Predictors of serological cure after treatment in patients with early syphilis: A retrospective observational study in Thailand.

BACKGROUND: Some patients with early syphilis who receive appropriate treatment do not reach a serological cure and have a persistent titer which does not meet the criteria for treatment failure (serofast state). AIMS: This retrospective study aimed to determine the prevalence of serological cure and the serofast state as well as the factors associated with serological cure after treatment of patients with early syphilis. METHODS: A serological cure was defined as occurring when there was a ≥4-fold decrease in nontreponemal titer, whereas patients with a ≥4-fold increase were considered as having either a treatment failure or reinfection. Nontreponemal titers that neither increased nor decreased ≥4-fold after treatment were considered to be in a serofast state. Seroreversion was defined as occurring when there was a negative test within 12 months of treatment. RESULTS: There were 179 patients with a mean age of 31.9 years; 174 (97.2%) were men, and 125 (70%) were HIV patients. Of the total, 174 (98%; 95% confidence interval 94.82-99.42%) patients achieved a serological cure, whereas five were in a serofast state 12 months after treatment. Those five serofast patients were all HIV-positive men, of which 4 (80%) had secondary-stage syphilis, a CD4 count ≤200 cells/µl and a titer <1:8. In a bivariate analysis, a serological cure was associated with a baseline Venereal Disease Research Laboratory >1:16 titers (P = 0.018), and a CD4 cell count >200 cells/µl in 6 months preceding treatment (P = 0.016). The median time to a serological cure was 96 days. Only 22 (12.3%) of the patients achieved seroreversion at 12 months after treatment. LIMITATIONS: A retrospective medical record review is likely to have a selection bias, and in our study, 196 (52%) patients were excluded due to missing information. CONCLUSIONS: Most patients with early syphilis who achieved a serological cure at 12 months after treatment had high baseline Venereal Disease Research Laboratory titers and CD4 cell counts. However, only 22 (12.3%) had a negative Venereal Disease Research Laboratory titer after 1 year of treatment.

Syphilis, leprosy, and human immunodeficiency virus coinfection: a challenging diagnosis.

The association between syphilis, leprosy, and human immunodeficiency virus (HIV) is not well documented, and the emergence of isolated cases raises the interest and indicates that this triple coinfection can occur. We report the case of a 42-year-old man from Rio de Janeiro, Brazil, who presented with erythematous papules on the trunk, back, and upper and lower extremities; an erythematous plaque on the upper abdomen; and an erythematous violaceous plaque on the right thigh with altered sensitivity. Laboratory investigation showed a reagent VDRL test (1:512) and positive test results for Treponema pallidum hemagglutination. Treatment with benzathine penicillin (2,400,000 U intramuscularly) was started (2 doses 1 week apart). On follow-up 40 days later, the lesions showed partial improvement with persistence of the plaques on the right thigh and upper abdomen as well as a new similar plaque on the back. Further laboratory examinations showed negative bacilloscopy, positive HIV test, and histologic findings consistent with tuberculoid leprosy. The patient was started on multidrug therapy for paucibacillary leprosy with clinical improvement; the patient also was monitored by the HIV/AIDS department. We emphasize the importance of clinical suspicion for a coinfection case despite the polymorphism of these diseases as well as the precise interpretation of laboratory and histopathology examinations to correctly manage atypical cases.

Prevalencia de la sífilis en embarazadas de seis ciudades Brasileñas / No disponible

Objetivos: Estimar la prevalencia de sífilis en gestantes de seis ciudades de Brasil y su asociación con variables socioeconómicas, demográficas y de comportamiento. Métodos: Estudio multicéntrico, transversal, que incluyó gestantes atendidas en consultorios prenatales de la atención primaria de salud entre los años 2004 y 2005. Se realizó examen de tamizaje para sífilis usando RPR y examen confirmatorio (ELISA) en la s que resultaron positivas. Se aplicó un cuestionario para colectar informaciones sociodemográficas, clínica-obstétricas, y de la actividad sexual de las voluntarias. Para le análisis estadístico y evaluar los factores de riesgo asociados a la sífilis se realizó análisis bivariado y multivariado por regresión logística múltiple y las pruebas “t” de Studen, Chi2 y test exacto de Fischer. Resultados: Fueron enroladas 3.303 gestantes, cuya edad media fue 23,8 años (± 6,9). La prevalencia de sífilis fue 2,6%. Más de 90% de las gestantes con sífilis presentaban infección latente. El riesgo de tener sífilis fue ocho veces mayor para las gestantes que refirieron haber tenido más de una pareja sexual en el último año. Otros predictores de la infección treponémica fueron: edad mayor de 40 años, nivel de escolaridad baja, tener antecedentes de úlceras genitales, y haber tenido pareja sexual con úlcera genital. Conclusiones: Se observó, en las gestantes brasileras una prevalencia de sífilis elevada. El principal factor de riesgo para esta infección fue tener más de una pareja sexual en los últimos 12 meses (AU)

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Sífilis congénita en comunidades indígenas de difícil acceso: desafío a superar mediante uso de la tecnología / No disponible

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