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2.
Microbiol Spectr ; 10(3): e0264221, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35638776

RESUMO

Because syphilis is a public health concern, new strategies and tools for detecting active syphilis cases should be evaluated for future implementation. We assessed the laboratory performance of the DPP Syphilis Screen & Confirm rapid immunodiagnostic test (Chembio Diagnostics, Medford, NY, USA), using visual reading and the manufacturer's electronic test microreader, for detection of treponemal and nontreponemal antibodies in 383 fully characterized stored serum specimens. We used the Treponema pallidum particle agglutination (TPPA) test and rapid plasma reagin (RPR) test as reference tests for the DPP Syphilis Screen & Confirm assay treponemal and nontreponemal components, respectively. The sensitivity values for treponemal antibody detection by electronic reader and visual interpretation were 83.2% and 85.9%, respectively, with 100% specificity. For nontreponemal antibody detection, the sensitivity values were 65.7% and 69.0% and the specificity values were 88.7% and 89.4% for electronic reader and visual interpretation, respectively. There was excellent correlation between visual interpretation and the microreader for either component (kappa coefficient, 0.953). When restricting the analysis to RPR titers of ≥1:8, the sensitivity was 96.9% for either reading method; numerical microreader values showed good correlation with RPR titers (Spearman rho of 0.77). The DPP Syphilis Screen & Confirm assay showed good performance, compared to reference syphilis tests, using serum. Field evaluation studies should be done to validate its use for detection of active cases and for monitoring of treated syphilis patients. IMPORTANCE Syphilis remains a public health problem; therefore, health systems must incorporate screening tools that allow a rapid and accurate diagnosis to provide adequate treatment. The DPP Syphilis Screen & Confirm Assay simultaneously detects treponemal and nontreponemal antibodies, emerging as an alternative for identifying cases in situations in which there is no infrastructure to perform conventional syphilis testing, but it is necessary to generate evidence regarding the performance of this technology in various scenarios. We found that the test performs well, compared to TPPA and RPR tests, using stored samples from participants at high risk of acquiring syphilis. Additionally, when the Chembio microreader was incorporated, similar results are obtained by the device, compared to those reported by trained laboratory professionals, and correlated with the semiquantitative results of the RPR test. We think that the use of the DPP Syphilis Screen & Confirm Assay with the microreader might help in detecting active syphilis cases and perhaps in monitoring treatment responses in the field.


Assuntos
Sífilis , Anticorpos Antibacterianos , Humanos , Sensibilidade e Especificidade , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum
3.
BMJ Case Rep ; 15(5)2022 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-35584858

RESUMO

A woman in her 30s presented to the emergency department with 4 days of fever, headache and back pain. The patient was admitted for pain control, inability to tolerate oral intake and intravenous antibiotics for presumed diagnosis of pyelonephritis. Following admission, CT of the abdomen/pelvis showed multiple prominent pelvic and inguinal lymph nodes, and the patient was noted to have anterior and posterior cervical and submandibular lymphadenopathy on examination. The differential diagnosis was broadened to infectious, haematological, malignant and autoimmune aetiologies of diffuse lymphadenopathy. Workup included serum studies, imaging, lumbar puncture and lymph node biopsy. Rapid plasma reagin (RPR) returned positive with titre 1:16 and confirmatory reactive Treponema pallidum particle agglutination. With an otherwise unrevealing workup, the diagnosis of secondary syphilis was confirmed. This case highlights the differential and diagnostic approach for diffuse lymphadenopathy and an unusual presentation of secondary syphilis. Additionally, it indicates that secondary syphilis can be present even with a relatively low RPR titre.


Assuntos
Exantema , Linfadenopatia , Sífilis , Exantema/complicações , Feminino , Febre/complicações , Humanos , Linfadenopatia/etiologia , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum
4.
Int J STD AIDS ; 33(6): 575-583, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35384775

