among animals infected with various syphilis strains and Tp subspecies. Rather than exhibiting strain-specificity, antisera showed various degrees of cross-reactivity with variant sequences from other strains. The data support the further exploration of TprC and TprD as vaccine candidates.
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Affiliation(s)
- Barbara Molini
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Mark C. Fernandez
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Anastassia Vorobieva
- VIB-VUB Center for Structural Biology, VIB, Brussels, Belgium
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lorenzo Giacani
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
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23
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Li C, Liu J, Zhang Y, Lei H, Xu J, Rong Y. A Markov based model to estimate the number of syphilis cases among floating population. Infect Dis Model 2022; 7:243-251. [PMID: 35155876 PMCID: PMC8804260 DOI: 10.1016/j.idm.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Syphilis is a sexually transmitted disease that spreads widely around the world, infecting tens of millions of people every year. In China, syphilis not only causes more than 1 million infections every year, but also has its own characteristics in spreading pattern: this disease always spreads with the migration of floating population. There have been many related investigations and studies on the transmission of syphilis with the floating population in China, but the study of quantitative modeling in this field is very limited. In this paper, based on the Markov process model and datasets collected in Zhejiang Province, China, we construct a new model to analyze the transmission and immigration process of syphilis. The results show that immigrant patients are one of the sources of infection of syphilis in Zhejiang province, and the infection rate is remarkable which should not be ignored. By using the PRCC method to analyze the relationship between parameters and infected cases, we also find two main effective measures that can control the spread of syphilis and reduce the infection rate: the self-attention of infected persons, and the use of sexual protection measures. With the increasing frequent exchanges of people among different countries and regions, studying the transmission of diseases with the floating populations has become more and more important. The method we use in this paper gives a new insight studying this issue, providing a quantitative research method using the data of diagnosed cases. All the methods and models in this paper can be extendly used in the studies of other diseases where immigrant patients should be considered.
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24
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Wang C, Zhao P, Xiong M, Tucker JD, Ong JJ, Hall BJ, Sami M, Zheng H, Yang B. New Syphilis Cases in Older Adults, 2004-2019: An Analysis of Surveillance Data From South China. Front Med (Lausanne) 2021; 8:781759. [PMID: 34926524 PMCID: PMC8674684 DOI: 10.3389/fmed.2021.781759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period. Methods: Using 16 years of data (2004-2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15-49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends. Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7-18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late. Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infections (STI) Control, Guangzhou, China.,Sexually Transmitted Diseases (STD) Control Department, Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infections (STI) Control, Guangzhou, China.,Sexually Transmitted Diseases (STD) Control Department, Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Mingzhou Xiong
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infections (STI) Control, Guangzhou, China.,Sexually Transmitted Diseases (STD) Control Department, Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,School of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Brian J Hall
- Department of Global Public Health, New York University Shanghai, Shanghai, China.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mojgan Sami
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infections (STI) Control, Guangzhou, China.,Sexually Transmitted Diseases (STD) Control Department, Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infections (STI) Control, Guangzhou, China.,Sexually Transmitted Diseases (STD) Control Department, Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
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25
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Luo Z, Ding Y, Yuan J, Wu Q, Tian L, Zhang L, Li B, Mou J. Predictors of Seronegative Conversion After Centralized Management of Syphilis Patients in Shenzhen, China. Front Public Health 2021; 9:755037. [PMID: 34900903 PMCID: PMC8655675 DOI: 10.3389/fpubh.2021.755037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to explore the seronegative conversion status of syphilis patients after centralized management and to analyze potential determinants. Materials and Methods: A retrospective population-based cohort study was conducted, and data for individuals who had been diagnosed with syphilis between 2011 and 2019 were retrieved from the Shenzhen Nanshan Center for Chronic Disease Control. Seroconversion statuses were summarized as percentages. Univariable and multiple Cox proportional hazard regression models were used to analyze the factors associated with seronegative conversion among syphilis patients. Results: During the study period, 1,545 patients with syphilis participated in the syphilis convergence case management program on a voluntary basis, of whom 290 were excluded due to missing follow-up data. A total of 27.6% (346/1255) of patients with syphilis showed seronegative conversion. Multivariable analysis revealed that the following significantly determined syphilis seroconversion from positive to negative: younger age (15–19 years vs. ≥30 years: HR = 2.18), male gender (HR = 1.45), lower baseline toluidine red unheated serum test (TRUST) titer of ≤ 1:8 (HR = 2.23), and different disease stages, including latent syphilis (HR = 1.98), primary syphilis (HR = 7.67), and secondary syphilis (HR = 4.83). Conclusions: Few patients with syphilis tested negative after treatment at the end of the study. Seronegative conversion in the patients was associated with age, sex, baseline TRUST titer, and syphilis stage.
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Affiliation(s)
- Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yi Ding
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jun Yuan
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Qiuhong Wu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lishan Tian
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bo Li
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jinsong Mou
- Pingshan District Maternal and Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
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26
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Wan Z, Tao Y, Zhang H, Hu Y, Shu K. Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China. Int J STD AIDS 2021; 33:156-163. [PMID: 34704494 DOI: 10.1177/09564624211052184] [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: 11/16/2022]
Abstract
BACKGROUND There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China. METHODS A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis. RESULTS 1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93-1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51-3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21-0.61, p < .001). CONCLUSIONS Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.
