Características sociodemográficas y clínicas de la sífilis gestacional en Cali, 2018 / Sociodemographic and clinical characteristics of gestational syphilis in Cali, 2018

Resumen | Introducción. La sífilis gestacional se considera de interés en salud pública por las repercusiones que tiene en la madre y el hijo. Pese a tener protocolos para su notificación, diagnóstico y manejo, en Colombia se siguen evidenciando limitaciones en su control. Objetivo. Describir las características sociodemográficas, clínicas y de distribución espacial de las pacientes con sífilis gestacional en Cali, Colombia, en el 2018. Materiales y métodos. Se hizo un estudio transversal con 427 casos de sífilis gestacional reportados al Sistema de Vigilancia en Salud Pública (Sivigila). Para el procesamiento estadístico, se utilizó el programa R, versión 3.5.3. Las variables cualitativas se presentan como proporciones y, las cuantitativas, mediante medidas de tendencia central y dispersión, Para la distribución espacial, se usó el programa Qgis 3.0. Resultados. La razón de sífilis gestacional fue de 17 casos por 1.000 vivos (incluidos los mortinatos). El 57,1 % de las pacientes pertenecía al régimen subsidiado de salud y el 16,6 % no estaba asegurado. El 90,4 % de los casos se diagnosticó durante el embarazo; el 47,2% recibió tres dosis de penicilina y el 57,6 % de los contactos recibió tratamiento. Conclusiones. La tasa de sífilis gestacional en Cali en el 2018 fue superior a la nacional y la enfermedad se presentó con mayor frecuencia en mujeres gestantes en condición de vulnerabilidad socioeconómica, lo que coincidió con la distribución espacial en general. Se evidenció la falta de oportunidad en la detección temprana y el manejo de la infección tanto en las pacientes como en sus contactos, lo cual dificulta el control de la enfermedad y refleja la inadecuada aplicación de la ruta integral de atención en salud materno-perinatal.

Abstract | Introduction: Gestational syphilis is considered an event of public health interest given its impact on mother and child. In Colombia, despite having specific protocols for its notification, diagnosis, and management, there are still limitations in its control. Objectives: To describe the sociodemographic and clinical characteristics, as well as the spatial distribution of gestational syphilis in Cali, Colombia, in 2018. Materials and methods: We conducted a cross-sectional study of 427 gestational syphilis cases reported to the Colombian national epidemiological surveillance system (Sivigila). For the statistical processing, we used the R program, version 3.5.3. We expressed qualitative variables as proportions and quantitative ones through central tendency and dispersion measures, and to establish the spatial distribution we used the Qgis program, version 3.0. Results: The prevalence of gestational syphilis was 17 cases per 1,000 live births (including stillbirths); 57.1% of patients belonged to the subsidized healthcare system and 16.6% had no health insurance; 90.4% of cases were diagnosed during pregnancy; 47.2% of the pregnant women received three doses of penicillin, yet only 57.6% of contacts were treated. Conclusions: The prevalence of gestational syphilis in Cali during 2018 exceeded the national rate with a higher frequency among women in socioeconomic vulnerability conditions consistent with the general spatial distribution. There was a lack of opportunity in the early detection and management of the infection both among pregnant women and their contacts, which hinders the control of the disease and reflects the inadequate application of the comprehensive maternal and perinatal health care route guidelines.

Sífilis congénita resultado de una Neurosífilis materna no diagnosticada. Reporte de caso / Congenital syphilis due to undiagnosed maternal neurosyphilis: case report

Resumen En el mundo, se ha evidenciado un aumento de los casos de sífilis, de sífilis gestacional y de sífilis congénita. Se presenta el caso de un recién nacido con sífilis congénita, hijo de una madre con sífilis latente de duración indeterminada (VDRL 1:4 diluciones) diagnosticada y tratada a la semana 12 de gestación, VIH negativa, con compañero seronegativo para sífilis; a pesar del tratamiento con tres dosis de 2'400 000 U de penicilina benzatínica, no modificó los títulos del VDRL ni en el control de la semana 25 de gestación, ni en el momento del parto. En el posparto, la madre fue diagnosticada con neurosífilis y recibió tratamiento con penicilina cristalina durante 14 días. El recién nacido fue diagnosticado con sífilis congénita por presentar VDRL 1:4 diluciones, aumento de aminotransferasas, hematuria y proteinuria, recibiendo tratamiento con penicilina cristalina durante 10 días. La paciente evolucionó favorablemente y el control a los 6 meses fue normal. Deben fomentarse medidas útiles en la prevención de la sífilis gestacional: métodos de barrera, conocimiento de la enfermedad y asistencia a control prenatal. Es fundamental identificar y tratar a las gestantes con sífilis mediante tamizaje serológico para prevenir la sífilis congénita; el seguimiento serológico debe ser estricto para verificar la eficacia del tratamiento e investigar las gestantes que no modifican los títulos después del tratamiento. MÉD.UIS.2020;33(1):73-80.