RESUMO

Serology is the mainstay for syphilis treatment monitoring. Baseline rapid plasma reagin (RPR) titre, HIV status, and syphilis stage have been found to be associated with the time to serological response among syphilis patients. This study mainly aims to evaluate the time to serological response, and to identify factors affecting the serological outcome. Medical records of syphilis cases diagnosed in Peking Union Medical College Hospital (PUMCH) between 2008 and 2018 were retrospectively reviewed. Kaplan-Meier analysis was performed to evaluate the median time to serologic response and cumulative probability of serologic response over time according to different variables. Cox regression model was conducted to find factors associated with serological response. There were 984 patients diagnosed with primary, secondary, or latent syphilis cases and receiving injections of benzathine penicillin G (BPG) as initial treatment at the Peking Union Medical College Hospital (PUMCH) between 2008 and 2018. Finally, data on 571 patients, including 49 (8.6%) primary syphilis, 261 (45.7%) secondary syphilis, and 261 (45.7%) latent syphilis, were used for analysis. It took longer time to achieve serological response for subjects aged ≥45 years than younger individuals (89 days versus 58 days; p=0.008). Males achieved serological response more quickly than females (71 days versus 83 days; p = 0.011). There was a significant difference in the time to serological response according to different syphilis stages (p < 0.001), with 55 days (95% CI, 43-67 days) for primary, 57 days (95% CI, 51-63 days) for secondary, and 117 days for latent syphilis. In addition, patients with lower baseline RPR titre had longer period to achieve serological response (252 days [95% CI, 129-375 days] for RPR titre ≤1:8, 78 days [95% CI, 63-93 days] for RPR titres from 1:16 to 1:32, and 53 days [95% CI, 49-57 days] for RPR titres ≥1:64, respectively; p<0.001). However, no significant difference in time to serological response to treatment was found according to HIV coinfection status. The result of multivariate Cox regression analysis showed that being older than 45 years with latent syphilis, HIV coinfection, or with baseline RPR titre ≤1:8 was associated with slow response. Among patients followed for at least 1 year or seroreverted, 128 (36.9%) had seroreverted within a year, and 219 (63.1%) still had a positive RPR after 1 year. For multiple logistical regression, being female and HIV coinfection were significantly associated with the failure of seroreversion (OR, 0.42 [95% CI, 0.26-0.68]; p <0.001). This study revealed that younger age, higher initial RPR titre, early syphilis stage, and HIV-negative status were associated with faster serological cure. Female sex, individuals with HIV coinfection, and latent syphilis were significantly associated with the failure of seroreversion.


Assuntos
Infecções por HIV , Sífilis Latente , Sífilis , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Penicilina G Benzatina/uso terapêutico , Estudos Retrospectivos , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis Latente/tratamento farmacológico , Sífilis Latente/epidemiologia , Resultado do Tratamento , Treponema pallidum
5.
Pediatr Infect Dis J ; 41(6): e268-e270, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35446812

RESUMO

Congenital syphilis represents an important public health challenge in the United States, and its prevalence has been increasing for the past 10 years because of many factors. The diagnosis can be difficult given its various and nonspecific clinical manifestations in newborns, and the possibility of false negative results during prenatal care. The prozone phenomenon, caused by an excess of antibody, which interferes with the regular screening tests, is a cause of false negative tests. This could delay the diagnosis and increase morbidity and mortality in the newborn. We present a case of congenital syphilis in a 3-month-old infant whose mother had prenatal care and negative tests for syphilis, which contributed to the late diagnosis. In the face of clinical findings suggestive of congenital syphilis and negative maternal syphilis tests healthcare providers should consider the possibility of maternal false negative test caused by the prozone phenomenon.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Sorodiagnóstico da Sífilis/métodos , Sífilis Congênita/diagnóstico
8.
Sex Transm Dis ; 49(6): 453-457, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35312664

RESUMO

BACKGROUND: Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. METHODS: Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. RESULTS: We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio ≥10.4. When the S/Co ratios were ≥7.2 and ≥10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio <10.4, and negative TPHA and RPR. CONCLUSIONS: We propose a potentially cost-effective reverse screening algorithm with a treponemal CMIA S/Co ratio ≥10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation.


Assuntos
Sífilis , Anticorpos Antibacterianos , Testes de Hemaglutinação , Humanos , Imunoensaio , Técnicas Imunoenzimáticas , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum
9.
Neurol India ; 70(1): 160-161, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263869

RESUMO

Syphilis is a reemergent infection worldwide. There has been a steady increase in incidence across many population groups in the last decades, requiring public health authorities' attention. We report a case of a 67-year-old man with neurosyphilis who presented with abrupt clinical ophthalmic changes and sensorineural hearing loss. The neuroradiological investigation demonstrated cranial nerves and vascular involvement, detected on high-resolution vessel wall imaging in brain magnetic resonance imaging. CSF and blood VDRL test were positive, as well as blood serum fluorescent treponemal antibody absorption test (FTA-ABS) and chemiluminescent magnetic microparticle immunoassay (CMIA). A test for the human immunodeficiency virus was negative. The patient was administered intravenous penicillin G for 21 days and was discharged well, with no neurologic signs.


