Utility of antitreponemal IgM testing in the diagnosis of early and repeat syphilis among HIV-infected and non-infected patients

Until now only non-treponemal tests (e.g. rapid plasma reagin [RPR]) have been used to monitor syphilis activity (e.g. distinguishing between treated, untreated and repeat disease) and efficacy of treatment. However, they usually require manual operation and are less specific than treponemal tests. The aim of the current study was to evaluate the use of the antitreponemal IgM testing in the diagnosis of early and repeat syphilis in HIV-infected and non-infected patients. One hundred and seventeen patients with early syphilis were included in this prospective study. RPR and anti- Treponema pallidum-IgM (TP-IgM) tests were conducted at onset and at three-month intervals during 24-month follow-up after initial treatment. In 31 of 117 syphilitic patients the co-occurrence of HIV infection was diagnosed. A positive TP-IgM test was present in 78.6% of patients with newly-diagnosed primary syphilis, 95.8% with secondary and 57.9% with early latent syphilis, but only in 38.5% patients with syphilis reinfection. There was a significant correlation between primary and secondary syphilis, higher baseline RPR titre and the pre-treatment IgM test reactivity. Regardless of the syphilis stage, HIV-seropositive individuals were more frequently positive for TP-IgM, both during the first onset of the disease (90.3%), and reinfection (71.4%), as compared to the HIV-seronegative group (71.4% and 0%, respectively, P < 0.03). TP-IgM seroreversion was observed in 115 out of 117 patients studied (98.3%) during follow-up (mean time to seroreversion 6.9 months). The time to TP-IgM seroreversion after treatment was significantly shorter in patients with early symptomatic syphilis (mean 4.9 months) when compared to early latent syphilis (7.7 months, P < 0.05). A negative TP-IgM test was found in approximately 20% and 40% of individuals with primary and early latent syphilis, respectively. The value of IgM testing in the diagnosis of syphilis reinfection is doubtful.

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The Effect of Treatment on the Treponema Pallidum Haemagglutination Test in Early Syphilis

Scottish Medical Journal ◽

10.1177/003693307902400411 ◽

1979 ◽

Vol 24 (4) ◽

pp. 307-312 ◽

Cited By ~ 2

Author(s):

Jennifer M. Hunter

Keyword(s):

Treponema Pallidum ◽

Secondary Syphilis ◽

Post Treatment ◽

Haemagglutination Test ◽

Early Syphilis ◽

Haemagglutination Assay ◽

Effect Of Treatment ◽

Pre Treatment ◽

Latent Syphilis

The response of the Treponema Pallidum Haemagglutination Assay (TPHA) to treatment was studied in 61 cases of early infectious syphilis. In none of the 55 cases of early syphilis in which the pre-treatment TPHA was positive did the TPHA test become consistently negative after treatment. In primary and early latent syphilis it was not possible to demonstrate any significant changes, but in some cases of secondary syphilis a significant and rapidfall in TPHA titre occurred with treatment. It is suggested that the post-treatment TPHA titre need not necessarily reflect the stage at which the disease was arrested.

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Post-treatment serological changes in some patients with early syphilis exhibit a parabolic trend

International Journal of STD & AIDS ◽

10.1177/0956462419871855 ◽

2019 ◽

Vol 30 (14) ◽

pp. 1389-1396

Author(s):

Yong Liu ◽

Que-Qiao Bian ◽

Shu-Huan Zhang ◽

Jun Wang ◽

Zhen-Ming Wang ◽

...

Keyword(s):

Treatment Effectiveness ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Post Treatment ◽

