Prevalence of syphilis infection and associated sociodemographic factors among antenatal-care attendees in Meghalaya, India: Revisiting HIV Sentinel Surveillance data

Background Despite relatively simple prevention and treatment, syphilis remains a major social and public health concern worldwide, particularly in developing nations. Objective To estimate the prevalence and to determine the sociodemographic factors associated with syphilis infection among antenatal-care (ANC) attendees in Meghalaya, India. Materials and Method A facility-based cross-sectional study was conducted utilizing National HIV Sentinel Surveillance of Meghalaya, January–March 2017. Pregnant women aged 15–49 years ( n = 3015) were recruited consecutively, interviewed, and tested for syphilis by Venereal Disease Research Laboratory test in eight selected ANC sites representing all districts of Meghalaya. Results Prevalence of syphilis was found to be 1.03 % (95% CI = 0.67–1.39) (31/3015). Prevalence was maximum among illiterates with gradual lowering of adjusted odds ratio (AOR) with improvement of education. Women whose husbands had no income were associated with higher risk (AOR = 4.97, 95% CI = 1.11–22.20) of syphilis. Significant risk (OR = 2.42, 95% CI = 1.02–5.74) was also observed with Jaintia Hills residents as compared to Garo Hills. Conclusions As high prevalence of gestational syphilis was identified in Meghalaya along with important sociodemographic predictors, evidence to policy translation is required at state and national level to scale up prevention, screening, and management of syphilis

Gummatous neurosyphilis in an elderly patient in the Australian outback: a case report

Introduction Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges. Despite being an Old World disease, the rates of infection continue to rise. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice. Case presentation A 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma. Conclusion The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging.

"For the Dead cannot Shrive me Now”: Gender Violence, Precariousness and the Neo-Victorian Gothic in Katy Darby’s The Whores’ Asylum (2012)

Katy Darby’s neo-Victorian novel The Whores’ Asylum (2012) is set in Oxford in the 1880s. The Gothic plays an important role in the process of re-writing the Victorian period as a mirror of our contemporary societies where depravity and lack of humanity co-exist with modernity and civilisation. The protagonists—Stephen, Edward and Diana—are involved in the process of showing sympathy for the lives and deaths of the destitute and the dispossessed. Under the stance of Judith Butler’s theories of mourning and violence, my analysis has a two-fold aim: to discuss issues of the Victorian past such as venereal disease, prostitution and gender violence in the text, and to question to what extent the novel can be an attempt to hear the voices of the victims of sexual exploitation, giving them restoration and agency. However, my conclusion is that the text does not grant the victims of sexual exploitation real voice or agency.

270. New Onset Seizure Presented as Neurosyphilis

Background The term “neurosyphilis” refers to infection of the central nervous system (CNS) by Treponema pallidum. It can occur at any time after initial infection. Early in the course of syphilis, the most common forms of neurosyphilis involve the cerebrospinal fluid (CSF), meninges, and vasculature (asymptomatic meningitis, symptomatic meningitis, and meningovascular disease). Late in disease, the most common forms involve the brain and spinal cord parenchyma (general paralysis of the insane and tabes dorsalis). Methods A 31-year-old man who suddenly developed a new onset generalized tonic clonic seizure, was admitted to the emergency department. He had no history of epilepsy and denied any vision or gait problems. The brain MRI showed no abnormalities. He had a history of rapid plasma reagent (RPR) titer 1:32 and a positive fluorescent treponemal antibody absorption (FTA-ABS) test in 2017. However, the RPR result was non-reactive when he retested a week later and therefore was not diagnosed with syphilis and did not get treated at that time. His most recent RPR titer was 1:16. HIV serology and other STD tests were all negative. His wife and his 3 kids were negative for syphilis. Due to serological evidence of syphilis and neurological symptoms, we arranged him to get a lumbar puncture to rule out neurosyphilis. Results His CSF study showed positive venereal disease research laboratory (VDRL), WBC cell count 44 cells/ul (lymphocytes 80%, Neutrophil 20%), Glucose 50 mg/dl, Protein 75 mg/dl. Based on the CSF study, he was diagnosed with neurosyphilis and was treated with intravenous Penicillin G 3-4 million units every 4 hours for 14 days, followed by Benzathine Penicillin 2.4million units intramuscularly on day 21. Conclusion This is an unusual case because his false negative RPR result has hindered the prompt diagnosis and management of syphilis. RPR is a nontreponemal test and therefore it is not always reliable as a diagnostic criteria. False negatives in RPR may occur in certain conditions such as in early primary or in late stage syphilis and prozone phenomenon. This case illustrates the importance of using a reverse sequence algorithm in diagnosing syphilis. Thorough history taking is also crucial in conjunction with serological tests to determine the diagnosis and to ensure appropriate treatment. Disclosures All Authors: No reported disclosures

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

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. 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 <em>Treponema pallidum </em>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.</p><p class="abstract"> </p>

Whole genome sequences of Treponema pallidum subsp. endemicum isolated from Cuban patients: the non-clonal character of isolates suggests a persistent human infection rather than a single outbreak

