Classification Criteria for Syphilitic Uveitis.

PURPOSE: To determine classification criteria for syphilitic uveitis. DESIGN: Machine learning of cases with syphilitic uveitis and 24 other uveitides. METHODS: Cases of anterior, intermediate, posterior, and panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the different uveitic classes. The resulting criteria were evaluated on the validation set. RESULTS: Two hundred twenty-two cases of syphilitic uveitis were evaluated by machine learning, with cases evaluated against other uveitides in the relevant uveitic class. Key criteria for syphilitic uveitis included a compatible uveitic presentation (anterior uveitis; intermediate uveitis; or posterior or panuveitis with retinal, retinal pigment epithelial, or retinal vascular inflammation) and evidence of syphilis infection with a positive treponemal test. The Centers for Disease Control and Prevention reverse screening algorithm for syphilis testing is recommended. The misclassification rates for syphilitic uveitis in the training sets were as follows: anterior uveitides 0%, intermediate uveitides 6.0%, posterior uveitides 0%, panuveitides 0%, and infectious posterior/panuveitides 8.6%. The overall accuracy of the diagnosis of syphilitic uveitis in the validation set was 100% (99% confidence interval 99.5, 100)-that is, the validation set's misclassification rates were 0% for each uveitic class. CONCLUSIONS: The criteria for syphilitic uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Boletim epidemiológico sífilis - 2020 / Syphilis Epidemiological Bulletin - 2020

A Sífilis é uma infecção bacteriana causada pelo agente Treponema pallidum, sistêmica, crônica, exclusiva do ser humano, que tem cura e tratamento garantido pelo Sistema Único de Saúde (SUS). A maioria das pessoas diagnosticadas com essa Infecção Sexualmente Transmissível (IST) tende a não ter conhecimento da infecção, ou seja são assintomáticas, podendo transmiti-la aos seus parceiros sexuais por meio de relação sexual - anal, vaginal e/ou oral. Contudo, pode ser transmitida verticalmente para o feto durante a gestação de uma mulher com sífilis não tratada ou tratada de forma não adequada. A principal forma de prevenção da Sífilis é utilizando o preservativo, seja ele masculino ou feminino. A sífilis é uma infecção que possui vários estágios, que se caracterizam de acordo com a sua infectividade e o tempo de exposição ao organismo

Syphilis is a systemic, chronic bacterial infection caused by the agent Treponema pallidum, exclusive to humans, which has a cure and treatment guaranteed by the Unified Health System (SUS). Most people diagnosed with this Sexually Transmitted Infection (STI) tend not to be aware of the infection, that is, they are asymptomatic, and can transmit it to their sexual partners through sexual intercourse - anal, vaginal and/or oral. However, it can be transmitted vertically to the fetus during pregnancy in a woman with untreated or inadequately treated syphilis. The main way to prevent syphilis is to use condoms, whether male or female. Syphilis is an infection that has several stages, which characterized according to their infectivity and the time of exposure to the organism

Treponema pallidum Nucleic Acid Amplification Testing To Augment Syphilis Screening among Men Who Have Sex with Men.

Syphilis rates in much of the world are now at their highest levels in almost three decades, and new approaches to controlling syphilis, including diagnostic tests with shorter window periods, are urgently needed. We compared the sensitivity of syphilis serological testing using the rapid plasma reagin (RPR) test with that of the combination of serological testing and an experimental 23S rRNA Treponema pallidum real-time transcription-mediated amplification (TMA) assay performed on rectal and pharyngeal mucosal swabs. T. pallidum PCR assays for the tpp47 gene were performed on all TMA-positive specimens, as well as specimens from 20 randomly selected TMA-negative men. A total of 545 men who have sex with men (MSM) who were seen in a sexually transmitted disease clinic provided 506 pharyngeal specimens and 410 rectal specimens with valid TMA results. Twenty-two men (4%) were diagnosed with syphilis on the basis of positive RPR test results and clinical diagnoses, including 3 men with primary infections, 8 with secondary syphilis, 9 with early latent syphilis, 1 with late latent syphilis, and 1 with an unstaged infection. Two additional men were diagnosed based on positive rectal mucosal TMA assay results alone, and both also tested positive by PCR assay. At least 1 specimen was TMA positive for 12 of 24 men with syphilis (sensitivity, 50% [95% confidence interval [CI], 29 to 71%]). RPR testing and clinical diagnosis were 92% sensitive (95% CI, 73 to 99%) in identifying infected men. Combining mucosal TMA testing and serological testing may increase the sensitivity of syphilis screening in high-risk populations.

