Analysis of molecular subtypes and antibiotic resistance in Treponema pallidum isolates from blood donors in Khyber Pakhtunkhwa, Pakistan.

Syphilis, caused by Treponema pallidum, is resurging globally. Molecular typing allows for the investigation of its epidemiology. In Pakistan and other nations, T. pallidum subsp. pallidum has developed widespread macrolide resistance in the past decade. A study at the Peshawar Regional Blood Centre from June 2020-June 2021 analyzed serum samples from 32,812 blood donors in Khyber Pakhtunkhwa, Pakistan, to assess circulating T. pallidum strains and antibiotic resistance. Blood samples were initially screened for T. pallidum antibodies using a chemiluminescent microparticle immunoassay (CMIA). CMIA-reactive samples underwent polymerase chain reaction (PCR) targeted the polA, tpp47, bmp, and tp0319 genes. PCR-positive samples were further analyzed for molecular subtyping using a CDC-developed procedure and tp0548 gene examination. All PCR-positive samples were analyzed for the presence of point mutations A2058G and A2059G in 23S rRNA, as well as the G1058C mutation in 16S rRNA. These mutations are known to impart antimicrobial resistance to macrolides and doxycycline, respectively. Out of 32,812 serum samples, 272 (0.83%) were CMIA-reactive, with 46 being PCR-positive. Nine T. pallidum subtypes were identified, predominantly 14d/f. The A2058G mutation in 23S rRNA was found in 78% of cases, while G1058C in 16S rRNA and A2059G in 23S rRNA were absent. The research found donor blood useful for assessing T. pallidum molecular subtypes and antibiotic resistance, especially when chancres are not present. The prevalent subtype was 14d/f (51.85%), and the high macrolide resistance of 36 (78%) indicates caution in using macrolides for syphilis treatment in Khyber Pakhtunkhwa, Pakistan.

Single-test syphilis serology: A case of not seeing the forest for the trees.

INTRODUCTION: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. METHODS: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. RESULTS: Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. CONCLUSION: Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.

Persistence of Treponema pallidum IgM antibodies in serum: What is their meaning?

We studied the detection of Treponema pallidum (TP)-IgM antibodies in the serum of 69 patients treated for syphilis. The persistence of TP-IgM antibodies in serum for more than 3 years was the only clue to suspect an active infection and, therefore, to investigate a central nervous system involvement.

Evaluation of rapid diagnostic test kits for detection of Treponema pallidum antibody.

Rapid syphilis testing plays a crucial role in global health strategies, addressing the urgent need for prompt and accurate diagnostics, especially in settings with limited resources. Despite their practical utility, these tests often lack thorough validation, leading to concerns about their efficacy and reliability. This study aims to evaluate two prototypes of the Onsite Syphilis Ab Combo Rapid Test (Fd and Ff) and compare their performance with the established chemiluminescent microparticle immunoassay (CMIA) method. Employing a reverse algorithm approach, the study analyzed 450 serum samples, including those from syphilis patients, healthy individuals, and cases with potential cross-reactions. Results of the rapid test kit were then correlated with CMIA findings, RPR, and TPPA titers. The results showed that prototype Fd exhibited a sensitivity of 100.0%, specificity of 98.8%, positive predictive value (PPV) of 8.4%, negative predictive value (NPV) of 100.00% and accuracy of 98.8%. Similarly, prototype Ff exhibited sensitivity of 100.0%, but with a slightly higher specificity of 99.6%, PPV of 21.5%, NPV of 100.0% and accuracy of 99.6%. Moreover, both prototypes Fd and Ff of the Onsite Syphilis Ab Combo Rapid Test demonstrated significant efficacy diagnostic tool, offering clear and straightforward interpretation for clinicians in varied CMIA, RPR and TPPA titer scenarios. The Onsite Syphilis Ab Combo Rapid Test prototypes, Fd and Ff, demonstrated high sensitivity and specificity, comparable to CMIA methods. The effectiveness highlights their suitability for syphilis screening, particularly in non-laboratory settings or situations requiring immediate results. The validation of these prototypes supports their integration into current syphilis diagnostic algorithms, potentially contributing to improved public health outcomes.

Seroprevalence of Treponema pallidum infection in Brazilian indigenous people: a cross-sectional study.

