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Being a whistleblower can be lonely. The public opposition to authority that it requires often results in assaults on one's reputation. Weathering such assaults is an ordeal--one that the three [...]

Syphilis is caused by the bacterium Treponema pallidum. Untreated maternal syphilis can lead to serious complications, including congenital syphilis, stillbirth, and neonatal death (1). In 2012, the estimated numbers of [...]

The case of a 54-year-old man with loss of vision and a rash is discussed to arrive at a better understanding of secondary syphilis involving the skin and optic nerve. The different treatment methodologies and management regime for the same are highlighted.

The case of a 37-year-old man with a lesion in the tongue is discussed to better understand the causes, diagnosis and treatment of oral syphilis. The different treatment methodologies and management of the ailment are highlighted.

We sought to identify and review the clinical features and treatment outcomes of eight recent cases of otosyphilis in HIV-positive patients seen in Toronto. All patients reported tinnitus, and seven (87.5%) reported subjective hearing loss. Not taking auditory findings into consideration, four patients would be classified as having secondary syphilis, three patients as having early latent syphilis, and one patient as having latent syphilis of unknown duration. The median CD4 cell count was 370 x 106/L. All patients were treated with intravenous aqueous penicillin G with regimens recommended for the treatment of neurosyphilis; four patients received adjunctive steroids. All eight patients experienced improvement in tinnitus and four of the seven (57.1%) patients with symptomatic hearing loss also experienced improvement. Otosyphilis can occur in HIV-positive individuals despite high CD4 cell counts, and is potentially reversible. Increased awareness of uncommon manifestations of syphilis in high-risk individuals is warranted to prompt appropriate investigation and treatment.

Diagnosis and treatment of syphilis are challenging because of its variable clinical presentation and course and the lack of definitive tests of cure after treatment. This review of the most [...]

ABSTRACT Background New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening [...]

A case report of acute, massive, prolonged hepatitis related to secondary syphilis in a patient with undiagnosed HIV infection is described together with possible pathogenetic mechanisms. This is a rare occurrence in resource-rich countries in the era of antibiotics. The impaired immune response and the dysregulation of the cytokine network may have played a role in mediating this severe expression of HIV-associated secondary syphilis. An apparently unexplained acute hepatitis should deserve accurate screening for sexually transmitted diseases, including syphilis and HIV infection.

Objectives. We measured and compared the concentration of primary and secondary syphilis, gonorrhea, chlamydial infection, and genital herpes in a large county with urban, suburban, and rural settings. Methods. We geocoded sexually transmitted infections reported to King County, Washington health department in 2000-2001 to census tract of residence. We used a model-based approach to measure concentration with Lorenz curves and Gini coefficients. Results. Syphilis exhibited the highest level of concentration (estimated Gini coefficient=0.68, 95% confidence interval [CI] = 0.64, 0.78), followed by gonorrhea (estimated Gini coefficient = 0.57; 95% CI = 0.54, 0.60), chlamydial infection (estimated Gini coefficient=0.45; 95% C1 = 0.40, 0.43), and herpes (estimated Gini coefficient = 0.26; 95% CI = 0.22, 0.29). Conclusions. Geographically targeted interventions may be most appropriate for syphilis and gonorrhea. For less-concentrated infections, control strategies must reach a wider portion of the population. (Am J Public Health. 2005;95: 324-330. doi: 10.2105/AJPH.2003.029413)