Caracterización de los casos de sífilis en el Hospital Argerich 2016: Situación epidemiológica y nuevas perspectivas / Characterization of syphilis cases at the Argerich Hospital 2016: Epidemiological situation and new perspectives

El presente diagnóstico tiene por objetivo describir y caracterizar los datos de los casos de sífilis, en especial los relacionados con la transmisión vertical y su relevancia en Salud Pública, evaluados en el Hospital General de Agudos Cosme Argerich (HGACA) y notificados a la División de Promoción y Protección entre la Semana Epidemiológica (SE) 1 y 52 de 2016, para la posterior toma de decisiones, ante el aumento de la morbimortalidad de esta patología. (AU)

[Syphilis]. / Syphilis.

Syphilis is back since the beginning of this century. The epidemic affects mainly men having sex with men with a high proportion of HIV-infected patients. The classification of syphilis distinguishes early syphilis where patients are contagious (primary, secondary and early latent of less than one year) and late syphilis where patients are not (or less) contagious (late latent of more than one year and tertiary). The clinical presentation of syphilis has not changed. However, we must insist on the early forms of neurosyphilis, notably ophthalmic syphilis often under-diagnosed, as it affects the treatment. Serologic tests may be improved but are very helpful for the positive diagnosis and the follow-up after treatment. Treatment of early syphilis is based on one injection of benzathine benzyl penicillin G. Patients who have had syphilis must be regularly followed-up after treatment, as re-infections are common and are often asymptomatic.

Pustular secondary syphilis: report of three cases and review of the literature.

BACKGROUND: Pustular syphilis is an extremely rare manifestation of secondary syphilis. Failure to recognize the disease can have devastating consequences. METHODS: We present three patients with pustular syphilis as the primary manifestation of secondary syphilis. RESULTS: Patient 1 was initially diagnosed by Venereal Disease Research Laboratory (VDRL) test (titers 1 : 32) and confirmed by enzyme immunoassay (EIA) for Treponema pallidum. Patient 2 was screened for syphilis by VDRL (titers 1 : 64), yielding a positive result, and tested negative for HIV. Secondary syphilis was confirmed by EIA. In Patient 3, a diagnosis of secondary syphilis was established by VDRL (titers 1 : 128) and EIA. Treponema pallidum was detected by dark field microscopy in three patients. Testing for HIV infection was negative in all patients. CONCLUSIONS: Diagnosis in secondary syphilis remains challenging because of the diversity of clinical presentations. The most commonly observed cutaneous presentation is a generalized, non-pruritic, papulosquamous eruption varying from pink to violaceous to brown, with mucous membrane involvement. The diagnostic methods used to identify secondary syphilis are the same as those used to diagnose other stages of syphilitic infection. The persistence of syphilis in both developed and underdeveloped regions highlights the importance of considering syphilitic infection in the setting of a cutaneous pustular eruption, especially one that fails to respond to standard therapy. Testing for other sexually transmitted diseases, including HIV, should be performed in all patients diagnosed with syphilis.

Yaws, syphilis, sexuality, and the circulation of medical knowledge in the British Caribbean and the Atlantic world.

