Syphilis and pregnancy.

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.

Oral syphilis - the great imitator: a series of six cases.

Syphilis is an infectious disease which can present with multitudinous mucocutaneous manifestations. Often referred to as the 'great mimicker', syphilis can present with non-specific symptoms and has a tropism for various organ systems. The oral cavity has been identified as a site commonly affected in the early stages of syphilis infection. Identification of the diverse presentations seen across the different stages of syphilis infection can assist in early diagnosis and treatment for this cohort of patients. Despite accurate diagnostic tools and the susceptibility of the infection to standard antimicrobial therapy, syphilis infections continue to rise worldwide.We present the clinical features and management of six cases of oral syphilis who presented to our unit. One case presented in 2008, but the other five cases presented between 2016 and 2023, reflecting the increasing incidence of syphilis infection. Five cases presented in the secondary stage of the infection while one presented with a primary infection in the form of a single chancre.The documented cases demonstrate the non-specific and variable clinical features of oral syphilis and highlight the importance of awareness in the dental profession of these manifestations. Dentists have an important role to play in recognising the disease and arranging appropriate testing for early intervention. This will not only reduce the incidence of the devastating consequences of tertiary infections but will also result in reduced spread of the disease.

Feasibility, Preference, and Impact of a Rapid Multiplexed Point-of-Care Digital Innovation (AideSmart!) to Expedite Screening of Sexually Transmitted Blood-Borne Infections in At-Risk Populations in Canada: Cross-Sectional Study.

BACKGROUND: With the need to expedite the detection of multiple sexually transmitted blood-borne infections (STBBIs), there is an increased demand for digital innovations and tests that improve the efficiency of point-of-care testing in outreach community settings. Multiplexed testing is being offered to at-risk populations by frontline health care professionals. OBJECTIVE: With this in mind, we evaluated AideSmart! (for health aides or health care workers), an integrated app and platform solution that enables multiplexed STBBI screening at the point of care, for feasibility, preference, accuracy, and impact. With AideSmart!, we provided trained health care workers with the ability to perform rapid multiplexed tests; offer STBBI pre- or posttest counseling; maintain quality assurance of testing; facilitate linkages to care; and enhance health care provider-patient communication, data documentation, and patient engagement through the multiplexed STBBI screening and linkage process. We evaluated the performance of multiplexed tests. METHODS: In a cross-sectional study conducted during the COVID-19 pandemic, we recruited at-risk populations in Canada from community-based organizations in Montreal, Quebec, and Saint John, New Brunswick, with unknown serostatus for HIV, hepatitis C virus (HCV), and syphilis. Following orientation and pretest counseling with AideSmart!, we performed multiplexed tests, simultaneously screening for HIV, HCV, and syphilis, using 2 rapid investigational multiplexed tests (Chembio for HIV and syphilis and MedMira for HIV, HCV, and syphilis) followed by confirmatory testing from local and national laboratories. RESULTS: Of the 401 participants, all (100%) accepted the AideSmart! multiplexed strategy: 59.4% (148/249) preferred multiplexed rapid tests over laboratory tests, and 56.6% (141/249) preferred receiving same-day test results. Rapid test results were obtained in 15 minutes (vs laboratory tests at 4-24 days). A total of 29 new infections (n=27, 93% HCV; n=1, 3% syphilis; and n=1, 3% HIV) were identified and treated within a week. Feasibility of the strategy (completion of testing and linkages to care) was at 76.1% (305/401). Health care professionals provided positive feedback and emphasized the importance of knowing one's negative or positive serostatus, especially during a pandemic. Multiplexed rapid tests' specificity (against laboratory reference standards) exceeded 98% (98.7%-100%) for all pathogens and devices. An electronic reader, used by the Chembio rapid test, enhanced sensitivity (HIV: 100%, 95% CI 79.4%-100%; syphilis: 86.8%, 95% CI 71.9%-95.6% [Chembio] vs HIV: 100%, 95% CI 78.2%-100%; HCV: 90.3%, 95% CI 80.1%-96.4%; and syphilis: 57.9%, 95% CI 40.8%-73.7% [MedMira]). CONCLUSIONS: The AideSmart! digital multiplexed rapid screening strategy for health care workers facilitated STBBI testing for multiple STBBIs and arranged for pre- or posttest counseling and rapid linkages with high feasibility and acceptability. Electronic readers enhanced the diagnostic performance of multiplexed biomarker tests. This study generated data in support of digital multiplexed strategies in digitally enabled settings for at-risk populations nationally and worldwide.

