ABSTRACT
Background: Some patients with early syphilis who receive appropriate treatment do not reach a serological cure and have a persistent titer which does not meet the criteria for treatment failure (serofast state). Aims: This retrospective study aimed to determine the prevalence of serological cure and the serofast state as well as the factors associated with serological cure after treatment of patients with early syphilis. Methods: A serological cure was defined as occurring when there was a ≥4-fold decrease in nontreponemal titer, whereas patients with a ≥4-fold increase were considered as having either a treatment failure or reinfection. Nontreponemal titers that neither increased nor decreased ≥4-fold after treatment were considered to be in a serofast state. Seroreversion was defined as occurring when there was a negative test within 12 months of treatment. Results: There were 179 patients with a mean age of 31.9 years; 174 (97.2%) were men, and 125 (70%) were HIV patients. Of the total, 174 (98%; 95% confidence interval 94.82–99.42%) patients achieved a serological cure, whereas five were in a serofast state 12 months after treatment. Those five serofast patients were all HIV-positive men, of which 4 (80%) had secondary-stage syphilis, a CD4 count ≤200 cells/μl and a titer <1:8. In a bivariate analysis, a serological cure was associated with a baseline Venereal Disease Research Laboratory >1:16 titers (P = 0.018), and a CD4 cell count >200 cells/μl in 6 months preceding treatment (P = 0.016). The median time to a serological cure was 96 days. Only 22 (12.3%) of the patients achieved seroreversion at 12 months after treatment. Limitations: A retrospective medical record review is likely to have a selection bias, and in our study, 196 (52%) patients were excluded due to missing information. Conclusions: Most patients with early syphilis who achieved a serological cure at 12 months after treatment had high baseline Venereal Disease Research Laboratory titers and CD4 cell counts. However, only 22 (12.3%) had a negative Venereal Disease Research Laboratory titer after 1 year of treatment.
ABSTRACT
@#The objective of this study was to examine the trends of primary and secondary syphilis in Tokyo between 2007 and 2016 using national infectious disease surveillance data. We analysed all 3269 cases reported during these 10 years. A statistically significant increase in cases was observed after 2010 with a more rapid rate of increase after 2014 mainly in urban areas in Tokyo. The notification rates per 100 000 population in 2010, 2014 and 2016 were 0.9 (n = 113), 2.2 (n = 295) and 8.7 (n = 1190), respectively. Domestic syphilis transmission was suspected in 92.6–99.3% of cases during the period 2007–2016. Until 2013, the increase was mainly observed among men who have sex with men (MSM); however, heterosexual transmission became more dominant and eventually surpassed transmission among MSM in 2015. In 2016, the notified cases of infections through heterosexual contact were 22.3 and 40.4 times higher in men and women, respectively, compared to those in 2010. The median ages of affected heterosexual men and women were 37 (interquartile range: 28–46) and 26 (interquartile range: 22–32) years, respectively. Reports of oropharyngeal lesions have been increasing among both men and women with syphilis. The number of congenital syphilis cases reported in Tokyo was 0 to 3 cases per year during the study period. More information and further analysis are needed to explain the reason for this increase.
ABSTRACT
Objective To investigate the clinical efficacy of penicillin combined with ceftriaxone in early syphilis patients.Methods60 patients with early syphilis treated from February 2014 to February 2016 were included in the study,according to the random number table method,the patients were divided into control group (simple penicillin treatment) and treatment group (Penicillin and ceftriaxone sodium), 30 cases in each group.The skin lesions subsided within one week of two groups were recorded.The toluidine red blood serum test (TRUST) was carried out at 3 months, 6 months, 9 months and 12 months after treatment, and the serum fixation rate of the patients in the two groups were observed.ResultsThe rate of pain relief within one week in the treatment group was 90.0% (27/30), which was significantly higher than that in the control group (66.7%, 20/30), (χ2=4.81, P=0.02);TRUST negative rates of the treatment group after treatment for 3 months, 6 months, 9 months and 12 months were 36.7%(11/30), 70.0% (21/30), 86.7% (26/30), 90.0% (27/30),the control group was 13.3%(4/30), 26.7% (8/30), 50.0% (15/30), 63.3% (19/30), [χ2=(4.35,11.27,9.31,5.96), P=(0.00,0.00,0.00, 0.01)].The serum fixation rate in the treatment group was 3.3%(1/30), which was significantly lower than that in the control group (20.0%, 6/30),(χ2=4.04, P=0.04).ConclusionPenicillin combined with ceftriaxone sodium in the treatment of early syphilis patients can help to promote the disappearance of skin lesions, accelerate the patients with syphilis serum negative and reduce serum fixation rate, the effect is significant, to be further studied to promote.
