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Gutierrez-Lanz E, Smith LB, Perry AM. Syphilis in Hematopathology Practice: A Diagnostic Challenge. Arch Pathol Lab Med 2024; 148:633-641. [PMID: 37535664 DOI: 10.5858/arpa.2023-0078-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT.— Syphilis, a reemerging disease caused by the spirochete Treponema pallidum, is becoming more frequent in surgical pathology and hematopathology practices. Hematopathologists typically receive lymph node biopsies from patients with syphilis who have localized or diffuse lymphadenopathy. Occasionally, syphilis infection in the aerodigestive tract can show a prominent lymphoplasmacytic infiltrate and mimic lymphoma. Besides the varying and occasional atypical morphology, the fact that clinical suspicion tends to be low or absent when histologic evaluation is requested adds to the importance of making this diagnosis. OBJECTIVE.— To summarize histologic features of syphilitic lymphadenitis and syphilis lesions in the aerodigestive tract, and to review differential diagnosis and potential diagnostic pitfalls. DATA SOURCES.— Literature review via PubMed search. CONCLUSIONS.— Characteristic histologic findings in syphilitic lymphadenitis include thickened capsule with plasma cell-rich inflammatory infiltrate, reactive follicular and paracortical hyperplasia with prominent lymphoplasmacytic infiltrate, and vasculitis. Lymph nodes, however, can show a number of other nonspecific histologic features, which frequently makes the diagnosis quite challenging. In the aerodigestive tract, syphilis is characterized by plasma cell-rich infiltrates. Immunohistochemistry for T pallidum is the preferred method for detecting spirochetes; however, this immunohistochemical stain shows cross-reactivity with other treponemal and commensal spirochetes. Differential diagnosis of syphilis in lymph nodes and the aerodigestive tract is broad and includes reactive, infectious, and neoplastic entities. Pathologists should be aware of the histologic features of syphilis and keep this challenging entity in the differential diagnosis.
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Gabster A, Fernández Díaz F, Zaldívar Y, Hernández M, Pascale JM, Orillac A, Moreno-Wynter S, Xavier Hall CD, Jhangimal M, Yu-Pon A, Rodríguez-Vargas C, Arjona-Miranda D, Fuentes B, Henestroza G, Araúz AB. Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study. Ther Adv Infect Dis 2024; 11:20499361241256290. [PMID: 38827952 PMCID: PMC11141218 DOI: 10.1177/20499361241256290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Background Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic. Methods A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis. Results In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14). Conclusion This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.
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Affiliation(s)
- Amanda Gabster
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Ave. Justo Arosemena y Calle 36, Panamá, Panamá 507-527-4952, Panama
- National Research System, National Secretariat of Science, Technology and Innovation, Panama City, Panama
- Center of Population Sciences for Health Equity, Faculty of Nursing, Florida State University, Tallahassee, FL, USA
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Yamitzel Zaldívar
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
- Facultad de Medicina, Universidad de Panamá, Transismica, Panama City, Panama
| | - Angelique Orillac
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | - Casey D. Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Mónica Jhangimal
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | - Anyi Yu-Pon
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | | | | | - Bárbara Fuentes
- Facultad de Medicina, Universidad Interamericana de Panamá, Panama City, Panama
| | - Germán Henestroza
- Division of Infectious Diseases, University of Alabama, Birmingham, AB, USA
| | - Ana Belén Araúz
- Hospital Santo Tomás, Panama City, Panama
- National Research System, National Secretariat of Science, Technology and Innovation, Panama City, Panama
- Facultad de Medicina, Universidad de Panamá, Transismica, Panama City, Panama
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Harper HE, Hegde S, Fraga GR, Hall JC. Syphilis presenting as exfoliative erythroderma. Int J Dermatol 2023; 62:e221-e223. [PMID: 35393692 DOI: 10.1111/ijd.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haleigh E Harper
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Siddhanth Hegde
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Garth R Fraga
- Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John C Hall
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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Freitas FLS, Benzaken AS, de Passos MRL, Coelho ICB, Miranda AE. Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis. Rev Soc Bras Med Trop 2021; 54:e2020616. [PMID: 34008726 PMCID: PMC8210480 DOI: 10.1590/0037-8682-616-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services. Most people with syphilis are asymptomatic; this contributes to the maintenance of the transmission chain. Without adequate treatment of pregnant women with syphilis, severe consequences can occur, such as miscarriage, prematurity, low birth weight, natimortality, and congenital syphilis.
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Affiliation(s)
- Francisca Lidiane Sampaio Freitas
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Adele Schwartz Benzaken
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
- AIDS Healthcare Foundation, Los Angeles, Califórnia, USA
| | | | | | - Angélica Espinosa Miranda
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil
- Universidade Federal do Espírito Santo, Vitória, Brasil
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5
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Freitas FLS, Benzaken AS, Passos MRLD, Coelho ICB, Miranda AE. [Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis]. ACTA ACUST UNITED AC 2021; 30:e2020616. [PMID: 33729409 DOI: 10.1590/s1679-4974202100004.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022]
Abstract
The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.