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Affiliation(s)
- Zhihua Wan
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yuling Tao
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Huan Zhang
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yang Hu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Kuanyong Shu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
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Tang S, Shi L, Chen W, Zhao P, Zheng H, Yang B, Wang C, Ling L. Spatiotemporal distribution and sociodemographic and socioeconomic factors associated with primary and secondary syphilis in Guangdong, China, 2005-2017. PLoS Negl Trop Dis 2021; 15:e0009621. [PMID: 34383788 PMCID: PMC8407558 DOI: 10.1371/journal.pntd.0009621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 08/31/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies exploring the factors associated with the incidence of syphilis have mostly focused on individual-level factors. However, recent evidence has indicated that social-level factors, such as sociodemographic and socioeconomic factors, also affect the incidence of syphilis. Studies on the sociodemographic and socioeconomic factors associated with syphilis incidence are scarce, and they have rarely controlled for spatial effects, even though syphilis shows spatial autocorrelation. Methodology/Principal findings Syphilis data from 21 cities in Guangdong province between 2005 and 2017 were provided by the National Notifiable Infectious Disease Reporting Information System. The incidence time series, incidence map, and space-time scanning data were used to visualize the spatiotemporal distribution. The spatial panel data model was then applied to explore the relationship between sociodemographic factors (population density, net migration rate, male:female ratio, and the number of health institutions per 1,000 residents), socioeconomic factors (gross domestic product per capita, the proportion of secondary/tertiary industry), and the incidence of primary and secondary syphilis after controlling for spatial effects. The incidence of syphilis increased slowly from 2005 (11.91 per 100,000) to 2011 (13.42 per 100,000) and then began to decrease, reaching 6.55 per 100,000 in 2017. High-risk clusters of syphilis tended to shift from developed areas to underdeveloped areas. An inverted U-shaped relationship was found between syphilis incidence and gross domestic product per capita. Moreover, syphilis incidence was significantly associated with population density (β = 2.844, P = 0.006), the number of health institutions per 1,000 residents (β = -0.095, P = 0.007), and the net migration rate (β = -0.219, P = 0.002). Conclusions/Significance Our findings suggest that the incidence of primary and secondary syphilis first increase before decreasing as economic development increases further. These results emphasize the necessity to prevent syphilis in regions at the early stages of economic growth. Syphilis is a sexually transmitted infection that continues to cause morbidity and mortality worldwide. The primary and secondary stages of syphilis are the most transmissive stages in the entire process of the disease. We analyzed primary and secondary (P&S) syphilis data from 2005 to 2017 in Guangzhou, China, provided by the National Notifiable Infectious Disease Reporting Information System. The results showed that the annual incidence rates of P&S syphilis slightly increased from 2005 to 2011 and then began to decrease in 2017. Cases of P&S syphilis were spatially clustered. The high-risk syphilis clusters tended to shift from developed areas to underdeveloped areas. There may be an inverted U-shaped relationship between the level of economic development and the incidence of P&S syphilis, suggesting that the incidence of P&S syphilis first increased before decreasing as the level of economic development increased further. These results emphasize the necessity of preventing syphilis at locations in the early stage of economic growth. Investments in syphilis prevention education for people in regions at early development stages may mitigate the increasing cost of syphilis to future healthcare systems.
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Affiliation(s)
- Shangqing Tang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lishuo Shi
- Clinical Research Center, The sixth affiliated hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, Guangdong, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (CW); (LL)
| | - Li Ling
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (CW); (LL)
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28
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Huang L, Wu H, Yan H, Liang Y, Li Q, Shui J, Han Z, Tang S. Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China. Front Med (Lausanne) 2021; 8:662689. [PMID: 34307399 PMCID: PMC8293274 DOI: 10.3389/fmed.2021.662689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives: The objectives of this study were to distinguish the role of men who have sex with men (MSM) with or without syphilis testing in HIV-1 transmission and to provide molecular evidence of syphilis testing as a proxy marker for identifying the subgroup of MSM. Methods: HIV-1 transmission clusters were constructed by HIV-TRACE and Cluster Picker using HIV-1 pol sequences from 729 newly diagnosed HIV-infected MSM from 2008 to 2012 in Guangzhou, China. The role of MSM in HIV-1 transmission networks was determined by a node influence measurement and centrality analysis. The association between syphilis testing and factors related to HIV-1 transmission and antiretroviral treatment (ART) were analyzed by the Cox regression model. Results: Among HIV-infected MSM, 56.7% did not test for syphilis at the time of HIV-1 diagnosis. MSM without syphilis testing was a specific subgroup of MSM with a larger closeness centrality and clustering coefficient than the recipients of syphilis testing (P < 0.001), indicating their central position in the HIV-1 transmission networks. The median degree and radiality within HIV-1 transmission networks as well as the median K-shell scores were also greater for MSM without syphilis testing (P < 0.001), suggesting their relatively greater contribution in transmitting HIV-1 than the receipts of syphilis testing. MSM with syphilis testing usually did not disclose their occupation or were more likely to be unemployed or to take non-skilled jobs, to have a history of sexually transmitted infections (STIs), and to be AIDS patients when diagnosed with HIV-1 infection (P < 0.05). Multivariable Cox regression analysis indicated that syphilis testing per se did not promote the engagement of ART (P = 0.233) or affect the speed of CD4+ T cell count recovery after treatment (P = 0.256). Conclusions: Our study identifies syphilis testing as a proxy marker of a specific subgroup of HIV-infected MSM who refuse syphilis testing during HIV-1 diagnosis with an important role in HIV-1 transmission. Specific prevention and intervention targeting MSM without syphilis testing during HIV-1 care are urgently needed.
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Affiliation(s)
- Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hao Wu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huanchang Yan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhao Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qingmei Li
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhigang Han
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.,Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.,Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
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Romeis E, Tantalo L, Lieberman N, Phung Q, Greninger A, Giacani L. Genetic engineering of Treponema pallidum subsp. pallidum, the Syphilis Spirochete. PLoS Pathog 2021; 17:e1009612. [PMID: 34228757 PMCID: PMC8284648 DOI: 10.1371/journal.ppat.1009612] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/16/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Despite more than a century of research, genetic manipulation of Treponema pallidum subsp. pallidum (T. pallidum), the causative agent of syphilis, has not been successful. The lack of genetic engineering tools has severely limited understanding of the mechanisms behind T. pallidum success as a pathogen. A recently described method for in vitro cultivation of T. pallidum, however, has made it possible to experiment with transformation and selection protocols in this pathogen. Here, we describe an approach that successfully replaced the tprA (tp0009) pseudogene in the SS14 T. pallidum strain with a kanamycin resistance (kanR) cassette. A suicide vector was constructed using the pUC57 plasmid backbone. In the vector, the kanR gene was cloned downstream of the tp0574 gene promoter. The tp0574prom-kanR cassette was then placed between two 1-kbp homology arms identical to the sequences upstream and downstream of the tprA pseudogene. To induce homologous recombination and integration of the kanR cassette into the T. pallidum chromosome, in vitro-cultured SS14 strain spirochetes were exposed to the engineered vector in a CaCl2-based transformation buffer and let recover for 24 hours before adding kanamycin-containing selective media. Integration of the kanR cassette was demonstrated by qualitative PCR, droplet digital PCR (ddPCR), and whole-genome sequencing (WGS) of transformed treponemes propagated in vitro and/or in vivo. ddPCR analysis of RNA and mass spectrometry confirmed expression of the kanR message and protein in treponemes propagated in vitro. Moreover, tprA knockout (tprAko-SS14) treponemes grew in kanamycin concentrations that were 64 times higher than the MIC for the wild-type SS14 (wt-SS14) strain and in infected rabbits treated with kanamycin. We demonstrated that genetic manipulation of T. pallidum is attainable. This discovery will allow the application of functional genetics techniques to study syphilis pathogenesis and improve syphilis vaccine development. Syphilis is still an endemic disease in many low- and middle-income countries, and it has been resurgent in high-income nations for almost two decades. In endemic areas, syphilis causes significant morbidity and mortality, particularly when its causative agent, the spirochete Treponema pallidum subsp. pallidum (T. pallidum) is transmitted to the fetus during pregnancy. A better understanding of T. pallidum biology and syphilis pathogenesis would help devise better control strategies for this infection. One of the limitations associated with working with T. pallidum was our inability to genetically alter this pathogen to evaluate the function of genes encoding virulence factors or create attenuated strains that could be informative for vaccine development when studied using the rabbit model of the disease. Here, we report a transformation protocol that allowed us to replace a specific region of the T. pallidum genome containing a pseudogene (i.e., a non-functional gene) with a stably integrated kanamycin resistance gene. To our knowledge, this is the first-ever report of a method to achieve a genetically modified T. pallidum strain.