This history of the disease categories "yaws" and "syphilis" explores the interplay between European and African medical cultures in the early modern Atlantic world. The assertion made by both early modern and modern medical authorities, that yaws and syphilis are the same disease, prompts a case study of the history of disease that reflects on a variety of issues in the history of medicine: the use of ideas about contagion to demarcate racial and sexual difference at sites around the British Empire; the contrast between persistently holistic ideas about disease causation in the Black Atlantic and the growth of ontological theories of disease among Europeans and Euro-Americans; and the controversy over the African practice of yaws inoculation, which may once have been an effective treatment but was stamped out by plantation owners who viewed it as a waste of their enslaved laborers' valuable time.

[Retrospective analysis of 50 cases of senile syphilis].

OBJECTIVE: To summarize the epidemiological features of senile syphilis. METHOD: The clinical data of 50 elderly (>60 years) patients with syphilis who were treated in the Clinic of Sexually Transmitted Diseases of Peking Union Medical College Hospital were retrospectively analyzed. RESULTS: There were 31 men and 19 women (male to female ratio:1.6:1). Non-marital sexual intercourse was the main route of transmission. The disease was mainly found before surgeries. Among these 50 syphilis cases, 3 were primary syphilis, 13 were secondary syphilis, 10 were early latent syphilis, 12 were late latent syphilis, and 12 were latent syphilis of unknown duration. Co-morbidities with other sexually transmitted diseases were found in 4 patients. The rate of sero-resistance was 40%. CONCLUSIONS: The incidence of syphilis in the senile population is higher than we expected. Routine serological screening for syphilis is required in clinical settings. The underlying diseases, human hosts-related spirochetes, and laboratory testing techniques are important reasons for the false positive findings in senile patients.

[Syphilis diagnosed by antenatal screening]. / Syfilis påvist ved screening i graviditeten.

Because of an increasing incidence of syphilis in Denmark, antenatal screening was re-introduced in 2010. We present two cases of latent syphilis diagnosed by antenatal screening alone. Neither of the two women recalled any previous symptoms of the disease. After treatment, both women gave birth to healthy children.

Shape and configuration of skin lesions: targetoid lesions.

What is probably the first description of targetoid or iris lesions, as they appear in erythema multiforme (EM), can be found in Thomas Bateman's 1836 textbook "Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr. Willan." EM was initially described by Bateman and later by von Hebra as an acute self-limiting skin disease, symmetrically distributed on the extremities with typical concentric "targetoid" or "iris" lesions, and often recurrent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were added to this syndrome later. A newer classification has created two disease spectra: EM consisting of EM minor and EM major (or bullous EM), and SJS and TEN. EM minor and EM major are often recurrent, postinfectious (especially after herpes and mycoplasma) disorders with low morbidity and almost no mortality. SJS and TEN are usually severe drug-induced reactions with high morbidity and poor prognosis. The target lesions found in each form of the disease are described and defined. Although the term "target lesion" originated from the description of EM and despite its being the dominant lesion in this disease, it is not pathognomonic for EM, and these lesions can sometimes appear in other diseases. Short descriptions of these other diseases are presented.

[Syphilis in Ferrara in the nineteenth century]. / La sifilide a Ferrara nel 1800.

In this article the authors highlight the behaviour of government authorities in the nineteenth century in Italy and especially in Ferrara to implement those measures deemed necessary to stem the spread of syphilis in epidemic form through the control of prostitution. Albeit discontinuously and until 1865, corrupted and infected women in Ferrara were assisted and treated by charitable institutions (Congregation of Charity, the Congregation of the Ladies of St. Vincent and the Sisters of Charity at the complex St. Mary of Consolation) since the Ferrara public hospital (Arcispedale S. Anna) could not accept or treat infected prostitutes for economic reasons and lack of beds. Subsequently, the hospital only treated prostitutes free of charge if they bore a certificate of poverty. The other infected prostitutes were sent to the sifilicomio in Modena. The authors also study mortality from syphilis in Ferrara from 1813 to 1899 in order to detect any significant differences according to age, sex and professional status and attempt to identify the stage of the disease (primary, secondary and tertiary), according to the terminology used by the doctors of that time.