Indigenous communities in Brazil have a complex epidemiological profile, which increases their chances of contracting sexually transmitted diseases. However, limited data is available on Treponema pallidum infections in this population. We investigated the seroprevalence and risk factors associated with T. pallidum infection in an indigenous population of Dourados, Mato Grosso do Sul. Blood samples were collected from September 2017 to March 2020, and the participants were interviewed to obtain comprehensive data on demography and sexual behavior. Serological tests were performed to detect T. pallidum infection. Besides conducting descriptive analysis, we performed Chi-squared tests and determined the bivariate odds ratio. The data were also analyzed using logistic regression. Among the 2190 invited individuals, 1927 (88%) were included in this study. The seroprevalence of T. pallidum infection was 2.91%. The results of a multivariate analysis showed that individuals who were 30-39 years old, with up to 4 years of school education, living in households without piped water, with a history of genital lesions, multiple sexual partners, and having a history of STIs had the highest seroprevalence of T. pallidum. This study showed that behavioral, social, and economic factors play an important role in the transmission of T. pallidum within the indigenous population. Thus, targeted intervention, including imparting education in the native language, mass testing initiatives, and implementing public policies to improve socioeconomic indicators, is needed to reduce the cases of syphilis in this community.

Performance Assessment of Treponemal and Nontreponemal Tests for the Diagnosis of Acquired Syphilis.

There are a variety of nontreponemal test (NTT) and treponemal test (TT) kits for the serologic diagnosis of syphilis. Because of the complexity of the infection (multiple clinical stages) and the different antigens used in these kits, a systematic evaluation of the accuracy of the currently available commercial tests is warranted. Our objective was to evaluate the performance of commercially available tests for the diagnosis of syphilis infection. In this study, we analyzed one NTT (Venereal Disease Research Laboratory [VDRL] test, Wiener Laboratories, Rosario, Argentina) and two TTs (fluorescent treponemal antibody absorption [FTA-ABS] test, Euroimmun, Lübeck, Germany, and syphilis recombinant ELISA v. 4.0 test [ELISA], Wiener Laboratories, Rosario, Argentina) using a panel of 187 samples, including serum samples from 31 individuals with primary syphilis, 77 with secondary syphilis, and 79 with latent syphilis. An additional 192 samples from uninfected individuals and 323 serum samples from individuals with other diseases were included. The sensitivities of the VDRL, ELISA, and FTA-ABS tests were 97.9%, 100%, and 96.3%, respectively. The VDRL and ELISA tests showed a specificity of 100%, and the FTA-ABS test showed a specificity of 99.5%. Accuracy was 98.9% for the VDRL test, 100% for the ELISA, and 97.9% for the FTA-ABS test. For primary, secondary, and latent syphilis, the ELISA achieved a diagnostic performance of 100%, whereas the sensitivity for the VDRL and FTA-ABS tests ranged from 96.8% to 98.7% and 93.7% to 98.7%, respectively. No difference was observed when the tests were used as traditional or reverse algorithms. In general, all three tests are able to discriminate positive and negative samples for syphilis, regardless of the diagnostic algorithm.

Evaluating the clinical utility of semi-quantitative luciferase immunosorbent assay using Treponema pallidum antigens in syphilis diagnosis and treatment monitoring.

To assess the clinical applicability of a semi-quantitative luciferase immunosorbent assay (LISA) for detecting antibodies against Treponema pallidum antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) in diagnosing and monitoring syphilis. LISA for detection of anti-TP15, TP17, and TP47 antibodies were developed and evaluated for syphilis diagnosis using 261 serum samples (161 syphilis, 100 non-syphilis). Ninety serial serum samples from 6 syphilis rabbit models (3 treated, 3 untreated) and 110 paired serum samples from 55 syphilis patients were used to assess treatment effects by utilizing TRUST as a reference. Compared to TPPA, LISA-TP15, LISA-TP17, and LISA-TP47 showed a sensitivity of 91.9%, 96.9%, and 98.8%, specificity of 99%, 99%, and 98%, and AUC of 0.971, 0.992, and 0.995, respectively, in diagnosing syphilis. Strong correlations (rs = 0.89-0.93) with TPPA were observed. In serial serum samples from rabbit models, significant differences in the relative light unit (RLU) were observed between the treatment and control group for LISA-TP17 (days 31-51) and LISA-TP47 (day 41). In paired serum samples from syphilis patients, TRUST titres and the RLU of LISA-TP15, LISA-TP17, and LISA-TP47 decreased post-treatment (P < .001). When TRUST titres decreased by 0, 2, 4, or ≥8-folds, the RLU decreased by 17.53%, 31.34%, 48.62%, and 72.79% for LISA-TP15; 8.84%, 17.00%, 28.37%, and 50.57% for LISA-TP17; 22.25%, 29.79%, 51.75%, and 70.28% for LISA-TP47, respectively. Semi-quantitative LISA performs well for syphilis diagnosis while LISA-TP17 is more effective for monitoring syphilis treatment in rabbit models and clinical patients.