Abstract In the world, there has been an increase in cases of syphilis, gestational syphilis and congenital syphilis. It's presented the case of a newborn with congenital syphilis, son of a mother with latent syphilis of indeterminate duration (VDRL 1: 4 dilutions) diagnosed and treated at week 12 of gestation, HIV negative, with seronegative partner for syphilis; despite treatment with three doses of 2'400 000 U of benzathine penicillin, the VDRL titres remained unaltered on both the control of the 25th week of gestation and at the time of delivery. The mother, in the postpartum period, was diagnosed with neurosyphilis and was treated with crystalline penicillin for 14 days. The newborn was diagnosed with congenital syphilis by presenting 1:4 VDRL dilutions, increased aminotransferases, hematuria and proteinuria; he was treated with crystalline penicillin for 10 days. Useful measures should be promoted in the prevention of gestational syphilis such as barrier methods, knowledge of the disease and assistance to prenatal control. It is mandatory to identify and treat pregnant women with syphilis by serological screening for the disease in order to prevent congenital syphilis. Serological follow-up should be strict to verify the effectiveness of the treatment and to investigate pregnant women who do not modify the titres after treatment. MÉD.UIS.2020;33(1):73-80.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de transmisión sexual y VIH/VIH avanzado. No. 07 / Protocol of the National Epidemiological Surveillance System for sexual transmission and advanced HIV / HIV. No. 07

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. En el presente protocolo se incluirán tres elementos: La vigilancia en poblaciones clave será centinela Se instituirá la vigilancia para la población general a través de Epiweb La vigilancia de la mujer embarazada para la prevención y eliminación de la transmisión materno infantil de la sífilis congénita, a través de Epiweb

Sífilis: a grande imitadora / Sífilis: The Great Mimicker

A Sífilis é uma doença de transmissão vertical ou sexual causada por uma bactéria espiroqueta anaeróbia restrita que parasita exclusivamente o homem. Esse termo foi usado pela primeira vez em 1530 mas só em 1905 foi associado ao Treponema. Desde o advento da penicilina, os casos de sífilis decresceram até que há cerca de 20 anos a incidência dessa doença voltou a aumentar. Apesar de ser uma doença com múltiplas manifestações sendo capaz de mimetizar outras comorbidades, o diagnóstico e tratamento do Lues é relativamente simples e barato o que vai de encontro a elevada prevalência dessa doença até os dias de hoje. Devido às mudanças epidemiológicas caracterizadas por aumento na incidência e prevalência na última década, o objetivo desta revisão foi apresentar os aspectos relevantes para detecção da doença e aspectos do seu tratamento, levando em conta as diferentes faces da doença, prevenção e tratamento.

Syphilis is a disease of sexual transmission or passed from the mother to fetus caused by a restricted anaerobic spirochete bacterium that parasites exclusively humans. This term was first used in 1530 but only in 1905 was it associated with Treponema. Since the advent of penicillin, cases of syphilis have declined until about 20 years ago when the incidence of this disease has increased again. Although it is a disease with multiple manifestations being able to mimic other comorbidities, the diagnosis and treatment of Lues is relatively simple and inexpensive, which contradicts the high prevalence of this disease until the present day. Due to the epidemiological changes characterized by increased incidence and prevalence in the last decade, the objective of this review was to present the relevant aspects to detect the disease and aspects of its treatment, according to the different faces of the disease, prevention and treatment.

Comparison of Traditional and Reverse Syphilis Screening Algorithms in Medical Health Checkups

BACKGROUND: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups. METHODS: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA). RESULTS: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(−)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U). CONCLUSIONS: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm.

