A brief recent history of the epidemiology of congenital syphilis in the United Kingdom.

Within a century, congenital syphilis has been reduced from a major cause of morbidity and mortality to a condition rarely seen in the UK. Here, newly-derived literature and information searches were used to create a contemporary overview of the epidemic, including its epidemiology. Although constrained by high-quality healthcare services and with an incidence below the World Health Organization elimination threshold, congenital syphilis still has the potential to cause major consequences for the health and life chances of affected infants. If the complex challenges presented by this preventable disease are to be resolved, intervention strategies need to be optimised, rigorously assessed and extended across Europe.

British Ocular Syphilis Study (BOSS): 2-year national surveillance study of intraocular inflammation secondary to ocular syphilis.

PURPOSE: The British Ocular Syphilis Study (BOSS) is the first national prospective epidemiological study of intraocular syphilis (IOS) in light of the global increase in early syphilis (ES). The aims were to ascertain the UK incidence, demographics, clinical features, laboratory data, and posttreatment visual outcomes of patients with IOS. METHODS: Prospective study of IOS, reported through the national reporting system (British Ocular Surveillance Unit) from 2009 to 2011. Case definition was any adult presenting with intraocular inflammation in ES. RESULTS: A total of 41 new cases (63 eyes) of IOS were reported, giving an annual incidence of 0.3 per million UK adult population. Mean age was 48.7 years (range, 20.6-75.1); 90.2% were male. All had RPR/VDRL titers of ≥1:16. Bilateral ocular involvement occurred in 56%; in unilateral cases, the left eye was more commonly affected (P = 0.009). Mean presenting logMAR visual acuity was 0.52 (20/63 Snellen; range, -0.2 to 2.30 logMAR). Panuveitis was the commonest diagnosis, seen in 41.3%, and isolated anterior uveitis was uncommon (9.5%). Subgroup analysis between HIV-positive and -negative patients found no significant differences in terms of proportion of bilateral disease, presenting or post treatment acuity. HIV-positive patients had higher rates of panuveitis. At final follow-up, 92.1% had visual acuity ≥ 0.3 logMAR (20/40 Snellen) after antibiotic therapy. CONCLUSIONS: This study is the largest prospective series of ocular syphilis in the post-penicillin era. It confirms good visual outcomes for treated IOS, irrespective of HIV status or time to presentation. The study identified an unexpected preponderance for left eye involvement in uniocular cases; which is unexplained.

Performance evaluation of a new rapid urine test for chlamydia in men: prospective cohort study.

OBJECTIVE: To evaluate the performance of a rapid test for chlamydia with first void male urine samples as a potential tool for diagnosis and screening of chlamydial infection in men. DESIGN: Evaluation of test performance in prospective cohort study. Settings A young people's sexual health centre (site 1) and a genitourinary medicine clinic (site 2) in the United Kingdom. PARTICIPANTS: 1211 men aged 16-73 attending either of the two sites. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test versus polymerase chain reaction assay. Relation between the visual signal of the Chlamydia Rapid Test and organism load. RESULTS: Detection rates for Chlamydia trachomatis infection with polymerase chain reaction were 4.4% (20/454) at site 1 and 11.9% (90/757) at site 2. Compared with polymerase chain reaction assay, the resolved sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test was 82.6% (90/109), 98.5% (1085/1102), 84.1% (90/107), and 98.3% (1085/1104), respectively. The organism load in first void urine samples that were positive for chlamydia ranged from 7.28x10(2) to 6.93x10(6) plasmids/ml and correlated significantly with the visual signal of the Chlamydia Rapid Test (r=0.7897, P<0.001). CONCLUSIONS: The performance of the new Chlamydia Rapid Test with first void male urine samples indicates that it would be an effective diagnostic tool for chlamydial infection in men. The availability of test results within an hour allows for immediate treatment and contact tracing, potentially reducing the risks of persistent infection and onward transmission. The test could also provide a simple and reliable alternative to nucleic acid amplification assays for testing of male urine in chlamydial screening programmes in high prevalence settings.

