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Sex Transm Dis 2021 Mar 16. Epub 2021 Mar 16.

Department of Neurologya, University of Washington, Seattle, WA.

Background: At least three syphilis typing systems are proposed. Recent work suggests that multilocus sequence typing (MLST) may be superior to enhanced CDC typing (ECDCT) by yielding a higher discriminatory power. The goal of this study was to compare the two systems and identify associations between neurosyphilis and strain types. Read More

Exp Ther Med 2021 Aug 26;22(2):803. Epub 2021 May 26.

Department of Dermatology, Lucian Blaga University of Sibiu, Faculty of Medicine, 550169 Sibiu, Romania.

Syphilis is the most common sexually transmitted disease that mainly affects socially active people, with a fluctuating worldwide incidence over the years. A retrospective study was conducted over a period of 10 years (2009-2018) that included 396 patients with syphilis diagnosed and monitored by Sibiu County Emergency Clinical Hospital, Romania. During this period (2009-2018), we observed a decrease in the new cases of syphilis by 35. Read More

Curr HIV/AIDS Rep 2021 Jun 6. Epub 2021 Jun 6.

Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Purpose Of Review: To highlight recent trends in the epidemiology of HIV and syphilis, the impact of the COVID epidemic, our approach to care of co-infected patients, and our views on important next steps in advancing the field.

Recent Findings: HIV and syphilis co-infection has been on the rise in recent years although since the COVID pandemic there is a decrease in new diagnoses-it remains unclear if this represents a true decline or inadequate testing or under-reporting. Standard HIV care should include regular syphilis serology . Read More

Lancet Infect Dis 2021 May 26. Epub 2021 May 26.

Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Centre National de Référence de la Syphilis, Institut Cochin, Unité Inserm U1016, Université de Paris, Paris, France. Electronic address:

Background: Intravenous benzylpenicillin is the gold-standard treatment for neurosyphilis, but it requires prolonged hospitalisation. Ceftriaxone is a possible alternative treatment, the effectiveness of which remains unclear. We aimed to assess the effectiveness of ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis. Read More

Rev Soc Bras Med Trop 2021 17;54(suppl 1):e2020630. Epub 2021 May 17.

Universidade Federal de Santa Catarina, Laboratório de Biologia Molecular, Microbiologia e Sorologia, Florianópolis, SC, Brasil.

The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. This article presents direct tests to detect Treponema pallidum in lesions and algorithms that combine treponemal and non-treponemal antibody tests to assist in syphilis diagnosis, with the aim of contributing to the efforts of health service managers and health professionals in qualifying health care. Read More

Rev Soc Bras Med Trop 2021 17;54(suppl 1):e2020616. Epub 2021 May 17.

Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services. Read More

Clin Infect Dis 2021 May 17. Epub 2021 May 17.

Medicine (Infectious Diseases), Seattle, WA, USA.

Background: The influence of previous syphilis on the course of a subsequent episode is unknown.

Methods: Individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were allowed to enroll in the study again with subsequent syphilis. For each participant, the index episode was defined as the most recent syphilis episode for which the study entry visit was performed within 30 days of the syphilis diagnosis date. Read More

Brain Behav 2021 May 16:e02187. Epub 2021 May 16.

Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.

Background And Purpose: Ischemic stroke is a common clinical feature of neurosyphilis, but its accompanying cognitive decline is often overlooked. The mechanisms of cognitive impairment in neurosyphilis presenting with ischemic stroke are not fully understood. Cerebral small vessel disease (CSVD) was recently shown to predict post-stroke cognitive decline. Read More

J Clin Microbiol 2021 May 12. Epub 2021 May 12.

Pathology Queensland, Townsville Hospital, Douglas, Townsville, Queensland 4814, Australia.

Syphilis is a multisystem infection caused by the spirochaete Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests IgG chemiluminescence immunoassay (CLIA) and the particle agglutination (TPPA). The non-treponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity. There has been a resurgence of syphilis diagnoses in Australia. Read More

Int J STD AIDS 2021 May 8:9564624211011917. Epub 2021 May 8.

