BackgroundAntimicrobial resistance of Neisseria gonorrhoeae is a serious health problem in China. Gonococcal antimicrobial susceptibility has been monitored in Shanghai since 1988. In this study, we examined the changing pattern of gonococcal antimicrobial susceptibility based on data from N. gonorrhoeae isolates collected over the past 25 years.MethodsApproximately 100–200 isolates each year (1988–2013) were tested for their susceptibility to penicillin (PEN), tetracycline (TET), ciprofloxacin (CIP), ceftriaxone (CRO) and spectinomycin (SPT), using the agar dilution method. Plasmid-mediated N. gonorrhoeae antimicrobial resistance, comprising penicillinase-producing N. gonorrhoeae (presumed PPNG) and high-level tetracycline resistance N. gonorrhoeae (presumed TRNG), were also determined. Breakpoints for susceptibilities followed those described by the Clinical and Laboratory Standard Institute and the European Committee on Antimicrobial Susceptibility Testing.ResultsA high proportion of isolates were resistant to PEN, TET and CIP, ranging from less than 20% at the beginning of the survey, increasing in the late 1990s and reaching over 90% in recent years. The proportion of isolates exhibiting plasmid-mediated resistance exceeded 38% for presumed PPNG and 20% for presumed TRNG in recent years. The proportion of CRO nonsusceptible isolates (MIC ≥ 0.125 mg/L) ranged from 7% to 13% in most of the study years. Almost all isolates were susceptible to SPT. The SPT MIC90 was 16–32 mg/L for 2008–2013. The proportion of CRO nonsusceptible-associated multiple-drug-resistant (MDR) isolates was over 5% in most of the study years.ConclusionsN. gonorrhoeae isolates in Shanghai were resistant to PEN, TET and CIP. Furthermore, CRO nonsusceptible and MDR isolates were prevalent. N. gonorrhoeae isolates were also found to be susceptible to SPT. It is recommended that the CRO dose be increased from currently recommended 250 mg to 500 mg and that SPT be an alternative in treating urogenital gonorrhea. Our findings highlight the importance of both regional and national surveillance programs for the prompt modification of treatment guidelines, vital in responding to the changing pattern of gonococcal antimicrobial susceptibility.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0731-9) contains supplementary material, which is available to authorized users.

ObjectiveTo assess the sensitivity, specificity, and feasibility of a new chemiluminescence immunoassay (CLIA) in the diagnosis of syphilis.MethodsAt first, a retrospective study was conducted, using 135 documented cases of syphilis and 30 potentially interfering samples and 80 normal sera. A prospective study was also performed by testing 2, 071 unselected samples for routine screening for syphilis. CLIA was compared with a nontreponemal test (TRUST) and a treponemal test (TPPA).ResultsThere was an agreement of 100% between CLIA and TPPA in the respective study. The percentage of agreement among the 245 sera tested was 100.0%. Compared with TPPA, the specificity of CLIA was 99.9% (1817/1819), the sensitivity of CLIA was 100.0% (244/244) in the prospective study. CLIA showed 99.5% agreement with TPPA by testing 2, 071 unselected samples. And CLIA seemed to be more sensitive than TPPA in detecting the samples of primary syphilis.ConclusionsCLIA is easy to perform and the indicator results are objective and unequivocal. It may be suitable for large-scale screening as a treponemal test substituted for TPPA.

The goal of the present study was to determine the performance of two traditional non-treponemal tests for syphilis. Syphilis sera (n = 209) included different stages of disease, and control sera (n = 247) were from patients with tumours, leprosy, systemic lupus erythematosus, hepatitis, pregnant women and healthy individuals. Treponema pallidum ELISA, Treponema pallidum particle agglutination and rapid treponema-specific tests were used as gold standards. Rapid plasma reagin or toluidine red unheated serum test had a sensitivity and specificity of over 95%. False-negative reactions of rapid plasma reagin and toluidine red unheated serum test were observed mainly in primary and latent syphilis cases, and false-positive reactions were present in systemic lupus erythematosus, hepatitis-infected patients. Overall, both non-treponemal tests had high sensitivities and specificities making the assays attractive as screening tests for syphilis. When examined on WHO reference serum samples and based on lower limits of detection, non-treponemal tests were less sensitive than treponema-specific tests.

Syphilis is a chronic, systemic, transmitted disease that is highly infectious and harmful. This study was established to analyze the specificity of miRNA in distinguishing patients at different stages of syphilis, so as to provide a theoretical basis for using miRNA as a new diagnostic marker of this disease. The data were collected on patients with secondary syphilis (SS, n = 44) and early latent syphilis (ELS, n = 35) at Shanghai Skin Disease Hospital from March 2017 to March 2021, along with 46 healthy volunteers during the same period as healthy controls. We screened out miRNAs that might be differentially expressed in patients at different stages of syphilis on high-throughput sequencing technology, and then used magnetic nanoparticle-assisted qRT-PCR to verify their expression in the three groups. Receiver operating characteristic (ROC) curve analysis showed that miR-125a-3p could be used to distinguish the normal population from patients with syphilis. Meanwhile, miR-185-3p and miR-660-3p could be used to distinguish patients with ELS and SS, respectively. The combined diagnostic sensitivity of miR-185-3p and miR-660-3p was higher than that of each of these alone. Next, the toluidine red unheated serological test (TRUST) titers in the three groups were determined, with the analysis showing that miR-125a-3p did not have the ability to distinguish patients with different TRUST titers, while miR-185-3p and miR-660-3p levels decreased with increasing TRUST titer, indicating that the levels of miR-185-3p and miR-660-3p also had good diagnostic ability of TP activity. In conclusion, miRNA is differentially expressed in patients with syphilis at different stages of the disease and has good potential as a biomarker of syphilis. The combined use of miRNA increases the sensitivity for diagnosing syphilis at different stages.