A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis

PURPOSE: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. CASE SUMMARY: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient's right eye improved to 20/20. CONCLUSIONS: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.

Interpretation of Serological Tests for Latent Syphilis / 대한내과학회지

No abstract available.

Clinical Course Following Intravitreal Bevacizumab Injection in Posterior Placoid Chorioretinitis

PURPOSE: To report the clinical course with optical coherence tomography findings following intravitreal bevacizumab injection in patients with posterior placoid chorioretinitis due to latent syphilis. CASE SUMMARY: A 43-year-old woman presented with visual dimness in the right eye 3 days in duration. Fundus examination showed yellow, placoid lesions in the right eye and there was no cell reaction in the anterior chamber and vitreous. An intravitreal bevacizumab injection was given and systemic work-up performed. After 1 week, the macular lesion disappeared. However, photoreceptor disarrangement was present on spectral-domain optical coherence tomography image. On serologic test, the Venereal Disease Research Laboratory test, and fluorescent treponemal antigen absorption test were positive. She was referred to a division of infectious diseases and confirmed as latent syphilis. The patient received intramuscular penicillin 3 times weekly. Visual acuity and outer retinal abnormality further improved and there was no recurrence during the 6-month follow-up. CONCLUSIONS: Intravitreal bevacizumab injection added to antibiotic treatment may be considered for treating patients with posterior placoid chorioretinitis. Further studies are necessary to evaluate precise disease mechanisms and treatment.

Cerebral Syphilitic Gumma Mimicking a Brain Tumor in the Relapse of Secondary Syphilis in a Human Immunodeficiency Virus-Negative Patient

Diagnosis of cerebral syphilitic gumma is frequently determined at the time of surgery, because imaging and laboratory findings demonstrate the elusive results. A 59-year-old woman presenting dysarthria showed a mass on her brain computed tomography. She was first suspected of brain tumor, but histological results from surgical resection revealed cerebral gumma due to neurosyphilis. After operation, she presented fever and rash with an infiltration on a chest X-ray. Histological assessment of skin was consistent with syphilis. Fluorescent treponemal antibody absorbed test IgG in cerebrospinal fluid was positive. She was successfully treated with ceftriaxone for 14 days.

Diagnóstico de sífilis em lesões orais: estudo comparativo utilizando-se as técnicas histoquímica e imuno-histoquímica / Diagnosis of syphilis in oral lesions: a comparative study using techniques of histochemistry and immunohistochemistry

A sífilis é uma doença infecciosa, cujo agente etiológico é o Treponema pallidum. Pode ser transmitida sexualmente ou verticalmente, via placenta. Seus estágios variam entre sífilis primária, sífilis secundária, sífilis latente e sífilis congênita. Dentre os diagnósticos mais eficazes, encontram-se os testes sorológicos, porém os falsos positivos e falsos negativos no estágio primário levam à procura de uma forma mais eficaz de se determinar, precocemente, a doença. Além disso, por várias razões, nem sempre o profissional clínico suspeita das lesões presentes na mucosa oral, cogitando de outras hipóteses diagnósticas. O objetivo deste trabalho foi avaliar imuno-histoquimicamente e histoquimicamente lesões bucais biopsiadas cujo aspecto histológico levou à suspeita de sífilis, buscando identificar os microorganismos, bem como correlacionar o quadro sorológico quando positivo. Para o estudo foram incluídas 34 lesões suspeitas de sífilis, que foram submetidas à reação imuno-histoquímica com o anticorpo anti-treponema e técnica histoquímica de coloração pela prata. Dos 34 casos avaliados 13 foram positivos para o anticorpo anti-treponema, todos posteriormente diagnosticados como sífilis secundária, com positividade sorológica, exceto por um caso em que a sorologia não foi realizada. Quando se comparou os métodos de diagnóstico, a técnica de coloração por prata obteve sensibilidade de 46,15% e a de imuno-histoquímica foi de 92,3%. Os aspectos histológicos variaram em um grande número de achados, dentre eles: intensa exocitose, infiltrado inflamatório predominantemente plasmocitário (justaepitelial e perivascular), áreas de ulceração, epitélio paraqueratinizado, edema, espongiose e hiperplasia epitelial. A marcação imuno-histoquímica dos treponemas foi, principalmente, epitelial (61,5%) e esse método se mostrou um meio de diagnóstico rápido, simples e eficiente no diagnóstico de lesões orais de Sífilis.

