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Nature Reviews. Disease Primers Oct 2017Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its... (Review)
Review
Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.
Topics: Algorithms; Humans; Syphilis
PubMed: 29022569
DOI: 10.1038/nrdp.2017.73 -
Clinical & Experimental Optometry Sep 2021Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, . The natural history of untreated syphilis progresses through four...
Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, . The natural history of untreated syphilis progresses through four distinct stages: primary, secondary, latent, and tertiary syphilis. Ocular involvement can occur at any stage of syphilis and any part of the eye can be affected. With the exception of syphilitic posterior placoid chorioretinitis, the diverse manifestations of ocular syphilis have few distinct features that can be used to assist in clinical diagnosis. Therefore, ocular syphilis should always be a part of the differential diagnosis of most, if not all, ocular infectious and inflammatory presentations. Specifically, uveitis presentations, high-risk sexual history, illicit drug use history, treatment failure, prior history of syphilis should prompt further diagnostic workup for ocular syphilis. A presumptive diagnosis of ocular syphilis relies on serological testing, both treponemal and nontreponemal tests. All patients with ocular syphilis should have their cerebrospinal fluids tested for the co-existence of neurosyphilis and their blood tested for human immunodeficiency virus co-infection. In the United States, Centers for Disease Control and Prevention recommend that ocular syphilis be managed according to its treatment guidelines for neurosyphilis, with parenteral aqueous crystalline penicillin G the drug of choice. With the timely diagnosis and appropriate treatment, ocular syphilis is curable. However, delayed diagnosis of ocular syphilis may result in long-term visual impairment. Delayed diagnosis occurs because of its diverse presentations mimicking other ocular diseases, and failure of the clinician to order serological testing. With the recent worldwide resurgence of ocular syphilis, clinicians should be familiar with the manifestation, diagnosis, and treatment of ocular syphilis.
Topics: Chorioretinitis; Endophthalmitis; Eye Infections, Bacterial; Humans; Syphilis
PubMed: 33831337
DOI: 10.1080/08164622.2021.1906848 -
Clinical Infectious Diseases : An... Jun 2020We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis,... (Review)
Review
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960-2017, and for data related to the venereal disease research laboratory test from 1940-1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
Topics: Humans; Laboratories; Neurosyphilis; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 32578862
DOI: 10.1093/cid/ciaa306 -
JAMA Nov 2014The incidence of syphilis in the United States is increasing; it is estimated that more than 55,000 new infections will occur in 2014. Treatment regimens are... (Review)
Review
IMPORTANCE
The incidence of syphilis in the United States is increasing; it is estimated that more than 55,000 new infections will occur in 2014. Treatment regimens are controversial, especially in specific populations, and assessing treatment response based on serology remains a challenge.
OBJECTIVE
To review evidence regarding penicillin and nonpenicillin regimens, implications of the "serofast state," and treatment of specific populations including those with neurosyphilis or human immunodeficiency virus (HIV) infection and pregnant women.
EVIDENCE REVIEW
We searched MEDLINE for English-language human treatment studies dating from January 1965 until July 2014. The American Heart Association classification system was used to rate quality of evidence.
FINDINGS
We included 102 articles in our review, consisting of randomized trials, meta-analyses, and cohort studies. Case reports and small series were excluded unless they were the only studies providing evidence for a specific treatment strategy. We included 11 randomized trials. Evidence regarding penicillin and nonpenicillin regimens was reviewed from studies involving 11,102 patients. Data on the treatment of early syphilis support the use of a single intramuscular injection of 2.4 million U of benzathine penicillin G, with studies reporting 90% to 100% treatment success rates. The value of multiple-dose treatment of early syphilis is uncertain, especially in HIV-infected individuals. Less evidence is available regarding therapy for late and late latent syphilis. Following treatment, nontreponemal serologic titers should decline in a stable pattern, but a significant proportion of patients may remain seropositive (the "serofast state"). Serologic response to treatment should be evident by 6 months in early syphilis but is generally slower (12-24 months) for latent syphilis. Evidence defining treatment for HIV-infected persons and for pregnant women is limited, but available data support penicillin as first-line therapy.
CONCLUSIONS AND RELEVANCE
The mainstay of syphilis treatment is parenteral penicillin G despite the relatively modest clinical trial data that support its use.