Bejel (endemic syphilis) is a neglected non-venereal disease caused by Treponema pallidum subsp. endemicum (TEN). Although it is mostly present in hot, dry climates, a few cases have been found outside of these areas. The aim of this work was the sequencing and analysis of TEN isolates obtained from "syphilis patients" in Cuba, which is not considered an endemic area for bejel. Genomes were obtained by pool segment genome sequencing or direct sequencing methods, and the bioinformatics analysis was performed according to an established pipeline. We obtained four genomes with 100%, 81.7%, 52.6%, and 21.1% of broad coverage, respectively. The sequenced genomes revealed a non-clonal character, with nucleotide variability ranging between 0.2–10.3 nucleotide substitutions per 100 kbp among the TEN isolates. Nucleotide changes affected 27 genes, and the analysis of the completely sequenced genome also showed a recombination event between tprC and tprI, in TP0488 as well as in the intergenic region between TP0127–TP0129. Despite limitations in the quality of samples affecting broad sequencing coverage, the determined non-clonal character of the isolates suggests a persistent infection in the Cuban population rather than a single outbreak caused by imported case.

Mycoplasma genitalium and Mycoplasma hominis infection in south Korea during 2018-2020

Background and Objectives: Sexually transmitted infections (STIs) can remain undetected and untreated; therefore, rapid diagnosis and treatment of STIs are important. Mycoplasma genitalium (MG), Mycoplasma hominis (MH), and Ureaplasma urealyticum are sexually transmitted pathogens that cause asymptomatic, organ-specific, and chronic infections, thereby pos- ing a threat to community health. Therefore, we investigated the epidemiological trends of MG and MH infections in South Korea for rapid diagnosis and treatment. Materials and Methods: From September 2018 to December 2020, samples (catheter, pus, tissue, swab, and urine) were collected from outpatients of hospitals in South Korea for molecular biological venereal disease testing. DNA was extracted and analyzed using real-time polymerase chain reaction. Results: Of the 59,381 samples analyzed, 8.78% (n=5,215) were positive for MG and MH. The MH positivity rate (5.51%, n=3,273) was higher than the MG positivity rate (3.27%, n=1,942). MG and MH positivity rates were the highest in patients aged <19 years. Men had higher MG positivity rate, whereas women had higher MH positivity rates. Furthermore, the MG- positivity rate was the highest in the swab samples of both men and women, whereas that of MH was the highest in the urine samples of men and swab samples of women. Conclusion: We identified the differences between MG and MH positivity rates based on sex, specimen, and age. Our findings can provide information for strategies that protect public health and reduce STI incidence and transmission.

Sex work, containment and the new discourse of public health in French colonial Levant

This article addresses how French academics, doctors and state bureaucrats formulated sex work as a pathology, an area of inquiry that had to be studied in the interest of public safety. French colonisation in the Levant extended the reach of this ‘expertise’ from the metropole to Lebanon under the guise of public health. Knowledge produced by academics was used to buttress colonial state policy, which demanded that sex workers be contained to protect society against medical contagion. No longer drawing conclusions based on speculation, the medical establishment asserted its authority by harnessing modern advances in science and uniting them with extensive observation. ‘Empirical facts’ replaced ‘opinions’, as doctors forged new approaches to studying and containing venereal disease. They accomplished this through the use of statistics and new methods of diagnosing and treating maladies. Their novel approach was used to treat sex workers and to support commercial sex work policy both at home and abroad. Sex workers became the objects of scientific study and were consequently problematised by the state in medicalised terms.

A rare case of genital porokeratosis clinically misdiagnosed as lichen planus

Introduction/Objective Porokeratosis is a clonal disorder of keratinization characterized by atrophic patches surrounded by a histologically distinctive hyperkeratotic ridge-like border called the cornoid lamella. Porokeratosis occurring on the genital area is considered a rare entity and much more unusual when in isolated form Methods/Case Report This is a case of a 54-year old man who presented with a penile lesion that has been present for 10 years, unchanged, non-bleeding and non-pruritic. There was no history of genital ulcer or inguinal swelling, neither any history of sexual promiscuity. The patient has a history of basal cell carcinoma on the right nasal area managed with Mohs surgery and scalp actinic keratoses treated with liquid nitrogen. On examination, there was a solitary 6-mm red linear macule with collarette of white scale on the corona of the penis. There was no similar lesion seen on other body parts. His blood investigations, including venereal disease research laboratory test (VDRL) and HIV screening, were negative. The initial clinical diagnosis was lichen planus, and triamcinolone was administered for three months with minimal benefit. This failed steroid management prompted a shave biopsy Results (if a Case Study enter NA) Histologic sections showed a column of hyperkeratosis arising from the epidermis (cornoid lamella) with absent granular layer and dyskeratotic cells beneath the cornoid lamella, confirming the diagnosis of porokeratosis limited to the genitalia Conclusion Porokeratosis is considered a pre-malignant condition based on clonal proliferation, dyskeratotic cells, abnormal keratinocyte maturation and p53 overexpression. Malignant progression to Bowen’s disease and squamous cell carcinoma has been documented in 6.9 to 30% of cases.