Syphilis is an infectious disease, whose etiologic agent is Treponema pallidum. It can be transmitted sexually or vertically via the placenta. Its stages include primary syphilis, secondary syphilis, latent syphilis and congenital syphilis. Among the diagnoses most effective are the serological tests, but false positives and false negatives in the primary stage lead to demand for a more effective way to determine the disease earlier. In addition, for various reasons, not always the professional clinical suspicion of lesions present in the oral mucosa, thinking in other possible diagnoses. The objective of this study was to identify microorganisms and set the best way forward to a diagnostic framework confirmed positive serology. The results for syphilis lesions in the oral mucosa corresponded to 13 cases, all of secondary iinjuries,with positive serology for syphilis and in only one of them serology had not been held. In a comparison of diagnostic methods, the technique of silver staining achieved sensitivity of 46.15% and immunohistochemistry was 92.3%. The histological features varied in a large number of findings, including: intense exocytosis, inflammatory infiltrate, predominantly plasmacytic (banda-like and infiltrate perivascular), areas of ulceration, parakeratinized epithelium, edema, spongiosis and epithelial hyperplasia. The immunohistochemical staining of treponemes was mainly epithelial (61.5%) and this method was a rapid, simple and efficient means in the diagnosis of oral lesions of syphilis.

Manifestaciones dermatológicas de la sífilis / Dermatologic manifestations of syphilis

La sífilis es una enfermedad de transmisión sexual causada por la espiroqueta Treponema pallidum. Aproximadamente se presentan 10.6 millones de nuevos casos por año a nivel mundial y en nuestro país 32 casos por cada 100.000 personas. La infección se clasifica en Sífilis primaria, secundaria, latente y terciaria. La sífilis primaria se caracteriza por una úlcera indolora y dura (chancro), que aparece en genitales o en cualquier otra área de contacto, con resolución de dos a seis semanas con o sin tratamiento. La sífilis secundaria se manifiesta de seis semanas a seis meses después de la resolución del chancro primario; esta fase se presenta con varias manifestaciones sistémicas y dermatológicas tales como: el clásico exantema maculopapular en palmas y plantas, la alopecia en parches, los parches mucosos y el condiloma lata. La sífilis latente se define como el periodo después de la infección del T. pallidum en los pacientes seroreactivos, en ausencia de manifestaciones clínicas. Y la sífilis terciaria, la cual puede presentarse como neurosífilis (paresia, tabes dorsal), sífilis cardiovascular (aneurisma aórtico) o goma (infiltrado de monocitos y destrucción tisular en cualquier órgano). Para su diagnóstico se usan inicialmente pruebas no treponémicas como el VDRL y el RPR, pero al ser inespecíficas pueden generar falsos positivos con diversas enfermedades agudas o crónicas, por esta razón se confirman con pruebas treponémicas como el FTA-ABS y la MHA-TP. El manejo es principalmente con peniclina, en casos de alergia se usa tetraciclina o doxiciclina, y ceftriaxona en casos de neurosífilis. El objetivo de este artículo es el enfoque en otros hallazgos dermatológicos diferentes al chancro sifilítico o a las úlceras que caracterizan la patología; se hace énfasis en mostrar cómo estos hallazgos, en ocasiones sutiles, pueden llevar al diagnóstico de las etapas avanzadas y que con mucha frecuencia se confunden con otras dermatosis o enfermedades sistémicas, proporcionando manejos erróneos que conllevan a la progresión de la verdadera enfermedad. De igual forma, se hace una revisión acerca de la actualidad sobre los últimos hallazgos en el diagnóstico y tratamiento, así como el panorama de la enfermedad en nuestro país...