Treatment Level ◽

Early Syphilis ◽

Primary Syphilis ◽

Serum Titer ◽

Pre Treatment ◽

Latent Syphilis

Early syphilis accounts for a large proportion of patients with syphilis. Non- Treponema pallidum tests are commonly used to assess treatment effectiveness by analyzing the serological titer before treatment and six months after treatment. However, serological changes during the first three months after completion of treatment have not been completely understood. This prompted us to investigate whether serum titers of patients exhibit a continuous decrease post-treatment and to assess the trend of change in serological titer during this period. One hundred and seventy-three eligible patients with early syphilis were included in the analysis. Pre-treatment serological titers and those at three and six months post-treatment were compared and analyzed. Serological recovery was defined as a 4-fold or greater decrease in titer from pre-treatment level. Forty patients (23.1%) were found to have an increased serum titer at three months after treatment. Among the 40 patients, 13 patients had primary syphilis, 5 patients had secondary syphilis, and 22 patients had early latent syphilis. The proportion of patients with primary syphilis was higher, and their initial titers were significantly lower. No significant differences were observed with respect to age, gender, or initial treatment. The assessment results of 17 patients (9.8% of the total patients) change. Serological changes in some patients exhibit a parabolic pattern that may affect the clinician’s assessment of patient recovery. Therefore, more frequent assessment of serological titer might be required within the first six months post-treatment.

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Sífilis: Prevalência num Hospital de Lisboa

Acta Médica Portuguesa ◽

10.20344/amp.6247 ◽

2016 ◽

Vol 29 (1) ◽

pp. 52 ◽

Cited By ~ 2

Author(s):

Leonor Lopes ◽

Rita Ferro-Rodrigues ◽

Samuel Llobet ◽

Luís Lito ◽

João Borges-Costa

Keyword(s):

Clinical Laboratory ◽

Transmitted Disease ◽

Public Health Problem ◽

Secondary Syphilis ◽

Disease Classification ◽

Serological Tests ◽

Important Public Health Problem ◽

Early Syphilis ◽

Latent Syphilis

Introduction: Syphilis is a sexual and vertical transmitted disease. Its incidence is increasing in Europe, particularly, in Portugal. Material and Methods: A descriptive, retrospective study was performed based on positive treponemal tests from January to December 2013, at the Santa Maria Hospital, Lisbon. In-patients and out-patients evaluated in medical appointments and at the emergency department were included. We proceeded to epidemiological characterization, disease classification and definition of risk factors. Results: We obtained a sample of 580 patients, of whom 51 with no clinical data and 45 with false positive serologies were excluded. There was a predominance of male patients (75%) and a mean age of 47 years. Most (59%) had syphilis successfully treated in the past and 3.7% were in follow-up. We recorded 13 primaries syphilis, 71 cases of secondary syphilis, 40 cases of early latent syphilis, 49 unknown duration syphilis and five cases of late latent syphilis. In the early syphilis group, 42% (n = 124) were HIV-positive and, in 8% both diagnosis were done simultaneously. Discussion: We emphasize the high prevalence of syphilis/HIV co-infection in patients with early syphilis, reinforcing the importance of promoting the use of preventive measures. We obtained 11% of patients with late clinical forms, which are notifiable since June 2014, in Portugal. All serological tests for the diagnosis of syphilis have limitations which emphasizes the importance of clinical-laboratory correlation. Conclusion: Syphilis remains an important public health problem. It is necessary to establish education programs, screening and follow-up strategies to reduce their prevalence and to perform more efficient screening of the partners.

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A New Specimen for Syphilis Diagnosis: Evidence by High Loads of Treponema pallidum DNA in Saliva

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1613 ◽

2020 ◽

Author(s):

Cuini Wang ◽

Zhixiang Hu ◽

Xin Zheng ◽

Meiping Ye ◽

Chunjie Liao ◽

...

Keyword(s):