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6
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Maier MM, Gylys-Colwell I, Lowy E, Borgerding J, Van Epps P, Ohl M, Hauser RG, Chartier M, Beste L. Differences in Syphilis Incidence Using a Laboratory Algorithm in People With and Without HIV in an 11-Year Nationwide Cohort Study. Open Forum Infect Dis 2021; 8:ofab030. [PMID: 33604407 DOI: 10.1093/ofid/ofab030] [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: 10/28/2020] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background To measure the incidence of syphilis diagnoses among people with HIV vs those without HIV in a national multiyear retrospective cohort. Methods Treponemal and nontreponemal tests, HIV status, and demographic data were identified among all individuals receiving Veterans Health Administration (VHA) care between January 1, 2009, and December 31, 2019. Syphilis testing rates and incident syphilis diagnoses as defined by a laboratory algorithm were stratified by HIV status. Results Syphilis was diagnosed in 1.2% (n = 2283) of 194 322 tested individuals in VHA care in 2019. Among individuals with HIV tested for syphilis, 6.1% met criteria for syphilis compared with 0.7% without HIV. Syphilis incidence in 2019 was 35/100 000, a 17% increase from 2009 (30/100 000). In 2019, syphilis incidence was 3381 per 100 000 persons among individuals with HIV and 19 per 100 000 in those without HIV. Conclusions Using a laboratory-based diagnostic algorithm, a 178-fold difference in syphilis incidence was observed between individuals with and without HIV in 2019. US syphilis incidence data that incorporate HIV status are needed. Interventions to monitor and prevent sexually transmitted infections should address the role of HIV status.
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Affiliation(s)
- Marissa M Maier
- OHSU Division of Infectious Diseases, VA Portland Healthcare System, Portland, Oregon, USA
| | - Ina Gylys-Colwell
- Health Services Research & Development, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Elliott Lowy
- Health Services Research & Development, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Joleen Borgerding
- Health Services Research & Development, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Puja Van Epps
- Department of Medicine, Case Western Reserve University School of Medicine, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Michael Ohl
- Center for Access and Delivery Research and Evaluation (CADRE), Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ronald G Hauser
- Pathology and Laboratory Medicine Department, Veterans Affairs Connecticut Healthcare, New Haven, Connecticut, USA.,Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maggie Chartier
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Lauren Beste
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, Washington, USA
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Rodríguez-Granger J, Espadafor López B, Cobo F, Blasco Morente G, Sampedro Martinez A, Tercedor Sánchez J, Aliaga-Martinez L, Padilla-Malo de Molina A, Navarro-Marí J. Update on the Diagnosis of Sexually Transmitted Infections. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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David JF, Lima VD, Zhu J, Brauer F. A co-interaction model of HIV and syphilis infection among gay, bisexual and other men who have sex with men. Infect Dis Model 2020; 5:855-870. [PMID: 33210053 PMCID: PMC7644589 DOI: 10.1016/j.idm.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 10/29/2022] Open
Abstract
We developed a mathematical model to study the co-interaction of HIV and syphilis infection among gay, bisexual and other men who have sex with men (gbMSM). We qualitatively analysed the model and established necessary conditions under which disease-free and endemic equilibria are asymptotically stable. We gave analytical expressions for the reproduction number, and showed that whenever the reproduction numbers of sub-models and co-interaction model are less than unity, the epidemics die out, while epidemics persist when they are greater than unity. We presented numerical simulations of the full model and showed qualitative changes of the dynamics of the full model to changes in the transmission rates. Our numerical simulations using a set of reasonable parameter values showed that: (a) both diseases die out or co-exist whenever their reproduction number is less than or exceed unity. (b) HIV infection impacts syphilis prevalence negatively and vice versa. (c) one possibility of lowering the co-infection of HIV and syphilis among gbMSM is to increase both testing and treatment rates for syphilis and HIV infection, and decrease the rate at which HIV infected individuals go off treatment.
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Affiliation(s)
- Jummy Funke David
- Department of Mathematics, University of British Columbia, Vancouver, BC, V6T 1Z2, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Department of Interdisciplinary Studies, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Jielin Zhu
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada
| | - Fred Brauer
- Department of Mathematics, University of British Columbia, Vancouver, BC, V6T 1Z2, Canada
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Abstract
Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in the third trimester and at delivery among women at high risk, adherence to recommended treatment regimens, and prompt reporting of newly diagnosed syphilis cases to local public health authorities are strategies that obstetrician-gynecologists can employ to fight the current epidemic. In this report, clinical manifestations and management of syphilis in pregnancy are reviewed, and both traditional and reverse sequence screening algorithms are reviewed in detail in the context of clinical obstetrics.
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Rodríguez-Granger J, Espadafor López B, Cobo F, Blasco Morente G, Sampedro Martinez A, Tercedor Sánchez J, Aliaga-Martinez L, Padilla-Malo de Molina A, Navarro-Marí JM. Update on the Diagnosis of Sexually Transmitted Infections. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:711-724. [PMID: 32663448 DOI: 10.1016/j.ad.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 01/12/2023] Open
Abstract
Sexually transmitted infections (STIs) are one of the most frequent and universal Public Health problems. Health professionals should be aware of the possibility of STIs due to their high morbidity and the presence of sequelae. The delay in the diagnosis is one of the factors that justifies the difficulty to infections control. Diagnostic tests allow the introduction of aetiological treatment and also lead to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. In this review we have made an update of the main existing diagnostic methods for the more important STIs.