Serological evaluation of recombinant protein antigen Tp0608 for the diagnosis of syphilis.

OBJECTIVE: To evaluate the serological diagnosis value of recombinant protein antigen Tp0608 for syphilis. METHOD: 406 patients with various stages of syphilis were enrolled. A recombinant protein antigen Tp0608 was established and ELISA was used to detect patients with various stages of syphilis. The results were compared with the conventional rapid plasma reagin test (RPR) and Treponema pallidum particle agglutination test (TPPA). The sensitivity of Tp0608 recombinant protein and RPR+TPPA screening was 96.6 % and 93.1 % respectively for patients with various stages of syphilis. For patients who may have cross reactivity, the specificity of Tp0608 recombinant protein screening is 98.9 %, and the AUC of the ROC curve is 0.99; The specificity of RPR+TPPA screening was 97.3 %, and the AUC of the ROC curve was 0.96. The sensitivity and specificity of Tp0608 recombinant protein in syphilis screening are higher than conventional RPR+TPPA methods, especially in congenital syphilis and primary syphilis. CONCLUSION: The Tp0608 recombinant protein is a promising diagnostic antigen for syphilis screening, but its intracellular location and protective response have not been determined, and further verification is needed.

Acceso al diagnóstico rápido de VIH/sífilis en contextos de encierro: relato de experiencia en una unidad penal de la provincia de Buenos Aires en el año 2021 / Access to rapid diagnosis of HIV/syphilis in confinement contexts: an experience report in a penal unit in the province of Buenos Aires in the year 2021

En Argentina se estima que 140 mil personas viven con VIH y de ellas el 17% no conocen su diagnóstico (Ministerio de Salud, 2021). La Dirección de Sida y Enfermedades de Transmisión Sexual (DSyETS) del Ministerio de Salud de la Nación realizó un estudio que mostró una prevalencia global de VIH de 2,68% en unidades del servicio penitenciario federal (DSyETS; 2017). Por ello nuestro objetivo fue favorecer el acceso al testeo y a la prevención de estas enfermedades en personas privadas de su libertad en una unidad penal de la provincia de Buenos Aires en el marco de la pandemia. Relato de experiencia: en diciembre del 2021 se ofreció el testeo voluntario, gratuito y confidencial para VIH y sífilis y accedieron 38 personas. Participaron de la actividad docentes, estudiantes del Departamento de Ciencias de la Salud de la Universidad Nacional del Sur y referentes del programa de VIH-ITS y HV de la Región Sanitaria I del ministerio de salud de la provincia de Buenos Aires. Conclusiones: Esta experiencia mostró la importancia de construcción de redes para la articulación de prácticas que favorezcan el acceso a un diagnóstico temprano y tratamiento oportuno para VIH y sífilis a las personas viviendo en contexto de encierro (AU)

In Argentina, it is estimated that 140 thousand people live with HIV and 17% of them do not know their diagnosis (Ministry of Health, 2021). The Directorate of AIDS and Sexually Transmitted Diseases (DSyETS) of the Ministry of Health of the Nation carried out a study that showed a global prevalence of HIV of 2.68% in units of the federal prison service (DSyETS; 2017). For this reason, our objective was to promote access to testing and the prevention of these diseases in people deprived of their liberty in a penal unit in the province of Buenos Aires in the context of the pandemic. Experience report: in December 2021, voluntary, free and confidential testing for HIV and syphilis was offered and 38 people agreed. Teachers, students from the Department of Health Sciences of the National University of the South and referents of the HIV-STI and HV program of the Sanitary Region I of the Ministry of Health of the province of Buenos Aires participated in the activity. Conclusions: This experience showed the importance of building networks for the articulation of practices that favor access to early diagnosis and timely treatment for HIV and syphilis for people living in a confinement context (AU)

Seropositivity for syphilis among Brazilian blood donors. A retrospective study 2015-2020.