Treponema Pallidum ◽

Digital Pcr ◽

Secondary Syphilis ◽

Clearance Time ◽

Chain Reaction ◽

Nested Polymerase Chain Reaction ◽

Detection Rates ◽

Polymerase Chain ◽

Pcr Targeting ◽

Latent Syphilis

Abstract Background DNA from many pathogens can be detected in saliva. However, the presence and quantity of Treponema pallidum DNA in patients with syphilis in saliva is unknown. Methods 234 patients with syphilis with different stages and 30 volunteers were enrolled. Paired saliva and plasma samples were collected from all participants. Consecutive saliva samples from 9 patients were collected every 4 hours following treatment. Treponema pallidum DNA in samples was determined by nested polymerase chain reaction (PCR) and droplet digital PCR targeting polA and Tpp47. Results Treponema pallidum DNA detection rates in saliva and plasma were 31.0% (9/29) and 51.7% (15/29) in primary syphilis (P = .11), 87.5% (63/72) and 61.1% (44/72) in secondary syphilis (P < .001), 25.6% (21/82) and 8.5% (7/82) in latent syphilis (P = .004), and 21.6% (11/51) and 5.9% (3/51) in symptomatic neurosyphilis (P = .021), respectively. Median (range) loads of Tpp47 and polA in saliva were 627 (0–101 200) and 726 (0–117 260) copies/mL, respectively, for patients with syphilis. In plasma, however, loads of Tpp47 and polA were low: medians (range) of 0 (0–149.6) and 0 (0–176) copies/mL, respectively. Loads of T. pallidum DNA in saliva during treatment fluctuated downward; the clearance time was positively correlated with the loads of T. pallidum DNA before treatment. Conclusions Collection of saliva is noninvasive and convenient. The high loads of T. pallidum DNA in saliva and reduction after treatment indicated that saliva can be not only a diagnostic fluid for syphilis but also an indicator of therapeutic effectiveness.

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Imunopatogenesis Treponema pallidum dan Pemeriksaan Serologi

Jurnal Kesehatan Andalas ◽

10.25077/jka.v3i3.203 ◽

2014 ◽

Vol 3 (3) ◽

Author(s):

Efrida Efrida ◽

Elvinawaty Elvinawaty

Keyword(s):

Clinical Symptoms ◽

Early Stage ◽

Transmitted Disease ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Major Health Problem ◽

Sexually Transmitted ◽

Tertiary Syphilis ◽

History Of ◽

Latent Syphilis

AbstrakSifilis adalah penyakit menular seksual yang sangat infeksius, disebabkan oleh bakteri berbentuk spiral, Treponema pallidum subspesies pallidum. Penyebaran sifilis di dunia telah menjadi masalah kesehatan yang besar dengan jumlah kasus 12 juta pertahun. Infeksi sifilis dibagi menjadi sifilis stadium dini dan lanjut. Sifilis stadium dini terbagi menjadi sifilis primer, sekunder, dan laten dini. Sifilis stadium lanjut termasuk sifilis tersier (gumatous, sifilis kardiovaskular dan neurosifilis) serta sifilis laten lanjut. Sifilis primer didiagnosis berdasarkan gejala klinis ditemukannya satu atau lebih chancre (ulser). Sifilis sekunder ditandai dengan ditemukannya lesi mukokutaneus yang terlokalisir atau difus dengan limfadenopati. Sifilis laten tanpa gejala klinis sifilis dengan pemeriksaan nontreponemal dan treponemal reaktif, riwayat terapi sifilis dengan titer uji nontreponemal yang meningkat dibandingkan dengan hasil titer nontreponemal sebelumnya. Sifilis tersier ditemukan guma dengan pemeriksaan treponemal reaktif, sekitar 30% dengan uji nontreponemal yang tidak reaktifKata kunci: sifilis, Treponema pallidum, serologiAbstractSyphilis is a sexually transmitted disease that is highly infectious, caused by a spiral -shaped bacterium, Treponema pallidum subspecies pallidum. The spread of syphilis in the world has become a major health problem and the common, the number of 12 million cases per year. Infectious syphilis is divided into early and late-stage syphilis. Early-stage syphilis is divided into primary, secondary, and early latent. Advanced stage of syphilis include tertiary syphilis (gumatous, cardiovascular syphilis, and neurosyphilis) and late latent syphilis. Primary syphilis is diagnosed by clinical symptoms of the discovery of one or more chancre (ulcer). Secondary syphilis is characterized by the finding of localized mucocutaneous lesions or with diffuse lymphadenopathy. Latent syphilis without clinical symptoms of syphilis with a nontreponemal and treponemal reactive examination, history of syphilis therapy in nontreponemal test titer increased compared with the results of previous nontreponemal titers. Tertiary syphilis is found guma with reactive treponemal examination, approximately 30% of the non- reactive nontreponemal testKeywords: syphilis, Treponema pallidum, serologi

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Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