Syphilis is a sexual transmitted disease caused by the spirochete Treponema Pallidum. Approximately 10.6 millions of new cases a year appeared worldwide and in our country 32 cases every 100.000 people. The infection is classified as primary, secondary, latent and tertiary Syphilis. Primary syphilis is characterized by painless and hard ulcer (chancre) that appears in genitals or any other contact area with a resolution from two to six weeks with or without treatment. Secondary syphilis is manifested from six weeks to six months after the resolution of primary chancre; this stage appeared with several systemic and dermatologic manifestations such as the typical maculopapular rash in palms and soles, alopecia in patches, mucous patches and condyloma latum. Latent syphilis is defined as the period after T. pallidum infection in seroreactive patients, in absence of clinical manifestations. And tertiary syphilis which may be presented as neurosyphilis, (paresis, tabes dorsalis), cardiovascular syphilis (aortic aneurysm) or gumma (monocytes infiltration and tissue destruction on any organ). Initially nontreponemal tests like the VDRL and the RPR are used for its diagnosis but when they are not specific, they may generate false positive reactions with several acute and chronic diseases, for that reason, they are confirmed with treponemal tests like the FTA-ABS ant the MHA-TP. The treatment is with penicillin, principally, or doxicycline and tetracicline in allergic cases, and ceftriaxone in neurosyphilis cases. The objective of this article is the approach in others dermatologic findings different to the syphilitic chancre, or the ulcer that is typical of the pathology; emphasis is placed on show how these findings, in some cases subtle, can lead the diagnosis of the advanced stages and with frequency are confused with other dermatosis or systemic diseases, giving mishandling that lead to the progression of the real problem. Similarly is reviewed about the update in diagnosis and treatment, as well as the outlook of the disease in our country...

Clinico-serologic Manifestation and Serologic Response to Treatment of Syphilis / 대한피부과학회지

BACKGROUND: Recently, there has been an increase in the prevalence of syphilis in Korea and in case reports of treatment failures of syphilis. OBJECTIVE: This study was designed to explicate the clinical and laboratory features of syphilis, underlying diseases of the VDRL false-positive group, and responses to treatment of patients with syphilis. METHODS: Between January 2001 and June 2010, we selected 115 patients with reactive results on the VDRL test. We evaluated several characteristics including their age, gender, clinical stage, skin lesion, serologic result, the rate and the underlying diseases of the VDRL false-positive group, and their serologic responses to syphilis treatment. RESULTS: There was no significant difference in the incidence of syphilis by gender except in the case of primary syphilis. The annual incidence of syphilis has shown a significant upward trend, especially in the younger age group (10~39 years). Using a serum VDRL titer of 8 as a cut-off value, we found a significant difference between early and latent syphilis. The rate for the VDRL false-positive group was 24.3%. Treatment failures were not reported and the median time to a successful serological response for patients with early syphilis treated with penicillin was 106 days. The Jarish-Herxheimer reaction occurred in 13.7%, and these symptoms were self-limited without any treatment. CONCLUSION: The annual incidence of syphilis in Korea has shown a significantly upward trend, especially in the younger age group. All responses evaluated were reported for those treated successfully without having any significant adverse effects. Thus, continued surveillance and adequate treatment of syphilis is important not only to enhance disease control but also to improve public health.

Clinical features and serologic analysis of latent syphilis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinical features and analyze the serologic test results of latent syphilis.</p><p><b>METHODS</b>The clinical data of 601 patients with latent syphilis who were treated in the sexually transmitted disease centre of Peking Union Medical College Hospital between January 2001 and November 2007 were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 601 cases of latent syphilis, there were 174 cases of early latent syphilis(EL), 170 cases of late latent syphilis(LL), and 257 cases of unknown latent syphilis. Male to female ratio was 0.74:1256 males and 345 females, respectively). Patients aged 20-39 years accounted for the largest proportion. Non-marital sexual intercourse was the main route of infection. Forty-six patients (7.65%) were co-infected with other sexually transmitted diseases. A total of 251 cases of latent syphilis (41.76%) were confirmed when the patients were receiving tests for other sexually transmitted diseases or suspected sexually transmitted diseases. Of the 601 patients with EL, LL and unknown latency, the proportion of serum rapid plasma reagin(RPR) titers higher than or equal to 8 were 72.99% (127/174), 52.94% (90/170), and 60.31%(155/257), respectively. Compared with the early syphilis, serological negative conversion rate was significantly lower after treatment for l2 months in the early latent syphilis patients (P=0.044).</p><p><b>CONCLUSION</b>Education and awareness raising on syphilis should be strengthened to lower the prevalence of latent syphilis.</p>

Pseudo-Obstruction of Jejunum due to AA Amyloidosis Associated with Latent Syphilis

