Resurgence of Syphilis in the United States: An Assessment of Contributing Factors

Dismantling Stereotypes About Being Top, Versatile, or Bottom: Sexual Minority Men's Anal Sex Position Identity as It Relates to Attraction, Sexual Behavior, and Anthropomorphic Characteristics

Many sexual minority men (SMM) use sex position self-labels, including "top," "bottom," "versatile," as well as combinations like "vers/top" and "vers/bottom" to describe engagement in anal intercourse. Despite the use of these labels, there is limited literature identifying various aspects that may impact SMM's chosen sex position label. The purpose of this study was to examine factors (i.e. sexual behavior, participants' anthropomorphic characteristics, and attraction to partners' attributes) associated with self-reported sex position label use. Participants (n = 4,802) were cisgender SMM from a U.S. nationwide cohort exploring missed opportunities for HIV prevention. The main analyses used iterative logistic regression models to predict self-reported sex position labels based on sexual behavior, participants' anthropomorphic characteristics, and attraction to partners' attributes. A higher proportion of participants identified as bottom/versatile (24%) followed by top/versatile (22.5%), versatile (20.3%), top (17.2%), and bottom (15.8%). Sexual attraction, behavior, and anthropomorphic characteristics poor-to-moderately predicted single sex position label categories. However, when considering near-adjacent sex positions (e.g. top/versatile as adjacent to top), model prediction improved substantially, indicating variability in self-labels and factors associated with each label. Sex positionality is complex and requires multidimensional measurement to fully understand this aspect of an individual's sexuality.

Syphilitic bi-valvular endocarditis and myocarditis: modern tools applied to long-forgotten complications of a re-emerging disease

The incidence of syphilis has increased steadily over the past 25 years. Undiagnosed cases have presumably increased in the same proportions, and rare complications are at particularly high risk of being unrecognised. A previously healthy 60-year-old man presented with rapidly progressive heart failure and severe aortic and mitral valve insufficiency, with direct valvular destruction and preservation of the aortic valve annulus and aortic root. Treponemal serology was reactive, with rapid plasma reagin titre of 1:128. The patient also had classic manifestations of tertiary syphilis: fusiform aneurysm of the aorta and meningovascular syphilis. He underwent bi-valvular and ascending aorta replacement, and the presence of Treponema pallidum was confirmed by specific immunohistochemistry and PCR in all tissues, including aortic and mitral valves, myocardium, and aorta. This case links T pallidum to infectious endocarditis with severe damage to both aortic and mitral valves, in addition to confirmed syphilitic myocarditis, a long-forgotten complication. It occurred 4 years after probable infection, long before what would be expected according to current understanding of its natural history. Syphilis serology should be considered in patients with culture-negative endocarditis as well as in those with heart failure or arrhythmias of unclear cause, especially in the presence of risk factors for syphilis. Syphilitic endocarditis and myocarditis are potentially lethal but treatable conditions.

'Unveiling the hidden threat: Delayed presentation of congenital syphilis'

Maternal and congenital syphilis are a major public health problem worldwide. The World Health Organization and Centre for Disease Control both recommend routine screening of pregnant females for syphilis. Despite guidelines in place, maternal syphilis often remains undiagnosed and untreated and there is currently a surge in cases of congenital syphilis. We present a case of a 3-month-old male illustrating a delayed diagnosis of congenital syphilis despite characteristic skin lesions, hepatosplenomegaly, haemolytic anaemia, failure to thrive and history of untreated syphilis in the mother. This case highlights the need to strengthen existing guidelines for intensive screening and early treatment for maternal syphilis. It also underscores the importance of increased awareness amongst paediatricians and dermatologists regarding overlapping clinical features of congenital syphilis.

Analysis of 2019 Ohio Disease Intervention Specialist Records for Syphilis Cases Using Clustering Algorithms

BACKGROUND

Developments in natural language processing and unsupervised machine learning methodologies (e.g., clustering) have given researchers new tools to analyze both structured and unstructured health data. We applied these methods to 2019 Ohio disease intervention specialist (DIS) syphilis records, to determine whether these methods can uncover novel patterns of co-occurrence of individual characteristics, risk factors, and clinical characteristics of syphilis that are not yet reported in the literature.

METHODS

The 2019 disease intervention specialist syphilis records (n = 1996) contain both structured data (categorical and numerical variables) and unstructured notes. In the structured data, we examined case demographics, syphilis risk factors, and clinical characteristics of syphilis. For the unstructured text, we applied TF-IDF (term frequency multiplied by inverse document frequency) weights, a common way to convert text into numerical representations. We performed agglomerative clustering with cosine similarity using the CLUTO software.

RESULTS

The cluster analysis yielded 6 clusters of syphilis cases based on patterns in the structured and unstructured data. The average internal similarities were much higher than the average external similarities, indicating that the clusters were well formed. The factors underlying 3 of the clusters related to patterns of missing data. The factors underlying the other 3 clusters were sexual behaviors and partnerships. Notably, 1 of the 3 consisted of individuals who reported oral sex with male or anonymous partners while intoxicated, and one comprised mainly of males who have sex with females.

CONCLUSIONS

Our analysis resulted in clusters that were well formed mathematically, but did not reveal novel epidemiological information about syphilis risk factors or transmission that were not already known.

Real-Time Linkage of Public-Facing Jail Registers and Syphilis Testing and Treatment Monitoring Data, Washington State, 2023-2024

Between June 22, 2023, and January 22, 2024, we implemented scripts to collect public-facing correctional facility rosters and used a matching algorithm to link these data to unresolved syphilis investigations in Washington state. We reviewed the results and sent alerts to the assigned disease intervention specialist. We captured data from 60 of Washington's 69 correctional facilities and linked 54 individuals to testing or treatment. Fifty-eight percent of individuals had been unlocated for 60 days or more and may not have been found otherwise. (Am J Public Health. 2025;115(3):282-286. https://doi.org/10.2105/AJPH.2024.307911).