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Affiliation(s)
- J Rodríguez-Granger
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - B Espadafor López
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - F Cobo
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - G Blasco Morente
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - A Sampedro Martinez
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J Tercedor Sánchez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L Aliaga-Martinez
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, España
| | | | - J M Navarro-Marí
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España
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11
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Diagnosis and Management of Syphilis in Patients With HIV Co-infection. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arando M, Fernandez-Naval C, Mota-Foix M, Martinez D, Armengol P, Barberá MJ, Esperalba J, Vall-Mayans M. Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients. BMC Infect Dis 2019; 19:727. [PMID: 31420018 PMCID: PMC6697967 DOI: 10.1186/s12879-019-4269-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Since 2000, substantial increases in syphilis in men who have sex with men (MSM) have been reported in many cities. Condomless anal sex (CAS) is one of the factors, along with drugs for sex and sex in group. This study identified factors and clinical manifestations as well as Treponema pallidum (T.pallidum) strains that could be related to early syphilis in Barcelona. METHODS This prospective study was conducted in a sexually transmitted infections unit in 2015. Epidemiological, behavioral, clinical and microbiological variables were collected in a structured form. Univariate and multivariate statistical analyses were performed focusing on HIV-positive patients. RESULTS Overall, 274 cases were classified as having early syphilis (27.5% primary, 51.3% secondary, and 21.2% early latent syphilis). In all, 94% of participants were MSM and 36.3% were HIV-positive. The median number of sexual contacts in the last 12 months was 10; 72.5% practiced CAS, 50.6% had sex in group, and 54.7% consumed drugs. HIV-positive cases had more anonymous sex contacts (p = 0.041), CAS (p = 0.002), sex in group (p < 0.001) and drugs for sex (p < 0.001). In the multivariate analysis, previous syphilis (adjusted odds ratio [aOR] 4.81 [2.88-8.15]), previous Neisseria gonorrhoeae infection (aOR 3.8 [2.28-6.43]), and serosorting (aOR 20.4 [7.99-60.96]) were associated with having syphilis. Clinically, multiple chancres were present in 31% of cases with no differences on serostatus, but anal chancre was most common in HIV-positive patients (p = 0.049). Molecular typing did not conclusively explain clinical presentation in relation to specific T.pallidum strains. CONCLUSION Control of syphilis remains a challenge. Similar to prior studies, HIV-positive patients were found to engage more often in sexual behaviors associated with syphilis than HIV-negative patients. Clinical manifestations were rather similar in both groups, although anal chancre was most common in HIV-positive patients. Various strain types of syphilis were found, but no clinical associations were identified.
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Affiliation(s)
- Maider Arando
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Candela Fernandez-Naval
- Vall d’Hebron Institute of Research, Barcelona, Spain
- Genetics and Microbiology Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Institute of Research, Barcelona, Spain
| | - Desi Martinez
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | - Pere Armengol
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | - Maria Jesús Barberá
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
| | | | - Martí Vall-Mayans
- STI Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Hospital Vall d’Hebron, Av Drassanes 17-21 STI Unit Vall d’Hebron-Drassanes, Barcelona, Spain
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Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol 2019; 20:423-442. [PMID: 30806959 DOI: 10.1007/s40257-019-00422-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antiretroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.
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Affiliation(s)
- Khatiya Chelidze
- Weill Cornell Medical College, Massachusetts General Hospital, 1300 York Avenue, New York, NY, 10021, USA
| | - Cristina Thomas
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA
| | - Aileen Yenting Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Esther Ellen Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA.
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
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15
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Jategaonkar A, Klimczak J, Agarwal J, Badhey A, Portnoy WM, Damiano A, Chai RL. Syphilis of the oropharynx: Case series of "The Great Masquerader". Am J Otolaryngol 2019; 40:143-146. [PMID: 30661890 DOI: 10.1016/j.amjoto.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Syphilis is a sexually transmitted infection with various presentations. Although, oropharyngeal manifestations are known to occur, the purpose of this study is to present the first case series in which the lesions were initially mistaken for human-papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). METHODS A multi-institutional retrospective review. RESULTS Six cases of oropharyngeal syphilis were initially thought to be secondary to OPSCC due to presentation. Symptoms were vague and exam findings consisted of either a tonsillar or base of tongue mass, or lymphadenopathy. Biopsies were negative for OPSCC. Further workup diagnosed syphilis, with resolution of symptoms and lesions after antibiotic treatment. CONCLUSIONS Head and neck manifestations of syphilis have been reported in the literature. However, this is the first series reporting on oropharyngeal syphilis masquerading as HPV-related OPSCC. Ultimately, otolaryngologists must maintain a high suspicion for syphilis in order to ensure prompt diagnosis and treatment.
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Tambe S, Zambare U, Nayak C. Nodulo-ulcerative and erythrodermic secondary syphilis in human immunodeficiency virus-infected individuals. Int J STD AIDS 2019; 30:505-508. [PMID: 30630397 DOI: 10.1177/0956462418815310] [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] [Indexed: 11/15/2022]
Abstract
Syphilis and human immunodeficiency virus (HIV) infections are both transmitted sexually. Co-infection of HIV and syphilis alters the course of both diseases. Clinical presentation of syphilis in patients of HIV may be atypical. HIV-infected individuals are at risk of developing lues maligna, which is characterized by nodulo-ulcerative lesions associated with severe constitutional symptoms. Erythroderma secondary to generalized papulo-squamous lesions of secondary syphilis is also uncommon. Here we report two cases of atypical presentations of secondary syphilis in HIV-positive patients.
