Serological Response to Treatment of Syphilis According to Disease Stage and HIV Status

Knaute, Damaris Fröhlich; Graf, Nicole; Lautenschlager, Stephan; Weber, Rainer; Bosshard, Philipp P.

doi:10.1093/cid/cis757

Cited by 87 publications

(79 citation statements)

References 28 publications

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“…Reactive specimens are retested in 2-fold dilution series for quantitative results. Titers usually decline significantly after successful therapy and are dependent on the syphilis stage as well as on the presence of HIV coinfection (16)(17)(18). Romanowski et al reported that patients with high pretreatment titers had a greater rate of decline than those with lower titers but were less likely to revert to the negative condition (19).…”

Section: Serologic Testsmentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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Section: Serologic Testsmentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

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“…Although further study is required, it may be prudent to screen all individuals with a repeat syphilis diagnosis three to six monthly or, failing that, screen them six monthly with a more sensitive test such as an IgM test. A study from 1999 to 2008 in Zurich, Switzerland, found that an IgM enzymelinked immunosorbent assay was negative in considerably fewer cases of primary syphilis cases compared with the RPR test (4% vs 42%) [30].…”

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

et al. 2014

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Persons with multiple syphilis reinfections may play an important role in syphilis transmission. We analysed all syphilis tests carried out for people attending the HIV/sexually transmitted infection (STI) clinic at the Institute of Tropical Medicine, Antwerp, Belgium, from 1992 to 2012 to evaluate the extent to which syphilis reinfections were contributing to the syphilis epidemic in Antwerp. We then characterised the features of the syphilis infections in individuals with five or more episodes of syphilis. A total of 729 syphilis episodes were diagnosed in 454 persons. The majority of syphilis episodes occurred in people who had more than one episode of syphilis (445/729; 61%). A total of 10 individuals had five or more episodes of syphilis diagnosed over this period. All were men who have sex with men, HIV positive and on antiretroviral therapy. They had a total of 52 episodes of syphilis diagnosed and treated. In 38/42 of the episodes of repeat syphilis in these 10 individuals, they presented without any signs or symptoms of syphilis. Given that the majority of cases of incident syphilis in our clinic were persons with reinfections and that they frequently presented without signs of symptoms of syphilis, there is a strong case for frequent and repeated screening in all persons with a diagnosis of syphilis.

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“…The systematic review by Blank et al was focused on HIV coinfected population (19); however, the review by Clement et al, focused more broadly on syphilis with some discussion of HIV co-infection (20). Studies were conducted in Taiwan (37), the United States (38) and Europe (39)(40)(41). The participants in the studies were predominantly male.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The participants in the studies were predominantly male. In four studies, the intervention was one or three doses of BP-G (37,(39)(40)(41). A single study compared one dose of BP-G with two or more doses of BP-G (38) ( Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Therefore, the use of anti-retroviral therapy is an important characteristic to include when assessing the efficacy of syphilis therapy. Tittes et al found a slower response to one-dose therapy within an HIV-positive group compared to an HIV-negative group, but there was no significant benefit when the two groups were treated with the three-dose regimen (41 1 Number of study participants analyzed and not necessarily the total number of infections 2 Reflects the number of cases as some study subjects contributed more than one infection SYSTEMATIC REVIEW significant association between higher CD4 count and time to response to therapy (38,40).…”

Section: Hiv Statusmentioning

confidence: 99%

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Benzathine penicillin G for the management of early syphilis among HIV co-infected persons: A systematic review

Niragira

Pogany

et al. 2016

Canada Communicable Disease Report

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Serological Response to Treatment of Syphilis According to Disease Stage and HIV Status

Abstract: The serological response to treatment was studied in 264 syphilis patients; it was influenced by syphilis stage but not by human immunodeficiency virus infection and reinfection. Some of the recommendations of current guidelines are critically discussed, and amendments are proposed.

Cited by 87 publications

References 28 publications

Recent Trends in the Serologic Diagnosis of Syphilis

Recent Trends in the Serologic Diagnosis of Syphilis

Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

Benzathine penicillin G for the management of early syphilis among HIV co-infected persons: A systematic review

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