[Syphilis].

In Japan, the incidence of syphilis has decreased, and clinicians might be more likely to overlook syphilis than before. We show typical clinical manifestations and treatment of syphilis for clinicians unfamiliar with the disease and emphasize that two types of serologic test, non treponemal tests and specific treponemal tests, are essential for diagnosis of syphilis. Recent automated serologic tests for syphilis are useful to examine patients' progress after they are treated. The early stage of syphilis is gradually spreading among men in Japan, and HIV coinfections are often caused by homosexual contacts. We present a sample figure in the classic medical book, "Atlas of syphilis and the venereal diseases".

Otosyphilis in HIV-coinfected individuals: a case series from Toronto, Canada.

We sought to identify and review the clinical features and treatment outcomes of eight recent cases of otosyphilis in HIV-positive patients seen in Toronto. All patients reported tinnitus, and seven (87.5%) reported subjective hearing loss. Not taking auditory findings into consideration, four patients would be classified as having secondary syphilis, three patients as having early latent syphilis, and one patient as having latent syphilis of unknown duration. The median CD4 cell count was 370 x 10(6)/L. All patients were treated with intravenous aqueous penicillin G with regimens recommended for the treatment of neurosyphilis; four patients received adjunctive steroids. All eight patients experienced improvement in tinnitus and four of the seven (57.1%) patients with symptomatic hearing loss also experienced improvement. Otosyphilis can occur in HIV-positive individuals despite high CD4 cell counts, and is potentially reversible. Increased awareness of uncommon manifestations of syphilis in high-risk individuals is warranted to prompt appropriate investigation and treatment.

[Sexually transmitted diseases in Poland in 2006 and in 2005]. / Choroby przenoszone droga plciowa w Polsce w 2006 roku w swietle danych z 2005 roku.

In 2006 year 936 cases of all form of syphilis notified in Poland; incidence 2.46 per 100,000 population (2005--809, incidence 2.12). The largest of cases was in mazowieckie (305, incidence 5.9), dolnoslaskie (110, incidence 3.8), slaskie (101, incidence 2.2) voivodeships. There were recognized 409 cases of gonorrhoea (in 2005--402). Epidemiological situation of sexually transmitted diseases has been getting worse. As in the past years the children with congenital syphilis was born. Decrease numbers of screening serological tests in syphilis and gonorrhoea. The rate of prophylaxis and immediate treatment (contacts) no change to improvement.

Syphilis in China: results of a national surveillance programme.

BACKGROUND: After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960-80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention. METHODS: We collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network. FINDINGS: In 1993, the reported total rate of cases of syphilis in China was 0.2 cases per 100,000, whereas primary and secondary syphilis alone represented 5.7 cases per 100,000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71.9%, from 0.01 cases per 100,000 livebirths in 1991 to 19.68 cases per 100 000 livebirths in 2005. INTERPRETATION: The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.

[Syphilis]. / Syphilis.

The incidence of syphilis, an infectious disease caused by Treponema pallidum, is low worldwide. The knowledge of its symptoms is however important, since the infectivity is high and therapy is comparatively easy. The first feature of an infection is the chancre, which is nearly always located in the genital region. In half of the infected patients after 8-12 weeks, if untreated, a generalisation takes place, during which the bacteria affect all organ systems. At first the skin diseases are most prominent; in long-term disease (late syphilis) symptoms of the central nervous system and the cardiovascular system become more relevant. In the chancre the infectious agent may be proven natively, but not in a culture. At about 3-6 weeks after infection specific serum antibodies may be proven with very sensitive and specific methods. Mainly the TPHA and FTA tests are used. These tests allow a reliable diagnosis to be made also in cases with ambiguous clinical features. The treatment of syphilis is performed by using parenteral depot penicillins for 14 days. It may also be applied as post-exposure prophylaxis. Specifics of the course have to be take into consideration in cases of coexisting HIV infections and neurosyphilis. The disease has a favourable prognosis, when treatment starts early enough.