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Affiliation(s)
- Swagata Tambe
- Department of Dermatology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Uddhao Zambare
- Department of Dermatology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Chitra Nayak
- Department of Dermatology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
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17
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Delgado S, Caceres J. Malignant Syphilis in a Human Immunodeficient Virus-Infected Patient. Am J Trop Med Hyg 2018; 96:523-524. [PMID: 28471744 PMCID: PMC5361521 DOI: 10.4269/ajtmh.16-0755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sandra Delgado
- Department of Tropical Medicine and Dermatology, Institute Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jaime Caceres
- Department of Pathology, Hospital Cayetano Heredia, Lima, Perú
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Jiang Y, Weng R, Zhang Y, Fan R, Liu Y, Chen Z, Peng F, Chen Y, Chen X. The performance of rapid plasma reagin (RPR) titer in HIV-negative general paresis after neurosyphilis therapy. BMC Infect Dis 2018; 18:144. [PMID: 29606102 PMCID: PMC5879544 DOI: 10.1186/s12879-018-3062-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 03/25/2018] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Repeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response. However, it is unknown whether serum rapid plasma reagin (RPR) titer can serve as a surrogate for determining the efficacy of treatment in general paresis (GP) remains unknown. METHODS We retrospectively reviewed data from 105 GP patients, who were divided into two groups (62 CSF RPR+ patients and 43 CSF RPR- patients) according to reactive RPR test status in CSF. Clinical assessment included the Mini-Mental State Examination (MMSE) scores, CSF examinations (WBC count, protein concentration and RPR titer), and serum tests (RPR titer and TPPA). Among the 105 GP patients, 13 CSF RPR+ patients and 6 CSF RPR- patients had a 12 months follow-up of CSF, serum measures and MMSE. RESULTS The median serum RPR titer was significantly higher in CSF RPR+ patients than that in CSF RPR- GP patients, 1:8 [IQR 1:4-1:32] vs. 1:4 [IQR 1:4-1:8] (P < 0.001). The number of CSF RPR+ patients with serum RPR titer≥1:32 was significantly higher when compared with CSF RPR- patients (P = 0.001). For CSF RPR+ patients, the MMSE scores improved or remained constantly after penicillin treatment. For CSF RPR+ patients, the CSF RPR titer declined four-fold in 85% (11/13) of the patients, whereas the serum RPR titer declined four-fold in only 46% (6/13) of the patients, the odds ratio is 6.4 (95% confidence interval 1.0-41.2). CONCLUSIONS A four-fold decline in CSF RPR titer is a good predictor for treatment efficacy in CSF RPR+ GP patients within 12 months after the completion of therapy.
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Affiliation(s)
- Ying Jiang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Ruihui Weng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yuefeng Zhang
- Department of Neurology, Guangzhou Brain Hospital, Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong, 510370, People's Republic of China
| | - Rong Fan
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yulun Liu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhigang Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Xiaohong Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
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19
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Refugio ON, Klausner JD. Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care. Expert Rev Anti Infect Ther 2018; 16:321-331. [PMID: 29489420 DOI: 10.1080/14787210.2018.1446828] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Syphilis continues to be a growing epidemic among men who have sex with men (MSM), particularly for those living with the human immunodeficiency virus (HIV). In 2016, MSM accounted for 80% of primary and secondary syphilis diagnoses in men in the United States; almost half of who were also HIV-infected. The synergistic relationship between HIV and syphilis has significant implications not only for HIV patient management, but also for sexually transmitted infection (STI) control among MSM. Areas covered: We review the literature on STI screening and treatment barriers at the patient-, provider-, and health system-levels, and present strategies to incorporate STI prevention into HIV care settings. Expert commentary: Integration of STI prevention into HIV care is paramount to stop the epidemic of not only syphilis, but also other curable STIs like gonorrhea and chlamydia. Although guidelines have been established for STI testing in HIV-infected MSM, screening rates continue to be lower than desired. Gonorrhea and chlamydia screening is below 50% in HIV-infected MSM; interventions that improve testing of those two infections must be implemented. For syphilis control, other additional strategies such as chemoprophylaxis should be considered given syphilis screening is above 50% in HIV-infected MSM.
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Affiliation(s)
- Oliver N Refugio
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Jeffrey D Klausner
- b Division of Infectious Diseases, Department of Medicine , UCLA , Los Angeles , California , USA
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20
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Son JH, Park SY, Chung BY, Kim HO, Cho HJ, Park CW. Nodular secondary syphilis in an immunocompetent woman: Case report and literature review. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Syphilis Masquerading As Mass Lesions: The Utility of Modern-Day Imaging and Molecular Sequencing in Clinical Diagnosis. Sex Transm Dis 2017; 44:303-305. [PMID: 28407647 DOI: 10.1097/olq.0000000000000582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Syphilis has been known to present in a myriad of symptoms throughout the ages, and until this day, the diagnosis remains elusive to the modern physician. We present 2 unusual cases of syphilis that posed diagnostic challenges even in the current era of new and advancing diagnostic tests.
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22
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Abstract
Syphilis is a chronic bacterial infection caused by Treponema pallidum that is endemic in low-income countries and and occurs at lower rates in middle-income and high-income countries. The disease is of both individual and public health importance and, in addition to its direct morbidity, increases risk of HIV infection and can cause lifelong morbidity in children born to infected mothers. Without treatment the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. Although syphilis is an ancient disease and the principles of recommended management have been established for decades, diagnosis and management are often challenging because of its varied manifestations and difficulty in interpretation of serological tests used to confirm diagnosis and evaluate response to therapy. In North America and western Europe, incidence of syphilis has increased dramatically in the past decade among men who have sex with men, particularly those with coexistent HIV infection. Only one drug, penicillin, is recommended for syphilis treatment and response to therapy is assessed based on changes over months in serological test titres. Treatment for patients who cannot receive penicillin and management of patients who do not serologically respond to treatment are common clinical problems.
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Affiliation(s)
- Edward W Hook
- University of Alabama at Birmingham, Birmingham, AL, USA.