Unraveling the resurgence of syphilis: a deep dive into the epidemic sweeping across the United States; a mini review

Syphilis, a resurging public health concern in the United States, has witnessed a staggering rise in cases over the past decade. This highly contagious sexually transmitted infection caused by Treponema pallidum presents significant challenges due to its infectious nature and potential for severe complications. Despite the successful syphilis elimination plan launched in the early 2000s, which showed a decline in syphilis cases in highly funded states, syphilis has rapidly reemerged, with incidence rates steadily climbing across many states. Transmitted through sexual contact and vertically from infected mothers to babies, syphilis progresses through distinct stages, each with varying symptoms and complications. Despite modern treatment availability such as the antibiotic benzathine penicillin G, cases often go undiagnosed until severe complications arise. Neurovascular and cardiovascular issues can result from untreated syphilis. The resurgence of syphilis is evident across demographics, with men, particularly men who have sex with men, and certain racial groups being disproportionately affected. Additionally, congenital syphilis cases have surged, leading to serious adverse outcomes for newborns. Public health initiatives must prioritize education, outreach, and preventive services tailored to high-risk populations. Partner notification, aided by technological advancements, is crucial for controlling transmission. Laboratories play a vital role in surveillance and disease monitoring. In conclusion, tackling syphilis resurgence demands a multifaceted approach addressing social, economic, and health care disparities. By implementing comprehensive public health strategies including enhanced screening and public awareness campaigns, the burden of syphilis and its associated adverse outcomes can be mitigated, safeguarding public health in the United States.

Secondary Syphilis Can Simultaneously Mimic Cholestatic Liver Injury and Glomerular Nephropathy

Syphilis, a disease affecting millions, still poses challenges for men who have sex with men in high-income countries and often presents in varying ways. It is exceedingly rare for syphilis to simultaneously cause an acute liver injury and nephropathy. This case describes the concomitant clinical presentation of these abnormalities and also describes a liver injury that mimicked cholestatic disease. Treatment of syphilis led to complete resolution of the liver and kidney injury. This case demonstrates a need to exclude syphilis in patients with high-risk behaviors who present with cholestatic liver injury in atypical fashions.

Rhegmatogenous Retinal Detachment in Syphilitic Uveitis: A Case Series and Comprehensive Review of the Literature

PURPOSE

Uveitis is the most common ocular manifestation of syphilis. However, an association between syphilitic uveitis and rhegmatogenous retinal detachment (RRD) is not widely recognized. We report a consecutive series of six new cases of syphilitic uveitis complicated by RRD and describe the typical characteristics, clinical course, and surgical management of such cases.

METHODS

Consecutive case series and comprehensive review of the literature.

RESULTS

We identified a total of 19 cases (23 eyes) with syphilitic uveitis subsequently complicated by RRD, including six new cases (seven eyes) reported here and 13 cases (16 eyes) previously reported in the literature. Fifteen patients (79%) were positive for human immunodeficiency virus (HIV) and not on combination antiretroviral therapy. Most retinal detachments developed within two months of uveitis presentation; retinal breaks were often found in areas of previous retinitis. Sixteen eyes (70%) were complicated by early proliferative vitreoretinopathy. Twenty-one eyes underwent surgical repair, of which six (26%) suffered re-detachment. Surgical management commonly involved pars-plana vitrectomy and silicone oil tamponade, with or without scleral buckling. Visual outcomes were generally poor: only six eyes (26%) attained visual acuity of 20/40 or better and 11 eyes (48%) remained 20/200 or worse.

CONCLUSIONS

Patients with syphilitic uveitis, as with viral retinitis, should be monitored closely for the development of retinal tears and RRD. A combination of pars plana vitrectomy with silicone oil tamponade and/or scleral buckle placement is a prudent surgical approach to most cases of syphilitic RRD, although visual prognosis remains guarded.

Disparities in Syphilis Trends and the Impact of the COVID-19 Pandemic: A Joinpoint Analysis of Florida Surveillance Data (2013-2022)

INTRODUCTION

Syphilis, a sexually transmitted infection caused by the bacterium ​​​​​​Treponema pallidum, has reemerged at an increasing rate globally in recent years, posing a significant public health concern. Visualizing and analyzing time series trends of syphilis across various demographics and geographic regions, and how syphilis trends varied during the pandemic coronavirus disease 2019 (COVID-19), would help public health policymakers develop targeted strategies and interventions to effectively address the rising rates of syphilis, ultimately improving overall public health outcomes.

METHODS

 A retrospective study was conducted using surveillance data on infectious syphilis cases reported to the Florida Department of Health, between 2013 and 2022. Age-standardized syphilis rates (ASSRs) per 100,000 persons were calculated using the 2000 U.S. standard population data. The average annual percentage change (AAPC) in the ASSRs was analyzed according to age, gender, race, geographic locations, and the COVID-19 pandemic period to quantify the epidemiological syphilis trends using joinpoint regression models.

RESULTS

 In Florida, the ASSR significantly increased from 8.65/100,000 in 2013 to 23.08/100,000 in 2022 across different demographic groups, with an overall AAPC of 11.47 (95% confidence interval (CI): 9.85-13.43). This increase in the AAPC was more pronounced in females (AAPC = 20.97; 95% CI, 18.61-24.49) than in males (AAPC = 10.34; 95% CI, 8.19-12.98). The increasing trends of infectious syphilis were observed across all age groups, with greater increases among those aged 25-49 years (AAPC = 12.32; 95% CI, 10.09-15.18), aged 50-69 years (AAPC = 13.42; 95% CI, 9.41-18.89), and aged over 70 years (AAPC = 13.63; 95% CI, 9.23-21.95), compared to those aged less than 24 years (AAPC = 7.86; 95% CI, 7.06-8.81). The increasing trends were comparable across racial groups, with an AAPC of 8.08 (95% CI, 5.47-11.15) for Hispanics, 11.84 (95% CI, 10.02-14.09) for non-Hispanic Whites, 10.49 (95% CI, 8.75-12.66) for non-Hispanic Blacks, and 11.29 (95% CI, 5.28-19.57) for non-Hispanic individuals of other races, respectively. The AAPC for the COVID-19 pandemic period was 12.99 (95% CI, 8.48-16.21), which was comparable to the pre-pandemic period (AAPC = 11.58; 95% CI, 10.17-12.76), indicating that this upward trend in infectious syphilis persisted throughout the COVID-19 pandemic. At the county level, over the 10-year period, the average ASSRs ranged from 0.89/100,000 in 2013 to 25.41/100,000 in 2022, with the estimated AAPCs varied from 2.47 (95% CI, -1.89 to 6.92) in Monroe County to 50.01 (95% CI, 37.71-62.27) in Okaloosa County.

CONCLUSIONS

 The trend of infectious syphilis increases substantially from 2013 to 2022, with notable differences observed among age, gender, and geographic regions in Florida. Females experienced a greater rise in infectious syphilis cases compared to males. This upward trend in infectious syphilis persisted throughout the COVID-19 pandemic. Efforts are needed to implement strategies to address the rising syphilis rates within high-incidence groups and communities across the state.

