Recent trends in seroprevalence of syphilis in different patient groups attending a regional centre for sexually transmitted infections in central India

Background: Easy access to Suraksha clinics for sexually transmitted infections calls for a review of seroprevalence of syphilis. Methods: Serum samples from attendees of sexually transmitted infections (STI)/ reproductive tract infections (RTI) clinic/antenatal clinic, and samples of high-risk group (HRG: female sex workers and men having sex with men) brought by non-government organizations from 2017-22 were screened for syphilis by Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination (TPHA) tests. Samples positive by both tests were considered seropositive for syphilis. Statistical methods used for analysis were chi square test for linear trends and Kruskal Wallis test. Results: In STI clinic percentage positivity for syphilis has shown a statistically significant decline from 2017-22. In RTI clinic the decline was significant from 2017-19 but not significant in the years 2019-22. In antenatal clinic and in HRGs the change in seroprevalence was not significant from 2017-22 and 2017-20 respectively. However, the HRGs showed a significantly increasing trend in syphilis seropositivity from 2020-22. Conclusions: There is a significantly declining trend in the seroprevalence of syphilis in patients attending the STI/RTI clinic from 2017-22 and in HRGs from 2017-20. However, a significant increase in trend in HRG from 2020-22 may have been due to behavioural changes during the lockdown for covid 19 pandemic. A significant decline in syphilis in patients attending the STI and RTI clinic and in HRGs attending the regional centre indicates the effectiveness of consistent detection, treatment and counselling efforts of the national control program on STI in the region.

Recent trends in seroprevalence of syphilis in different patient groups attending a regional centre for sexually transmitted infections in central India

Background: Easy access to Suraksha clinics for sexually transmitted infections calls for a review of seroprevalence of syphilis. Methods: Serum samples from attendees of sexually transmitted infections (STI)/ reproductive tract infections (RTI) clinic/antenatal clinic, and samples of high-risk group (HRG: female sex workers and men having sex with men) brought by non-government organizations from 2017-22 were screened for syphilis by Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination (TPHA) tests. Samples positive by both tests were considered seropositive for syphilis. Statistical methods used for analysis were chi square test for linear trends and Kruskal Wallis test. Results: In STI clinic percentage positivity for syphilis has shown a statistically significant decline from 2017-22. In RTI clinic the decline was significant from 2017-19 but not significant in the years 2019-22. In antenatal clinic and in HRGs the change in seroprevalence was not significant from 2017-22 and 2017-20 respectively. However, the HRGs showed a significantly increasing trend in syphilis seropositivity from 2020-22. Conclusions: There is a significantly declining trend in the seroprevalence of syphilis in patients attending the STI/RTI clinic from 2017-22 and in HRGs from 2017-20. However, a significant increase in trend in HRG from 2020-22 may have been due to behavioural changes during the lockdown for covid 19 pandemic. A significant decline in syphilis in patients attending the STI and RTI clinic and in HRGs attending the regional centre indicates the effectiveness of consistent detection, treatment and counselling efforts of the national control program on STI in the region.

Alopecia areata y vitamina D sérica en pacientes iraquíes: un estudio de casos y controles / Alopecia Areata And Serum Vitamin D in Iraqi Patients: a case-control study

Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.

Seroprevalence of syphilis in human immunodeficiency virus patients

Background: Syphilis is a sexually transmitted infection caused by, Treponema pallidum. Syphilis facilitates the transmission and acquisition of human immunodeficiency virus (HIV) and causes transient increase in the viral load. Sexually transmitted infections (STI) are 3-5 times more likely to acquire HIV infection, if exposed to the virus through sexual contact. Aim of the study was to estimate the seroprevalence of Syphilis in HIV patients.Methods: A total of 920 blood samples were collected from HIV patients attending ART (Antiretroviral therapy) centre and were tested for Syphilis by using Rapid Plasma Reagin (RPR) and Treponema pallidum Hemagglutination Assay (TPHA). A total of 100 HIV non-reactive individuals were taken as a control group.Results: Out of 920 samples, 102 (11.1%) were positive for Syphilis. Out of 102 Syphilis seropositive patients, males (76.5%) were more commonly affected in age group of 21-40 years. Both RPR and TPHA were reactive in 46% of cases and only TPHA reactive in 53.9% of cases. Out of 100 HIV non-reactive patients, 5% of patients are reactive for Syphilis.Conclusions: In the present study, prevalence of Syphilis was more in HIV patients compared to HIV non-reactive persons. Persons with HIV infection acquired through sexual route should be screened for Syphilis by one nonspecific test along with specific test to confirm the diagnosis. This will help in proper management of the patients having Syphilis and HIV co-infection.

