2020 European guideline on the management of syphilis.

The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.

2014 European guideline on the management of syphilis.

BACKGROUND: Syphilis remains a major public health problem in Europe (both in Eastern Europe since the 1990's and in Western Europe since the re-emergence of the disease in the late 1990's-early 2000's). METHODS: This guideline is an update of the IUSTI: 2008 European guideline on the management of syphilis and is produced by the European Guideline Editorial Board (http://www.iusti.org/regions/Europe/pdf/2013/Editorial_Board.pdf) and EDF Guideline Committee. RESULTS: It provides recommendations concerning the diagnosis and management of syphilis in Europe. Major advances include (1) broader use of PCR, immunohistochemistry, subtyping of the etiological agent Treponema pallidum subspecies pallidum, new treponemal tests, and rapid-point-of-care (POC) tests detecting both treponemal and non-treponemal antibodies, (2) more flexible options for screening (TT-treponemal test- first or NTT -non treponemal test- first or both TT and NTT), and (3) procaine penicillin is no longer the first line therapy option in any phase of the disease, i.e. long acting penicillin G (i.e. benzathine penicillin G-BPG) is the only first line therapy regimen in early syphilis and in late latent syphilis. CONCLUSIONS: Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe.

Treatment failure of pharyngeal gonorrhoea with internationally recommended first-line ceftriaxone verified in Slovenia, September 2011.

We describe the second case in Europe of verified treatment failure of pharyngeal gonorrhoea, caused by an internationally occurring multidrug-resistant gonococcal clone, with recommended first-line ceftriaxone 250 mg in Slovenia. This is of grave concern since ceftriaxone is last remaining option for empirical treatment. Increased awareness of ceftriaxone failures, more frequent test-of-cure, strict adherence to regularly updated treatment guidelines, and thorough verification/falsification of suspected treatment failures are essential globally. New effective treatment options are imperative.

Papulonodular secondary syphilis in a 52-year-old non-HIV heterosexual patient.

There has been a recent increase in the incidence of syphilis in Slovenia, similar to other countries. Secondary syphilis can manifest with various clinical and histopathological presentations. We report the case of a 52-year-old patient that presented with nonpruritic nodular lesions on the face, trunk, and insteps that clinically mimicked lymphoma or sarcoidosis. Histopathological findings showed granulomatous inflammation. The serology revealed positive non-treponemal and treponemal tests. Treatment with benzathine penicillin G was successful.

Distribution of human papillomavirus (HPV) genotypes in genital warts from males in Slovenia.

BACKGROUND: Genital warts (GWs) are the most frequent benign tumors in the anogenital region of both males and females. Human papillomaviruses (HPV) are etiologically associated with the development of virtually all GWs. HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other alpha-HPV genotypes have occasionally been found in GW tissue specimens. OBJECTIVE: There is limited knowledge of GWs in Slovenia. Thus in this study we tested 55 GW tissue specimens collected from the same number of male patients using 2 different PCR protocols to obtain the first data concerning HPV and GWs in Slovenia. MATERIAL AND METHODS: 55 GW tissue specimens were tested for the presence of HPV using PGMY09/PGMY11 and CPI/CPIIg polymerase chain reaction (PCR). HPV genotypes were determined using restriction fragment length polymorphism analysis of PGMY09/11 PCR products or by sequencing of the CPI/CPIIg PCR products. In some GWs, the genotyping results were also confirmed using the Linear Array HPV Genotyping Test. RESULTS: HPV DNA was detected in all 55 tissue specimens of GWs. HPV-6 or HPV-11 was detected in 53 cases of GWs, and HPV-44 and candHPV-91 in one GW each. HPV-6 was detected approximately 4 times more frequently than HPV-11. In addition, HPV-16, HPV-31, HPV-51, HPV-53, HPV-55, candHPV-62, HPV-66, HPV-70, HPV-73, and HPV-84 were detected in some GW specimens. According to the published data, our study is the first to report the presence of candHPV-62 and candHPV-91 in GW tissue specimens. CONCLUSIONS: Our study showed that HPV can be found in virtually all GW tissue specimens obtained from male patients in Slovenia. Because HPV-6 or HPV-11 was detected in 96.4% of GWs studied, it seems that, if a quadrivalent HPV vaccine proves to be effective in males, this vaccine could prevent the great majority of incidental GWs in males in Slovenia.

Intrathecal antitreponemal antibody synthesis determination using the INNO-LIA Syphilis Score.