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Affiliation(s)
- Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Lauren Tantalo
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Nicole Lieberman
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Quynh Phung
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Alex Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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30
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Xie T, Wang G, Sun Q. Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys. J Multidiscip Healthc 2021; 14:853-860. [PMID: 33888989 PMCID: PMC8057824 DOI: 10.2147/jmdh.s305492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose Female sex workers play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, epidemic trends and risk factors for syphilis in Chinese female sex workers (FSWs) remain unclear. Methods Using convenient sampling methods, 2482 FSWs were interviewed and tested for syphilis from 2014 to 2019, all of them were divided into two groups of high-grade FSWs and low-grade FSWs according to service solicited and clients price there were. Demographic data were collected and logistic regression analysis was used to identify risk factors for syphilis. Results 43.67% of participants have received free condoms, 76.15% of them engaged in peer education of the 2482 FSWs tested for syphilis, 107 (4.31%) were positive. The prevalence of syphilis in high-grade FSWs was significantly lower than that in low-grade FSWs (3.14% and 5.62%, respectively).The overall prevalence of syphilis increased from 3.19% to4.47%. The percentage of FSWs received free condoms and engaged in peer education increased significantly. With upgraded awareness of syphilis, the number of FSWs having protected sex also increased significantly. It is also found that low-grade female sex workers are at greater risk of syphilis than those high-grade ones (odds ratio (OR) = 1.76, 95% CI 1.18–2.63, p < 0.05). Conclusion Great awareness of syphilis and the increased utilization of condom did not reduce the prevalence of syphilis, especially in low-grade FSWs group. More effective integrated interventions should be developed for such populations.
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Affiliation(s)
- Tiansheng Xie
- Zhejiang Sino-German Institute of Life Science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, Zhejiang, 310023, People's Republic of China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Guohua Wang
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
| | - Qiang Sun
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
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31
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Detection-Based Monetary Incentives to Improve Syphilis Screening Uptake: Results of a Pilot Intervention in a High Transmission Setting in Southern China. Sex Transm Dis 2021; 47:187-191. [PMID: 31842086 DOI: 10.1097/olq.0000000000001116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Underscreening of syphilis in clinical settings is a pervasive problem in resource-constrained settings where heavy patient loads and competing health priorities inhibit health providers' ability to meet screening coverage targets. A "detection-based" pay-for-performance (P4P) strategy can incentivize more targeted testing by rewarding providers with a monetary bonus for every confirmed case. METHODS Five clinics in a high transmission setting of China participated in the 6-month pilot intervention. Seropositive proportions during the P4P intervention were compared with those during the preintervention phase using multilevel logistic regression models adjusted for age and sex of clinic attendees. RESULTS There were 8423 patients that sought care at 1 of the 6 clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the preintervention interval (odds ratio, 1.33; 95% confidence interval, 1.14-1.56). Variability in clinic-level effects was substantial given the small number of sites of this pilot study. CONCLUSIONS Results of this detection-based P4P pilot study demonstrate the feasibility and preliminary effectiveness of this approach for improving syphilis case detection in resource-constrained clinical settings. A fully powered randomized trial is needed to inform the full utility of this approach for improving sexually transmitted disease detection globally.
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32
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Haynes AM, Fernandez M, Romeis E, Mitjà O, Konda KA, Vargas SK, Eguiluz M, Caceres CF, Klausner JD, Giacani L. Transcriptional and immunological analysis of the putative outer membrane protein and vaccine candidate TprL of Treponema pallidum. PLoS Negl Trop Dis 2021; 15:e0008812. [PMID: 33497377 PMCID: PMC7864442 DOI: 10.1371/journal.pntd.0008812] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/05/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background An effective syphilis vaccine should elicit antibodies to Treponema pallidum subsp. pallidum (T. p. pallidum) surface antigens to induce pathogen clearance through opsonophagocytosis. Although the combination of bioinformatics, structural, and functional analyses of T. p. pallidum genes to identify putative outer membrane proteins (OMPs) resulted in a list of potential vaccine candidates, still very little is known about whether and how transcription of these genes is regulated during infection. This knowledge gap is a limitation to vaccine design, as immunity generated to an antigen that can be down-regulated or even silenced at the transcriptional level without affecting virulence would not induce clearance of the pathogen, hence allowing disease progression. Principal findings We report here that tp1031, the T. p. pallidum gene encoding the putative OMP and vaccine candidate TprL is differentially expressed in several T. p. pallidum strains, suggesting transcriptional regulation. Experimental identification of the tprL transcriptional start site revealed that a homopolymeric G sequence of varying length resides within the tprL promoter and that its length affects promoter activity compatible with phase variation. Conversely, in the closely related pathogen T. p. subsp. pertenue, the agent of yaws, where a naturally-occurring deletion has eliminated the tprL promoter region, elements necessary for protein synthesis, and part of the gene ORF, tprL transcription level are negligible compared to T. p. pallidum strains. Accordingly, the humoral response to TprL is absent in yaws-infected laboratory animals and patients compared to syphilis-infected subjects. Conclusion The ability of T. p. pallidum to stochastically vary tprL expression should be considered in any vaccine development effort that includes this antigen. The role of phase variation in contributing to T. p. pallidum antigenic diversity should be further studied. Syphilis is still an endemic disease in many low- and middle-income countries and has been resurgent in high-income nations for almost two decades now. In endemic areas, syphilis still causes significant morbidity and mortality in patients, particularly when its causative agent, the bacterium Treponema pallidum subsp. pallidum is transmitted to the fetus during pregnancy. Although there are significant ongoing efforts to identify an effective syphilis vaccine to bring into clinical trials within the decade in the U.S., such efforts are partially hindered by the lack of knowledge on transcriptional regulation of many genes encoding vaccine candidates. Here, we start addressing this knowledge gap for the putative outer membrane protein (OMP) and vaccine candidates TprL, encoded by the tp1031 gene. As we previously reported for other putative OMP-encoding genes of the syphilis agent, tprL transcription level appears to be affected by the length of a homopolymeric sequence of guanosines (Gs) located within the gene promoter. This is a mechanism known as phase variation and often involved in altering the surface antigenic profile of a bacterial pathogen to facilitate immune evasion and/or adaptation to the host milieu.
