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

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

International Journal of STD & AIDS ◽

10.1177/0956462418762849 ◽

2018 ◽

Vol 29 (9) ◽

pp. 890-894 ◽

Cited By ~ 6

Author(s):

Maciej Pastuszczak ◽

Agnieszka Kotnis-Gąska ◽

Bernadetta Jakubowicz ◽

Iwona Martyka ◽

Monika Bociaga-Jasik ◽

...

Keyword(s):

Treponema Pallidum ◽

Secondary Syphilis ◽

Newly Diagnosed ◽

Rapid Plasma Reagin ◽

First Onset ◽

Pre Treatment ◽

Mean Time ◽

Hiv Seropositive ◽

Latent Syphilis

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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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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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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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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Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review

International Journal of STD & AIDS ◽

10.1177/0956462418805197 ◽

2018 ◽

Vol 30 (3) ◽

pp. 304-309

Author(s):

Hongfang Liu ◽

Beng-Tin Goh ◽

Taoyuan Huang ◽

Yinghui Liu ◽

Ruzeng Xue ◽

...

Keyword(s):

Plasma Cell ◽

Erythema Multiforme ◽

Treponema Pallidum ◽

Inflammatory Cells ◽

Secondary Syphilis ◽

Penicillin G ◽

Cell Infiltrate ◽

Early Syphilis ◽

Skin Histology ◽

Anal Warts

Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G.

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Clinical Study of Fludarabine, Mitoxantrone, and Dexamethasone in the Treatment of Refractory or Relapsed Multiple Myeloma.

Blood ◽

10.1182/blood.v106.11.5187.5187 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5187-5187

Author(s):

Shao-Kai Luo ◽

Juan Li ◽

Wen-De Hong ◽

Ying Zhao ◽

Xiu-Zhen Tong

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Clinical Study ◽

Serum Calcium ◽

Post Treatment ◽

High Recurrence Rate ◽

Treatment Level ◽

Myeloma Cells ◽

Number Of Patients ◽

Pre Treatment

Abstract BACKGROUND & OBJECTIVE: Until today, multiple myeloma is still an incurable malignancy by conventional therapy; it has low complete remission rate and high recurrence rate. Recurrence or relapse of the disease is almost inevitable for most of the patients after several cycles of combined chemotherapy. A safe and effective therapy for the treatment of relapsed and refractory multiple myeloma is urgently needed in clinical practice. This clinical study was designed to compare the safety and efficacy of the fludarabine-based regimen (fludarabine, mitoxantrone and dexamethasone [FMD]) with that of pirarubicin, vincristine and dexamethasone (VAD) in refractory or relapsed multiple myeloma. METHODS: The clinical data were retrospectively analyzed. The following indices were assessed before, during, and after the treatment in FMD-arm and VAD-arm: the partial remission (PR) rate, overall response (OR) rate, time to achieve PR, the number of patients and time to achieve the following: a decline in the serum M-component of more than 50% of the pre-treatment value, the ratio of myeloma cells in bone marrow drop to less than 50% of the pre-treatment value, the ratio of myeloma cells in bone marrow drop to less than 5% or drop more than 80% than pre-treatment level, the hemoglobin level increased more than 20 g/L, the white blood cell and platelet count of the peripheral blood, serum calcium, creatinine, β2-microglobin and ALT level, adverse events. RESULTS: The PR rate and OR rate are significantly higher in the FMD-arm than in the VAD-arm (PR rates were 46.2% vs 22.7% and OR rates were 61.5% vs 31.8%, P <0.05, respectively). The median time to achieve PR was 88 days in the FMD-arm, compared to 68 days in the VAD-arm (P <0.05). Approximately 40.0% of patients in the FMD-arm had >50% decrease in M-component or >20 g/L elevation in hemoglobin, compared to 22.7% and 18.2% in the VAD-arm respectively (P <0.05). The median times to achieve >50% decrease in M-component, decline of >80% of myeloma cells in the bone marrow than the pre-treatment level or ratio drop to less than 5%, or >20g/L elevation in hemoglobin were 62 days, 57 days, and 70 days, respectively. There were no significant differences between groups in serum calcium, creatinine, and ALT level pre-and post-treatment. The level of serum β2-microglobin was (1042.8±72.3 mg/L) post-treatment in the FMD-arm, which was lower than that observed before treatment (2350.2±184.0 mg/L; P <0.05). Most patients (76.9%) in the FMD-arm occurred III/IV grade leukocytopenia while 81.8% patient were I/II grade in the VAD-arm. The incidences of fever and cough were higher in FMD-arm comparing to VAD-arm (P <0.05). The progression free survival (PFS) on 1st and 2nd year and overall survival (OS) on 2nd year were 46.2%, 30.8% and 53.8% in the FMD-arm, while they were 50%, 27.3% and 40.9% respectively in the VAD-arm, which had no significant statistic difference (P >0.05). CONCLUSION: The PR rate and OR rate of FMD-arm are significantly higher than in the VAD-arm in the treatment of refractory or relapsed multiple myeloma, but it took longer time to achieve PR. The regimen of FMD shows no significant renal or hepatic toxicity, it’s a safe and effective regimen in the treatment of refractory or relapsed multiple myeloma.

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Confirmatory serological testing of blood donors positive on TPHA screening in Singapore

International Journal of STD & AIDS ◽

10.1258/0956462971919237 ◽

1997 ◽

Vol 8 (12) ◽

pp. 760-763 ◽

Cited By ~ 1

Author(s):

S S Wong ◽

D L T Teo ◽

R K W Chan

Keyword(s):

Blood Donors ◽

Congenital Syphilis ◽

Past History ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Serological Testing ◽

Sexually Transmitted ◽

Blood Transfusion Service ◽

History Of ◽

Latent Syphilis

Summary: Seventy-two blood donors who were tested positive by the Singapore Blood Transfusion Service (SBTS) for Treponema pallidum haemagglutination (TPHA) test, were evaluated at the Department of Sexually Transmitted Diseases Clinic (DSC) between November 1994 to December 1996. All underwent syphilis serological testing, including rapid plasma reagin test (RPR), TPHA test and fluorescent treponemal antibody-absorption (FTA-Abs) test. All except one (98.6%) were confirmed TPHA positive by the DSC. Of the 71 TPHA-confirmed-positive donors, 53 (74.6%) were subsequently tested positive for FTA-Abs and 18 (25.4%) were tested negative for FTA-Abs. Twenty-two (31%) of the 71 TPHA-positive blood donors had reactive RPR and 49 (69%) had non-reactive RPR. Of the 22 TPHA-positive donors who had reactive RPR, 19 (86%) had positive FTA-Abs (13 late latent syphilis, 4 serological scar, one late congenital syphilis, one secondary syphilis), and 3 (14%) had negative FTA-Abs (all late latent syphilis). Of the 49 TPHA-positive donors who had non-reactive RPR, 34 (69%) had positive FTA-Abs (24 late latent syphilis, 9 serological scar, one late congenital syphilis) and 15 (31%) had negative FTA-Abs (12 late latent syphilis, 2 serological scar, one false-positive TPHA). Only one TPHA-positive donor referred by the SBTS subsequently turned out to have negative syphilis serology at the DSC. Overall, 68 (95.8%) TPHApositive donors who had a past history of sexual exposure were managed as treated or untreated syphilis, regardless of their RPR or FTA-Abs results. However, FTAAbs was found to be useful in the management of 3 (4.2%) TPHA-positive blood donors in the absence of a history of sexual exposures.

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