Amyloidosis uncommonly presents with intestinal pseudo-obstruction. According to previous reports, patients with primary AL amyloidosis presented with a chronic process with symtom duration of more than 1 year, but patients with secondary AA amyloidosis presented as an acute illness, usually less than 10 weeks. Localized gastrointestinal amyloidosis limited to the jejunum, without involvement of stomach, duodenum, colon, or rectum, is very rare. Imaging studies in small intestinal amyloidosis generally show a symmetrical uniform appearance. AA amyloidosis with acute-phase reactant serum amyloid A protein is associated with inflammatory, infectious or neoplastic disorders. To our knowledge, no case of amyloidosis associated with latent syphilis has been reported to date. We present a case of a 56-year-old man who presented with clinical and radiographic features of a small bowel obstruction and obscure gastrointestinal bleeding. Investigations including laparoscopy and other laboratory dataled to a diagnosis of pseudo-obstruction of the jejunum due to AA amyloidosis associated with latent syphilis. After appropriate treatment for latent syphilis, abdominal symptoms had been disappeared, but jejunal dilatation was still present two years later.

Clinical Observation and Statistical Consideration of Syphilis (2000~2007) / 대한피부과학회지

BACKGROUND: Syphilis is infectious and chronic disease transmitted sexually and caused by Treponema pallidum subspecies pallidum. Thanks to the wide-ranging variance in clinical presentations, the disease has earned the name, "the Great Mimicker". The prevalence rate of syphilis in Korea dropped sharply since the 1970s and has remained low until recently when the rate started to show signs of a modest but clear increase. OBJECTIVE: The objective of this study is to evaluate the incidence of syphilis and describe its clinical characteristics of each stage as we have observed for the past 8 years at our hospital. METHODS: We conducted a retrospective analysis on the 279 syphilis patients who visited our hospital from 2000 to 2007. For the diagnosis of the disease, we used nontreponemal (VDRL) and treponemal test (TPHA, FTA-ABS) in serum and evaluated the clinical features of the subjects. RESULTS: The annual incidence and prevalence rate of early syphilis showed a statistically significant upward trend. By gender, the annual incidence rate among males also drew an upward curve. Among 279 patients, 28 cases of early syphilis were found in males, whereas only 16 cases were found in females. Early syphilis is found most frequently in the twenties. Secondary syphilis showed various skin lesions including alopecia syphlitica, macular syphilid, papulosquamous syphlid and annular patch. Nine cases among 19 syphilis patients showed coppery red macules on palms and soles. One case of early latent syphilis was found in a HIV-positive patient. The serum VDRL titers according to stages did not show a statistically significant difference. CONCLUSION: We have observed statistically significant (p<0.05) increase in the incidence and prevalence rates of early syphilis in recent years. Thus, dermatologists should be rightly aware of and familiarize themselves with the diverse clinical features of syphilis and be attentive and alert to effectively diagnose the disease in its early stages.

Clinical Observation and Statistical Consideration of Syphilis (2000~2007) / 대한피부과학회지

BACKGROUND: Syphilis is infectious and chronic disease transmitted sexually and caused by Treponema pallidum subspecies pallidum. Thanks to the wide-ranging variance in clinical presentations, the disease has earned the name, "the Great Mimicker". The prevalence rate of syphilis in Korea dropped sharply since the 1970s and has remained low until recently when the rate started to show signs of a modest but clear increase. OBJECTIVE: The objective of this study is to evaluate the incidence of syphilis and describe its clinical characteristics of each stage as we have observed for the past 8 years at our hospital. METHODS: We conducted a retrospective analysis on the 279 syphilis patients who visited our hospital from 2000 to 2007. For the diagnosis of the disease, we used nontreponemal (VDRL) and treponemal test (TPHA, FTA-ABS) in serum and evaluated the clinical features of the subjects. RESULTS: The annual incidence and prevalence rate of early syphilis showed a statistically significant upward trend. By gender, the annual incidence rate among males also drew an upward curve. Among 279 patients, 28 cases of early syphilis were found in males, whereas only 16 cases were found in females. Early syphilis is found most frequently in the twenties. Secondary syphilis showed various skin lesions including alopecia syphlitica, macular syphilid, papulosquamous syphlid and annular patch. Nine cases among 19 syphilis patients showed coppery red macules on palms and soles. One case of early latent syphilis was found in a HIV-positive patient. The serum VDRL titers according to stages did not show a statistically significant difference. CONCLUSION: We have observed statistically significant (p<0.05) increase in the incidence and prevalence rates of early syphilis in recent years. Thus, dermatologists should be rightly aware of and familiarize themselves with the diverse clinical features of syphilis and be attentive and alert to effectively diagnose the disease in its early stages.