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23
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Kenyon C, Osbak KK, Crucitti T, Kestens L. The immunological response to syphilis differs by HIV status; a prospective observational cohort study. BMC Infect Dis 2017; 17:111. [PMID: 28143443 PMCID: PMC5286814 DOI: 10.1186/s12879-017-2201-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
Background It is not known if there is a difference in the immune response to syphilis between HIV-infected and uninfected individuals. Methods We prospectively recruited all patients with a new diagnosis of syphilis and tested their plasma for IFNα, IFNγ, IL-1β, IL-12p40, IL-12p70, IP-10, MCP-1, MIP-1α, MIP-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10 and IL-17A at baseline pre-treatment and 6 months following therapy. Results A total of 79 HIV-infected [44 primary/secondary syphilis (PSS) and 35 latent syphilis (LS)] and 12 HIV-uninfected (10 PSS and 2 LS) cases of syphilis and 30 HIV-infected controls were included in the study. At the baseline visit, compared to the control group, concentrations of IL-10 were significantly elevated in the HIV-infected and uninfected groups. The level of IL-10 was significantly higher in the HIV-infected compared to the HIV-uninfected PSS group (25.3 pg/mL (IQR, 4.56–41.76) vs 2.73 pg/mL (IQR, 1.55–9.02), P = 0.0192). In the HIV-infected PSS group (but not the HIV-infected LS or HIV-uninfected PSS groups) the IP-10, MIP-1b, IL-6 and IL-8 were raised compared to the controls. IL-10 levels decreased but did not return to control baseline values by 6 months in HIV infected PSS and LS and HIV uninfected PSS. Conclusion PSS and LS in HIV-infected individuals is characterized by an increase in inflammatory and anti-inflammatory cytokines such as IL-10. The increase of IL-10 is greater in HIV-infected than uninfected individuals. Further work is required to ascertain if this is part of an immunological profile that correlates with adverse outcomes such as serofast syphilis and neurosyphilis, in HIV-infected individuals. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2201-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. .,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory 7700, Cape Town, South Africa.
| | | | - Tania Crucitti
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luc Kestens
- Immunology Unit, Institute of Tropical Medicine,, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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24
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Ahn JY, Boettiger D, Kiertiburanakul S, Merati TP, Huy BV, Wong WW, Ditangco R, Lee MP, Oka S, Durier N, Choi JY. Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database. J Int AIDS Soc 2016; 19:20965. [PMID: 27774955 PMCID: PMC5075717 DOI: 10.7448/ias.19.1.20965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/29/2016] [Accepted: 09/14/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. METHODS Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. RESULTS We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. CONCLUSIONS We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.
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Affiliation(s)
- Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | | | | | - Tuti Parwati Merati
- Faculty of Medicine, Udayana University and Sanglah Hospital, Bali, Indonesia
| | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Shinichi Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Nicolas Durier
- TREAT Asia, Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea;
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Szetela B, Gasiorowski J. Rapid Progression and Overlapping of Skin Eruptions in a Patient with Secondary and Tertiary Syphilis Coinfected with HIV. AIDS Res Hum Retroviruses 2016; 32:874-5. [PMID: 27138340 DOI: 10.1089/aid.2015.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith NH, Musher DM, Huang DB, Rodriguez PS, Dowell ME, Ace W, White AC. Response of HIV-Infected Patients with Asymptomatic Syphilis to Intensive Intramuscular Therapy with Ceftriaxone or Procaine Penicillin. Int J STD AIDS 2016; 15:328-32. [PMID: 15117503 DOI: 10.1177/095646240401500511] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this prospective pilot study was to evaluate the response of HIV-infected patients with asymptomatic syphilis to one of two intensive antibiotic treatment regimens. Thirty-one HIV-infected patients with serum rapid plasma reagin titre ≥1:4 and no clinical findings of syphilis were randomized to receive daily intramuscular injections of ceftriaxone or procaine penicillin (plus oral probenecid) for 15 days; 24 returned for follow-up study. Seven of 10 (70%) procaine penicillin-treated patients and 10 of 14 (71%) ceftriaxone-treated patients had a ≥4-fold decline in RPR ( P=0.94); two penicillin-treated and one ceftriaxone-treated patient relapsed. Two patients failed ceftriaxone therapy. Three penicillin-treated, and two ceftriaxone-treated patients were serofast. Serological responses were similar in those patients with and without asymptomatic neurosyphilis. There was no difference in the serologic response to daily treatment with ceftriaxone vs that with procaine penicillin plus probenecid; both treatments were associated with comparatively high rates of serological non-response and relapse.
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Affiliation(s)
- N H Smith
- Infectious Disease Section, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, 561E, Houston, Texas 77030, USA
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Merins V, Hahn K. Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid. Eur J Med Res 2015; 20:81. [PMID: 26445822 PMCID: PMC4596308 DOI: 10.1186/s40001-015-0175-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients. Methods We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant. Results Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %. Discussion Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.
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Affiliation(s)
- V Merins
- Group Practice Family Physicians, Alt-Buckow 9-11, 12349, Berlin, Germany.
| | - K Hahn
- Department of Neurology, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Germany.
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Rowley D, Swięcki P, Firlag-Burkacka E, Sabin C, Kümmerle T, Surah S, Sadlier C, O'Dea S, Horban A, Fätkenheuer G, Mulcahy F. Clinical and epidemiological characteristics of patients with early syphilis from three academic centres in Poland, Germany and Ireland: initial findings from the POETS study. Sex Transm Infect 2015; 91:389-94. [PMID: 25742696 DOI: 10.1136/sextrans-2014-051844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/01/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the characteristics of patients including sexual behaviour, rates of concurrent sexually transmitted infections (STI) and type of treatment given. METHODS Patients were recruited from Ireland, Poland and Germany. Data gathered included demographics, method of syphilis acquisition, stage of syphilis infection, HIV status, nadir and current CD4 counts and HIV viral suppression rates. Data were then subanalysed into HIV-positive and HIV-negative groups. RESULTS Of 175 patients recruited, 68% were HIV-positive and 86.3% were men who have sex with men. Most HIV-positive patients presented with secondary syphilis (55.7% vs 13.2%) (p=0.0001) while the majority of HIV-negative patients had primary syphilis noted at the time of recruitment (47.2% vs18.9%, p=0.0002). Approximately half of all patients had a HIV RNA viral load <40 copies/mL (55%). Previous syphilis infection occurred more frequently in HIV-positive than HIV-negative patients (p=0.0001). Concurrent STIs at the time of syphilis diagnosis were found in 26.8%, of whom 31 (25.4%) were HIV-positive (p=0.64). HIV-positive patients received doxycycline more frequently than their HIV-negative counterparts (33.6% vs 1.9%, p=0.0001) while HIV-negative patients were treated with long-acting penicillin in 88.7% of cases vs 58% of HIV-positive patients (p=0.0002). CONCLUSIONS A 40% rate of unsuppressed viraemia, high levels of STIs and varying treatment regimens represent a public health risk for Europe, suggesting the model of sexual healthcare delivery in HIV-positive patients requires further evaluation.