Syphilis Should not be Overlooked in any Individual, Irrespective of their Condition

Introduction

Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability.

Case description

We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient's pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis.

Conclusion

This case highlights the importance of considering syphilis as a potential diagnosis in individuals regardless of their medical history.

LEARNING POINTS

The incidence of syphilis cases is on the rise, presenting an ongoing challenge.Faced with atypical neurological symptomatology, it is necessary to know how to investigate and discuss tertiary syphilis.In the event of neurological worsening in a neuro-injured patient, it is necessary to know how to discuss a curable diagnosis.

Benzathine Penicillin G Shortage and Secondary Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. This disease is characterized by four different stages, each presenting with a variety of manifestations or asymptomatic disease. These stages can be further broken down into early-stage syphilis, which includes primary and secondary syphilis, and late-stage syphilis, which includes tertiary syphilis. It is crucial to recognize and treat syphilis early because the later stages of the disease are marked by irreversible damage to the central nervous system (CNS) and cardiovascular system, and can even increase mortality risk. The primary recommended treatment for early-stage syphilis is intramuscular (IM) benzathine penicillin G (BPG). In this case report, we present a patient with secondary syphilis who exhibited red papules and nonspecific skin eruptions. Due to the unavailability of BPG, the patient initially received doxycycline as an alternative treatment. After eight days of searching multiple facilities and pharmacies, a dose of BPG was finally located and administered to the patient. We highlight crucial information about the BPG shortage, including supply and demand challenges, infrastructure issues, and the broader impact on numerous other antimicrobials. We emphasize the importance of recognizing this issue and provide alternatives for managing the disease in resource-limited settings.

Transactional sex among adults accessing sexual health services in Alabama, 2008-2022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis

BACKGROUND

The U.S. Deep South bears a disproportionate burden of HIV and other STIs. Transactional sex may influence these epidemics, but few studies have estimated its prevalence or correlates in the Deep South.

METHODS

We estimated the history of transactional sex among adults accessing an Alabama AIDS Service Organization from 2008-2022, using chi-square tests to examine its sociodemographic and behavioral correlates. We used modified Poisson regression with cluster-robust standard errors to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) for the associations between transactional sex and new HIV, hepatitis C (HCV), and STI diagnoses.

RESULTS

Transactional sex was reported at 944/20,013 visits (4.7 %) and associated with older age, being a cisgender woman or gender minority, identifying as white, diverse drug use, and sharing of drug equipment. Compared to others, clients reporting transactional sex had increased prevalence of syphilis (apR 3.60, 95 % CI 1.16-11.19) and HCV (aPR 1.53, 95 % CI 1.24-1.88).

CONCLUSION

Using 14 years of community-based data, this study is the first to estimate the relationship between transactional sex and HIV, HCV, and STIs in Alabama and highlights the need address STI burden and diverse drug use among people who transact sex in the Deep South.

Secondary syphilis presenting as fever of unknown origin

A thirty-eight year-old male presented with a seven-week history of persistent fever accompanied by recurrent night sweats, chills, arthralgias, headache, and chest tightness.Initial laboratory testing showed non-specific elevation of inflammatory markers, but was otherwise unremarkable.A palmar rash developed one week later, prompting testing for syphilis. Fluorescent treponemal antibody absorption (FTA-ABS) and rapid plasma reagin (RPR) tests were both positive.Penicillin G was administered and the patient recovered uneventfully.Our case emphasizes the need for increased syphilis screening to ensure proper diagnosis and prompt treatment.

Increase in human immunodeficiency virus and syphilis prevalence and incidence among men who have sex with men, vietnam 2015 - 2020

INTRODUCTION

We assessed trends in HIV and syphilis prevalence, HIV incidence, related risk factors, and preventive behaviors among men who have sex with men (MSM) in Vietnam from 2015 to 2020.

METHODS

Data originated from the HIV Sentinel Surveillance Plus system, which sampled MSM at venues and hotspots in seven of Vietnam's 63 provinces in 2015, 2016, 2018, and 2020 (N = 1100-1445 per year; ∼150-300 per province per year).

RESULTS

HIV prevalence estimates increased from 6.6% (95% CI 4.5-9.6) in 2015 to 13.8% (95% CI 10.5-18.2, p = .001 for trend) in 2020 overall, and separately in An Giang, Can Tho, Hai Phong, and Khanh Hoa provinces but not in Ho Chi Minh City, Hanoi, or Kien Giang. Syphilis prevalence increased from 2.7% (95% CI 1.4-5.1) in 2015 to 12.6% (95% CI 8.7-18.0) in 2020 overall (p < .001 for trend), and separately in An Giang, Can Tho, and Hai Phong provinces but not in Ho Chi Minh City or Kien Giang. We calculated time-at-risk from first anal sex to first HIV-positive or last HIV-negative test to estimate HIV incidence. Estimated HIV incidence suggested increasing rates of seroconversion from 1.36 per 100 person-years experienced by participants in 2015 to 2.61 per 100 person-years among participants in 2020 (hazard ratio per year 1.13, 95% CI 1.08-1.18, p < .001). There was a statistically significant increase in HIV testing, STI testing, and receipt of free condoms over the period (p < .05 for trend), and a statistically significant decrease in amphetamine use (p = .043 for trend).

CONCLUSIONS

Despite prevention efforts and improvements in some risk indicators, consecutive cross-sectional sampling results provide evidence of increasing incidence of HIV and syphilis among MSM in Vietnam, especially outside the major cities. Aggressive HIV prevention and treatment services can be expanded while conducting deeper investigations into the causes of these increases.

[Association of illicit drug use in pregnant women and congenital syphilis in a public hospital in Mexico]

We conducted a nested case-control study within a cohort with the aim of studying the association between illicit drug use and congenital syphilis (CS). Cases were diagnosed based on treponemal and non-treponemal tests conducted both in the mother and the newborn (NB). Multivariate analysis with logistic regression was performed. A total of 6171 births with a mean gestational age of 37.8 weeks were recorded and 62 CS events were diagnosed (incidence 10.5 events/1000 NB). Associated maternal factors were illicit drug use (OR 14.08, 95% CI 1.19-166.6), <5 prenatal visits (OR 2.9, 95% CI 1.12-7.53), more than two sexual partners (OR 3.76, 95% CI 1.62-8.71) and professional education level (OR 0.06, 95% CI 0.005-0.85). Among the mothers of the cases presented, the prevalence of illicit drug use was 22.6% and the most frequent drugs were methamphetamines and cannabis.