Our Dermatology Online ◽

10.7241/ourd.2021e.2 ◽

2021 ◽

Vol 12 (e) ◽

pp. 1-3

Author(s):

Hafssa Chehab ◽

Bertrand Richert

Keyword(s):

Hair Loss ◽

Previous History ◽

Treponema Pallidum ◽

Clinical Manifestations ◽

Skin Lesions ◽

Secondary Syphilis ◽

Laboratory Evaluation ◽

History Of ◽

High Level

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

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Sífilis: Prevalência num Hospital de Lisboa

Acta Médica Portuguesa ◽

10.20344/amp6247 ◽

2016 ◽

Vol 29 (1) ◽

pp. 52

Author(s):

Leonor Lopes ◽

Rita Ferro-Rodrigues ◽

Samuel Llobet ◽

Luís Lito ◽

João Borges-Costa

Keyword(s):

Clinical Laboratory ◽

Transmitted Disease ◽

Public Health Problem ◽

Secondary Syphilis ◽

Disease Classification ◽

Serological Tests ◽

Important Public Health Problem ◽

Early Syphilis ◽

Latent Syphilis

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Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20214217 ◽

2021 ◽

Vol 7 (6) ◽

pp. 872

Author(s):

Rajesh Munusamy ◽

Nithin Nagaraja

Keyword(s):

Sexual Abuse ◽

Venereal Disease ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Penicillin G ◽

Intellectually Disabled ◽

Transmitted Infection ◽

Sexual Transmitted Infection ◽

Benzathine Penicillin G

Syphilis is a sexual transmitted infection (STI) caused by a spirochete, Treponema pallidum. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and Treponema pallidum hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.

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Treponema pallidumNucleic Acid Amplification Testing To Augment Syphilis Screening among Men Who Have Sex with Men

Journal of Clinical Microbiology ◽

10.1128/jcm.00572-19 ◽

2019 ◽

Vol 57 (8) ◽

Cited By ~ 1

Author(s):

Matthew Golden ◽

Meghan O’Donnell ◽

Sheila Lukehart ◽

Paul Swenson ◽

Paul Hovey ◽

...

Keyword(s):

Transmitted Disease ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

23S Rrna ◽

Serological Testing ◽

Content Type ◽

Sexually Transmitted ◽

Syphilis Screening ◽

Sex With Men ◽

Latent Syphilis

ABSTRACTSyphilis 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 rRNATreponema pallidumreal-time transcription-mediated amplification (TMA) assay performed on rectal and pharyngeal mucosal swabs.T. pallidumPCR assays for thetpp47gene 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.

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Quality-Adjusted Survival for Low-Dose Cytarabine (LDAC) Versus Glasdegib+LDAC Among Newly Diagnosed Acute Myeloid Leukemia Patients Who Are Not Candidates for Intensive Chemotherapy: A Q-TWiST Analysis

Blood ◽

10.1182/blood-2019-126672 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2610-2610 ◽

Cited By ~ 1

Author(s):

Youngmin Kwon ◽

Timothy J Bell ◽

Caitlyn Solem ◽

Joseph C Cappelleri ◽

Courtney Johnson ◽

...

Keyword(s):