Optimal method of collection of first-void urine for diagnosis of Chlamydia trachomatis infection in men.

First-void urine (FVU) is the preferred specimen for the diagnosis of urogenital Chlamydia trachomatis infection in men. We have developed FirstBurst, a urine collection device that collects the first 4 to 5 ml of FVU and yields a specimen with a sixfold higher C. trachomatis organism load than the regular urine cup by quantitative PCR (32,533 versus 5,271 plasmids/ml; P < 0.0001). Consequently, the use of FirstBurst to collect a urine sample improved the sensitivity of a rapid test for Chlamydia over testing of samples collected with a urine cup (82 versus 47% sensitivity using PCR as a reference; P < 0.0015).

New point of care Chlamydia Rapid Test--bridging the gap between diagnosis and treatment: performance evaluation study.

OBJECTIVE: To evaluate the performance of a new Chlamydia Rapid Test with vaginal swab specimens as a potential tool for chlamydia diagnosis and screening. DESIGN: Performance evaluation study. Settings A young people's sexual health centre (site 1) and two genitourinary medicine clinics (sites 2 and 3) in the United Kingdom. PARTICIPANTS: 1349 women aged between 16 and 54 attending one of the three clinics. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test versus polymerase chain reaction and strand displacement amplification assays; correlation between the Chlamydia Rapid Test visual signal and organism load; acceptability to participants of self collected vaginal swabs as the specimen type for Chlamydia testing. RESULTS: Polymerase chain reaction positivity rates for Chlamydia trachomatis infection were 8.4% (56/663) at site 1, 9.4% (36/385) at site 2, and 6.0% (18/301) at site 3. Compared with polymerase chain reaction assay, the resolved sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test were 83.5% (91/109), 98.9% (1224/1238), 86.7% (91/105), and 98.6% (1224/1242). Compared with strand displacement amplification assay, sensitivity and specificity of the Chlamydia Rapid Test were 81.6% (40/49) and 98.3% (578/588). Organism load of self collected vaginal swabs ranged from 5.97x10(2) to 1.09x10(9) Chlamydia plasmids per swab, which correlated well with the Chlamydia Rapid Test's visual signal (r=0.6435, P<0.0001). Most (95.9%) surveyed participants felt comfortable about collecting their own swabs. CONCLUSIONS: The performance of the Chlamydia Rapid Test with self collected vaginal swabs indicates that it would be an effective same day diagnostic and screening tool for Chlamydia infection in women. The availability of Chlamydia Rapid Test results within 30 minutes allows for immediate treatment and contact tracing, potentially reducing the risks of persistent infection and onward transmission. It could also provide a simple and reliable alternative to nucleic acid amplification tests in chlamydia screening programmes.

Management issues in syphilis.

Syphilis is a sexually transmitted infection which is systemic from the outset and has increased in incidence worldwide over the last decade. There has been concern as to whether or not co-infection with HIV can modify the clinical presentation of syphilis and, as a genital ulcer disease, it can facilitate the transmission of HIV infection. Diagnosis is based on the microscopic identification of the causative treponeme and serological testing. Recommendations for the treatment of syphilis have been based on expert opinion, case series, some clinical trials and 50 years of clinical experience. Penicillin, given intramuscularly, is the mainstay of treatment and the favoured preparations for early infectious syphilis are benzathine penicillin as a single injection or a course of daily procaine penicillin injections for 10 to 14 days. The duration of treatment is longer for late syphilis. There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. The main alternative to penicillin is doxycycline, but the place of azithromycin and ceftriaxone is yet to be established. It is not necessary to carry out examination of the cerebrospinal fluid in patients with early infectious syphilis but it should be performed in those with neurological or ocular signs, psychiatric signs or symptoms, when there is evidence of treatment failure and in those who are co-infected with HIV. Follow-up is an essential part of management and should be particularly assiduous, for at least 24 months, in those co-infected with HIV. Partner notification should be mandatory to try to contain the spread of infection.