Seasonality of syphilis in males through the 2011 to 2019 mandatory surveillance period: A cross-sectional study in South Korea

Although the effects of seasonality on syphilis have been discussed previously, no previous study has evaluated the seasonality of syphilis incidence by sex and age group. We examined the seasonality of syphilis incidence by sex and age group in Korea from 2011 to 2019. The incidence of syphilis was calculated on the basis of Korea Diseases Control and Prevention Agency data, and an autoregressive integrated moving average (ARIMA) model and seasonal and trend decomposition using Loess were used to analyze the seasonality of the incidence in relation to epidemiological factors. The annual age-standardized incidence rates of primary, secondary, and congenital syphilis were 21.1, 8.8, and 64.0 cases/million persons, respectively, from 2011 to 2019. The highest incidence rates for primary and secondary syphilis were observed among those aged 20 to 29, 13 to 19, and 30 to 49 years, but not among the lower age groups. In analyses based on the ARIMA model, all univariate time series showed the highest goodness-of-fit results with ARIMA for primary syphilis (1,1,2), secondary syphilis (1,1,1), and congenital syphilis (0,1,2) (2,0,0) models. This study suggests that the incidence of secondary syphilis shows a summer seasonality for males and the highest incidence rate in the 20 to 29-year age group for both males and females in Korea. Public health action is needed to prevent an increase in syphilis incidence associated with sex, age group, and seasonal patterns.

Barriers to optimal management of syphilis in pregnancy and congenital syphilis in south-east Queensland: a qualitative investigation

BACKGROUND

Australia, like many high-income countries, is experiencing a resurgence of infectious syphilis in pregnancy and congenital syphilis. Evaluations of public health notifications and clinical records suggest that healthcare systems may not be providing optimal care to women and their neonates. This study aims to explore the barriers to optimal management of syphilis in pregnancy and congenital syphilis to identify key areas for improvement.

METHODS

Between 2021 and 2022, 34 healthcare workers (HCW) practicing in south-east Queensland (SEQ) Australia were recruited to complete semi-structured interviews regarding their perceptions towards management of syphilis in pregnancy and congenital syphilis. Interviews were analysed thematically.

RESULTS

Thematic analysis identified four themes related to the management of syphilis in pregnancy. These included poor communication between disciplines, services, and teams from delivery through to management and post-delivery, lack of formal internal and external referral pathways, unclear and often complex maternal and congenital syphilis management procedures, and limited HCW knowledge of infectious syphilis in pregnancy and congenital syphilis.

CONCLUSION

As congenital syphilis numbers continue to rise in SEQ, it is imperative that healthcare systems and HCWs identify and address gaps in the provision of health care.

Through the Eyes: A Case of Ocular Syphilis

Syphilis is a bacterial disease caused by Treponema pallidum and is sexually transmitted via vaginal, anogenital, or orogenital contact. Vertical transmission between mother and unborn child is also possible, but transmission via skin-to-skin or blood contact is rare. The objective of this case is to highlight this rare ocular manifestation of syphilis as it manifests as a multisystemic disease affecting many organ systems. This is a case of a 46-year-old male with vision loss who was referred to the emergency department by an ophthalmologist. Two days before the presentation at the emergency department, the ophthalmologist observed the presence of optic disc edema in the left eye. At the emergency department, he complained of bright light spots in the left eye and complete darkness in the central aspect of the eyes. He reported having a non-pruritic erythematous rash on the anterior abdomen that began one week before his presentation at the emergency department. The patient also reported having multiple sexual partners. Physical examination findings showed a visual field defect in the left eye, normal bilateral eye movement, and a non-tender skin reticulation over the anterior abdominal wall. Lab results showed complete blood count (CBC) and comprehensive metabolic panel (CMP) within normal limits, fluorescent treponemal antibody (FTA) antibody reactive, human immunodeficiency virus (HIV) test and hepatitis panel negative, rapid plasma reagin (RPR) titer 1:64, and imaging results negative for any significant abnormalities. The infectious disease specialists were consulted, and the recommended IV penicillin of four million units every four hours was given. The patient reported an improvement in his blurry vision over three days. By six months, his vision was back to baseline. This case report is significant due to the rare occurrence of ocular complications as an initial presentation of syphilis. Considering the rising cases of syphilis in the United States, it is important to highlight the possibility of this uncommon clinical presentation of syphilis.

Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis

PURPOSE OF REVIEW

This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs.

RECENT FINDINGS

The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.

Spike in Congenital Syphilis, Mississippi, USA, 2016-2022

In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.

Syphilis Resurrected: Case Series of Palmoplantar Secondary Syphilis

Introduction Syphilis is a sexually transmitted infection caused by Treponema pallidum which has protean manifestations. The cutaneous presentation of syphilis can mimic many dermatologic conditions.  Materials & methods With an aim to describe palmoplantar involvement in syphilis, a retrospective study of case series was done with 11 patients having palmoplantar skin lesions in syphilis within a period of two years. Only serologically confirmed cases were included. Results The prevalence of palmoplantar involvement in syphilis was 47.85% and all of them except one patient (congenital syphilis) were secondary syphilis. A major proportion of cases (72.8%) studied had no history or presentation of genital lesions. Biett's collar which is an indicator of palmoplantar syphilis was seen only in 45.5% of the cases. Conclusion The clinicians must be aware that palmoplantar skin lesions might be the only clinical presentation of syphilis and a high index of suspicion is needed to correctly diagnose and treat the condition in such a setting.

Incidence, risk factors, and clinical findings of syphilis among men living with HIV in Croatia during the COVID-19 pandemic

We conducted a nationwide longitudinal observational study to estimate the incidence of syphilis in a cohort of male persons living with HIV (MLWH) in Croatia in the pre-COVID-19 and COVID-19 years. Data were reviewed and extracted from the clinical database. We analyzed 1187 MLWH (≥ 18 years) in care in Croatia from 2018 to 2021 and used Poisson regression to calculate rates. We observed a 91.4% increase in incidence between 2019 and 2020; the overall rate was 6.0/100 person-years, and the annual rate ranged from 3.3/100 person-years in 2018 to 9.3/100 person-years in 2021. We found higher rates in men who have sex with men, MLWH with a baseline history of syphilis, MLWH with a more recent HIV diagnosis, and a lower rate in those who had clinical AIDS. The rate of syphilis serological testing was 3.5% lower in 2020 compared to 2019. Recurrent syphilis was more likely asymptomatic compared to the first episodes. In conclusion, during the COVID-19 epidemic years, there was a huge increase in syphilis. Results highlight the need for enhanced and novel prevention interventions.

Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis

INTRODUCTION

The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment.

AREA COVERED

This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis.

EXPERT OPINION

In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.

Granulomatous secondary syphilis: Another diagnostic pitfall for the dermatopathologist

Syphilis is growing ever more prevalent in the United States with its incidence rising every year. Dermatopathologists need to maintain a high index of suspicion to avoid delayed diagnosis of this treatable disease. Accordingly, it is imperative to be aware of its myriad of presentations-including secondary syphilis with granulomatous inflammation. Most cases show aggregations of epithelioid histiocytes associated with plasma cells. Other patterns include an interstitial granuloma-annulare-like pattern, sarcoidal, and tuberculoid pattern. Immunohistochemical stains for Treponema pallidum may be negative, especially in late secondary or tertiary syphilis. We present a case of nodular secondary syphilis with granulomatous inflammation with negative T. pallidum staining.

Lifetime prevalence of syphilis infection among predominantly Black sexual and gender minorities living with HIV in Atlanta, Georgia: a cross-sectional analysis

OBJECTIVES

Syphilis infection disproportionately impacts Black sexual and gender minorities (SGM) in the United States. The extent of this impact among those living with HIV has been minimally examined. This study sought to examine lifetime syphilis prevalence and associated factors in a community sample of predominantly Black SGM living with HIV in the Southeastern US.

DESIGN

Participants (N = 174) enrolled in a stigma-mitigation trial for people living with HIV in Atlanta, Georgia, completed a sub-study involving testing for Treponema pallidum antibodies, indicative of lifetime syphilis infection. We performed chi-square and Fisher's exact tests to assess sociodemographic and healthcare differences by presence/absence of lifetime syphilis infection.

RESULTS

Most participants identified as non-Hispanic Black (n = 142/174; 81.6%) and cisgender male (n = 146/174; 83.9%). More than two thirds (n = 120/174) identified as gay/homosexual. We documented a 55.7% (n = 97/174) lifetime prevalence of syphilis infection and observed differences by sexual identity, with 77.3% (n = 75/97) of those screening positive reporting gay/homosexual identity relative to 58.4% (n = 45/77) of those screening negative (chi-square[1] = 7.8, p < 0.010).

CONCLUSION

Findings underscore how syphilis prevention efforts have missed the most marginalized, warranting a renewed, comprehensive strategy for improving the sexual health of Black SGM. Embedding targeted, respectful community engagement, expanded testing access, and healthcare provider training into broader sexual health and psychosocial wellness efforts is needed.

Social Network Influence on Syphilis Testing for Black Sexual Minority Men in Baltimore, Maryland: A Cross-sectional Social Network Analysis

ABSTRACT

Black sexual minority men (BSMM), including those with HIV, have disproportionate rates of syphilis infection. This study examines the associations of social network characteristics on syphilis testing, given that social network approaches are well established as effective methods to establish health-promoting social norms. We analyzed baseline data from a sexual health behavioral intervention. Using multivariable logistic regression, we modeled individual and social network characteristics on syphilis testing. Of the 256 participants, 37% tested for syphilis in the past year. In the adjusted model controlling for individual factors, odds of syphilis testing increased 89% for each increase in network member participants being encouraged to get a syphilis test (95% confidence interval [1.19-3.00]). Feeling comfortable accompanying a friend for HIV/sexually transmitted infection testing was associated with 2.47 increased odds of syphilis testing. Encouraging and training individuals to discuss sexual health topics with their network members may lead to the establishment of testing in social networks of Black sexual minority men.

Are we moving from symptomatic to asymptomatic syphilis: A retrospective analysis

Background

Syphilis remains a global health problem with recent reports of resurgence from various parts of the world. We undertook this study to analyze the current epidemiological and clinical trends of syphilis in our part of the country.

Aim and Objectives

To analyze the changing trends in clinical presentation of syphilis and the current status of HIV/AIDS-syphilis co-infection in our area.

Materials and Methods

This is a hospital-based retrospective analysis of records of sexually transmitted disease (STD) patients enrolled in "Suraksha clinic" in the department of Skin and VD at a Tertiary Care Hospital in North India. Patient records were analyzed from January 2018 to December 2021. The demographic, clinical, and serological profiles of patients were assessed to study the percentage of syphilis patients attending the STD clinic and their clinical presentations.

Results

A total of 7153 patients were enrolled in the"Suraksha clinic" from January 2018 to December 2021, these included the venereal disease patients (3137) and nonvenereal disease patients (4016) who were registered for HIV and venereal disease research laboratory (VDRL) screening from the dermatology outpatient department. Out of 3137 sexually transmitted infection (STI) patients, 139 patients tested positive for VDRL. Treponema pallidum hemagglutination was found positive in 137 patients and negative in two patients. Hence, 137 patients were confirmed syphilis cases, constituting 4.36% of total STD cases in our STI clinic in 4 years. Out of 137 patients, 2 (1.45%) presented with primary chancre, 6 (4.37%) with lesions of secondary syphilis and 129 (94.16%) were found serologically reactive without any symptoms or clinical signs, i.e., in latent syphilis. Our records also showed 14 (10.21%) cases of HIV and syphilis co-infection.

Conclusion

In our study, a remarkable rise in the number of patients in the latent syphilis stage is observed over primary and secondary syphilis stage. This signifies the persistence of syphilis in subclinical phase in the community and unfortunately, it goes unnoticed. These could be "warning signs" for changing disease pattern of syphilis in India and points toward hidden resurgence of syphilis as being reported in various parts of the world. To actively look for these "hidden cases," there is a need to strengthen "Suraksha clinics." VDRL testing should be mandatory along with routine testing in all patients visiting the hospital irrespective of their disease. We also propose for the central registration of syphilis patients on lines of HIV-infected patients' registry.

Multidisciplinary Approach to Improve Human Immunodeficiency Virus and Syphilis Testing Rates in Emergency Departments

BACKGROUND

Best practice guidelines recommend that patients at risk for sexually transmitted infections (STIs), such as gonorrhea (GC) and chlamydia, should also be tested for human immunodeficiency virus (HIV) and syphilis. This prospective quality assurance study aimed to increase HIV and syphilis testing rates in emergency departments (EDs) across the Cleveland Clinic Health System from January 1, 2020 through January 1, 2022.