INTRODUCTION: Syphilis is a transfusion-transmitted infection and the disease re-emerged in many countries, including Brazil, as a public health risk. OBJECTIVE: Evaluate the prevalence of positive serology in blood donations rejected by Hemobanco (Curitiba- PR) from January 2015 to December 2020, with special focus in syphilis. METHODOLOGY: In the studied period, we analyzed the number of blood donations discarded annually for each serological test performed on blood donors' samples, according to gender and donors age. RESULTS: Within the studied period, 134,741 blood donation were analyzed. 54.5 % of sample were male. Otherwise, it was observed a significant increase in the number of donations by females (P < 0.0001). There was an increase of 437 % in the prevalence of syphilis positive serology made by donors with ≥ 60 years. Besides that, it was noticed a significant increase in donations by aged people throughout these six years (P < 0.0001). The percentage of total blood donation deferred had a significant reduction, although it was observed an increase in the rate of discarded blood bags due to positive serology in the first 4 studied years. It was observed an increase of 20 % in positive syphilis serology. CONCLUSION: The greatest cause of discard of blood donations changed during the analyzed 5-years; there was an increase in seropositivity donations from donors with ≥ 60 years old. In 2015, Hepatitis B (0.8 %) was the most prevalent and in 2020, syphilis became more prevalent (0.82 %). The medical community should be aware of the rising number of cases of syphilis infection. There is an urgent need to implement actions against the dissemination of this disease.

Evaluation of the effect of extended refrigerated storage of serum and plasma specimens on syphilis serologic test results.

The effect of extended refrigerated storage of 14 serum and plasma specimens on 5 syphilis serologic tests was evaluated for 16 weeks. Higher stability of nontreponemal and treponemal antibodies in serum was recorded compared to plasma. Described work may provide insights on refrigerated specimens' stability and suitability for syphilis tests.

Seroprevalencia de infecciones hemotransmisibles en donantes de sangre / Seroprevalence of transmissible infections in blood donors

Introducción. La seguridad transfusional es el objetivo primordial de los bancos de sangre, sin embargo, conlleva un alto riesgo de eventos adversos como son las infecciones transmisibles por transfusión (ITT). El conocimiento de la prevalencia de estas infecciones fue de particular interés en esta investigación, donde se determinó su frecuencia, coinfección y relación con el tipo de donantes admitidos. Metodología. Estudio observacional retrospectivo de 2017 y 2018, en el que se incluyeron todos los registros de donantes de sangre que contenían datos demográficos y resultados de los marcadores obligatorios en el país (Ecuador), tanto de pruebas serológicas como moleculares. Se obtuvo el permiso del custodio de la información y del subcomité de bioética de investigaciones en seres humanos. Para el análisis de los datos se utilizó estadística descriptiva e inferencial. Resultados. Se determinó una prevalencia del 3,18 % de resultados reactivos para una o más ITT, el rango de edad más prevalente fue de 29 a 40 años, el 89,8 % fueron donantes compensatorios, y de ellos el 90 % fueron reactivos para una o más ITT. El marcador serológico más prevalente fue el anti-core del virus de la hepatitis B (anti-HBc), seguido por el de sífilis y los anticuerpos contra el virus de la hepatitis C (VHC). La coinfección más prevalente fue con sífilis y hepatitis B. Se encontró una diferencia estadísticamente significativa entre los resultados obtenidos en las pruebas serológicas y las moleculares (x2=26,9; p=0,000). Conclusión. Las ITT en los bancos de sangre son un riesgo latente, por lo que es necesario conocer las variaciones epidemiológicas que existen en cada población. El conocimiento de la prevalencia de las ITT en donantes de sangre permite establecer nuevas estrategias de selección del donante, que garanticen la mejor seguridad posible en las transfusiones, además debe verificarse siempre la metodología utilizada y hacer monitoreo permanente del sistema de calidad establecido