Assuntos
Neurite (Inflamação) , Neurossífilis , Sífilis , Vasculite , Idoso , Humanos , Masculino , Neurossífilis/diagnóstico por imagem , Neurossífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis/métodos
10.
Asia Pac J Public Health ; 34(4): 346-353, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35168408

RESUMO

The aim of this study was to understand the availability of laboratory testing for syphilis among hospitals in Shandong province. Basic information on hospitals that provide clinical health service for sexually transmitted infections (STIs) and the type of laboratory tests for syphilis provided was collected and analyzed using the chi-square test. A total of 410 and 456 hospitals that provided clinical services for STI were surveyed in 2012 and 2018. Significant differences in the availability of nontreponemal tests were observed among different levels (χ2 = 6.624) and types (χ2 = 17.752) of hospitals in 2012, but not in 2018. A significant difference in the availability of treponemal tests was observed among different levels of hospitals in 2012 (χ2 = 9.937) but not in 2018. Significant differences in the availability of nontreponemal tests, titer of nontreponemal tests, and treponemal tests were observed among hospitals with different affiliations in 2018 (P = 0.000; χ2 = 15.274, P < .001; P = .021) but not in 2012. The availability of nontreponemal and treponemal tests for syphilis among hospitals in 2018 was higher than that in 2012 (90.13% vs. 57.56%, χ2 = 121.219). The availability of laboratory testing has been much improved. Further efforts are needed to reduce the disparity in the availability among different hospitals.


Assuntos
Sífilis , China/epidemiologia , Hospitais , Humanos , Sífilis/diagnóstico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis
11.
Am J Dermatopathol ; 44(5): 372-375, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35120035

RESUMO

ABSTRACT: Although a rare disease, the incidence of congenital syphilis is on the rise in the US. We report a case of early congenital syphilis in a 1-day-old premature boy with positive Rapid plasma reagin titer, respiratory insufficiency, disseminated intravascular coagulation, and encephalopathy, born to a mother with known syphilis infection. Skin examination showed diffuse truncal petechiae, desquamation of the distal extremities, and violaceous, retiform plaques on the buttocks and lower extremities. A biopsy was performed to rule out an infectious etiology or vasculitis. Histopathologic examination revealed irregular epidermal acanthosis with orthokeratosis and parakeratosis. There were foci of neutrophilic infiltrate forming rare pustules within the stratum corneum and focal intraepidermal eosinophils, neutrophils, and rare dyskeratotic keratinocytes. In the dermis, there was some minimal endothelial swelling with a perivascular, interstitial, and periadnexal infiltrate of lymphocytes, eosinophils, and rare plasma cells. A Treponema pallidum immunostain highlighted spirochetes present within the epidermis and within the eccrine ducts. Penicillin G therapy was administered for 10 days. The infant's Rapid plasma reagin titer trended downward until it was negative 6 months after birth. Literature review reveals 8 case reports within the last 20 years describing the histopathology of rashes in congenital syphilis. Herein we summarize the reported histopathology of rashes in congenital syphilis and compare it to the histopathology of rashes in secondary syphilis in adults.


Assuntos
Exantema , Sífilis Congênita , Sífilis , Adulto , Humanos , Lactente , Masculino , Reaginas , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Sífilis Congênita/diagnóstico , Treponema pallidum
12.
Int J Infect Dis ; 117: 345-348, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35189340

RESUMO

Neurosyphilis is a late complication of primary syphilis and occurs with a multitude of vague symptoms. In this study, we report a patient with neurosyphilis who presented with status epilepticus, hemiplegia, and aphasia, which may be easily misdiagnosed. After performing the reactive serum test, including the toluidine red unheated serum test and the Treponema pallidum particle agglutination assay test, and cerebrospinal fluid analysis, as well as the brain Magnetic Resonance Imaging (MRI) results, we consider it general paresis of the insane, also known as dementia paralytica. The patient was started on a 14-day course with high-dose intravenous penicillin. After this treatment, the patient made significant recovery with improved cognitive function, evidenced by his Mini-mental State Examination score of 21. However, before this treatment, he could not cooperate with this exam. General paresis of the insane typically has a progressive course and normally presents 10 to 30 years after the initial infection. The manifestations of this patient and his suspicious history of transient ischemic attacks may mislead to the diagnosis of Todd's paresis or stroke. The prevalence of syphilis has been rising again in recent years. To date, there is no gold standard for the diagnosis of neurosyphilis. Early diagnosis is of great importance, as penicillin therapy is highly effective.