University Malaya Eye Research Centre, Department of Ophthalmology, Faculty of Medicine, University of Malaya, Malaysia.

Background: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection.

Methods: Case Series. Read More

Sex Transm Dis 2021 May 6. Epub 2021 May 6.

Sexually Transmitted Diseases (STD) Control Branch, Division of Communicable Disease Control (DCDC), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Richmond, California Office of AIDS (OA), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Sacramento, California.

Abstract: Accurate reporting of neurosyphilis diagnoses is important to quantify and monitor severe outcomes associated with infection of Treponemal pallidum. This analysis compared the demographic distribution of neurosyphilis diagnoses in STD surveillance data to administrative hospital data in the California Project Area from 2016-2018. Although neurosyphilis morbidity was similar, significant differences were noted by sex, age group, race/ethnicity, and region. Read More

Sex Transm Dis 2021 May 6. Epub 2021 May 6.

Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.

Background: The diagnosis of neurosyphilis relies in large part on the cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test, which is diagnostically specific but not sensitive.

Methods: We determined the sensitivity and specificity of three CSF tests in addition to the CSF-VDRL in participants with syphilis enrolled in a research study: detection of T. pallidum rRNA, Treponema pallidum Particle Agglutination (TPPA) titer, and chemokine (C-X-C motif) ligand 13 (CXCL13) concentration. Read More

J Dtsch Dermatol Ges 2021 May 5. Epub 2021 May 5.

University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Read More

Eur J Clin Microbiol Infect Dis 2021 May 3. Epub 2021 May 3.

Neuroscience Research Laboratory of Marrakech Medical School, Cadi Ayyad University, Marrakesh, Morocco.

Neurosyphilis (NS) is an infection of the central nervous system (CNS), caused by Treponema pallidum. Up to 4-10% of patients with untreated syphilis may develop NS which still constitutes a health challenge. The aim of this study is to analyze epidemiological, clinical, paraclinical, therapeutic, and progression profiles of NS in the south of Morocco. Read More

Klin Monbl Augenheilkd 2021 04 30;238(4):434-436. Epub 2021 Apr 30.

Department of Ophthalmology (Chairman Prof. Dr. med. Ch. Valmaggia), Kantonsspital St Gallen, Sankt Gallen, Switzerland.

Microorganisms 2021 Apr 23;9(5). Epub 2021 Apr 23.

Department of Neurosurgery, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany.

Infection with is on the rise. In this narrative literature review, we show that the incidence of rare manifestations of syphilis, such as intracerebral gummata, is increasing and should be considered in the differential diagnosis of intracerebral lesions. With the exemplary case that we present here, we aim to raise awareness of the resurgence of this disease, which should be considered in the differential diagnosis of intracerebral lesions, especially for patients who have a risk profile for syphilis, and serological testing for prior to surgery should be discussed in order to avoid an unnecessary operation. Read More

Cureus 2021 Mar 20;13(3):e14011. Epub 2021 Mar 20.

Internal Medicine, HCA Westside-Northwest, Plantation, USA.

Syphilitic myelitis, also known as tabes dorsalis, is a disease affecting the posterior columns of the spinal cord and dorsal roots and presents as sensory ataxia and neuropathic pain and less commonly as paresthesia and gastrointestinal disturbance. Tabes dorsalis is the clinical manifestation of a previous infection with syphilis, and the average latency period from initial infection to presentation of symptoms is approximately 25 years. This is a rarely encountered manifestation of syphilis since the widespread usage of antibiotics. Read More

Sex Transm Infect 2021 Apr 19. Epub 2021 Apr 19.

Department of Medicine, Imperial College London, London, UK.

Sex Transm Dis 2021 05;48(5):353-356

Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA.

Background: The diagnosis of neurosyphilis relies on cerebrospinal fluid (CSF) abnormalities (pleocytosis, elevated protein) and CSF-Venereal Disease Research Laboratory (VDRL) test. In resource-limited settings, the CSF-VDRL test may not be widely available.