Introduction. Transfusion safety is the primary objective of blood banks, however one of the adverse reactions to blood transfusion are the transfusion transmissible infections (TTIs). Knowledge of the prevalence of these infections was of particular interest in this study where we determined their frequency, co-infection and relationship with the type of donors admitted. Methodology. Retrospective observational study during 2017 and 2018, in which all blood donor records containing demographic data and results of the country's (Ecuador) mandatory serological markers of both serological and molecular tests were included. Permission was obtained from the data custodian and the Human Research Bioethics Subcommittee. Descriptive and inferential statistics were used for data analysis. Results. A prevalence of 3,18% of reactive results to one or more TTIs was determined, the most prevalent age range was 29 to 40 years, 89.8% were compensatory donors and 90% of them were reactive to one or more TTIs. The anti- core serological marker of the hepatitis B virus (anti-HBc) was the most prevalent, followed by syphilis and hepatitis C antibodies. Syphilis and hepatitis B were identified as the most prevalent coinfection. The correlation between the results obtained in the serological and molecular tests was determined to be different and statistically significant (x2=26.9; p=0.000). Conclusion. TTIs in blood banks are a latent risk, so it is necessary to know the epidemiological variations that exist in every population. Knowledge of the prevalence of TTIs in blood donors facilitates new donor selection strategies that guarantee the best possible safety in transfusions. In addition, the methodology used must always be verified and the established quality system must be permanently monitored

CXCL8, CXCL9, and CXCL10 serum levels increase in syphilitic patients with seroresistance.

BACKGROUND: Recently, the rise of syphilitic seroresistance brings great confusion to the clinical diagnosis and treatment of syphilis, and no clear diagnostic marker has been found to distinguish syphilitic seroresistance from other progression of syphilis. This study evaluated the serum chemokines levels of CCL2, CXCL8, CXCL9, and CXCL10 and its correlation with blood routine, coagulation, and biochemical indexes in seroresistant syphilitic patients. METHOD: Serum levels of chemokines were quantitatively determined by Flow Cytometric Bead Array (CBA). The results expressed in pg/ml. Clinical parameters were detected and analyzed according to the clinical laboratory standards. A correlation analysis was subsequently performed. RESULTS: The seroresistant syphilitic patients increased significantly serum chemokines levels of CXCL8 (***p < 0.001), CXCL9 (***p < 0.001), and CXCL10 (**p < 0.01) when compared to noninfected individuals, but the CCL2 was not statistically significant, and serum CXCL8 shows a strong association with platelets (r = 0.51, **p = 0.004) and serum CXCL10 was significantly positively related to INR levels (r = 0.49, **p = 0.007). CONCLUSION: Increasing serum abnormalities in CXCL8, CXCL9, and CXCL10 level combining with platelets of peripheral blood and plasmatic INR in syphilis patients may be helpful for the diagnosis of serofast state.

Magnitude of syphilis sero-status and associated factors among pregnant women attending antenatal care in Jinka town public health facilities, Southern Ethiopia, 2020.

INTRODUCTION: Syphilis is one of the leading causes of perinatal morbidity and mortality and is one of the most important public health problems. There was no study showing syphilis serostatus and its related factors among pregnant women in the current study area. This study was aimed to assess the magnitude of syphilis serostatus and associated factors among pregnant women attending antenatal care in Jinka town public health facilities. METHOD: Institution based cross-sectional study design was conducted in Jinka town public health facilities, southern Ethiopia from the 1st July to the 1st September, 2020. A systematic sampling technique was used to select 629 study subjects. Data were collected using a structured questionnaire through face-to-face interviews and records were reviewed to check syphilis test results. Data were coded and entered by using Epi-data version 4.432 and analyzed using SPSS version 25. The binary logistic regression model was used to investigate factors associated with syphilis. A p-value of < 0.05 at multivariable analysis was considered statistically significant. RESULT: In this study, syphilis sero-prevalence among pregnant women attending antenatal care clinics was 4.8% (95% CI: 3.12, 6.48). Rural residence [AOR: 2.873; 95%CI (1.171, 7.050)], alcohol use [AOR: 3.340; 95% CI (1.354, 8.241)] and having multiple sexual partner [AOR: 5.012; 95% CI (1.929, 13.020)] were statistically significantly associated with syphilis. CONCLUSION: Sero-prevalence of syphilis was high. Being a rural residence, having multiple sexual partners, alcohol use were factors associated with syphilis. Therefore, substantial efforts have to be made to provide regular health education for pregnant women at the antenatal clinic on the avoidance of risky behaviors and the risk of syphilis on their pregnancy.

Genome-Wide MicroRNA Analysis of Peripheral Blood Mononuclear Cells Reveals Elevated miR-142-3p Expression as a Potential Biomarker for Secondary Syphilis.