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Affiliation(s)
- D Rowley
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - P Swięcki
- The Hospital for Infectious Diseases, Warsaw, Poland
| | | | - C Sabin
- University College London, Royal Free Campus, Rowland Hill street, London, United Kingdom
| | - T Kümmerle
- Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany
| | - S Surah
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - C Sadlier
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - S O'Dea
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
| | - A Horban
- The Hospital for Infectious Diseases, Warsaw, Poland
| | - G Fätkenheuer
- Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - F Mulcahy
- The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland
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29
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Tipple C. Impact of HIV-1 infection on the clinical presentation of syphilis in men who have sex with men. Sex Health 2015; 12:110-8. [PMID: 25513993 DOI: 10.1071/sh14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM), especially those with HIV-1 infection, are disproportionately affected by syphilis in higher income countries. The course, and some of the clinical features of the disease, especially the development of neurosyphilis, can be affected by HIV-1 co-infection. This review documents potential differences in the clinical features of syphilis in HIV-1 infected and uninfected MSM and highlights the importance of a thorough examination and high index of suspicion when seeing and treating MSM at risk of sexually transmissible infections.
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Affiliation(s)
- Craig Tipple
- Department of Medicine, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK.
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30
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Jinno S, Anker B, Kaur P, Bristow CC, Klausner JD. Predictors of serological failure after treatment in HIV-infected patients with early syphilis in the emerging era of universal antiretroviral therapy use. BMC Infect Dis 2013; 13:605. [PMID: 24369955 PMCID: PMC3877955 DOI: 10.1186/1471-2334-13-605] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal treatment of early syphilis (primary, secondary and early latent) in HIV-infected patients remains controversial. The Center for Diseases Control STD Treatment Guidelines recommended 1 dose of benzathine penicillin G (BPG) regardless of HIV infection. However, many providers modify the treatment for early syphilis. METHODS We performed a retrospective chart review of all cases of early syphilis with positive serologic test results in HIV-infected patients from May 2006 to May 2011 in 2 large, urban HIV clinics. Early syphilis includes primary, secondary, and early latent syphilis. Serological failure was defined as a lack of 4-fold decrease in rapid plasma reagent (RPR) titers 9 to 12 months after syphilis treatment. Patients whose RPR titers decreased after treatment and subsequently increased 4-fold at 9 to 12 months were excluded from the analysis of serological response because of possibility as "reinfection". Baseline characteristics were tested as predictive factors of serological failure using a univariate and multivariate logistic regression model, respectively. RESULTS Of 560 patients with confirmed cases of early syphilis, 51 (9.0%) experienced serological failure. Multivariate logistic regression modeling demonstrated that the predictive factors associated with serological failure after early syphilis treatment were baseline RPR titer ≤ 1:16 (OR 3.91 [95% CI, 2.04-7.47]), a previous history of syphilis (OR 3.12 [95% CI, 1.55-6.26]), and a CD4 T-cell count below 350 cells/ml (OR 2.41 [95% CI, 1.27-4.56]). Of note, type of syphilis treatment (1 dose versus 3 doses of BPG) did not appear to affect the proportion of serological failure (4% versus 10%, P = 0.29), however the power of this study to detect small differences was limited. CONCLUSIONS HIV-infected patients with baseline RPR titer ≤1:16, syphilis history, and/or a CD4 T-cell count <350 cells/ml should be closely monitored for serologic failure after early syphilis treatment. This study did not detect a substantial difference between treatment with > 1 dose of BPG and decreased frequency of serological failure, supporting the current recommendation that one dose of BPG is adequate treatment for early syphilis in HIV-infected patients.
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Affiliation(s)
- Sadao Jinno
- Department of Medicine, AIDS Healthcare Foundation, Los Angeles, CA USA.
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31
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Scythes JB, Jones CM. Syphilis in the AIDS era: diagnostic dilemma and therapeutic challenge. Acta Microbiol Immunol Hung 2013; 60:93-116. [PMID: 23827743 DOI: 10.1556/amicr.60.2013.2.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review argues that syphilis has been underdiagnosed and undertreated, a problem that goes back to the beginning of the Wassermann era, and indeed long before. Non-treponemal tests do not detect the larger pool of persons with latent syphilis, the immunological consequences of which have not been systematically investigated in the context of HIV infection and progression to AIDS. Recent efforts to confirm the prevalence of syphilis in high-risk patients by reverse sequence screening, i.e. using a treponemal test first, as the screening test, have revealed untreated syphilis at higher rates than expected. Further testing using PCR discovered even more previously undetected cases. We suggest that latent syphilis is a chronic active immunological condition that drives the AIDS process and cannot be managed with the older Wassermann-based algorithm, and that non-treponemal tests have failed to associate syphilis with immune suppression since this screening concept was developed in 1906. In light of the overwhelming association between a past history of syphilis and HIV seroconversion, more sensitive tools, including recombinant antigen-based immunological tests and direct detection (PCR) technology, are needed to adequately assess the role of latent syphilis in persons with HIV/AIDS. Repeating older syphilis reinoculation studies may help establish a successful animal model for AIDS, and resolve many paradoxes in HIV science.
