Direct fluorescence antibody testing augments syphilis diagnosis, compared to serology alone

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.

"Luotest" (syphilitic rabbit testicle extract) with luetin reaction

Planner (Wien. Klin. Woch., 1929, no. 36) tried Luotest (extract of syphilitic rabbit testicle) with luetin reaction in 106 cases of tertiary and late congenital syphilis, receiving 80% positive results. Since the luetin reaction in experiments a. coincided with RW only in 70%, giving often positive results with negative RW, then a. highly recommends introducing it into syphilis serology along with RW.

Significance of the Sachs-Witebsky cytochol reaction for serodiagnosis of syphilis

Serology of syphilis, which has a relatively recent past (since 1907), in recent years has written into its pages a number of huge successes, which greatly facilitated the diagnosis of syphilis. Serology of syphilis owes such success to the so-called groove. flocculation reactions, the number of which is increasing every year, since despite the great successes in this area, still no other reaction has been proposed, in 100% of cases positive at different stages of syphilis and not possessing a groove. nonspecificity, i.e. the ability to give a positive result in the absence of syphilis.

Neurosyphilis in a suspected case of giant cell arteritis

A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.

Comparative Analysis of Molecular and Serologic Testing for Primary Syphilis: A Population-Based Cohort Study

Rising rates of syphilis (T. pallidum; Tp) requires rapid diagnosis and treatment to manage the growing epidemic. Syphilis serology is imperfect and requires interpretation of multiple tests while molecular diagnostics allows for potential yes-no identification of highly infective, primary anogenital lesions. Accuracy of this testing modality has thus far been limited to small, highly selective studies. Therefore, we retrospectively assessed a large, adult population of patients with anogenital lesions seen at Sexually Transmitted Infection (STI) clinics in Alberta, Canada who were screened for syphilis and herpes simplex (HSV) 1/2 using PCR to evaluate Tp-PCR versus serology to diagnose primary syphilis. 114 (3.1%) of the 3,600 adult patients had at least one Tp-PCR+ anogenital lesion with 99 (2.8%) patients having newly positive syphilis serology (new INNO-LIA positive or 4-fold RPR increase). Tp-PCR had a sensitivity of 49.3% (95% CI 42.6-56.1) and specificity of 99.9% (99.7-100.0). Positive predictive values and negative predictive values in the study population or when corrected for provincial prevalence were 97.4% (92.5-99.5) or 0.4% (0.4-1.2) and 96.7% (96.1-97.3) or 100.0% (100.0-100.0), respectively. Positive and negative likelihood ratios were estimated at 555 (178-1733) and 0.5 (0.4-0.6), respectively. Review of all Tp-PCR performed with or without exclusion of HSV-positive lesions resulted in no significant change in Tp-PCR characteristics. Interestingly, 12 of the Tp-PCR+ samples had negative serology at time of lesion sampling but became positive within our 28-day testing window. Overall, this study further supports the use of Tp-PCR as an accurate assay to rapidly identify, treat, and prevent the spread of primary syphilis.

Sweet Syndrome and Secondary Syphilis in a Person with Acute Necrotizing Tonsillitis

Syphilis has received its classical designation as one of “the great imitators,” reflecting a wide variety of symptoms and presentations, which can cause difficulties in diagnosis. Here we report an unusual case of secondary syphilis in a person with acute necrotizing tonsillitis and Sweet syndrome. A 33-year-old female presented with fever, bilateral cervical lymphadenopathy, tonsillar enlargements with ulcerated pus-filled lesions on the right tonsil, and multiple pseudovesicular, mammillated, edematous plaques on her neck, face, and extremities. Syphilis serology was positive and a skin biopsy demonstrated a neutrophil-rich dermatitis characteristic of Sweet syndrome. The association of <i>Treponema pallidum</i> infection with Sweet syndrome may be a coincidence; nevertheless, our case serves as a reminder that secondary syphilis should remain in the differential diagnosis of the acute febrile neutrophilic dermatosis.