BACKGROUND: Treponema pallidum subspecies pallidum (T. pallidum) infection induces significant immune responses, resulting in tissue damage. Gene expression plays an essential role in regulating the progression of syphilis infection. However, little is known about the regulatory role of microRNAs (miRNAs) in the immune response to T. pallidum infection. Here, we analyze the differential expression of miRNAs in peripheral blood mononuclear cells (PBMCs) between untreated secondary syphilis patients and healthy controls and study the correlation between miRNA expression and clinical features with bioinformatics. METHODS: The expression profile of miRNAs was measured by microarray analysis in PBMCs of untreated secondary syphilis patients and healthy controls. Weighted Gene Coexpression Network Analysis (WGCNA) was used to construct the expression of miRNAs and the clinical data of secondary syphilis patients. Gene ontology (GO) and KEGG enrichment analyses were performed on target genes of miR-142-3p. RESULTS: 244 miRNAs exhibited at least 1.0-fold differential expression between secondary syphilis patients and healthy controls. The miRNAs were divided into three modules by WGCNA. The blue module was positively correlated with TPHA, TRUST, duration of disease, and erythema. And in the blue module, the expression of miR-142-3p was significantly higher in secondary syphilis patients than in healthy controls (p = 0.02), which is also close to the clinical features of secondary syphilis. GO and KEGG pathway analyses showed that these target genes of miR-142-3p are correlated with endocytosis and positive regulation of the apoptotic process. CONCLUSION: The elevated miR-142-3p expression in PBMCs may play an important role in the immune response to T. pallidum infection and may be a potential biomarker for secondary syphilis.

Acquired Syphilis by Nonsexual Contact in Childhood.

BACKGROUND: Children may acquire syphilis by nonsexual contact as a consequence of close and repetitive contact with mucosal or skin lesions of people with active syphilis. METHODS: Prospective cohort study of pediatric patients with acquired syphilis by nonsexual contact. Demographics, clinical findings, posttreatment serology development and general laboratory data were collected. Sexual transmission was ruled out after a careful medical and psychosocial evaluation of the patient and his/her family. RESULTS: Twenty-four patients were included in the study. Mean age at diagnosis was 4.2 years old. All of them came from overcrowded households with poor hygiene conditions. The most frequent reason for consultations was secondary syphilis skin lesions (79.2%). The psychosocial evaluation of children and their families did not reveal signs of sexual abuse in any of the cases. Seventy-eight families and their cohabitants were evaluated, 23 (29.5%) resulted positive for rapid plasma reagin and treponemal test of hemagglutination; 60.9% of the cases were asymptomatic. The symptomatic relatives showed lesions of secondary syphilis. A sustained fall on nontreponemal antibodies titer (rapid plasma reagin) was observed after treatment, becoming negative in 6/24 (25%) cases within 12 months posttreatment. DISCUSSION: Following evaluation, it was considered that sexual abuse was unlikely. However, if examination and psychosocial evaluation do not support it, other ways of transmission must be considered. Overcrowded and poor household conditions boost the risks for nonsexual treponema transmission. An infected member of the family or a caretaker are a particular risk to an infant due to common practices such as using saliva to moisten the rubber nipples of the milk bottles or trying the food temperature using the lips before feeding the infants.

Seroprevalence and Associated Factors of Human Immunodeficiency Virus, Treponema pallidum, Hepatitis B Virus, and Hepatitis C Virus among Female Sex Workers in Dessie City, Northeast Ethiopia.

INTRODUCTION: Sexually transmitted infections (STIs) are prevalent in Ethiopia and elsewhere among different population groups particularly among female sex workers (FSWs). Because of their work and their behavior, FSWs are at high risk to acquire STIs. The aim of the study was to assess the seroprevalence and associated factors of HIV, HBV, HCV, and T. pallidum among FSWs in Dessie City, Northeast Ethiopia. METHODS: This cross-sectional study was conducted in Dessie City, Amhara Region, Northeastern Ethiopia, from November 2017 to April 2018. A total of 360 FSWs whose age is greater than or equal to 18 years and who are willing to participate were recruited by simple random sampling technique. Interview-based questionnaire was administered, and 5 ml of venous blood from each participant was drawn under aseptic conditions. The rapid test was performed to obtain the result of the four STIs (HIV, T. pallidum, HBV, and HCV). The collected data were entered and analyzed by SPSS version 20.0. From the bivariable analysis, variables having P value < 0.2 were retained into multivariable analysis. From the multivariable analysis, variables with P value < 0.05 were affirmed as statistically associated factors. Adjusted odds ratios and their 95% confidence intervals were used as indicators of the strength of association. RESULTS: Majority of study participants were urban dwellers, 10 (2.8%) respondents were married, 61 (16.9%) have more than two children, and more than half of them were at the age range between 18 and 27 years. Any infection with STIs was 84 (23.3%), whereas 27 (7.5%), 47 (13.1%), 2 (0.6%), and 45 (12.5%) study participants were positive for laboratory test of HIV, HBV, HCV, and T. pallidum, respectively. Marital status, sharing of sharp materials, breakage of condom, number of customers per week, genital discharge, and pain had significant association with any STI. CONCLUSIONS: In comparison with different research works in Ethiopia and abroad, the prevalence of any STI, HIV, HBV, and T. pallidum was found to be relatively high. Preventive approach and appropriate treatment of STIs should be developed. Concerned body should work together to alleviate the problem by counseling and recruiting them on other productive job sectors in the country.