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Affiliation(s)
- Austin M. Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Mark Fernandez
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Emily Romeis
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Oriol Mitjà
- Fight Aids and Infectious Diseases Foundation, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Kelika A. Konda
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- David Geffen School of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, United States of America
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
- School of Public Health and Administration “Carlos Vidal Layseca”, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Maria Eguiluz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano-Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, United States of America
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Tao Y, Chen MY, Tucker JD, Ong JJ, Tang W, Wong NS, Chu M, Zhuang X, Fairley CK, Zhang L. A Nationwide Spatiotemporal Analysis of Syphilis Over 21 Years and Implications for Prevention and Control in China. Clin Infect Dis 2021; 70:136-139. [PMID: 31237616 DOI: 10.1093/cid/ciz331] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/22/2019] [Indexed: 11/13/2022] Open
Abstract
Syphilis control programs have been scaled up due to the substantial burden in China. We analyzed syphilis incidence according to demographic, spatiotemporal, and economic factors. The increasing latent syphilis diagnoses and declining congenital syphilis suggest the effectiveness of scale-up screening. However, primary and secondary cases persist, especially in inland provinces.
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Affiliation(s)
- Yusha Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Jiangsu, People's Republic of China, Melbourne, Australia.,School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina.,University of North Carolina Project-China.,SESH (Social Entrepreneurship to Spur Health) Global, Guangzhou, Guangdong, People's Republic of China, London, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Weiming Tang
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina.,University of North Carolina Project-China.,SESH (Social Entrepreneurship to Spur Health) Global, Guangzhou, Guangdong, People's Republic of China, London, United Kingdom.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, Guangdong
| | - Ngai Sze Wong
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina.,University of North Carolina Project-China.,Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong
| | - Minjie Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Jiangsu, People's Republic of China, Melbourne, Australia
| | - Xun Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Jiangsu, People's Republic of China, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia.,Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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Syphilis infection and epidemiological characteristics in Haidian District, Beijing, China, 2013-2018. Public Health 2020; 190:62-66. [PMID: 33360028 DOI: 10.1016/j.puhe.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the epidemiological characteristics of syphilis between 2013 and 2018 in the Haidian District of Beijing in China. In addition, this study suggests potential strategies to control the spread of syphilis infection. STUDY DESIGN Observational study. METHODS Data were collected from the Infectious Disease Reporting System at medical institutions within the Haidian District of Beijing between 2013 and 2018. Epidemiological methods, combined with Chi-squared test, were used to analyse the distribution of syphilis in terms of time, region, population and development stage. RESULTS In total, 3048 patients with syphilis were reported in the Haidian District between 2013 and 2018, with an average annual prevalence of 14.26 per 100,000 population. The prevalence of syphilis was higher in rural than urban regions, and the sex ratio of male-to-female was 1.52:1. Patients aged 20-29 years accounted for 22.60% (689/3048) of the total cases. In terms of occupational distributions, the highest proportion (30.61%; 933/3048) was seen in individuals who were homemakers or unemployed. Latent syphilis was present in 66.83% (2037/3048) of patients and accounted for an increased proportion of syphilis cases each year. CONCLUSIONS Syphilis was epidemic in the Haidian District of Beijing between 2013 and 2018. High prevalence was seen in young and middle-aged males living in urban areas. The prevalence of syphilis has been increasing since 2016; thus, public health policies and intervention strategies need to be strengthened to curb the spread of infection.
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Zhang Y, Wang J, Wei Y, Liu H, Wu C, Qu B, Yan Y. CXCL13 concentration in latent syphilis patients with treatment failure. Open Med (Wars) 2020; 15:635-643. [PMID: 33336020 PMCID: PMC7712197 DOI: 10.1515/med-2020-0204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/15/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022] Open
Abstract
We aimed to investigate the CXCL13 concentration of the serum and cerebral spinal fluid (CSF) in human immunodeficiency virus (HIV)-negative latent syphilis patients with treatment failure and explore the change in CXCL13 after treatment. Sixty-eight latent syphilis patients with treatment failure (failure group), 68 syphilis patients with successful treatment (seroconversion group) and 18 patients with non-inflammatory diseases of the nervous system (control group) were included and serum and CSF were collected. Enzyme-linked immunosorbent assay was employed to detect the CXCL13 in the serum and CSF. Results showed that the serum CXCL13 concentration was comparable among three groups, and the CSF leukocyte count, IgG index and CXCL13 concentration in the failure group were significantly higher than those in the seroconversion group and control group (P < 0.05, P < 0.01). CSF CXCL13 concentration in the failure group was positively related to the CSF leukocyte count (r = 0.3594, P < 0.001). Of the 68 patients in the treatment failure group, neurosyphilis was found in 17 (25.0%). In conclusion, involvement of nervous system is one of the reasons for the treatment failure in patients with latent syphilis. Detection of CSF CXCL13 concentration is helpful for the diagnosis and therapeutic evaluation of HIV-negative latent syphilis patients with treatment failure and neurosyphilis.
