Serologic response to treatment of infectious syphilis.
ABSTRACT To evaluate the serologic response to treatment of patients with infectious syphilis.
Historical cohort study of all cases of infectious syphilis in Alberta from 1981 to 1987.
A total of 1090 patients were entered; 857 with primary syphilis, 183 with secondary syphilis, and 50 with early latent disease. Two hundred and eight patients were excluded who either were pregnant, had negative serologic results before treatment, had clinical relapse, were treatment failures, or were lost to follow-up.
All 882 evaluable patients were treated with a recommended antibiotic regimen for infectious syphilis and returned for re-assessment including repeat serologic testing.
Seventy-two percent (95% CI, 66% to 77%) and 56% (CI, 43% to 70%) of patients with initial episodes of primary or secondary syphilis had seroreverted according to rapid plasma reagin (RPR) test results by 36 months. A 2- and 3-tube decline was seen by 6 and 12 months in primary and secondary syphilis. Early latent syphilis resulted in only a 2-tube decrease at 12 months. Serologic response was not affected by sex, age, race, or sexual orientation. Patients with their first infection were more likely to experience RPR seroreversal than those with repeat infections. The RPR reversal rates also depended on the pretreatment titer and stage of disease. At 36 months, 24% (CI, 20% to 28%) of patients had nonreactive fluorescent treponemal antibody absorption tests (FTA-Abs), and 13% (CI, 11% to 15%) had nonreactive microhemoglutination tests for Treponema pallidum (MHA-TP).
Adequate therapeutic response for syphilis must be based on illness episode and the pretreatment RPR titer. Treponemal tests can demonstrate seroreversion after 36 months, and a negative treponemal test does not rule out a past history of syphilis.
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ABSTRACT: Since the incidence of syphilis is constantly rising in western countries during the last few years the awareness of atypical presentations of this treatable disease is warranted. Especially since early treatment results in complete elimination of Treponema pallidum, thus preventing disabilities and neurological deterioration as a consequence of late stage infection. We describe a case in which a patient with asymptomatic neurosyphilis presented with a history of longstanding episcleritis. The patient was first seen in an outpatient setting, where the resistance of ocular inflammation to steroid treatment led to the uncommon diagnosis. Prolonged antibiotic treatment resulted in a complete solution of all clinical findings and a decrease of specific treponemal antibody titers. This case might serve as an example that with the recent increase in sexual transmitted diseases practitioners might be more often confronted with uncommon presentations of syphilis.European journal of medical research 08/2006; 11(7):309-12. · 1.13 Impact Factor
Article: Syphilis testing behavior following diagnosis with early syphilis among men who have sex with men--San Francisco, 2005-2008.[show abstract] [hide abstract]
ABSTRACT: In San Francisco, men who have sex with men (MSM) with early syphilis are at high risk of reinfection. We described syphilis testing behavior among MSM after diagnosis, identified factors associated with not testing, and developed algorithms to identify nontesters. We used syphilis surveillance data from 2005 through 2008 to describe follow-up testing behavior among MSM with early syphilis and titers of non-treponemal serologic tests ≥1:16. We analyzed data from contact-tracing interviews to identify factors associated with not testing during the 1 to 6 months post-diagnosis. We developed and applied a multivariate model in a derivation set (2005-2006) and a validation set (2007-2008), respectively, calculating correct classification rates (CCR) to assess predictive ability and evaluating patient characteristics for potential interventions. Among 795 MSM, 260 (33%) did not have a follow-up syphilis test. Not testing was associated with being HIV-uninfected (risk ratio [RR]: 1.9, 95% confidence interval [CI]: 1.5-2.6), residing outside of San Francisco's gay-identified neighborhood (RR: 1.7, 95% CI: 1.0-2.9), and being diagnosed at the municipal sexually transmitted disease clinic (RR: 1.5, 95% CI: 1.2-2.0) (CCR derivation set, 71.6%; CCR validation set, 71.3%). An intervention focusing on MSM with those 3 characteristics would include 13% of syphilis cases among MSM and identify 26% of nontesters. Although MSM in San Francisco are at high risk for syphilis reinfection, one-third of MSM diagnosed with syphilis did not test during the 1 to 6 months post-diagnosis. Interventions to encourage follow-up testing among persons with syphilis might contribute to more effective syphilis prevention and control efforts.Sexually transmitted diseases 01/2011; 38(1):24-9. · 2.58 Impact Factor
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ABSTRACT: Sexually transmitted diseases (STDs) are the most common infectious diseases worldwide, with over 350 million new cases occurring each year, and have far-reaching health, social, and economic consequences. Failure to diagnose and treat STDs at an early stage may result in serious complications and sequelae. STDs are passed from person to person primarily by sexual contact and are classified into varied groups. Some cause mild, acute symptoms and some are life-threatening. They are caused by many different infectious organisms and are treated in different ways. Syphilis and gonorrhea are ancient afflictions. Now, however, Chlamydia is prevalent and has become the most common bacterial STD. Antimicrobial resistance of several sexually transmitted pathogens is increasing, rendering some regimens ineffective, adding to therapeutic problems. A standardized treatment protocol for STDs is recommended to ensure that all patients receive adequate treatment. Appropriate treatment of STDs is an important public health measure.Korean journal of urology 09/2011; 52(9):589-97.