ABSTRACT
Objective To evaluate the diagnostic value of treponema pallidum particle agglutination (TPPA) and toludine red unheated serum test (TRUST) for the therapeutic effects of early syphilis.Methods Syphilis patients visited the Dermatological Department of Beijing Tongren Hospital, Capital Medical University from January 2012 to October 2016 were recruited, including 189 patients with early syphilis and 39 patients without clinical symptoms but with risky behavior within 3 months.Serum samples were tested by TPPA and TRUST respectively before treatment and at month 3, 6, 12 after treatment.Comparison between groups was done by χ2 test.Results Serum TPPA results of 228 patients with early syphilis prior to the treatment and within 12 months after treatment were all positive.Before treatment, TRUST tests results of 225 patients were positive, and 156 patients turned negative after 12 months of treatment with the negative conversion rate of 69.3%.The TRUST titer ≤1∶4 before treatment was defined as low-titer group, and ≥1∶8 before treatment was defined as high-titer group.There were 93 patients in the low-titer group, including 3 patients with negative results, and 90 patients with titer 1∶1-1∶4.There were 135 patients in the high-titer group.Twenty-seven patients achieved TRUST negative conversion after 3 months of treatment, among which 19.35%(18/93) with the negative conversion rate in the low-titer group and 6.67%(9/135) in the high-titer group.The difference between the two groups was statistically significant (χ2=7.10, P0.05).Conclusion Serological tests combined with clinical signs can accurately diagnose early syphilis and evaluate the therapeutic effects.
ABSTRACT
Introducción: la sífilis ocurre en todo el planeta, siendo más común en áreas urbanas. Dado el incremento de la sífilis temprana, a pesar de los ingentes esfuerzos del estado, de sus estructuras sanitarias en la prevención de esta enfermedad, en estos momentos en el municipio de Cárdenas, esta es una realidad. Objetivo: evaluar el comportamiento del diagnóstico de sífilis temprana en el Policlínico Universitario “Héroes del Moncada”, en el período enero-octubre de 2014. Materiales y métodos: se realizó un estudio descriptivo, transversal, en los 37 pacientes diagnosticados con sífilis temprana adquirida, en el período correspondiente de enero a octubre de 2014, en el Policlínico Universitario “Héroes del Moncada”, en el municipio Cárdenas. Resultados: en el período evaluado se diagnosticaron 37 pacientes, de los cuales las edades estaban comprendidas entre 35 y 40 años, para un 24 %. El sexo femenino prevalece con 24 (64 %). Referente a la conducta sexual, se pudo constatar que 33 pacientes (89 %) fueron heterosexuales. Atendiendo a la clasificación del diagnóstico, 22 (59 %) correspondieron a la sífilis temprana adquirida sintomática, que incluyó a una paciente en edad pediátrica. Fueron diagnosticadas seis gestantes (16,1 %) con sífilis temprana adquirida latente. No fue significativo el color de la piel de los pacientes. En lo relativo al lugar de residencia, correspondió al Consejo Popular Versalles, del área urbana del policlínico, con un total de 18 (48,6 %) pacientes diagnosticados. Conclusiones: en el período evaluado fueron diagnosticados 37 pacientes con sífilis temprana adquirida; el grupo de edad de 35 a 40 años fue el de mayor prevalencia, y el sexo femenino prevaleció con 64,8 % del total de los pacientes.