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Affiliation(s)
- Yan Zhang
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Jun Wang
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Yingnan Wei
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Huili Liu
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Chunli Wu
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Bin Qu
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Yongxing Yan
- Department of Neurology, The Third people's Hospital of Hangzhou, Hangzhou, Zhejiang, China
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Weng C, Huang K, Jiang T, Zhou G, Wu T. Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report. Neurosurg Focus 2020; 47:E15. [PMID: 31370018 DOI: 10.3171/2019.5.focus1953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
A 45-year-old man was admitted with severe headache and left-sided weakness, which worsened over 1 week. Brain imaging revealed a small lesion close to the sagittal sinus in the right frontal lobe with severe perilesional edema and showed enhancement on both CT and MRI obtained with contrast. Serological findings were positive for toluidine red unheated serum test (TRUST) positivity and Treponema pallidum particle agglutination assay. The patient was first suspected of having a malignant brain tumor and subsequently received emergency craniotomy. Brain biopsy suggested a diagnosis of syphilitic cerebral gumma; meanwhile the postoperative CSF TRUST titer was positive, and the patient's improvement with high-dose intravenous aqueous crystalline penicillin further supported this etiology. Finally, the lesion on the right frontal lobe had disappeared during the follow-up imaging examination and the myodynamia of the left limbs gradually improved. The authors recommend that diagnostic penicillin treatment should be first implemented. When a patient's history, clinical manifestations, syphilis serology, CSF examination, and other physiological changes indicate a diagnosis of syphilitic cerebral gumma, there is no doubt that surgery should be performed in patients with acute intracranial hypertension, but unnecessary craniotomy should be avoided as far as possible.
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Affiliation(s)
- Chuanbo Weng
- 1Department of Neurosurgery, Fourth Affiliated Hospital of Anhui Medical University, Hefei
| | - Kebing Huang
- 2School of Neurosurgery, Anhui Medical University, Hefei
| | - Tao Jiang
- 1Department of Neurosurgery, Fourth Affiliated Hospital of Anhui Medical University, Hefei.,2School of Neurosurgery, Anhui Medical University, Hefei
| | - Gege Zhou
- 3Department of Pathology, Second Affiliated Hospital of Anhui Medical University, Hefei.,4Department of Pathology, People's Hospital of Ningguo; and
| | - Tingmiao Wu
- 5Department of Imaging, Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
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Xia W, Zhao J, Su B, Jiao Y, Weng W, Zhang M, Wang X, Guo C, Wu H, Zhang T, Gao Y, Li Z. Syphilitic infection impairs immunity by inducing both apoptosis and pyroptosis of CD4 + and CD8 + T lymphocytes. Innate Immun 2020; 27:99-106. [PMID: 32873094 PMCID: PMC7780356 DOI: 10.1177/1753425920952840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Syphilis is an important health problem worldwide; however, few studies have probed the impact of syphilitic infection on T cell turnover. The mechanisms behind the frequency of T cell subset changes and the associations between these subsets during syphilitic infection remain unclear. Herein, we used a cell-staining method and flow cytometry to explore changes in T cell subpopulations and potential contribution of apoptosis and pyroptosis that triggered therein. We investigated caspase-1-mediated pyroptosis and caspase-3-mediated apoptosis of CD4+ and CD8+ T cells, the major effector lymphocytes with pivotal roles in the pathogenesis of infectious diseases. We found that the levels of caspase-1 and caspase-3 increased in both the circulation and intracellularly in CD4+ and CD8+ T cells. Caspase-1 showed a continual increase from early latent stage infection through to phase 2 disease, whereas caspase-3 increased through to phase 1 disease but declined during phase 2. In addition, serum levels and intracellular expression of caspase-1 and caspase-3 were positively correlated. Overall, this study increases our understanding of how syphilitic infection influences CD4+ and CD8+ T-cell turnover, which may help with designing novel and effective strategies to control syphilis infection and prevent its transmission.
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Affiliation(s)
- Wei Xia
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Beijing Key Laboratory for HIV/AIDS Research, China
| | - Jinxue Zhao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, The First Hospital of Fangshan District, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Beijing Key Laboratory for HIV/AIDS Research, China
| | - Yanmei Jiao
- Treatment and Research Center for Infectious Diseases, the Fifth Medical Center of the General Hospital of PLA, China *Wei Xia and Jinxue Zhao contributed equally to the article
| | - Wenjia Weng
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, Beijing Youan Hospital, Capital Medical University, China
| | - Ming Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, Beijing Youan Hospital, Capital Medical University, China
| | - Xiaodan Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, Beijing Youan Hospital, Capital Medical University, China
| | - Caiping Guo
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Beijing Key Laboratory for HIV/AIDS Research, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Beijing Key Laboratory for HIV/AIDS Research, China
| | - Yanqing Gao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China.,Department of Dermatology, Beijing Youan Hospital, Capital Medical University, China
| | - Zaicun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, China
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Wong NS, Powers KA, Tucker JD, Lee SS, Goh BT, Zhao P, Chen L, Wang C, Yang LG, Yang B, Zheng H, Huang S, Mitchell KM. Modelling the impact of a sex work crackdown on syphilis transmission among female sex workers and their clients in South China. Sex Transm Infect 2020; 97:45-50. [PMID: 32769203 DOI: 10.1136/sextrans-2020-054497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the potential effects of an intense sex work crackdown on syphilis transmission in Guangdong Province, China. METHODS We developed a deterministic compartmental model of syphilis transmission among female sex workers (FSW) and their male clients in Guangdong Province, China. We based model assumptions on census data and scientific literature, and we fitted the model to sentinel surveillance estimates of syphilis prevalence (positive results in both treponemal and non-treponemal tests) among FSW between 2009 and 2013. We estimated the impact of an intense sex work crackdown in 2014 by comparing the number of new syphilis infections between 2014 and 2020 in crackdown versus basecase (no crackdown) scenarios. In modelling scenarios, we examined main crackdown mechanisms of impact, including changed number of FSW engaging in sex work, reduction of weekly transactions, condom usage rate and syphilis diagnosis rate. RESULTS In the basecase, predicted syphilis prevalence in FSW decreased from 2% in 2014 to 0.4% in 2020. In crackdown scenarios, syphilis incidence was predicted to transiently decrease and then to rebound relative to basecase levels a few years later. Shorter crackdowns led to higher, faster rebounds. CONCLUSIONS Short-term intense crackdowns may exacerbate syphilis transmission among FSW and further marginalise an already vulnerable group. This study provides a quantitative, infection-related basis for changing sex work policies to reduce harms.