Trend of Seroprevalence of Syphilis in a Tertiary Care Centre

Syphilis is a sexually transmitted disease (STD), caused by Treponema pallidum subsp. pallidum. In this study done in a Tertiary Care Centre, seroprevalence and rising or falling trend of syphilis in different groups among patients was analyzed. Aims: To study trend of seroprevalence of syphilis in a tertiary care centre. Methods: A retrospective study was carried over a period of 3 alternate years from 1st May 2012 to 30th April 2013, 1st May 2014 to 30th April 2015 and 1st May 2016 to 30th April 2017. Seroprevalence of syphilis in different patient groups was analyzed by Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Hemagglutination Assay (TPHA). A Rising or falling trend of syphilis seroprevalence was also analyzed. Results: Among the 17941 serum samples tested, 504 (2.80%) were found reactive by VDRL test. A total of 1244 were tested by both quantitative VDRL test & TPHA assay. A falling trend of seroprevalence was observed from 1.04% in May 2012-April 2013 to 0.58% in May16-April17. A falling trend was observed in STD clinic attendees from 7.9% in May 2012-April 2013 to 6.12% in May 2016-April 2017. A seroprevalence of 61.72% was observed in males compared to 38.27% in females. Conclusion: A decreasing trend of syphilis was observed over a study period among antenatal women, STD clinic attendees & HIV-seropositive individuals. These findings could be interpreted as indicators of sustained efforts for case detection, treatment and improved programme for prevention & management of STD’s.

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis / El examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis

ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

RESUMO La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacientes fueron seleccionados para este estudio, el VDRL fue positivo en 5. El diagnóstico se elevó a 14 cuando se sumaron el resto de las técnicas. No se evidenció que la celularidad y el aumento de proteínas fueran herramientas auxiliares para el diagnóstico. De acuerdo a nuestro trabajo el estudio del LCR con las técnicas señaladas puede ser de utilidad en el diagnóstico de NS en estos pacientes.

Evaluation of Automated Architect Syphilis TP as a Diagnostic Laboratory Screening Test for Syphilis / 대한진단검사의학회지

BACKGROUND: The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS: A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS: The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS: Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.

Evaluation of IMMUNOTICLES Auto3RPR and Auto3TP for Testing of Syphilis Infection / 임상검사와정도관리

BACKGROUND: The serologic tests for syphilis infection have been performed manually, but the procedures are time-consuming and interpretations may be subjective. Recently, automated assays were developed for rapid and efficient testing for syphilis infection. In this study, we evaluated the performances of IMMUNOTICLES Auto3 RPR and Auto3TP (A&T Corporation, Japan) using latex agglutination turbidimetry method. METHODS: Using 236 serum samples referred for syphilis at Ewha Womans University, Mokdong Hospital, between March 2004 and April 2007, we evaluated precision, linearity, detection limit and compared with the results of manual serologic tests, RPR (RPR card test, ASAN Pharmaceutical, Korea) and TPHA (ASAN-TPHA, ASAN Pharmaceutical). RESULTS: The within-run and between day precisions of Auto3RPR and Auto3TP were from 2.1% to 4.8%. The linearity was good up to 5.0 RU for Auto3RPR and to 250 TU for Auto3TP. Agreement of Auto3RPR with RPR was 65.7% (155/236) and 32.6% of patients (77/236) were RPR positive and Auto3RPR negative. RPR titers were less than 1:8 in 99% of these discrepant samples (76/77) and 65% (50/77) were latent infection and the others were false positive (32%, 27/77). Agreement of Auto3TP with TPHA was 97.1%. CONCLUSIONS: IMMUNOTICLES Auto3RPR and Auto3TP may be useful for rapid and efficient testing for syphilis. However, discrepant results were present in patients with low titer RPR positivity and method of reporting shoud be considered in individual clinical situation. In addition, linear range was not wide and further study is needed for reporting of quantitative results.