Adverse Events ◽

Myeloid Leukemia ◽

Research Funding ◽

Newly Diagnosed ◽

Employment Equity ◽

Equity Ownership ◽

Relative Gains ◽

Mean Time ◽

Low Dose Cytarabine

Introduction: The efficacy and safety of glasdegib (a selective oral inhibitor of hedgehog signaling pathway) in combination with low-dose cytarabine (LDAC) was evaluated in a randomized, phase 2 trial of newly diagnosed acute myeloid leukemia (AML) patients (BRIGHT AML 1003; NCT01546038). Patients receiving glasdegib+LDAC experienced statistically significant and meaningful gains in overall survival (OS) compared with patients receiving LDAC alone (median OS [95% CI]): 8.3 months [4.7-12.2] vs 4.3 months [1.9-5.7]). This analysis examined whether quality-adjusted survival improvements were similarly observed using a quality-adjusted time without symptoms of disease progression or toxicities (Q-TWiST) approach to evaluate possible trade-offs between time with adverse events (toxicities), time in relapse/progression (i.e., with symptoms of disease), and 'good' survival (i.e., time without toxicities or symptoms of progression [TWiST]) when comparing regimens. Methods: OS in BRIGHT AML 1003 data, restricted to a follow-up of 20 months, was partitioned into time with toxicity (TOX: grade 3+ adverse events prior to progression), TWiST, and time post-progression (REL). Progression was defined as treatment discontinuation due to insufficient clinical response or death; patients who discontinued for other reasons (including adverse events) were censored at the date of discontinuation unless death occurred within 28 days of discontinuation. Q-TWiST was calculated by multiplying restricted mean time in each state by respective utilities (U) and then summing up the utility-adjusted time. Base case analysis used U(TOX)=U(REL)=0.5 and U(TWiST)=1.0; threshold analyses were performed varying U(TOX) and U(REL) jointly each from 0 to 1. Relative gains in Q-TWiST (i.e., Q-TWiST difference (combination vs LDAC) / OS in LDAC arm) of ≥15% were considered clearly clinically meaningful per the clinical literature. Sensitivity analysis varied the length of follow-up and AE definitions; subgroup analyses were also performed. 95% confidence intervals were obtained using the bootstrap procedure. Results: At 20 months of follow-up, the survival rate for glasdegib+LDAC and LDAC arm was 28.2% and 7.9%, respectively. Glasdegib+LDAC patients (n=78) compared with LDAC patients (n=38) had significantly longer mean time in TWiST (+3.4 [95% confidence interval: 1.8, 5.2] months) and TOX (+0.8 [0.1, 1.6] months), and longer but non-significant REL (+0.3 [-1.9, 2.3] months). Q-TWiST was 4.0 [2.1, 5.8] months longer for glasdegib+LDAC, translating into a 75% relative improvement in quality-adjusted survival relative to LDAC alone. In threshold analyses, absolute and relative Q-TWiST gains ranged from 3.5 to 4.5 months and 66% to 85%, respectively (Table 1). They exceeded the clinically meaningful threshold for gains in Q-TWiST and were statistically significant across all combinations of U(TOX) and U(REL). Results were robust to length of follow-up 6 to 24 month and remained significant when including all adverse events regardless of grade. Discussions/Conclusions: Glasdegib+LDAC is an add-on therapy that has demonstrated significant survival benefits for newly diagnosed AML patients who are unable to receive intensive chemotherapy. While patients can experience a longer time with toxicities from receiving glasdegib+LDAC (as expected since it is given as an add-on therapy), the trade-off can still be favorable as the treatment provides added time spent in 'good' health (i.e., a significantly longer time in TWiST). In the BRIGHT AML 1003 cohort, the relative gains in OS greatly exceeded previously established thresholds for being clearly clinically meaningful, which suggests that the benefits of glasdegib+LDAC vs LDAC alone outweigh the risks. Table 1 Disclosures Kwon: Pfizer Inc.: Research Funding; Pharmerit International: Employment. Bell:Pfizer Inc.: Employment, Equity Ownership. Solem:Pharmerit International: Employment; Pfizer Inc.: Research Funding. Cappelleri:Pfizer: Employment, Equity Ownership. Johnson:Pfizer Inc.: Research Funding; Pharmerit International: Employment. Bhattacharyya:Pfizer Inc: Employment, Equity Ownership. Hoang:Pfizer Inc.: Employment, Equity Ownership. Cortes:Novartis: Consultancy, Honoraria, Research Funding; Biopath Holdings: Consultancy, Honoraria; Takeda: Consultancy, Research Funding; BiolineRx: Consultancy; Forma Therapeutics: Consultancy, Honoraria, Research Funding; Daiichi Sankyo: Consultancy, Honoraria, Research Funding; Astellas Pharma: Consultancy, Honoraria, Research Funding; Jazz Pharmaceuticals: Consultancy, Research Funding; Merus: Consultancy, Honoraria, Research Funding; Immunogen: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Sun Pharma: Research Funding; Pfizer: Consultancy, Honoraria, Research Funding.

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