BACKGROUND: Laboratory detection of intrathecal synthesis of specific antitreponemal antibodies remains a challenge. Traditional syphilis serology is unable to provide a satisfactory result; therefore, several other diagnostic procedures were used to demonstrate central nervous system (CNS) involvement in this disease. The introduction of molecular methods makes today's laboratory testing easier. OBJECTIVE: Our study used a new commercially available test, the INNO-LIA Syphilis Score, intended for use on serum samples, to detect specific antitreponemal antibodies in the cerebrospinal fluid (CSF) of patients with the tertiary stage of syphilis. PATIENTS AND METHODS: We tested 26 patients suspected of neurological complications of late syphilis with conventional immunological tests such as VDRL-RPR, TPHA, FTA-ABS IgG, FTA-ABS-IgM, and the molecular INNO-LI Syphilis Score test for the presence of nontreponemal and treponemal antibodies. All tests were performed simultaneously in serum and CSF. The test results were evaluated with descriptive statistics and the probability was tested with an ANOVA test. RESULTS: All 26 samples of serum were LIA-S (line immune assay in serum) positive and presented anticardiolipin and antitreponemal antibodies in high titer. Seventeen samples of CSF were LIA-L (line immune assay in liquor) positive and nine were LIA-L negative. Anticardiolipin and antitreponemal antibodies were detected only in the group of LIA-L positive samples. Anticardiolipin antibodies were present in two cases, antitreponemal (TPHA) in five cases, specific IgG (FTA-ABS IgG) in six cases, and specific IgM (FTA-ABS IgM) in one case. Six patients with antitreponemal antibodies in CSF presented with pathologic albumin index, two with a milder form, and four with a severe form. Two had a pathological IgG index and four a pathological IgM index. Altogether, two of the patients had laboratory signs of neurosyphilis. CONCLUSIONS: Detecting anticardiolipin and antitreponemal antibodies in CSF in patients with a late form of syphilis is laborious. Using the new INNO-LIA Syphilis Score molecular test, we were able to identify patients with silent neurosyphilis together with patients with active intrathecal synthesis of IgG antibodies. The development of a new generation of tests for the detection of specific antitreponemal antibodies in CSF offers a valuable tool for discovering possible CNS involvement in syphilis.

Chlamydia trachomatis infections in heterosexuals attending sexually transmitted disease clinics in Slovenia.

This study assessed the age and gender distribution of Chlamydia trachomatis infections among patients attending two clinics for sexually transmitted diseases (STDs) in Slovenia. Between January 1999 and December 2003, 1714 heterosexual male and 892 heterosexual female patients were tested for C. trachomatis. The prevalence of C. trachomatis infection was 19.5% (n = 334) for male patients and 10.7% (n = 96) for female patients, with the highest prevalence in the group aged 15-30 years. The prevalence decreased between 2000 and 2003 among female patients. The results support the implementation of routine screening for C. trachomatis genital infection among male and female patients aged < 30 years attending STD clinics in Slovenia.

Prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region, Slovenia.

The aim of this research was to evaluate the prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region (population 300,000), Slovenia. A first-void urine specimen was tested for Chlamydia trachomatis using the polymerase chain reaction assay. The research was supported by a questionnaire to obtain information on sexual behaviour of the participants. In the cross-sectional study from 1999 to 2001, 1272 asymptomatic recruits were included. None had received antibiotics in the previous two weeks. The mean age was 19.9 years. At the time of their first sexual experience the mean age was 16.6 years, whereas the age of their female sexual partners was 17.1 years. During their first sexual intercourse 77% of recruits used contraception (condom, diaphragm, contraceptive pill), most of those a condom (86%). The prevalence of asymptomatic chlamydial urethritis was 2.6% (95% confidence interval: 1.7 to 3.5). The mean age of those infected was 19.8 years. At the time of their first sexual experience the mean age was 16.2 years, whereas the age of their female sexual partners was 16.9 years. During their first sexual intercourse 57% of infected subjects used protection, half of which was a condom. Those who never or only occasionally used condoms were at a greater risk of being infected with C. trachomatis (adjusted odds ratio 2.04).

Syphilis epidemic in Slovenia influenced by syphilis epidemic in the Russian Federation and other newly independent states.

In 1994 an 18-fold increase in the annually reported incidence rate of early syphilis (to 1.81 cases per 100,000 total population) in comparison to the preceding year was observed in Slovenia. The reported incidence rates remained elevated for a period of five years. The possible link between the evolving syphilis epidemic in the Russian Federation and newly independent States (NIS) during the 1990s and the observed increases in the reported early syphilis incidence rates in Slovenia, was explored. Surveillance data obtained by mandatory reporting of all newly diagnosed syphilis cases between 1994 and 1999 were analysed according to the information on sexual partners, the country of probable source of infection, and occupation. More than half of all reported cases (62%) were directly or indirectly linked to a source of infection abroad. Among these, the majority of cases (73%) were linked to the Russian Federation or NIS. Of these, 68% occurred in males, a high proportion being long-distance lorry drivers.

Subclinical microbial infection in patients with chronic plaque psoriasis.

Epidemiological evidence implicates bacterial infection as a common triggering stimulus for psoriasis. Recent studies suggest that continuing, subclinical streptococcal and staphylococcal infections might be responsible not only for relapse of acute guttate psoriasis but also for a new episode of chronic plaque psoriasis. In this study 195 patients suffering from a severe form of chronic plaque psoriasis hospitalized between 1996 and 1998 were examined. The presence of subclinical microbial infection of the upper respiratory tract was studied by the cultivation of pathogens from this area. Patients with other provoking factors, such as a positive history of taking any drugs that may exacerbate psoriasis, endocrine and metabolic factors, alcohol abuse, trauma, dental focus and clinically evident bacterial infection, were excluded. Subclinical streptococcal and/or staphylococcal infections were detected in 68% of tested patients and in only 11% of the control group. The results of this study indicate that subclinical bacterial infections of the upper respiratory tract may be an important factor in provoking a new relapse of chronic plaque psoriasis. Searching for, and eliminating, microbial infections could be of importance in the treatment of psoriasis.