Analysis of Positive Results in Mediace Rapid Plasma Reagin and Treponema pallidum Latex Agglutination as the Automated Syphilis Test / 대한진단검사의학회지

BACKGROUND: We compared the results of automated and quantitative methods for the diagnosis of syphilis, Mediace Rapid Plasma Reagin (RPR) and Mediace Treponema pallidum Latex Agglutination (TPLA) (Sekisui Chemical Co., Ltd, Japan) with those of conventional methods. METHODS: Sera from 3,896 persons who had health checkups between December 2005 and November 2006 were included in the evaluation of positive rates and biological false positives (BFP) for Mediace RPR and TPLA. In addition, 134 patients' sera positive for automated Mediace RPR or TPLA were tested for VDRL and TPHA. Discrepancies between TPLA and TPHA results were confirmed by the RecomBlot Treponemal IgG/IgM (Mikrogen GmbH, Germany). Automated Mediace RPR and TPLA were performed using the Hitachi 7600 chemistry autoanalyzer (Hitachi, Japan). Samples with positive Mediace RPR and negative TPLA results were defined as BFP. RESULTS: Positive rate of automated Mediace RPR was 0.23% (9/3,896). BFP of the Mediace RPR was 0.18%. Positive rate of automated TPLA was 1.62% (37/2,284). Among the 134 patients' sera, 33 (24.6%) showed a discrepancy between conventional VDRL and automated Mediace RPR results: Among 31 Mediace RPR(+)/VDRL(-) sera, 13 were positive and 18 were negative for TPLA. The remaining 2 sera of discrepancy with Mediace RPR(-)/VDRL(+) were all positive for TPLA. There were seven sera that showed a discrepancy between automated TPLA and TPHA results: Two sera with Mediace RPR(+)/TPLA(-)/TPHA(+) showed negative recomBlot Treponemal IgG/IgM results, and among five sera with TPLA(+)/TPHA(-), three demonstrated IgG or IgM by recomBlot Treponemal IgG/IgM. CONCLUSIONS: The results of comparison data demonstrated that automated TPLA results had a high concordance with recomBlot Treponemal IgG/IgM results. Moreover, there are additional advantages of automated methods such as quantitative detection, low infection risk, and no influence by human handling.

Evaluation of different methods for detection of Treponema pallidum antibody-positive samples / 临床检验杂志

Objective To analyze the false-positive results of Treponema pallidum antibody caused by 3 different assay in comparison with Treponema pallidum hemagglutination assay (TPHA).Methods Research group included 3957 clinically asymptomatic syphilis patients,and control group was 344 outpatients with sex-transmitted diseases (STD).The serum samples from the patients who were TPHA-positive were tested in parallel by enzymeimmunoassay (EIA) and syphilis toluidine red untreated serum test (TRUST).Western blot (WB) was performed as confirmatory test.Results In the clinically asymptomatic patients,60 were TPHA-positive.Among them 57 were confirmed by western blot assay,and 1 was false-positive and 2 were borderline in WB.Of the 60 TPHA-positive patients,53 were positive in EIA and 23 were positive in TRUST.In STD patients 40 were TPHA,WB and EIA-positive but 32 were TRUST-positive.Conclusions The results of TPHA and EIA were consistent for diagnosis of syphilis patients who may suffer from previous or latent infection.