Evaluation of the Seroprevalence of Infectious Diseases in 2,445 in vitro Fertilization Cycles.

OBJECTIVE: To evaluate the seroprevalence of positive markers for syphilis, human immunodeficiency virus (HIV) I and II, human T cell lymphotropic virus (HTLV) I and II, and hepatitis B and C among women undergoing in vitro fertilization (IVF). METHODS: We conducted a retrospective analysis among patients who underwent IVF, between January 2013 and February 2016, and who had complete screening records. RESULTS: We analyzed 1,008 patients who underwent IVF, amounting to 2,445 cycles. Two patients (0.2%) tested positive for HIV I and II and none for HTLV I and II. Three patients (0.3%) had positive screening for syphilis, and two (0.2%) had positive hepatitis C antibody test (anti-HCV). A positive hepatitis B virus surface antigen (HbsAg) test was observed in 4 patients (0.4%), while 47 (4.7%) patients were positive for IgG antibody to hepatitis B core antigen (anti-HbC IgG), and only 1 (0.1%) was positive for IgM antibody to hepatitis B core antigen (anti-HbC IgM). The anti-HbS test was negative in 659 patients (65.3%). Only 34.7% of the patients had immunity against the Hepatitis B virus. Patients with an anti-HbS negative result were older than those with a hepatitis B test (anti-HbS) positive result (36.3 versus 34.9; p < 0.001). CONCLUSION: The present study showed lower infection rates than the Brazilian ones for the diseases studied in patients undergoing IVF. Only a few patients were immunized against hepatitis B.

OBJETIVO: Avaliar a soroprevalência de marcadores positivos para sífilis, vírus da imunodeficiência humana (HIV) I e II, vírus linfotrópicos de células T humanas (HTLV) I e II e hepatite B e C em mulheres submetidas a fertilização in vitro (FIV). MéTODOS: Realizamos uma análise retrospectiva entre as pacientes submetidas a FIV, entre janeiro de 2013 e fevereiro de 2016, e que possuíam prontuários completos. RESULTADOS: Foram analisadas 1.008 pacientes submetidas a FIV, totalizando 2,445 ciclos. Duas pacientes (0,2%) apresentaram resultado positivo para HIV I e II, e nenhuma para HTLV I e II. Três pacientes (0,3%) apresentaram triagem positiva para sífilis, e duas (0,2%) apresentaram teste de pesquisa de anticorpos anti-HCV (anti-HCV) positivo. Um teste de antígeno de superfície do vírus da hepatite B (HbsAg) positivo foi observado em 4 pacientes (0,4%), enquanto 47 (4,7%) pacientes foram positivas para anticorpos IgG contra o antígeno de superfície da hepatite B (IgG anti-HbC), e apenas 1 (0,1%) foi positiva para anticorpos IgM contra o antígeno central da hepatite B (IgM anti-HbC). O teste de anticorpos contra hepatite B (anti-HbS) foi negativo em 659 pacientes (65,3%). Apenas 34,7% das pacientes tinham imunidade contra o vírus da hepatite B. Pacientes com resultado negativo anti-HbS eram mais velhas do que aquelas com resultado positivo anti-HbS (36,3 versus 34,9; p < 0,001). CONCLUSãO: Este estudo mostrou taxas de infecção inferiores às taxas brasileiras para as doenças estudadas em pacientes submetidas à FIV. Apenas alguns pacientes foram imunizados contra a hepatite B.