Assuntos
Neurossífilis , Estado Epiléptico , Sífilis , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Sífilis/complicações , Sorodiagnóstico da Sífilis , Treponema pallidum
13.
Eur J Med Res ; 27(1): 16, 2022 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-35109919

RESUMO

BACKGROUND: Due to the inconsistent results of anti-treponema pallidum (TP) specific antibodies by enzyme-linked immunosorbent assay (ELISA) and Treponema pallidum granule agglutination assay (TPPA) in clinical work, there will be a certain proportion of false-positives and false-negatives depending on TPPA as confirmation results. This study aimed to evaluate the necessity of Western blotting (WB) in samples with inconsistent results in detecting anti-TP antibodies by ELISA and TPPA. METHODS: Specific anti-TP test results in our clinical laboratory were retrospectively analyzed. The specimens with a positive or a negative result, but with colored ELISA plates, were retested by TPPA. WB was used to confirm the suspicious results between ELISA and TPPA. The Chi-square test was used to analyze whether the difference was statistically significant. RESULTS: A total of 106,757 anti-TP specimens were screened by ELISA from August 2018 to December 2019; 3972 were retested by TPPA, and 3809 were positive by TPPA. ELISA and TPPA showed different results in 163 specimens. Among them, 29 specimens were negative and 134 were positive by ELISA; 76 were negative, 23 were positive, and 64 were "reserve" by TPPA; 93 were negative, 31 were positive, and 39 were suspicious by the WB confirmation test. Compared with WB, the difference in the results of ELISA and TPPA was statistically significant. CONCLUSIONS: TPPA is an effective retest method for anti-TP antibody detection. If the results of anti-TP antibodies by ELISA and TPPA are inconsistent, it is necessary to use WB for confirmation. Trial registration This retrospective analysis is in accordance with the ethical guidelines of China and approved by the second hospital of Jiaxing (jxey-2018048).


Assuntos
Anticorpos Antibacterianos/análise , Western Blotting/métodos , Sorodiagnóstico da Sífilis/métodos , Sífilis/diagnóstico , Treponema pallidum/imunologia , Humanos , Curva ROC , Estudos Retrospectivos , Sífilis/microbiologia
14.
JAMA ; 327(2): 161-172, 2022 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-35015033

RESUMO

Importance: Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. Observations: From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception. Conclusions and Relevance: Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.


Assuntos
Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Infecções Assintomáticas/epidemiologia , Infecções Assintomáticas/terapia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/etnologia , Busca de Comunicante , Resistência Microbiana a Medicamentos , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Gonorreia/etnologia , Infecções por HIV/complicações , Infecções por HIV/transmissão , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Herpes Genital/epidemiologia , Herpes Genital/etnologia , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpes Simples/epidemiologia , Herpes Simples/etnologia , Humanos , Masculino , Programas de Rastreamento , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/etnologia , Mycoplasma genitalium , Técnicas de Amplificação de Ácido Nucleico , Distribuição por Sexo , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/etnologia , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sífilis/etnologia , Sorodiagnóstico da Sífilis/métodos , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/tratamento farmacológico , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/etnologia , Estados Unidos/epidemiologia
15.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 40(1): 1-3, Enero, 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-203289

RESUMO

IntroducciónLa serología luética en la sífilis primaria puede ser negativa los primeros 5-15 días. El objetivo de este trabajo fue evaluar los beneficios de incluir la microscopia de campo oscuro (MCO) en el algoritmo diagnóstico de la sífilis primaria.MetodologíaSe incluyó a todos los pacientes que acudieron a una clínica de infecciones de transmisión sexual de la Comunidad de Madrid entre 2015 y 2019 que presentaban una úlcera genital sospechosa de sífilis primaria. Se les realizó MCO y serología (EIA/TPPA/RPR).ResultadosDe las 806 muestras, el 53,2% (429) fueron positivas para MCO. De los 429, el 48% presentaba screening serológico negativo (EIA/RPR) y de ellos en el 77,6% el TPPA fue positivo.ConclusionesLa MCO permite un diagnóstico de sífilis primaria precoz, incluso sin confirmación serológica. Si no se dispone de técnicas directas, en primoinfección, la TPPA es de gran ayuda en el diagnóstico.


IntroductionSerological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis.Materials/methodsPatients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).ResultsOver the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.ConclusionsDFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.