Evaluation of Treponema pallidum antibody test in blood donors / 대한수혈학회지

BACKGROUND: Current serologic tests for Syphilis(STS) in the blood donors are Veneral Disease Reseach Laboratory(VDRL), Rapid Plasma Reagin(RPR) test or Groupamatic Automated Syphilis Test(GAST) using modified VDRL antigen as screening method, and Treponema Pallidum Hemagglutination(TPHA) test as a confirmatory method in Korean Red Cross Blood Centers. This study was carried out to evaluate the usefulness of Enzyme Immunoassay(EIA) as STS in blood donors. METHODS: A total of 11,335 donors s serum samples were tested by RPR and GAST. We analyzed 138 samples including 6 samples of anti-treponema pallidum panel with TPHA and EIA to compare as a confirmatory test. RESULTS: The positive rate of RPR and GAST in 11,335 samples were 0.68%, 0.24%, respectively. Confirmed positive rates by TPHA was 0.26%, and by EIA was 0.27%. False negative results of GAST were 0.11% and 0.13%, respectively according to the results of TPHA and EIA. The agreement between TPHA and EIA was 98.5%(130/132). CONCLUSION: The EIA results were comparable with RPR, GAST and TPHA test. It is considered that EIA method for STS would be alternative one for TPHA as a conformative test because there was excellent agreement between TPHA and EIA method, and EIA method showed almost same results as that of TPHA test.

Reactivity of the 19S ( IgM ) - FTA Test Among the Sera from VDRL Reactive Patients without History of Syphilitic Symptoms or Treatment / 대한피부과학회지

On a total 233 sera from the VDRL reactive patients without a history of syphilitic symptoms or treatment for syphilis, TPHA and 19S(IgM)-FTA tests were performed, Also the reactivities of the 19 S (IgM)-FTA test in relation to the VDRL and the TPHA titers were observed. The results are summarized as follows: 1. Among 233 sera, 103 sera(44%) showed negative results in the 19S(IgM)- FTA test. 2. Reactivities of the 19 S(IgM)-FTA test were significantly increased in relation to the VDRL, titers arnong 233 sera reactive in the VDRL test: 47% in the VDRL titer 1: 1, 61% in 1: 2, 71% in 1: 4, 62% in 1: 8, 96% 1: 16 or more. 3. There was no relationship statistically (IgM)-FTA test and the TPHA titers. It can be derived from the above results that when a person with no history of treatment for syphilis and clear of any signs of syphilis shows a positive reaction in the VDRL test, he is less likey to be a syphilis patient when the VDRL titer is low.

VDRL and TPHA tests in pregnant women and biological false positive for VDRL.

In 1980, 1981, 1982, 1983 and 1984, the author and colleagues performed serological tests for syphilis in 25,860, 27,971, 26,655 and 25,348 pregnant women respectively. The results obtained showed reactive VDRL at the rate 3,952, 3,800, 3,741, 3,500 and 3,156 cases in 1980, 1981, 1982, 1983 and 1984 respectively per 100,000 population,. When TPHA test, which is more specific for syphilis, was performed in the same groups of subjects, positive results was obtained at the rate of 2,394, 2,535, 2,416, 2,328 and 2,320 case per 100,000 populations respectively. The results of both tests performed during different years showed no statistically significant difference. False positive for VDRL in these pregnant women was obtained in 1.56, 1.26, 1.32, 1.17 and 0.84 percent of the studied cases in the testing years respectively; and such false positive VDRL in pregnant women is significant when VDRL is the only test available in the laboratory.

Syphilis Prevalence in Teagu Hope Village / 대한피부과학회지

Serologic tests for syphilis, including VDRL and TPHA tests, and Physical examination were carried out on 1, 605 subjects who lived in Taegu Hope Village, a social welfare center, from April, 198R to May, 1985. We prepared this study comparing with previous reports for healthy individuals and prostitutes. The results were as follows, The reactive rate of VDRL. qualitative test was 11. 6% in total, 10. 3%, in men and l3. 5%. in women. The reactive rates of VDRL. qualitative tests were highest in 7 th decade as 28, 7% and followed by 6 th decade as 16. 7% the decacile as 16. 0% 8 th decade as 14,3% 4th decade as 8. 8% and 3rd decade as 5. 9%, 3 In ]Hg sero-positive subjects, VDRL quantitative tests were done, and 35. 5% were reacted with 1: 8 or high and 29. 0% had one or more syphilitic lesions. 4 In 54 subjects who had one or more syphilitic lesions, 19 had chancres, 17 had alopecia syphilitica, 7 had rnaculopapular syphilid, 7 had condylomata lata. 3 had papular syphilid, and 1 had maculopapular syphilid and alopecia syphilitica. The biological false positive rate was 10. 1,4 in 138 VDRL reactive subjects, using 1;he TPHA test standard.