Clinical aspects of adult syphilis

Read, Phillip; Donovan, Basil

doi:10.1111/j.1445-5994.2012.02814.x

Cited by 58 publications

(39 citation statements)

References 26 publications

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“…Rates of syphilis in Australia are highest among two distinct populations - gay men living in urban centres and Aboriginal and Torres Strait Islander people living in remote regions across Australia [20]. The incidence of syphilis in gay men with HIV infection is five-times higher than the incidence in MSM without HIV (2.5 vs. 0.5 per 100 person years) [21].…”

Section: Methodsmentioning

confidence: 99%

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

et al. 2014

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BackgroundSyphilis point-of-care tests may reduce morbidity and ongoing transmission by increasing the proportion of people rapidly treated. Syphilis stage and co-infection with HIV may influence test performance. We evaluated four commercially available syphilis point-of-care devices in a head-to-head comparison using sera from laboratories in Australia.MethodsPoint-of-care tests were evaluated using sera stored at Sydney and Melbourne laboratories. Sensitivity and specificity were calculated by standard methods, comparing point-of-care results to treponemal immunoassay (IA) reference test results. Additional analyses by clinical syphilis stage, HIV status, and non-treponemal antibody titre were performed. Non-overlapping 95% confidence intervals (CI) were considered statistically significant differences in estimates.ResultsIn total 1203 specimens were tested (736 IA-reactive, 467 IA-nonreactive). Point-of-care test sensitivities were: Determine 97.3%(95%CI:95.8–98.3), Onsite 92.5%(90.3–94.3), DPP 89.8%(87.3–91.9) and Bioline 87.8%(85.1–90.0). Specificities were: Determine 96.4%(94.1–97.8), Onsite 92.5%(90.3–94.3), DPP 98.3%(96.5–99.2), and Bioline 98.5%(96.8–99.3). Sensitivity of the Determine test was 100% for primary and 100% for secondary syphilis. The three other tests had reduced sensitivity among primary (80.4–90.2%) compared to secondary syphilis (94.3–98.6%). No significant differences in sensitivity were observed by HIV status. Test sensitivities were significantly higher among high-RPR titre (RPR≥8) (range: 94.6–99.5%) than RPR non-reactive infections (range: 76.3–92.9%).ConclusionsThe Determine test had the highest sensitivity overall. All tests were most sensitive among high-RPR titre infections. Point-of-care tests have a role in syphilis control programs however in developed countries with established laboratory infrastructures, the lower sensitivities of some tests observed in primary syphilis suggest these would need to be supplemented with additional tests among populations where syphilis incidence is high to avoid missing early syphilis cases.

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Section: Methodsmentioning

confidence: 99%

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

et al. 2014

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“…pallidum, causes over 10 million infections worldwide each year (1). The public health importance of this condition relates not only to the early and late manifestations in infected adults, but also the particularly devastating consequences of congenital syphilis (2). Although endemic in the heterosexual population in many low-and middle-income countries, many high-income countries, as well as China (3), have witnessed a resurgence of syphilis over the last decade, predominantly among homosexually active men (4), where it may contribute to ongoing transmission of HIV (5)(6).…”

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confidence: 99%

Azithromycin-Resistant Syphilis-Causing Strains in Sydney, Australia: Prevalence and Risk Factors

et al. 2014

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e Azithromycin has shown high efficacy in randomized trials when used for treating infectious syphilis in Africa. However, its use in clinical practice has been limited by the development of antimicrobial drug resistance. Resistance has not previously been reported from Australasia. The aim of this study was to determine the prevalence of and risk factors for azithromycin-resistant syphilis-causing strains in Sydney, Australia. We evaluated 409 samples that were PCR positive for Treponema pallidum DNA collected between 2004 and 2011 for the presence of the A2058G mutation, which confers resistance to macrolide antibiotics such as azithromycin. Overall, 84% of samples harbored the mutation. The prevalence of the mutation increased during the study period (P trend, 0.003). We also collected clinical and demographic data on 220 patients from whom these samples had been collected to determine factors associated with the A2058G mutation; 97% were from men who have sex with men. Reporting sex in countries other than Australia was associated with less macrolide resistance (adjusted odds ratio, 0.25; 95% confidence interval, 0.09 to 0.66; P ‫؍‬ 0.005), with other study factors showing no association (age, HIV status, recent macrolide use, stage of syphilis, or history of prior syphilis). Azithromycin cannot be recommended as an alternative treatment for syphilis in Sydney.

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“…Since 2000, a steady increase in the incidence of syphilis has been observed in most European countries and North America [3]. The natural course of the infection is characterized by several clinical manifestations and by periods without clinical signs [4]. Therefore, it is mandatory that the clinical diagnosis is always supported by appropriate laboratory testing and that the laboratory test results are interpreted with reference to the patient's history and physical examination findings.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of different confirmatory algorithms using seven treponemal tests on Architect Syphilis TP-positive/RPR-negative sera

Jonckheere

Berth

Esbroeck

et al. 2015

Eur J Clin Microbiol Infect Dis

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The Architect Syphilis TP is considered to be a suitable screening test due to its high sensitivity and full automation. According to the International Union against Sexually Transmitted Infections (IUSTI) 2014 guidelines, however, positive screening tests need confirmation with Treponema pallidum particle agglutination (TP.PA). Among Architect-positive results, samples with a negative non-treponemal test present the major diagnostic challenge. In this multicenter study, we investigated if other, preferable less labor-intensive treponemal tests could replace TP.PA. A total of 178 rapid plasma reagin (RPR)-negative sera with an Architect value between 1 and 15 S/CO were prospectively selected in three centers. These sera were analyzed with TP.PA and six alternative treponemal tests: three immunoblots and three tests on random-access analyzers. The diagnostic performance of the treponemal tests differed substantially, with the overall agreement between the six alternative tests ranging from 44.6 to 82.0%. Based on TP.PA as the gold standard, the INNO-LIA IgG blot, the BioPlex 2200 IgG, and the Syphilis TPA showed a high sensitivity, while the EUROLINE-WB IgG blot, recomLine Treponema IgG blot, and the Chorus Syphilis screen showed a high specificity. However, an Architect cut-off of 5.6 S/CO can serve as an alternative for these confirmatory treponemal tests in case of an RPR-negative result. Treponemal tests show poor agreement in this challenging group of Architect-positive/RPR-negative sera. The most optimal algorithm is obtained by assigning sera with an Architect value >5.6 S/CO as true-positives and sera with a value between 1 and 5.6 S/CO as undetermined, requiring further testing with TP.PA.

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Clinical aspects of adult syphilis

Cited by 58 publications

References 26 publications

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

Azithromycin-Resistant Syphilis-Causing Strains in Sydney, Australia: Prevalence and Risk Factors

Evaluation of different confirmatory algorithms using seven treponemal tests on Architect Syphilis TP-positive/RPR-negative sera

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