Atypical Presentation of Tertiary Syphilis.

Syphilis is a sexually transmitted infection characterized by multiple stages. Cardiovascular involvement is a manifestation of tertiary syphilis, occurring between 10 and 40 years after the primary infection. The authors present a case of atypical presentation of tertiary syphilis in a 49-year-old male patient who was admitted to the hospital with bilateral transient loss of vision. Contrast-enhanced CT imaging revealed thoracic aortitis with carotid occlusion, coronary artery stenosis, ischemic stroke, myocardial infarction, and multiple intracardiac thrombi. A postmortem autopsy revealed positive laboratory results for syphilis, which was corroborated by medical autopsy findings of syphilitic aortitis. Keywords: CT-Angiography, Aorta, Cardiac, Vascular, Tertiary Syphilis © RSNA, 2024.

Acute hepatitis as a manifestation of secondary syphilis: a case report and literature review.

This is the case of a 25-year-old patient, with the notion of unprotected sexual relations with multiple partners consulted for cholestatic icterus with pruritus evolving for 2 months. The general examination found an intense mucocutaneous icterus. The examination of the lymph nodes revealed multiple lymph nodes. A thoracic-abdominal-pelvic scanner showed peri-portal edema and adenopathies above and below the diaphragm without suspicious lesions. Biologically, there was acute cytolysis with ASAT at 1612IU/L, ALAT at 1506IU/L, and icteric cholestasis, the acute viral serologies and other autoantibodies were all negative. Given the presence of adenopathy and sexual risk factors, a syphilis serology was requested and was positive: a TPHA at 2560UI/L, and a VDRL at 1/32 UI/L. A liver biopsy was performed, which showed the presence, on immunohistochemistry, of anti-treponemal-pallidum antibodies. After eliminating all etiologies of cytolytic hepatitis, we retained the diagnosis of syphilitic hepatitis. Therapeutically, we started a treatment based on ceftriaxone 2g/dl with spectacular biological improvement at H48 of the beginning of treatment.

Where would young people using an online STI testing service want to be treated? A survey of young Australians.

Background Although there has been growth in online STI testing services, more attention is needed to understand how to facilitate effective treatment pathways for users. This study investigated where young people want to be treated for gonorrhoea and syphilis if they test positive using an online service. Methods We conducted an online survey of Australians aged 16-29years that included multiple choice and free-text questions about their preferred location for receiving injectable antibiotics. Multivariable multinomial logistic regression examined associations between respondent characteristics and service preferences. Content analysis was used to code free-text responses. Results Among 905 survey respondents, 777 (85.9%) answered questions on treatment preferences. Respondents most commonly preferred injectable antibiotics provided by a sexual health clinic (294; 37.8%) or a nurse in a pharmacy (208; 26.8%). Gender/sexually diverse respondents were more likely to select sexual health clinics over general practice (MSM RRR 2.5, 95% CI 1.1-5.7; WSW RRR 2.6, 95% CI 1.1-5.7; trans/non-binary RRR 2.5; 95% CI 1.0-6.0). Older respondents (aged 25-29years) were more likely to choose all alternatives over general practice, with the reverse found for those who had previously tested. From open-text answers, pharmacies were valued for their convenience, and sexual health clinics for providing non-judgemental, free services by specialists. Conclusions Differences in treatment preferences by certain groups of young people suggest that different service offerings may influence treatment-seeking outcomes from online STI testing services.

Acute Arthritis Presentations of Gonorrhea and Syphilis - A Concise Update.

According to the 2021 CDC sexually transmitted disease surveillance report, national cases of syphilis and gonorrhea continue to rise. Currently, South Dakota ranks #1 in syphilis and #2 in gonorrhea cases per 100,000 population. The higher incidence increases the likelihood South Dakota clinicians will encounter different presentations of syphilis and gonorrhea. Recently, we have seen patients presenting with acute STI related inflammatory arthritis. This review discusses the acute arthritic presentations associated with gonorrhea and syphilis and its treatment.

Syphilis presenting as optic neuritis and subdural haematoma with complicating neuro Jarisch-Herxheimer reaction.