Topics: Adult; Anti-Bacterial Agents; Female; Humans; Injections, Intramuscular; Male; Penicillin G Benzathine; Pregnancy; Syphilis
PubMed: 25387188
DOI: 10.1001/jama.2014.13259 -
Clinical Infectious Diseases : An... Apr 2022A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed...
A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these questions. Available data suggest no clinical benefit to >1 dose of benzathine penicillin G for early syphilis in human immunodeficiency virus (HIV)-infected patients. While penicillin remains the drug of choice to treat syphilis, doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There are very limited data regarding the impact of additional antibiotic doses on serologic responses in serofast patients and no data on the impact of additional antibiotic courses on long-term clinical outcomes. In patients with isolated ocular or otic signs and symptoms, reactive syphilis serologic results, and confirmed ocular/otic abnormalities at examination, a diagnostic cerebrospinal fluid (CSF) examination is not necessary, because up to 40% and 90% of patients, respectively, would have no CSF abnormalities. Based on the results of 2 studies, repeated CSF examinations are not necessary for HIV-uninfected patients or HIV-infected patients on antiretroviral therapy who exhibit appropriate serologic and clinical responses after treatment for neurosyphilis. Finally, several important gaps were identified and should be a priority for future research.
Topics: Adult; Anti-Bacterial Agents; Centers for Disease Control and Prevention, U.S.; HIV Infections; Humans; Neurosyphilis; Penicillin G Benzathine; Syphilis; United States
PubMed: 35416969
DOI: 10.1093/cid/ciac060 -
Ugeskrift For Laeger May 2018Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. Syphilis re-emerged worldwide in the late 1990s, and hereafter increasing... (Review)
Review
Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. Syphilis re-emerged worldwide in the late 1990s, and hereafter increasing rates of syphilis were seen also in Denmark. Currently, around 700 cases are diagnosed yearly in Denmark, and syphilis is mainly encountered among men, who have sex with men. However, because of the risk of congenital infection screening of pregnant women has been introduced. Syphilis gives rise to highly variable symptoms such as chancre, skin rashes and fever or latent infection. The recommended treatment is intramuscular administration of penicillin.
Topics: Anti-Bacterial Agents; Coinfection; Denmark; Female; HIV Infections; Humans; Injections, Intramuscular; Male; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Sexual and Gender Minorities; Syphilis; Syphilis, Congenital; Treponema pallidum
PubMed: 29798749
DOI: No ID Found -
Indian Journal of Sexually Transmitted... 2023There is a change in the pattern and prevalence of acquired syphilis due to better awareness, surveillance, laboratory diagnosis, and treatment in India in recent years....
BACKGROUND
There is a change in the pattern and prevalence of acquired syphilis due to better awareness, surveillance, laboratory diagnosis, and treatment in India in recent years. However, restrictive measures for COVID-19 may produce different effects on incidence.
AIMS AND OBJECTIVES
We aimed to study the changing trend of acquired syphilis in relation to COVID-19 outbreak in a tertiary care hospital in North India.
MATERIALS AND METHODS
A retrospective analysis of all the cases of sexually transmitted infections (STIs) was done from January 2016 to June 2022. Demographic, clinical, and laboratory data of acquired syphilis were recorded and analyzed for changing trends in prevalence, clinical presentations, association with HIV and other sexually transmitted diseases (STDs), and its relation to COVID-19. Statistical analysis was done using SPSS software.
RESULTS
A total of 1105 patients attended STD clinic from January 2016 to June 2022, of which 216 patients were venereal disease research laboratory and hemagglutination assay positive (19.5%). Before COVID-19, there was an increasing trend of acquired syphilis (late latent). Patients diagnosed with syphilis pre- and postlockdown did not differ significantly in their mean age, median age, male/female ratio, and HIV status. However, there is an increase in number of cases of primary and secondary syphilis postlockdown which was statistically significant.
CONCLUSION
Restrictive measures for COVID-19 during the lockdown produced a declining trend of syphilis. It is unclear whether the observed decrease in number of STI cases was due to true decline, inadequate testing, underreporting, or avoidance of high-risk sexual activities. The upsurge in the number of cases of acquired syphilis after lockdown suggests the possibility that lockdowns did not completely disrupt STI transmission.
PubMed: 38223155
DOI: 10.4103/ijstd.ijstd_22_23