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Affiliation(s)
- Ngai Sze Wong
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Project-China, Guangzhou, Guangdong Province, China.,Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Kimberly A Powers
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Project-China, Guangzhou, Guangdong Province, China.,SESH Global, Guangzhou, Guangdong, China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Beng Tin Goh
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Royal London Hospital, London, UK
| | - Peizhen Zhao
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lei Chen
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Gang Yang
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Yang
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Heping Zheng
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Shujie Huang
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China .,Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Kate M Mitchell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Identification of the Neuroinvasive Pathogen Host Target, LamR, as an Endothelial Receptor for the Treponema pallidum Adhesin Tp0751. mSphere 2020; 5:5/2/e00195-20. [PMID: 32238570 PMCID: PMC7113585 DOI: 10.1128/msphere.00195-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Treponema pallidum subsp. pallidum is the causative agent of syphilis, a human-specific sexually transmitted infection that causes a multistage disease with diverse clinical manifestations. Treponema pallidum undergoes rapid vascular dissemination to penetrate tissue, placental, and blood-brain barriers and gain access to distant tissue sites. The rapidity and extent of T. pallidum dissemination are well documented, but the molecular mechanisms have yet to be fully elucidated. One protein that has been shown to play a role in treponemal dissemination is Tp0751, a T. pallidum adhesin that interacts with host components found within the vasculature and mediates bacterial adherence to endothelial cells under shear flow conditions. In this study, we further explore the molecular interactions of Tp0751-mediated adhesion to the vascular endothelium. We demonstrate that recombinant Tp0751 adheres to human endothelial cells of macrovascular and microvascular origin, including a cerebral brain microvascular endothelial cell line. Adhesion assays using recombinant Tp0751 N-terminal truncations reveal that endothelial binding is localized to the lipocalin fold-containing domain of the protein. We also confirm this interaction using live T. pallidum and show that spirochete attachment to endothelial monolayers is disrupted by Tp0751-specific antiserum. Further, we identify the 67-kDa laminin receptor (LamR) as an endothelial receptor for Tp0751 using affinity chromatography, coimmunoprecipitation, and plate-based binding methodologies. Notably, LamR has been identified as a receptor for adhesion of other neurotropic invasive bacterial pathogens to brain endothelial cells, including Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, suggesting the existence of a common mechanism for extravasation of invasive extracellular bacterial pathogens.IMPORTANCE Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subsp. pallidum. The continued incidence of syphilis demonstrates that screening and treatment strategies are not sufficient to curb this infectious disease, and there is currently no vaccine available. Herein we demonstrate that the T. pallidum adhesin Tp0751 interacts with endothelial cells that line the lumen of human blood vessels through the 67-kDa laminin receptor (LamR). Importantly, LamR is also a receptor for meningitis-causing neuroinvasive bacterial pathogens such as Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae Our findings enhance understanding of the Tp0751 adhesin and present the intriguing possibility that the molecular events of Tp0751-mediated treponemal dissemination may mimic the endothelial interaction strategies of other invasive pathogens.
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The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China. Sci Rep 2020; 10:5472. [PMID: 32214152 PMCID: PMC7096386 DOI: 10.1038/s41598-020-62208-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 03/09/2020] [Indexed: 11/08/2022] Open
Abstract
The Spectrum-STI model, structured by sub-groups within a population, was used in a workshop in Yunnan, China, to estimate provincial trends in active syphilis in 15 to 49-year-old adults. Syphilis prevalence data from female sex workers (FSW), men who have sex with men (MSM), and lower-risk women and men in Yunnan were identified through literature searches and local experts. Sources included antenatal care clinic screening, blood donor screening, HIV/STI bio-behavioural surveys, sentinel surveillance, and epidemiology studies. The 2017 provincial syphilis prevalence estimates were 0.26% (95% confidence interval 0.17-0.34%) in women and 0.28% (0.20-0.36%) in men. Estimated prevalence was 6.8-fold higher in FSW (1.69% (0.68-3.97%) than in lower-risk women (0.25% (0.18-0.35%)), and 22.7-fold higher in MSM (5.35% (2.74-12.47%) than in lower-risk men (0.24% (0.17-0.31%). For all populations, the 2017 estimates were below the 2005 estimates, but differences were not significant. In 2017 FSW and MSM together accounted for 9.3% of prevalent cases. These estimates suggest Yunnan's STI programs have kept the overall prevalence of syphilis low, but prevalence remains high in FSW and MSM. Strengthening efforts targeting FSW and MSM, and identification of other risk populations e.g. among heterosexual men, are critical to reduce syphilis.
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Time series analysis and forecasting of chlamydia trachomatis incidence using surveillance data from 2008 to 2019 in Shenzhen, China. Epidemiol Infect 2020; 148:e76. [PMID: 32178748 PMCID: PMC7163807 DOI: 10.1017/s0950268820000680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chlamydia trachomatis (CT) infection has been a major public health threat globally. Monitoring and prediction of CT epidemic status and trends are important for programme planning, allocating resources and assessing impact; however, such activities are limited in China. In this study, we aimed to apply a seasonal autoregressive integrated moving average (SARIMA) model to predict the incidence of CT infection in Shenzhen city, China. The monthly incidence of CT between January 2008 and June 2019 in Shenzhen was used to fit and validate the SARIMA model. A seasonal fluctuation and a slightly increasing pattern of a long-term trend were revealed in the time series of CT incidence. The monthly CT incidence ranged from 4.80/100 000 to 21.56/100 000. The mean absolute percentage error value of the optimal model was 8.08%. The SARIMA model could be applied to effectively predict the short-term CT incidence in Shenzhen and provide support for the development of interventions for disease control and prevention.