METHODS

A multidisciplinary team of emergency medicine, infectious diseases, pharmacy, and microbiology personnel convened to identify barriers to HIV and syphilis testing during ED encounters at which GC/chlamydia were tested. The following interventions were implemented in response: rapid HIV testing with new a workflow for results follow-up, a standardized STI-screening order panel, and feedback to clinicians about ordering patterns.

RESULTS

There were 57 797 ED visits with GC/chlamydia testing completed during the study period. Human immunodeficiency virus testing was ordered at 5% of these encounters before the interventions were implemented and increased to 8%, 23%, and 36% after each successive intervention. Syphilis testing increased from 9% before the interventions to 12%, 28%, and 39% after each successive intervention. In multivariable analyses adjusted for age, gender, and location, the odds ratio for HIV and syphilis testing after all interventions was 11.72 (95% confidence interval [CI], 10.82-12.71; P ≤.001) and 6.79 (95% CI, 6.34-7.27; P ≤.001), respectively.

CONCLUSIONS

The multidisciplinary intervention resulted in improved testing rates for HIV and syphilis.

Syphilitic Folliculitis: A Case Report With Demonstration of Spirochetes Showing Follicular Epitheliotropism

ABSTRACT

We report a case of a 59-year-old man presenting with a widespread follicular-based papular rash with a several-month history of myalgias, lymphadenopathy, fatigue, and weight loss who was diagnosed with acute syphilitic folliculitis by tissue biopsy analysis with immunohistochemical demonstration of spirochetes in hair follicle epithelium. Serologic analysis also showed evidence of Treponema sp. infection. Owing to the rising number of syphilis cases in the last decade, it is important to recognize classic cutaneous findings of syphilis in addition to unusual presentations such as syphilitic folliculitis.

Prevalence of syphilis among people living with HIV and its implication for enhanced coinfection monitoring and management in China: A meta-analysis

Background

People living with HIV (PLWH) are at an increased risk of syphilis infection. The objectives of this study were to assess the overall prevalence of syphilis among PLWH in China and identify factors associated with syphilis infection among PLWH.

Methods

We searched Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang Data, and Chinese Biomedical Literature Database (CBM) to identify studies that reported the prevalence of syphilis among PLWH in China and were published in English or Chinese from January 1, 1990, to May 31, 2022. The reference lists of retrieved articles and relevant reviews were also checked to identify additional studies. A random-effect model was fitted to calculate the pooled syphilis prevalence among PLWH. Subgroup analyses, meta-regression analyses and sensitivity analyses were conducted to determine the potential source of heterogeneity.

Results

Of the 1,599 articles screened, 29 studies involving 34,740 participants were eligible for inclusion in this meta-analysis. The overall prevalence of syphilis among PLWH in China was 19.9% [95% confidence interval (CI): 15.4-24.8%, I 2 = 98.9%]. Subgroup analysis showed that the pooled prevalence of syphilis among men who have sex with men (MSM) with HIV (21.9%, 95% CI: 17.2-26.9%) was much higher than that among heterosexuals (10.3%, 95% CI: 5.2-16.8%); there was regional diversity in the prevalence of syphilis, the highest in northern China (31.7%, 95% CI: 17.9-47.4%), followed by central-southern China (26.7%, 95% CI: 11.4-45.7%), and the lowest in northwestern China (15.0%, 95% CI: 6.9-25.4%); the syphilis prevalence among PLWH decreased as CD4 + T cell count increased (19.6% in CD4 + T cell < 200 vs. 8.7% in ≥ 500) and was higher among non-antiretroviral therapy (non-ART) HIV-infected patients (21.0%, 95% CI: 9.9-35.0%) than that among ART ones (16.1%, 95% CI: 3.9-34.3%).

Conclusions

Our study showed a significantly high prevalence of syphilis among PLWH in China, particularly among MSM with HIV. Developing national guidelines for the integrated screening, monitoring, and management of HIV and syphilis as well as syphilis diagnosis and treatment training programs for physicians at designated HIV treatment hospitals is urgent and crucial to combat HIV and syphilis coinfection in China.

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

PURPOSE OF REVIEW

In light of alarming increases in the incidence of congenital syphilis in many middle and higher income countries across the globe, this review summarizes recent changes in the epidemiology of syphilis, highlights recommended changes to testing in pregnancy and provides an update for the management of syphilis infection in pregnancy (SIP) and of the infant born to a mother with SIP.

RECENT FINDINGS

The re-emergence of congenital syphilis is a result of increasing infectious syphilis in women of childbearing age, which is in turn a result of increasing syphilis in the general population particularly in Indigenous and marginalized populations. Potential reasons for the increase include changing sexual practices and increased travel and migration, as well as factors that limit healthcare access, particularly access to antenatal care and limited awareness and education amongst mothers and maternity services. A single antenatal test for syphilis is insufficient; more frequent testing in pregnancy is necessary even for women deemed to be low risk. The management of SIP and of the newborn is complex and guidelines should be readily available with clear recommendations.

SUMMARY

Congenital syphilis is preventable. The current crisis calls for a global and national multipronged, co-ordinated approach involving public health and hospital systems which includes education of individuals and healthcare workers, availability of updated guidelines for prevention and treatment, prioritization of antenatal testing, assurance of accessible and prompt treatment and appropriate assessment and follow-up of infants.

Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine

Hospital-based clinicians frequently care for patients with opioid withdrawal or opioid use disorder (OUD) and are well-positioned to identify and initiate treatment for these patients. With rising numbers of hospitalizations related to opioid use and opioid-related overdose, the Society of Hospital Medicine convened a working group to develop a Consensus Statement on the management of OUD and associated conditions among hospitalized adults. The guidance statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. To develop the Consensus Statement, the working group conducted a systematic review of relevant guidelines and composed a draft statement based on extracted recommendations. Next, the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. The iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD. Most recommendations in the Consensus Statement were derived from guidelines based on observational studies and expert consensus. Due to the lack of rigorous evidence supporting key aspects of OUD-related care, the working group identified important issues necessitating future research and exploration.

Acquired oral syphilis: A multicenter study of 339 patients from South America

OBJECTIVE

To report the clinicopathologic features of acquired oral syphilis cases in South American countries.

MATERIALS AND METHODS

Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis.

RESULTS

The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic.