A Clinical Study of Cases of Syphilis Referred to Our Dermatologic Clinic (2002~2007): Clinical Presentation and Changes in Symptomatic Stage / 대한피부과학회지

BACKGROUND: There are many differences in the prevalence of syphilis according to the objects and districts. Recently, the incidence of syphilis increased in the world because of various factors. OBJECTIVE: The purpose of this study is to investigate the changes of the epidemiological, clinical characteristics, and stages of syphilis. METHODS: We selected 357 patients with reactive results on VDRL among 79,991 cases who visited in our hospital, between January 2002 and December 2007. We assessed the age, gender, skin lesion, serologic result, clinical stage, treatment history, and underlying disease. RESULTS: During the 7-year period under study, the reactive rate of serum VDRL test was 4.5% in 79,991 people (preoperation or admission examinees: 35.0%. physical examinees: 30.8%, skin lesion: 21.3%, partner's (+): 9.0%, pregnant women: 3.7%). The annual incidence of syphilis had increased from 3.5% in 2002 to 6.3% in 2007. On a total 357 sera with reactive results on VDRL, the symptomatic syphilis rate was 21.3%, increased from 13.6% in 2002 to 26.8% in 2007 (p=0.001). Statistically, there are differences in age distribution between both sexes. The male:female ratio was 1:3.3 in 0~19 years and 1.9:1 in 60~69 years (p=0.029). The incidence of symptomatic syphilis cases was 8 (66.7%) in 0~19 years, 22 (39.3%) in 20~29 years, while latent syphilis was 53 (74.6%) in 50~59 years and 35 (60.3%) in 60~69 years (p<0.001). CONCLUSION: This study suggests that the incidence of symptomatic syphilis may be increasing. Further observation, analysis, and continued vigilance in the general population are required.

Comparação de testes nao treponêmicos utilizados no diagnóstico da sifilis e interferência da inativação do soro / Comparison of non treponemic assays used in syphilis diagnosis and interference of serum inactivation

A sífilis é uma doença infecciosa crônica causada pelo Treponema pallidum, cujo diagnóstico incorreto propicia a transmissão da doença via sexual e placentária. O trabalho avaliou comparativamente os testes Veneral Diseases Research Laboratory (VDRL) e Rapid Plasm Reagin (RPR) na triagem sorológica e determinou a interferência da inativação do soro. Foram empregados reagentes comerciais na avaliação de amostras de soro de 110 indivíduos saudáveis e de 20 pacientes portadores de sífilis, antes e após a inativação a 56ºC/30min. O procedimento técnico seguindo as instruções do fabricante mostrou sensibilidade de 100% para ambos os testes, embora 45% das amostras reativas tenham mostrado títulos superiores no VDRL. A especificidade foi de 100% no VDRL e 97,3% no RPR. A inativação do soro mostrou não interferir nos resultados do VDRL, enquanto que o RPR mostrou maior especificidade para amostras inativadas, embora sem diferença significativa (p=0,248).

Syphilis is a chronic infectious illness caused by the Treponema pallidum, which incorrect diagnosis propitiates the transmission mainly by sexual contact and from mother to child (trans-placentary). The present work evaluated the Veneral Diseases Research Laboratory (VDRL) and the Rapid Plasm Reagin (RPR) assays and also determined the interference of the serum inactivation. Commercial reagents were used to evaluate sera samples from 110 healthful individuals and 20 patients with syphilis, before and after inactivation at 56ºC/30min. In the technical procedure according the manufacturers’ instructions, both assays had presented 100% of sensitivity, although 45% of the reactive samples have shown bigger values in VDRL. The specificity was 100% for VDRL and 97.3% for RPR. The serum inactivation showed no interference in VDRL results, while in RPR was observed a greater specificity with inactivated samples, although with no significant difference (p=0,248).