A man in his 50s presented with a 3-week history of painless blurry vision. The ocular examination showed decreased visual acuity and 3+ bilateral papilloedema. A CT of the brain without contrast revealed a 5 mm left subdural haematoma. Anti-treponemal IgG antibodies were positive, and a reflex rapid plasma regain (RPR) was >1:64. HIV serology was negative. Ophthalmology and infectious diseases agreed that the presentation was consistent with ocular syphilis. Cerebrospinal fluid (CSF) examination revealed an elevated CSF protein of 52 mg/dL and CSF Venereal Disease Research Laboratory (VDRL) of 1:1. Penicillin was started. The patient developed a Jarisch-Herxheimer reaction soon after. He had a fever, rash and worsening headaches due to the enlargement of subdural haematoma for which he underwent a burr hole drainage. Vision improved after completing penicillin therapy but did not recover fully. The CSF VDRL became non-reactive and serum RPR titre decreased to 1:8 3 months later.

Worrying increase in the risk of vertical transmission of syphilis in Croatia, 2020 to 2024.

Four infants potentially exposed to syphilis infection in utero, meeting World Health Organization surveillance criteria of congenital syphilis (CS), were diagnosed in Croatia between September 2020 and January 2024. We conducted a retrospective analysis of epidemiological, clinical and laboratory data of these cases to assess compliance with surveillance case definitions. As only one confirmed CS case has been reported in Croatia in over 2 decades, these reports signal an increased risk of syphilis vertical transmission and warrant strengthening antenatal screening.

Case report: Concurrent MOG antibody-associated disease and latent infections in two patients.

Objectives: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is frequently preceded by infections. The underlying pathomechanism, however, remains poorly understood. Here, we present the clinical data of two MOGAD patients with concurrent syphilis infection and investigate the reactivity of patient-derived antibodies to MOG and Treponema pallidum (T. pallidum). Methods: Longitudinal serum samples and soluble immunoglobulins in single B cell supernatants were measured for MOG reactivity by a live cell-based assay. Reactivity against T. pallidum was assessed by enzyme-linked immunosorbent assay. Results: The two patients presented MOGAD and concurrent latent syphilis infection, manifesting as cervical myelitis and unilateral optic neuritis, respectively. The first patient had been living with HIV on antiretroviral therapy, and the second was concomitantly diagnosed with chronic hepatitis B infection. Upon screening of B cell supernatants, we identified reactivity to MOG or T. pallidum. Notably, one B cell showed reactivity to both antigens. Discussion: The coexistence of MOGAD diagnoses and latent syphilis, alongside the identification of antibody reactivity to MOG and T. pallidum, underscores the potential pathomechanistic link between syphilis infection and subsequent autoimmune neuroinflammation. Cross-reactivity between MOG and T. pallidum antibodies remains to be validated on a molecular level, and further characterization of infectious triggers associated with MOGAD is needed.

Mpox, sexually transmitted infections and combination prevention: insights from a major cohort in Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the prevalence and characteristics of concurrent bacterial sexually transmitted infections (bSTIs) among individuals with mpox. DESIGN: Prospective cohort study of participants aged 18 years or older with confirmed mpox conducted in Rio de Janeiro, Brazil. This cross-sectional analysis includes only participants who underwent bSTI testing at baseline between June 2022 and January 2024. METHODS: Participants were offered testing for chlamydia/gonorrhea (NAAT, anorectal swabs) and syphilis (active diagnosis if VDRL ≥ 1/8). Baseline prevalence of bSTIs was calculated, and participant characteristics were described based on concomitant bSTI diagnosis (yes/no). Chi-squared/Fisher's tests were used for qualitative variables, and the Wilcoxon rank-sum test for quantitative variables. RESULTS: Out of 634 enrolled participants, 538 (84.9%) were tested for STIs and included in this analysis, mostly cisgender men, aged 30-39 years with postsecondary education. Overall prevalence of concomitant bSTI was 37.3%, mainly syphilis, followed by chlamydia and gonorrhea. Half of the participants were living with HIV, and one third was on HIV pre-exposure prophylaxis. Concomitant bSTI diagnosis at the time of mpox assessment was associated with being aged 30-39 years, self-identifying as cisgender men, having HIV-positive status, reporting proctitis symptoms and reporting any STI in the past 12 months. CONCLUSIONS: Our data reveals a notable prevalence of concomitant bSTIs among participants with confirmed mpox at a prominent infectious diseases' referral center in Rio de Janeiro, Brazil. These findings underscore the importance of integrating mpox into the differential diagnosis of anogenital manifestations and the promotion of combination prevention strategies within sexual healthcare services.

[Translated article] AEDV Expert Consensus for the Management of Syphilis.

Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.