Diagnostic role of CXCL13 and CSF serology in patients with neurosyphilis

BackgroundConsidering the unknown prevalence of neurosyphilis in West China, and the confusing diagnosis of neurosyphilis, the role of CSF_CXCL13 and syphilis serology was studied to provide a more accurate reference for the clinical detection and diagnosis of neurosyphilis.MethodsA retrospective data set I was used to investigate the prevalence of neurosyphilis, as well as the laboratory characteristics of 244 patients. Besides, to explore the diagnostic value of CSF_CXCL13 and syphilis serology for neurosyphilis, another 116 CSF_serum paired samples (data set II) were collected from 44 neurosyphilis and 72 non-neurosyphilis/syphilis patients.ResultsAbout 6.25% (156 out of 2494) syphilis was neurosyphilis. When Treponema pallidum infection occurs, syphilis serology (sero_TRUST ≥1:16 and sero_TPPA titre ≥1:10240) can be good predictors of neurosyphilis, as well as syphilis CSF serology (CSF_TPPA ≥1:320, CSF_TRUST and venereal disease research laboratory). The sensitivity of serology in neurosyphilis can be complemented by CSF_CXCL13, which could be the therapy monitor of neurosyphilis.ConclusionDue to the lack of ideal biomarkers for neurosyphilis, the importance of syphilis serology cannot be ignored, and their combination with CSF_CXCL13 or other biomarkers should be further investigated.

Syphilis-associated septic cardiomyopathy: case report and review of the literature

Background Septic cardiomyopathy has been observed in association with influenza, indicating that not only bacteria but also other infective agents can cause this condition. There has been no systematic study as to whether Treponema pallidum infection induces septic cardiomyopathy, and we are the first to report this possibility. Case presentation We report two cases of a 48-year-old man and a 57-year-old man who were diagnosed with syphilis-related septic cardiomyopathy. The diagnosis of cardiomyopathy was made based on elevation of cardiogenic markers and decrease in ejection fraction evaluated by echocardiography. Screen for infective pathogens was negative except for syphilis, which supported our diagnosis. The two patients recovered following effective anti-syphilis treatment and advanced life support technology. Syphilis serology became negative after treatment. Conclusion Syphilis has the potential to cause septic cardiomyopathy. Clinicians should consider Treponema pallidum in cases of septic cardiomyopathy with unknown pathogens. However, the specific pathophysiological mechanism of syphilis-associated septic cardiomyopathy has not been elucidated, and more specific studies are needed.

Prevalence of syphilis reactivity in patients with stroke, cognitive impairment and extrapyramidal syndromes: a retrospective study.

In the last two decades, there has been a resurgence of syphilis worldwide. However, epidemiological data on neurosyphilis are inconsistent for the lack of reporting data and diagnostic gold standard tests. The aim of the present study was to estimate the prevalence of syphilis reactivity in a cohort of patients with neurological diseases of our hospital. We retrospectively analyzed the medical records of the patients hospitalized at the Stroke Unit of the Neurology Clinic and those suffering from cognitive impairment hospitalized at the acute ward of the Geriatrics Clinic between January 2017 and December 2019. Also the patients who attended the Movement disorder outpatient clinic during the same study period were examined. To detect syphilis reactivity a qualitative specific treponemal test on patient’s serum was performed: the Treponema pallidum haemagglutination assay (TPHA). A total of 652 patients were admitted and 315 of them (52%) were submitted to a routine screening for syphilis: 307 (97%) were negative while 8 (3%) had a positive syphilis serology. The TPHA-positive patients (4 males, 4 females) were 2 patients with stroke, 5 with cognitive impairment and 1 with Parkinsonism with a mean age of 83 years, suffering from multiple comorbidities. Although the patients we have retrospectively studied have not undergone lumbar puncture to confirm the diagnosis of neurosyphilis, the not negligible syphilis reactivity rate found in our series suggests that serological screening for syphilis should be reviewed as a routine screening test in neurology and geriatrics departments, especially if the clinical presentation of the neurological diseases is atypical.