CONCLUSION

This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

Upward trends of syphilis in the non-pregnant adults: A six-year report on clinical and epidemiological profile of syphilis from a tertiary care center, India

Since 2000, a resurgence of syphilis has been noted in many developed and developing countries, especially among men who have sex with men (MSM). Incidence and prevalence of syphilis in pregnant women have been reduced drastically by mandatory screening in early pregnancy. Insufficient data in other populations especially from developing countries limit targeted public health interventions. This study aimed to describe the clinical and epidemiological profile of serologically confirmed syphilis cases among the non-pregnant high-risk group reporting to a tertiary care center in Southern India. A retrospective study was carried out in a tertiary care center in Southern India for 6 years from 2015 to 2020. A total of 265 serologically confirmed syphilis patients were included. A statistically significant increase in positivity from 0.52 to 2.1% was observed in this study (2015 to 2020). Among risk factors, high-risk behavior with multiple heterosexual partners was the commonest (51.3%), followed by marital partners who tested positive (9.4%) and MSM (7.5%). The majority of the patients were diagnosed at the latent stage (79%), followed by secondary syphilis (10%) and tertiary syphilis (8%). A quarter of patients (23%) were coinfected with HIV. Serological non-responsiveness was more common among HIV infected (47 vs. 24%). Sixteen had neurosyphilis and six had ocular involvement. HIV co-infection complicated 50% (8/16) of neurosyphilis patients. Syphilis is still prevalent, especially in high-risk groups including those are attending STI clinics. Further prospective multicentric studies are needed to identify and implement public health measures.

Congenital Syphilis and the Prozone Phenomenon: Case Report

Congenital syphilis represents an important public health challenge in the United States, and its prevalence has been increasing for the past 10 years because of many factors. The diagnosis can be difficult given its various and nonspecific clinical manifestations in newborns, and the possibility of false negative results during prenatal care. The prozone phenomenon, caused by an excess of antibody, which interferes with the regular screening tests, is a cause of false negative tests. This could delay the diagnosis and increase morbidity and mortality in the newborn. We present a case of congenital syphilis in a 3-month-old infant whose mother had prenatal care and negative tests for syphilis, which contributed to the late diagnosis. In the face of clinical findings suggestive of congenital syphilis and negative maternal syphilis tests healthcare providers should consider the possibility of maternal false negative test caused by the prozone phenomenon.

A Case Report of Secondary Syphilis Co-Infected with Measles: A Diagnostic Dilemma with Fever and Rash

Fever and rash as manifestations of infection by microorganisms are collectively known as febrile exanthem. Since viruses are more frequently associated with fever and rash, these symptoms are thus impetuously termed viral exanthem. However, bacteria represent a frequently overlooked infectious etiology causing rash in humans. In addition, certain microbes may exhibit pathognomonic features that erupt during illness and facilitate clinical diagnosis. Conversely, coinfections often obscure the clinical characteristics of the primary disease and further challenge clinicians attempting to reach a diagnosis. We retrospectively looked at de-identified clinical data of a patient who presented to the Hospital for Tropical Diseases in Bangkok in July 2019 with complaints of fever and rash. The case involved a 35-year-old who presented with a 3-day history of fever, respiratory symptoms, myalgia, conjunctivitis, diarrhea, and a generalized maculopapular rash. On examination, the patient was febrile, tachycardic, and tachypneic, with a mean arterial pressure of 95 mmHg. A differential white blood cell count showed: leukocytes, 5800/µL; neutrophils, 4408/µL; lymphocytes, 406/µL; and platelets, 155,000/µL. Striking findings involving the integumentary system included Koplik’s spots and generalized maculopapular rash. Further serology revealed positive immunoglobulin (Ig)M and IgG for both measles and rubella virus, including reactive serology for Treponema pallidum. Here we describe the clinical course and management of this patient.

Incidence Trends of Five Common Sexually Transmitted Infections Excluding HIV From 1990 to 2019 at the Global, Regional, and National Levels: Results From the Global Burden of Disease Study 2019

Objective

Sexually transmitted infections (STIs) are common worldwide and pose a challenge to public health. We conducted this study to assess the annual incidence of five common STIs, including syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes at the global, regional, and national levels.

Materials and Methods

We obtained detailed data on STIs excluding HIV from 1990 to 2019 from the Global Burden of Disease (GBD) 2019 database. Estimated annual percentage change (EAPC) was calculated to quantify trends in age-standardized incidence rates (ASR) of STIs, stratified by gender, sociodemographic index (SDI) region, and pathogenic microorganism.

Results

Globally, incident cases of STIs increased by 58.15% from 486.77 million in 1990 to 769.85 million in 2019, but the annual change in ASR was only -0.04% (95% CI -0.09 to 0.01) per year. EAPC was 0.16 (0.06 to 0.26) for syphilis, 0.09 (0.05 to 0.13) for genital herpes, 0.06 (0.03 to 0.09) for trichomoniasis, -0.21 (-0.36 to -0.06) for chlamydia, and -0.14 (-0.19 to -0.08) for gonorrhea. High SDI regions reported significant increases in ASR of syphilis and chlamydia.

Conclusions

The burden of disease from STIs remains large, though control of STIs has contributed to the decreasing incidence in most regions, especially in the low-SDI regions. Globally, over the past 20 years, the ASR has remained stable for trichomoniasis and genital herpes decreased for chlamydia and gonorrhea, and increased for syphilis.

Resurgence of syphilis, the great imitator

Syphilis, one of the earliest diseases to be discovered in humans, still remains an enigma when it comes to its myriad manifestations and changing epidemiological profiles. There has been a surge in cases in the last few decades due to various factors. The human immunodeficiency virus (HIV) epidemics, global travel, increased incidence of male to male sexually transmitted diseases, online relationships culminating in casual sex are few of the important factors. Increased awareness could also be a factor for increased diagnosis. The multitude of clinical features especially when it comes to secondary syphilis and the rare tertiary manifestations, which can mimic various systemic disorders still pose a diagnostic challenge to the best of venereologists and physicians. This review aims to discuss the causes of resurgence in syphilis and few recent developments in pathogenesis, which could have led to this resurgence.

Otosyphilis with Clinical and Serologic Responses with Weekly Intramuscular Penicillin: A Case Report and Literature Review

With the increasing prevalence of syphilis in different parts of the world, it is important to be cognizant of serious forms of syphilis. Otosyphilis is a rare form of syphilis with an extremely high rate of complications. Early diagnosis is essential to prevent a complete loss of hearing and decrease mortality. We present a unique case of otosyphilis who presented with left hearing loss, tinnitus, and vertigo, with audiometric findings confirming the hearing loss. An MRI brain showed asymmetric enhancement of the left cochlea and vestibular apparatus. She initially received oral steroids and trans-tympanic steroid injections with transient improvement of symptoms. She was diagnosed with syphilis through contact tracing after her ex-boyfriend tested positive. She received three weekly doses of intramuscular penicillin. Interestingly, her symptoms, rapid plasma regain (RPR) titer, and audiometry findings markedly improved. Once a diagnosis of otosyphilis was established, she received 14 days of intravenous penicillin.