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Jaiswal AK, Tiwari S, Jamal SB, de Castro Oliveira L, Alves LG, Azevedo V, Ghosh P, Oliveira CJF, Soares SC. The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis. BMC Genomics 2020; 21:33. [PMID: 31924165 PMCID: PMC6953169 DOI: 10.1186/s12864-019-6430-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/24/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that causes syphilis in human. Treponema pallidum subsp. endemicum (TEN) causes endemic syphilis (bejel); T. pallidum subsp. pallidum (TPA) causes venereal syphilis; T. pallidum subsp. pertenue (TPE) causes yaws; and T. pallidum subsp. Ccarateum causes pinta. Out of these four high morbidity diseases, venereal syphilis is mediated by sexual contact; the other three diseases are transmitted by close personal contact. The global distribution of syphilis is alarming and there is an increasing need of proper treatment and preventive measures. Unfortunately, effective measures are limited. RESULTS Here, the genome sequences of 53 T. pallidum strains isolated from different parts of the world and a diverse range of hosts were comparatively analysed using pan-genomic strategy. Phylogenomic, pan-genomic, core genomic and singleton analysis disclosed the close connection among all strains of the pathogen T. pallidum, its clonal behaviour and showed increases in the sizes of the pan-genome. Based on the genome plasticity analysis of the subsets containing the subspecies T pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue, we found differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) on subsp.-based study. CONCLUSIONS In summary, we identified four pathogenicity islands (PAIs), eight genomic islands (GIs) in subsp. pallidum, whereas subsp. endemicum has three PAIs and seven GIs and subsp. pertenue harbours three PAIs and eight GIs. Concerning the presence of genes in PAIs and GIs, we found some genes related to lipid and amino acid biosynthesis that were only present in the subsp. of T. pallidum, compared to T. pallidum subsp. endemicum and T. pallidum subsp. pertenue.
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Affiliation(s)
- Arun Kumar Jaiswal
- PG Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.,Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Sandeep Tiwari
- PG Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Syed Babar Jamal
- Department of Biological Sciences, National University of Medical Sciences, Abid Majeed Road, Rawalpindi, Punjab, 46000, Pakistan
| | - Letícia de Castro Oliveira
- PG Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.,Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Leandro Gomes Alves
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Vasco Azevedo
- PG Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA-23284, USA
| | - Carlo Jose Freira Oliveira
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Siomar C Soares
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.
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Lin P, Li Y, Tillman J. Guangdong Province: Trade Liberalization and HIV. HIV/AIDS IN CHINA 2020. [PMCID: PMC7120785 DOI: 10.1007/978-981-13-8518-6_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Guangdong experience is interesting as a case study, given its role as an economic hub, having attracted both domestic migrant workers, as well as people from abroad ever since the economic reforms of the late 1970s. The first Special Economic Zones were set up in Guangdong, due to its proximity to Hong Kong, most famously in the city of Shenzhen. The region has a prospering manufacturing industry, where both labor-intensive manufacturing products, as well as high-end technology products, are produced and assembled. Trade liberalization and rapid economic growth have also created a booming commercial sex industry and a situation where many economically-marginalized workers are migrating to the region. Here, we document the development of Guangdong’s HIV epidemic, which has grown dramatically from 1997 to 2017, and we describe epidemic response efforts in Guangdong over the same period.
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Chemaitelly H, Weiss HA, Smolak A, Majed E, Abu-Raddad LJ. Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics. J Glob Health 2019; 9:020408. [PMID: 31360448 PMCID: PMC6642815 DOI: 10.7189/jogh.09.020408] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown. OBJECTIVE To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an in-depth quantitative assessment. METHODS A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions. RESULTS One T. pallidum incidence study and 144 STI prevalence studies were identified for 45 812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI) = 8.5%-17.7%) for T. pallidum, 14.4% (95% CI = 8.2%-22.0%) for C. trachomatis, 5.7% (95% CI = 3.5%-8.4%) for N. gonorrhoeae, and 7.1% (95% CI = 4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI = 9.4%-16.6%) for T. pallidum, 80.3% (95% CI = 53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI = 10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI = 2.5-16.7) and 5-fold (AOR = 5.0; 95% CI = 2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR = 0.93; 95% CI = 0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence. CONCLUSIONS STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alex Smolak
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Elzahraa Majed
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Abstract
Syphilis, caused by the spirochete Treponema pallidum subspecies pallidum, continues to be a prevalent disease in low- and middle-income countries, and has reemerged in key populations, including men who have sex with men, in high-income nations. The rising number of cases shows that syphilis elimination will require augmentation of public health screening and treatment campaigns with syphilis vaccine development and implementation initiatives. Optimal vaccine candidates, deciphered from careful consideration of the pathogenic mechanisms used by T. pallidum, will need to be paired with appropriate human-track adjuvants designed to elicit the correlates of protection needed to prevent infection/disease. This article provides an overview of the development pipeline customized for a syphilis vaccine, including the preferred product characteristics, the investment case, and a proposed vaccinogen selection strategy outlining the essential qualities that need to be targeted by a syphilis vaccine.
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Evaluation of the Protective Ability of the Treponema pallidum subsp. pallidum Tp0126 OmpW Homolog in the Rabbit Model of Syphilis. Infect Immun 2019; 87:IAI.00323-19. [PMID: 31182617 DOI: 10.1128/iai.00323-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
In silico analyses of Treponema pallidum subsp. pallidum genomes and predicted proteomes to search for homologs of known bacterial outer membrane proteins (OMPs) led to the identification of tp0126 as a gene encoding a putative member of the OmpW family of porins/virulence factors. Our previous investigations on the role of Tp0126 in T. pallidum biology and syphilis pathogenesis showed that Tp0126 is fully conserved among T. pallidum strains and that transcription of tp0126 is driven by σ70 These initial results pointed to a housekeeping function for this protein. We also demonstrated that a guanosine homopolymer of various lengths located between the -10 and -35 consensus sequences in the tp0126 promoter modulates transcription consistently with phase variation, a mechanism that we also previously described for other T. pallidum genes encoding putative OMPs/virulence factors and that is often employed as a strategy for immune evasion. Circular dichroism spectra of recombinant Tp0126 also supported its structural homology with OmpW. Here we further investigated the humoral and cellular responses to Tp0126 during experimental and natural syphilis and the ability of Tp0126 to confer protection against syphilis in immunized rabbits. B-cell epitope mapping showed that compared to sera from experimentally infected animals, immunizations enhanced humoral immunity to sequences located in the putative Tp0126 surface-exposed loops, while phagocytosis assays showed that postimmunization sera opsonized T. pallidum Despite such promising results, no significant protection was seen following infectious challenge in immunized animals versus controls. Functional redundancy and phase variation might explain the lack of effectiveness of this vaccine candidate and/or design.