Methods: We optimized a commercial immunochromatographic strip test, the DPP Chembio syphilis assay, for performance with CSF and tested centrifuged CSF samples of 71 patients with syphilis (35 with neurosyphilis and 36 without neurosyphilis). Read More

J Med Virol 2021 Apr 10. Epub 2021 Apr 10.

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

There is an increased risk of stroke and other neurological complications in human immunodeficiency virus (HIV) infected patients with no large population-based studies in the literature. We aim to evaluate the prevalence of stroke, HIV-associated neurological complications, and identify risk factors associated with poor outcomes of stroke among HIV admissions in the United States. In the nationwide inpatient sample with adult HIV hospitalizations, patients with primary cerebrovascular disease (CeVDs) and HIV-associated neurological complications were identified by ICD-9-CM codes. Read More

Clin Exp Optom 2021 Apr 8:1-4. Epub 2021 Apr 8.

Department of Optometry, Northwest Permanente-Kaiser Permanente, Portland, OR, USA.

Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, . The natural history of untreated syphilis progresses through four distinct stages: primary, secondary, latent, and tertiary syphilis. Ocular involvement can occur at any stage of syphilis and any part of the eye can be affected. Read More

Am Fam Physician 2021 04;103(7):422-428

Womack Army Medical Center, Fort Bragg, NC, USA.

Cerebrospinal fluid (CSF) analysis is a diagnostic tool for many conditions affecting the central nervous system. Urgent indications for lumbar puncture include suspected central nervous system infection or subarachnoid hemorrhage. CSF analysis is not necessarily diagnostic but can be useful in the evaluation of other neurologic conditions, such as spontaneous intracranial hypotension, idiopathic intracranial hypertension, multiple sclerosis, Guillain-Barré syndrome, and malignancy. Read More

Sci Rep 2021 03 30;11(1):7169. Epub 2021 Mar 30.

Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.

In current international classification systems (ICD-10, DSM5), the diagnostic criteria for psychotic disorders (e.g. schizophrenia and schizoaffective disorder) are based on symptomatic descriptions since no unambiguous biomarkers are known to date. Read More

J Antimicrob Chemother 2021 Mar 30. Epub 2021 Mar 30.

56 Dean Street, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.

Objectives: Penicillin-based antibiotic treatment for syphilis infection with CNS involvement (early neurosyphilis) is not always a suitable treatment option. We compared outcomes of patients diagnosed with early neurosyphilis and treated with doxycycline or procaine G penicillin.

Methods: Serological and clinical outcomes were analysed in patients diagnosed with early neurosyphilis between January 2015 and October 2019 at 56 Dean Street, a combined sexual health and HIV service based in London, UK. Read More

Arq Neuropsiquiatr 2021 02;79(2):103-106

Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.

Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis.

Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD).

Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Read More

Arq Neuropsiquiatr 2021 02;79(2):101-102

University of Pennsylvania, Perelman School of Medicine, Department of Neurology, Philadelphia PA, USA.

Mil Med 2021 Mar 22. Epub 2021 Mar 22.

Department of Allergy and Immunology, Wilford Hall Medical Center, 59th Medical Group, San Antonio, TX 78236, USA.

We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and "shaky" vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. Read More

Epidemiol Serv Saude 2021 15;30(spe1):e2020630. Epub 2021 Mar 15.

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Florianópolis, SC, Brasil.

The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. Aiming to contribute to the efforts of health service managers and health professionals in qualifying health care, this article presents the use of direct tests to detect Treponema pallidum in lesions, as well as algorithms that combine treponemal and non-treponemal antibody tests to assist in the diagnosis of syphilis. Read More

Epidemiol Serv Saude 2021 15;30(spe1):e2020616. Epub 2021 Mar 15.

Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services. Read More

Curr Opin Neurol 2021 Jun;34(3):403-409

Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.

Purpose Of Review: Neurosyphilis (NS) and Lyme neuroborreliosis (LNB) are spirochetal diseases with distinct clinical manifestations. The diagnosis of NS remains challenging due to imperfect diagnostic criteria and testing modalities. With LNB, misconceptions about diagnosis and treatment lead to considerable morbidity and drug related adverse effects. Read More