Detection of Treponema pallidum DNA during early syphilis stages in peripheral blood, oropharynx, ano-rectum and urine as a proxy for transmissibility

Background

Syphilis diagnosis may be challenging, especially in the asymptomatic and early clinical stages. We evaluated the presence of Treponema pallidum DNA (TP-DNA) in various sample types to elucidate transmissibility during various syphilis stages.

Methods

The study was conducted at the Amsterdam Centre for Sexual Health. We included adult men who have sex with men (MSM), who were suspected of having syphilis. The 2020 European guidelines definitions were followed for the diagnosis and staging of syphilis. Using a polymerase chain reaction (PCR) targeting the polA gene of Treponema pallidum (TP-PCR), we tested the following study samples on TP-DNA: peripheral blood, oropharyngeal swab, ano-rectal swab, and urine.

Results

From November 2018 to December 2019 we included 293 MSM. Seventy clients had primary syphilis, 73 secondary syphilis, 86 early latent syphilis, 14 late latent syphilis, 23 treated syphilis, and 27 had no syphilis. TP-DNA was detected in at least 1 study sample in 35/70 clients with primary syphilis (2/70 peripheral blood, 7/70 oropharynx, 13/70 ano-rectum, and 24/70 urine); in 62/73 clients with secondary syphilis (15/73 peripheral blood, 47/73 oropharynx, 37/73 ano-rectum, and 26/73 urine); and in 29/86 clients with early latent syphilis (5/86 peripheral blood, 21/86 oropharynx, 11/86 ano-rectum, and 6/86 urine). TP-DNA was not detected in clients with late latent syphilis or treated syphilis, nor in clients without syphilis.

Conclusions

TP-DNA was frequently detected in various sample types in the absence of lesions. This is in line with the high transmission rate of syphilis and opens diagnostic opportunities for early presymptomatic syphilis stages.

Neurosyphilis presenting with a large vessel occlusion: A case report

We describe a case of a 36-year-old man who presented with stroke in the right paramedian pons in the pontine perforator territory, manifesting as intermittent headache, slurred speech, left-sided weakness, and paresthesia. This case highlights the diagnostic challenge in identifying neurosyphilis as a cause of stroke in young individuals. Clinicians should maintain vigilance for this uncommon etiology through conducting a detailed history and investigation in susceptible patients with key risk factors. Once the diagnosis was confirmed in our case, a multidisciplinary approach was used for management with neurologists, infectious disease specialists, and the neurointerventional team. Our patient ultimately underwent successful therapy with mechanical thrombectomy for basilar artery thrombosis from meningovascular syphilis.

Re-emergence of syphilis in women of reproductive age and its association with the increase in congenital syphilis in Mexico during 2010-2019: an ecological study

Background

Syphilis is a sexually transmitted infection that is re-emerging in different parts of the world. This infection can be transmitted during pregnancy, causing neonatal syphilis. The objective of this study was to examine trend in syphilis, congenital syphilis, and neonatal deaths among the Mexican population during 2010–2019.

Methods

An ecological study was carried out to collect information about the incidence of syphilis, the incidence of congenital syphilis, and the incidence of neonatal death from congenital syphilis. The variables were described considering age, sex, Mexican state, and year. Trends across time (calendar year) were analyzed using linear regression, increases were estimated with 95% confidence intervals, and p < 0.05 was considered statistically significant.

Results

The incidence of syphilis increased by an average of 0.336 cases/100,000 per year and was higher among women aged 15–19 years (0.693 cases). Cases of congenital syphilis increased from 62 cases in 2010 to 372 cases in 2019; furthermore, the increase in syphilis cases among women aged 20 to 24 years was associated with an increase in cases of congenital syphilis. In 2010, 50% of Mexican states did not report cases of congenital syphilis, but in 2018, only 10% did not report cases of congenital syphilis. Between 2010 and 2018, 83 neonatal deaths were reported, with the highest incidence in 2018 (0.88 deaths/100,000 newborns).

Conclusion

The incidence of congenital syphilis is increasing in Mexico. As a consequence of the reemergence of syphilis among the population of reproductive age, it is necessary to address and treat syphilis in various population groups.

Diagnosis and Treatment of Secondary Syphilis in Women

Secondary syphilis develops approximately 3 to 12 weeks following undetected and untreated primary syphilis. Despite historically low rates of syphilis infection in 2000, the United States is now experiencing an alarming resurgence in primary, secondary, and congenital syphilis. This case report describes an unexpected presentation in a young woman presenting for an initial well-woman examination. Social and behavioral drivers of syphilis infection, diagnosis, and treatment are presented. Implications for women's health are examined. The need for new and more effective preventive health strategies is reviewed.

Epidemiological study in Brazilian women highlights that syphilis remains a public health problem

Syphilis, an infectious disease considered a global public health concern, can cause stillbirths and neonatal deaths. This highlights the importance of continuous surveillance studies among women of reproductive age. A cross-sectional study was carried out to analyze the prevalence and risk factors associated with Treponema pallidum infection in women assisted by primary health care units in Dourados, a city located in Mato Grosso do Sul State, Brazil, which borders Paraguay. A questionnaire was applied to a population-based sample, blood samples were collected for syphilis testing and multivariable analyses were performed to screen associations with T. pallidum infection. The prevalence of T. pallidum infection was 6.04%. Bivariate analysis showed that women referring multiple sexual partners (c2: 6.97 [p=0.014]), income less 2 minimal wages (c2: 15.93 [p=0.003]), who did not have high school (c2: 12.64 [p=0.005]), and reporting history of STIs (c2: 7.30 [p=0.018]) are more likely to have syphilis. In the multivariate analysis, a highest prevalence ratio was observed in women with income less than 2 minimal wages (PR: 0.96 [95% CI: 0.85 - 0.97]), and who did not have high school (PR: 0.94 [95% CI: 0.90 - 0.98]). In addition, 80% of the women reported irregular use of condoms and 63.89% declared having sexual intercourses with multiple partners, which creates more opportunities for the transmission of the infection. These results highlight the need for healthcare systems to implement initiatives to monitor syphilis screening and the commitment of patients and their sexual partners to the treatment in order to achieve a decrease of new cases.