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Demographic characteristics of transfusion-transmitted infections among blood donors in China. BMC Infect Dis 2019; 19:514. [PMID: 31185990 PMCID: PMC6558676 DOI: 10.1186/s12879-019-4044-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Demographic characteristic surveillance of transfusion-transmitted infections (TTIs) among blood donors is crucial to formulating control strategies and preventing TTIs. This study aimed to investigate the demographic characteristics and social factors associated with TTIs among blood donors from 14 different blood centers or banks in China, covering almost the entire China. Methods Demographic information of 1976 blood donations were obtained from the donor databases of 14 blood centers. The results of the samples were confirmed by the National Center for Clinical Laboratories (NCCL). Results Of the 1976 donations, 928 were confirmed as TTI positive (HBV, 309; HCV, 162; HIV, 116; syphilis, 341), while 1048 tested negative. The differences in demographic distribution of TTI positive and negative donations regarding age, previous donation history, occupation, and education were statistically significant (p < 0.001). The factors mentioned above and marital status had associations with TTIs. Among the TTIs, only syphilis was related to ethnicity (adjusted odds ratio [aOR]: 2.309, 95% confidence interval [CI]: 1.378–3.868, p = 0.001), and only HBV positivity was not associated with marital status (HBV, aOR: 0.933, 95% CI: 0.670–1.299, p = 0.681). Gender and education were independent predictors of HIV and syphilis infections (p < 0.05). Conclusions Demographic characteristics in this study included age, gender, previous donation history, ethnicity, marital status, occupation, and education, some of which were associated with TTIs. The most susceptible populations for TTIs were unmarried males and first-time donors aged between 26 and 55 years, and blood donors who were workers or company employees with low-educational level. Timely surveillance and updated demographic data on blood donors are critical for blood safety.
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Liu H, Chen N, Yu J, Tang W, He J, Xiao H, Lin S, Hu F, Feng Q, Tucker JD, Xia H, Qiu X. Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment. BMC Infect Dis 2019; 19:292. [PMID: 30925908 PMCID: PMC6439997 DOI: 10.1186/s12879-019-3896-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Syphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy. The purpose of this study was to compare the frequency of adverse pregnancy outcomes among syphilis-seropositive women who received different treatment regimens at different times in Guangzhou, China. Methods Pregnant women with syphilis infection who received prenatal and delivery services in Guangzhou between January 2014 and December 2016 were included. Association between treatment status and the composite adverse outcomes (preterm birth, infant smaller than gestational age, stillbirth, and spontaneous abortion) was estimated. Results Of 1187 syphilis-seropositive pregnant women included in the analysis, 900 (75.8%) syphilis-seropositive pregnant women received treatment, and 287(24.2%) did not receive treatment. Adverse pregnancy outcomes were observed among 16.3% (147/900) of women with treatment and 33.8% (97/287) of women without treatment. Syphilis-seropositive pregnant women treated with one or two courses of penicillin had a similar risk of adverse pregnancy outcomes (adjusted RR = 1.36, 95% CI: 0.94–1.96). Adverse outcomes were more common among women whose non-treponemal serum test titer was >1:8 and received treatment after 28 weeks compared to before 28 weeks (adjusted RR = 2.34, 95% CI: 1.22–4.48). Conclusions Women who received one course of penicillin and women who received two courses of penicillin had a similar risk of adverse pregnancy outcomes. Syphilis treatment before 28 weeks of pregnancy is critical. Strategies to promote high-quality prenatal services are needed.
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Affiliation(s)
- Huihui Liu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Niannian Chen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Jia Yu
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Weiming Tang
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina, 27599, USA
| | - Jianrong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Huiyun Xiao
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Suifang Lin
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Fang Hu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Qiong Feng
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina, 27599, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Huimin Xia
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China. .,Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China. .,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China. .,Department of Obstetrics and Gynecology, Guangzhou Women and Children Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
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Parveen N, Fernandez MC, Haynes AM, Zhang RL, Godornes BC, Centurion-Lara A, Giacani L. Non-pathogenic Borrelia burgdorferi expressing Treponema pallidum TprK and Tp0435 antigens as a novel approach to evaluate syphilis vaccine candidates. Vaccine 2019; 37:1807-1818. [PMID: 30797635 DOI: 10.1016/j.vaccine.2019.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/16/2019] [Accepted: 02/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Syphilis is resurgent in many developed countries and still prevalent in developing nations. Current and future control campaigns would benefit from the development of a vaccine, but although promising vaccine candidates were identified among the putative surface-exposed integral outer membrane proteins of the syphilis spirochete, immunization experiments in the rabbit model using recombinant antigens have failed to fully protect animals upon infectious challenge. We speculated that such recombinant immunogens, purified under denaturing conditions from Escherichia coli prior to immunization might not necessarily harbor their original structure, and hypothesized that enhanced protection would result from performing similar immunization/challenge experiments with native antigens. METHODS To test our hypothesis, we engineered non-infectious Borrelia burgdorferi strains to express the tp0897 (tprK) and tp0435 genes of Treponema pallidum subsp. pallidum and immunized two groups of rabbits by injecting recombinant strains intramuscularly with no adjuvant. TprK is a putative integral outer membrane protein of the syphilis agent, while tp0435 encodes the highly immunogenic T. pallidum 17-kDa lipoprotein, a periplasmic antigen that was also shown on the pathogen surface. Following development of a specific host immune response to these antigens as the result of immunization, animals were challenged by intradermal inoculation of T. pallidum. Cutaneous lesion development was monitored and treponemal burden within lesions were assessed by dark-field microscopy and RT-qPCR, in comparison to control rabbits. RESULTS Partial protection was observed in rabbits immunized with B. burgdorferi expressing TprK while immunity to Tp0435 was not protective. Analysis of the humoral response to TprK antigen suggested reactivity to conformational epitopes. CONCLUSIONS Immunization with native antigens might not be sufficient to obtain complete protection to infection. Nonetheless we showed that non-infectious B. burgdorferi can be an effective carrier to deliver and elicit a specific host response to T. pallidum antigens to assess the efficacy of syphilis vaccine candidates.
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Affiliation(s)
- Nikhat Parveen
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, Newark, NJ 07103, United States
| | - Mark C Fernandez
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, United States
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, United States
| | - Rui-Li Zhang
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, United States; Department of Dermatology, Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, 214002 Wuxi, China
| | - B Charmie Godornes
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, United States
| | | | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, United States; Department of Global Health, University of Washington, Seattle, WA 98104, United States.
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