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Affiliation(s)
- John B Scythes
- Community Initiative for AIDS Research, Toronto, Canada.
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Mamoojee Y, Tan G, Gittins S, Sarfo S, Stephenson L, Carrington D, Bedu-Addo G, Phillips R, Appiah LT, Chadwick D. Diagnosis of treponemal co-infection in HIV-infected West Africans. Trop Med Int Health 2012; 17:1521-6. [DOI: 10.1111/j.1365-3156.2012.03090.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Knaute DF, Graf N, Lautenschlager S, Weber R, Bosshard PP. Serological response to treatment of syphilis according to disease stage and HIV status. Clin Infect Dis 2012; 55:1615-22. [PMID: 22955437 PMCID: PMC3501331 DOI: 10.1093/cid/cis757] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The serological response to treatment was studied in 264 syphilis patients; it was influenced by syphilis stage but not by human immunodeficiency virus infection and reinfection. Some of the recommendations of current guidelines are critically discussed, and amendments are proposed. Background. Serology is the mainstay for syphilis diagnosis and treatment monitoring. We investigated serological response to treatment of syphilis according to disease stage and HIV status. Methods. A retrospective cohort study of 264 patients with syphilis was conducted, including 90 primary, 133 secondary, 33 latent, and 8 tertiary syphilis cases. Response to treatment as measured by the Venereal Disease Research Laboratory (VDRL) test and a specific IgM (immunoglobulin M) capture enzyme-linked immunosorbent assay (ELISA; Pathozyme-IgM) was assessed by Cox regression analysis. Results. Forty-two percent of primary syphilis patients had a negative VDRL test at their diagnosis. Three months after treatment, 85%–100% of primary syphilis patients had reached the VDRL endpoint, compared with 76%–89% of patients with secondary syphilis and 44%–79% with latent syphilis. In the overall multivariate Cox regression analysis, serological response to treatment was not influenced by human immunodeficiency virus (HIV) infection and reinfection. However, within primary syphilis, HIV patients with a CD4 count of <500 cells/μL had a slower treatment response (P = .012). Compared with primary syphilis, secondary and latent syphilis showed a slower serological response of VDRL (P = .092 and P < .001) and Pathozyme-IgM tests (P < .001 and P = .012). Conclusions. The VDRL should not be recommended as a screening test owing to lack of sensitivity. The syphilis disease stage significantly influences treatment response whereas HIV coinfection only within primary syphilis has an impact. VDRL test titers should decline at least 4-fold within 3–6 months after therapy for primary or secondary syphilis, and within 12–24 months for latent syphilis. IgM ELISA might be a supplement for diagnosis and treatment monitoring.
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Affiliation(s)
- Damaris Fröhlich Knaute
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, CH-8091 Zürich, Switzerland
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Lourari S, Bulai-Livideanu C, Giordano-Labadie F, Lamant L, Launay F, Viraben R, Paul C. [Bullous secondary syphilis]. Presse Med 2011; 40:550-3. [PMID: 21251793 DOI: 10.1016/j.lpm.2010.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022] Open
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Abstract
After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade.
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McVey M, Cameron W, MacPherson P. When infections collide—gummatous syphilis in an HIV-infected individual. Int J Infect Dis 2010; 14 Suppl 3:e283-6. [DOI: 10.1016/j.ijid.2009.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 11/25/2009] [Indexed: 10/19/2022] Open
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Mullooly C, Higgins SP. Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy. Int J STD AIDS 2010; 21:537-45. [DOI: 10.1258/ijsa.2010.010243] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
After years of declining incidence in many developed countries, syphilis infection has re-emerged as a major public health problem in the past decade. The secondary stage of syphilis epitomizes the capacity of the infection to present in myriad ways. The skin, lymph glands and mucosal membranes are the most commonly affected tissues.
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Affiliation(s)
- C Mullooly
- Department of Genitourinary Medicine, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK
| | - S P Higgins
- Department of Genitourinary Medicine, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK
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Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study. AIDS 2010; 24:1907-16. [PMID: 20616699 DOI: 10.1097/qad.0b013e32833bfe21] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. METHODS Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. RESULTS Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:>or=32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. CONCLUSION Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.
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Hall CS, Marrazzo JD. Emerging issues in management of sexually transmitted diseases in HIV infection. Curr Infect Dis Rep 2010; 9:518-30. [PMID: 17999888 DOI: 10.1007/s11908-007-0077-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Sexually transmitted diseases (STDs) occur often among sexually active persons with HIV infection. Incident STDs may complicate the course of HIV infection and potentiate HIV transmission in the coinfected individual by mucosal disruption and an increase in HIV concentration in ulcers and involved mucous membranes. Conducting ongoing periodic sexual risk assessments in HIV-positive patients in routine medical care is critical to identifying asymptomatic infections. HIV clinicians should be familiar with updated recommendations for screening, diagnosis, and treatment of bacterial and viral STDs, including those specific to HIV infection. This article addresses emerging issues in the management of STDs in HIV-infected persons and summarizes the latest evidence that can be applied to clinical decision-making in this population.