Background: syphilis occurs everywhere around the world, being more common in urban areas. Due to the early syphilis increment, in spite of the government increasing efforts and the efforts of its health structures in preventing this disease, in the municipality of Cardenas it is a current reality. Aim: to evaluate the behavior of the early syphilis diagnosis in the University Policlinic “Heroes del Moncada” in the period January-October 2014. Materials and Methods: a cross-sectional, descriptive study was carried out in 37 patients diagnosed with early syphilis acquired in the correspondent period from January to October 2014 in the University Policlinic “Heroes del Moncada”, municipality of Cardenas. Outcomes: in the evaluated period 37 patients were diagnosed; of them, those aged between 35 and 40 years prevailed, for 27 %. Female patients also prevailed with 24 (64.8 %) patients. According to the sexual behavior, it was established that 33 patients (89 %) were heterosexual. Taking into account the diagnosis classification, 22 (59 %) corresponded to symptomatic early acquired syphilis, including a pediatric-age female patient. 6 pregnant women (16.1 %) were diagnosed with latent early acquired syphilis. The patients´ skin color was not significant. In relation with the residence place, it was the Popular Council Versalles, of the policlinic urban area, the one with more patients, with a total of 18 (48.6 %) patients diagnosed. Conclusions: in the evaluated period, there they were diagnosed 37 patients with early acquired syphilis; the 35-40 years-old group was the one with more prevalence, and female gender prevailed with 64.8 % of the total of the patients.
ABSTRACT
Objective To evaluate efficacy of thymopentin combined with ceftriaxone on patients with early syphilis serum fixation.Methods A total of 108 patients with early syphilis serum fixation were chosen and divided into observation group and control group by the number of tables (54 cases in each group).The control group were underwent conventional sodium penicillin with benzathine with nursing treatment,the observation group were treated with ceftriaxone thymopentin combined with nursing treatment,changes in the relevant indicators before and after treat-ment were observed.Results After treatment,IL -2,IL -10 and other indicators in the observation group were improved compared to the control group[IL -2:the control group before treatment (20.8 ±4.9)μg/L,after treatment (42.7 ±7.3)μg/L;the observation group before treatment(19.8 ±5.1)μg/L,after treatment (54.6 ±8.3)μg/L;IL -10:the control group before treatment (76.3 ±16.1)μg/L,after treatment (51.3 ±5.4)μg/L;the observation group before treatment(78.3 ±4.1)μg/L,after treatment(23.8 ±5.1)μg/L],the differences of the two groups after treatment were statistically significant (t =3.923,8.832,all P <0.05);after treatment,the RPR negative rates of the observation group at 3,6,12 months after treatment(72.2%,85.2%,96.3%)was significantly higher than those of the control group(53.7%,57.4%,63.0%),the differences were statistically significant (χ2 =4.932,11.372, 22.842,all P <0.05);the efficacy of the observation group at 3,6,12 months after treatment(75.9%,79.6%, 75.9%)were significantly better than those of the control group (72.2%,64.8%,57.4%),the differences were statistically significant (χ2 =5.232,6.183,all P <0.05 ).Conclusion Thymopentin combined with ceftriaxone treatment of early syphilis can significantly improve its fixed immunological parameters,which coordinated with nursing measures can strengthen patient care awareness,then the efficacy will be better,so it is worthy of clinical further promotion.
ABSTRACT
Objective To observe the clinical effect of three antisyphilic drugs in the treatment of early syphilis.Methods From January 2007 to March 2013, 90 cases early syphilis in department of dermatology of our hospital were selected and randomly devided into three groups: benzathine penicillin group, clarithromycin group and azithromycin group.The efficacy including the onset time of improvement, recovery time of skin lesions and TRUST negative conversion rate were compared in three groups.Results The onset time of skin lesions improvement in patients with primary syphilis result showed that there was significant difference between benzathine penicillin and clarithromycin (t =14.603, P<0.05), clarithromycin and azithromycin (t=12.682, P<0.05).While in the treatment of primary syphilis and secondary syphilis, there were no significant differences among recovery time of skin lesions.And there were no significant differences the onset time of skin lesions improvement in treatment of secondary syphilis among three groups.The TRUST negative conversion rates of benzathine penicillin and clarithromycin both were 100%, and azithromycin was 96.7%, with no significant difference.Conclusion The antisyphilic efficacy of three drugs are similar.The patients allergic to penicillin may be treated with clarithromycin or azithromycin, who would aquaire a satisfied result.