Syphilis is a major cause of adverse outcomes in pregnancy in developing countries. Fetal death and morbidity due to cogenital syphilis are preventable if infected mothers are identified and treated appropriately by the middle of the second trimester. Most pregnant women with syphilis are asymptomatic and can only be identified through serological screening. Non-treponemal tests, such as the rapid plasma reagin (RPR) test, are sensitive, simple to perform, and inexpensive. However, they have often not been available at primary health-care settings because they required cold storage for reagents and electricity to operate a rotator. Additionally, as many as 28% of positive RPR results in pregnant women are biological false positives. Confirmatory assays are usually available only in reference laboratories. Technological advances have resulted in improved serodiagnostic tools for syphilis. New enzyme immunoassays are available for surveillance and for large-scale screening programmes. Decentratized antenatal screening with on-site confirmation is now possible since new RPR reagents that are stable at room temperature have become commercially available, as have solar-powered rotators and simple, rapid point-of-care treponemal tests that use whole blood and do not require electricity or equipment. These will be valuable tools for preventing or eliminating congenital syphilis. The development of a non-invasive rapid treponemal test that distinguishes between active and past infections remains a high priority in areas where syphilis is endemic. Keywords Syphilis, Congenital Syphilis/diagnosis/therapy; Syphilis serodiagnosis/utilization; Immunoenzyme techniques/utilization; Treponema pallidum/isolation and purification; Prenatal diagnosis; Evaluation studies (source: MeSH, NLM). Mots cles Syphilis congenitale/diagnostico/therapeutique; Sero-diagnostic syphilis/utilisation; Methode immunoenzymatique/ utilisation; Treponema pallidum/isolement et purification; Diagnostic prenatal; Elude evaluation (source: Me5H, INSERM). Palabras clave Sifilis congenita/diagnostico/terapia; Serodiagnostico de la sifilis/utilizacion; Tecnicas para inmunoenzima/utilizacion; Treponema pallidum/aislamiento y purificacion; Diagnostico prenatal; Estudios de evaluacion (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.] Resume Outils de diagnostic pour la prevention et la prise en charge de la syphilis maternelle et congenitale : vue d'ensemble La syphilis est une cause majeure d'issue defavorable de la grossesse dans les pays en developpement. Les morts foetales et la morbidite due a la syphilis congenitale peuvent etre evitees si les meres infectees sont identifiees et traitees vers le milieu du deuxieme trimestre de la grossesse. La plupart des femmes enceintes atteintes de syphilis sont asymptomatiques et ne peuvent etre identifiees que par depistage serologique. Les tests ne reposant pas sur la recherche des treponemes, comme le test RPR (rapid plasma reagin) sont sensibles, faciles a executer et peu couteux. Mais dans bien des cas ils n'etaient jusqu'ici pas disponibles au niveau des soins de sante primaires car les reactifs devaient etre conserves au froid et une alimentation electrique etait necessaire pour l'agitateur rotatif. De plus, jusqu'a 28 % des resultats RPR positifs chez la femme enceinte sont des faux positifs dus a des causes biologiques, et les tests de confirmation ne peuvent en general etre realises que dans un laboratoire de reference. Les progres de la technologie ont permis d'ameliorer les tests de serodiagnostic de la syphilis. De nouveaux tests immunoenzymatiques sont maintenant disponibles pour la surveillance et pour les programmes de depistage & grande echelle. Le depistage antenatal decentralise avec confirmation sur place est desormais possible depuis que de nouveaux reactifs pour le test RPR, stables a la temperature ambiante, sont commercialises, de meme que des agitateurs rotatifs fonctionnant a l'energie solaire et des tests treponemiques simples et rapides, realisables sur place sur le sang total et ne necessitant ni electricite ni materiel. Ces tests seront des outils precieux pour la prevention et l'elimination de la syphilis congenitale. Le developpement d'un test treponemique rapide et non invasif permettant de distinguer les infections actives des infections passees reste hautement prioritaire dans les regions ou la syphilis est endemique. Resumen Medios diagnosticos para prevenir y tratar la sifilis materna y congenita: panorama general La sifilis es una causa destacada de resultados adversos en el embarazo en los paises en desarrollo. La muerte fetal y la morbilidad por sifilis congenita se pueden prevenir si se consigue identificar y tratar apropiadamente a las madres infectadas para la mitad del segundo trimestre. La mayoria de las mujeres embarazadas aquejadas de sifilis son asintomaticas y solo pueden identificarse mediante cribado serologico. Las pruebas no treponemicas, como la prueba de reagina rapida en plasma (RRP), son sensibles, sencillas y baratas. Sin embargo, a menudo no es posible aplicarlas en los entornos de atencion primaria debido a que requieren sistemas de refrigeracion para los reactivos, asi como electricidad para utilizar un rotador. Ademas, hasta un 28% de los resultados RRP positivos detectados en mujeres embarazadas eran falsos positivos biologicos. Generalmente los analisis confirmatorios solo se pueden realizar en laboratorios de referencia. Los adelantos tecnicos han permitido obtener mejores instrumentos serodiagnosticos para la sifilis. Existen nuevos inmunoensayos enzimaticos, usados con fines de vigilancia y en los programas de cribado en gran escala. El cribado prenatal descentralizado con confirmacion in situ es ya posible gracias a la comercializacion de reactivos de RRP estables a temperatura ambiente, asi como de rotadores de energia solar y de pruebas treponemicas sencillas, rapidas y aptas para el lugar de consulta que usan sangre entera y no requieren ni electricidad ni equipo especial alguno. Estas herramientas seran de gran utilidad para prevenir o eliminar la sifilis congenita. El desarrollo de una prueba treponemica rapida no invasiva que permita diferenciar las infecciones activas y las antiguas sigue siendo una alta prioridad en las zonas con sifilis endemica. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Important advances in the diagnosis and treatment of syphilis have been made since the causative organism, Treponema pallidum, was discovered in 1905 by Schaudinn and Hoffmann. Despite these achievements, [...]

Objectives. We estimated the number and cost of syphilis-attributable HIV cases among African Americans. Methods. A mathematical model of HIV transmission was used to estimate the number of partnerships consisting of HIV-discordant African Americans in which infectious syphilis was present and the number of new HIV cases attributable to syphilis in these partnerships. Results. In 2000, an estimated 545 new cases of HIV infection among African Americans could be attributed to the facilitative effects of infectious syphilis, at a cost of about $113 million. Conclusions. Syphilis prevention could reduce HIV incidence rates and the disproportionate burden of HIV/AIDS on the African American community, resulting in substantial reductions in future HIV/AIDS medical costs.

Research has been comnducted on the trends in the HIV infection and syphilis prevalence in young women attending antenatal care clinics in Addis Ababa, Ethiopia. Results indicate that the declininmg trends in HIV infection and syphilis among young women are encouraging but no change ha been observed in older age groups.