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Affiliation(s)
- Christopher S Hall
- Division of Allergy & Infectious Diseases, University of Washington, Harborview Medical Center, Center for AIDS and STD, 325 Ninth Avenue, Mailbox #359931, Seattle, WA 98104-2499, USA
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Weis L, Bonamigo RR, Weber MB, Petry V, Luzzatto L. Malignant syphilis and neurolues in an HIV infected patient. Int J Dermatol 2010; 49:590-2. [DOI: 10.1111/j.1365-4632.2010.04247.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Farhi D, Benhaddou N, Grange P, Zizi N, Deleuze J, Morini JP, Gerhardt P, Krivine A, Avril MF, Dupin N. Clinical and serologic baseline and follow-up features of syphilis according to HIV status in the post-HAART era. Medicine (Baltimore) 2009; 88:331-340. [PMID: 19910747 DOI: 10.1097/md.0b013e3181c2af86] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.
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Affiliation(s)
- David Farhi
- From Department of Dermatology and Venereology (DF, NZ, JD, JPM, PG, MFA, ND), Hôpital Cochin-Pavillon Tarnier, AP-HP, Université Paris 5-René Descartes, Paris; Department of Bacteriology (NB), Hôpital Cochin, AP-HP, Université Paris 5, Paris; Laboratoire de Recherche en Dermatologie et Centre National de Référence de la Syphilis (PG, ND), UPRES EA 1833, Université Paris 5-René Descartes, Paris; Department of Virology (AK), Hôpital Saint-Vincent de Paul, AP-HP, Université Paris 5, Paris, France
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Santos NPD, Castro BG, Rios-Grassi MF. Aplicação do protocolo do "Projeto Nascer Maternidades" em uma maternidade de referência em Feira de Santana, Bahia, Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2009. [DOI: 10.1590/s1519-38292009000100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: analisar a aplicação do protocolo do "Projeto Nascer Maternidades", estratégia do Ministério da Saúde para a adoção de medidas profiláticas e/ou terapêuticas no momento do parto, para gestantes com sorologias para sífilis/Aids desconhecidas, no primeiro ano de implantação em uma maternidade de referência em Feira de Santana, Bahia, Brasil. MÉTODOS: foram analisadas sorologias para HIV e sífilis solicitadas no pré-natal e na maternidade e a adoção de medidas profiláticas e/ou terapêuticas. Os dados foram coletados em uma amostra randomizada de 337 prontuários de gestantes admitidas para assistência obstétrica no período de julho de 2003 a julho de 2004. RESULTADOS: no pré-natal, 8,4% das gestantes realizaram sorologia para HIV e 8% para sífilis. Na maternidade, o teste rápido para HIV foi realizado para 17,7% das gestantes e o VDRL para 97,8%. A profilaxia das gestantes infectadas pelo HIV foi aplicada no momento do parto. Quanto à sífilis, não houve tratamento para 80% das mulheres com VDRL reagente. Os recém-nascidos foram tratados. CONCLUSÕES: as determinações do "Projeto Nascer-Maternidades" não foram seguidas no primeiro ano de implantação na maternidade estudada.
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Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Canadian Journal of Public Health 2009. [PMID: 19009926 DOI: 10.1007/bf03405250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the epidemiology of an outbreak of infectious syphilis in Ottawa. METHODS A retrospective chart review of infectious syphilis cases in Ottawa from 2001-2006. RESULTS Rates of syphilis have risen more than tenfold. The epidemic was centered in men, with the majority of cases (83.5%) occurring among men who have sex with men (MSM). These individuals differed from the general MSM population residing in Ottawa in their being older, more likely to be HIV positive, and more sexually promiscuous. Inconsistent condom use by MSM engaged in either oral or anal sex was pervasive. Thirty-seven percent of MSM reported sexual encounters with men from Montreal and Toronto. Visceral manifestations of syphilis, including neurosyphilis, were more common in persons co-infected with HIV. As a result, this subgroup was more likely to have received an extended antibiotic treatment regimen. There was a substantial delay between serological diagnosis and treatment. Less than half of treated cases returned for a six-month evaluation. CONCLUSIONS Multiple sexual partners, unprotected oral sex, and increased age among MSM were the predominant risk factors contributing to this syphilis epidemic. Co-infection with HIV modified the clinical presentation of syphilis, necessitating a more intensive diagnostic and therapeutic approach. The interconnection of urban sexual networks has likely contributed to the dynamics of local syphilis transmission and suggests that effective interventions will require a coordinated national approach.
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Affiliation(s)
- Aviva Leber
- Department of Medicine, University of Ottawa, Ottawa, ON
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Quatresooz P, Piérard GE. Skin Homing of Treponema pallidum in Early Syphilis. Appl Immunohistochem Mol Morphol 2009; 17:47-50. [DOI: 10.1097/pai.0b013e3181788186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosen T, Vandergriff T, Harting M. Antibiotic Use in Sexually Transmissible Diseases. Dermatol Clin 2009; 27:49-61. [DOI: 10.1016/j.det.2008.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K. Syphilis and HIV co-infection. Eur J Intern Med 2009; 20:9-13. [PMID: 19237085 DOI: 10.1016/j.ejim.2008.04.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 01/15/2008] [Accepted: 04/27/2008] [Indexed: 11/22/2022]
Abstract
Syphilis is a complex disease, which is sexually transmitted. The incidence of syphilis is rising all over the world, partly due to the increased transmission in HIV patients and other high risk groups such as men who have sex with men. Interestingly syphilis itself facilitates HIV infection in several ways. Great importance exists in recognition of both diseases and their complex interactions. This article will review the manifestations of syphilis in the context of HIV infected patients, and the challenging diagnosis and management of these patients.
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Affiliation(s)
- Galia Karp
- Internal Medicine Department, Soroka University Medical Center, P.O. Box 151, Beer Sheva, Israel.
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Seronegative Syphilis in an AIDS Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e3181637a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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