Assuntos
Humanos , Ciências da Saúde , Microscopia , Sífilis , Sorologia , Sorodiagnóstico da Sífilis , Treponema pallidum , Doenças Transmissíveis , Tiamina Pirofosfatase
16.
Int J STD AIDS ; 33(2): 123-128, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34723748

RESUMO

In Ottawa, Canada, we initiated protocols to include non-serologic syphilis testing, as direct fluorescence antibody (DFA) for patients with syphilis symptoms. The purpose was to assess the ability of DFA to detect syphilis during acute infection and to determine if non-serologic testing could yield an increased number of syphilis diagnoses. We reviewed charts of patients of our local sexual health clinic for whom syphilis was suspected. A total of 69 clinical encounters were recorded for 67 unique patients, most of whom were male. The most common symptom was a painless genital lesion. Of the 67 patients, 29 were found to have a new syphilis diagnosis, among whom, 52% had positive syphilis serology and positive DFA, 34% had a positive syphilis serology and negative DFA, and 14% had negative syphilis serology and positive DFA. While DFA testing did not yield an abundance of new cases, it was useful to support findings from syphilis serology or confirm diagnosis where serology was negative. Where available, alternate non-serologic tests, such as nucleic acid amplification tests, should be considered above DFA due to its higher sensitivity for detecting syphilis in primary lesions; however, in clinical situations, when new syphilis infection is suspected, empiric treatment should not be delayed.


Assuntos
Sífilis , Canadá , Humanos , Masculino , Testes Sorológicos , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis/métodos
17.
Diagn Microbiol Infect Dis ; 102(2): 115588, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34883351

RESUMO

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.


Assuntos
Anticorpos Antibacterianos/análise , Anticorpos Antibacterianos/sangue , Refrigeração/métodos , Manejo de Espécimes/métodos , Sorodiagnóstico da Sífilis/métodos , Sífilis/sangue , Sífilis/diagnóstico , Sífilis/microbiologia , Humanos , Plasma/microbiologia , Soro/microbiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34732343

RESUMO

INTRODUCTION: Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis. MATERIALS/METHODS: Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTS: Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONS: DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.


Assuntos
Sífilis , Humanos , Microscopia , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum
19.
Sex Transm Infect ; 98(3): 173-177, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33782148

RESUMO

OBJECTIVES: Intramuscular benzathine penicillin G is not available in certain countries. In a previous report, 3 g/day amoxicillin with probenecid was shown to be effective in treating syphilis in patients with HIV; however, 7.3% of patients changed their therapy owing to adverse events. The objective of this study was to assess the clinical efficacy and tolerability of 1.5 g/day amoxicillin without probenecid for the treatment of syphilis. METHODS: The routine clinical records of patients diagnosed with syphilis and treated with 1.5 g/day amoxicillin at a tertiary care hospital between 2006 and 2018 were retrospectively analysed. Syphilis was diagnosed if serum rapid plasma reagin (RPR) titres were ≥8 RU and the Treponema pallidum latex-agglutination test was positive. Serological cure was defined as a ≥fourfold decrease in the RPR titre within 12 months in symptomatic early syphilis and within 24 months in latent syphilis. RESULTS: Overall, 138 patients (112 with HIV) were analysed. The percentages of primary, secondary, early latent, late latent and latent syphilis of unknown duration were 8.0%, 50.0%, 25.4%, 5.8% and 10.9%, respectively. The median treatment duration was 4.5 weeks (IQR 4-8 weeks), which was not related to the stage of syphilis. Two patients (1.5%) changed treatment due to skin rash. The rate of serological cure was 94.9% (131/138; 95% CI 89.8% to 97.9%) overall; 93.8% (105/112; 95% CI 87.5% to 97.5%) in patients with HIV and 100% (26/26; 95% CI 86.8% to 100%) in patients without HIV. Treatment duration was not related to the treatment efficacy. CONCLUSION: The regimen of 1.5 g/day amoxicillin without probenecid is highly effective with a low switch rate in patients with and without HIV.


Assuntos
Infecções por HIV , Sífilis , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Probenecid/efeitos adversos , Estudos Retrospectivos , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Resultado do Tratamento , Treponema pallidum
20.
Sex Transm Infect ; 98(3): 161-165, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33782149

RESUMO

BACKGROUND: Serology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert. METHODS: Serodiscordant primary syphilis cases that were T. pallidum PCR-positive and serology-negative (including rapid plasma reagin, T. pallidum particle agglutination, T. pallidum enzyme immunoassay or T. pallidum chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined. RESULTS: There were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6 weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1. DISCUSSION: Earlier treatment of primary syphilis can prevent the development of serological markers. T. pallidum PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.


Assuntos
Minorias Sexuais e de Gênero , Sífilis , Anticorpos Antibacterianos , Estudos Transversais , Homossexualidade Masculina , Humanos , Masculino , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Treponema pallidum
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