Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology - an infrequent but important laboratory phenomenon

Sexual Health ◽  
2012 ◽  
Vol 9 (5) ◽  
pp. 488 ◽  
Author(s):  
Jeffrey J. Post ◽  
Candice Khor ◽  
Virginia Furner ◽  
Don E. Smith ◽  
L. Ross Whybin ◽  
...  
Keyword(s):  
Previous History ◽  
Treponema Pallidum ◽  
Delayed Diagnosis ◽  
Secondary Syphilis ◽  
Serum Samples ◽  
Syphilis Infection ◽  
Reactive Sample ◽  
Assay Result ◽  
History Of ◽  
Prozone Phenomenon

Background Treponema pallidum specific serology generally remains reactive for life. Therefore, the diagnosis of syphilis reinfection relies on clinical assessment and nontreponemal (reagin) serologic testing. The prozone phenomenon can lead to a falsely nonreactive rapid plasma reagin (RPR) assay result. Methods: We report a case of secondary syphilis in a HIV infected patient with a previous history of syphilis infection, where a falsely nonreactive RPR assay was associated with a delayed diagnosis of reinfection and infectious syphilis. The prozone phenomenon was detected in several of the patient’s serum samples collected around this time. We subsequently undertook a prospective evaluation for the prozone phenomenon in 3222 consecutive sera, which were assayed using the RPR assay for clinical purposes over a 10-month period. Results: The overall rate of the prozone phenomenon was 2 out of 3222 samples (0.06%; 95% confidence interval (CI): 0.02–0.22%) and the rate per reactive sample was 2 out of 397 (0.5%; 95% CI: 0.14–1.81%). Conclusion: Clinicians should request RPR testing at dilutions of sera when syphilis is suspected clinically and the RPR assay is nonreactive.

scholarly journals Syphilitic Balanitis of Follmann: Laboratory Pitfalls

2020 ◽  
Vol 78 (3) ◽  
pp. 265-268
Author(s):  
Filipa Tavares Almeida ◽  
Filomena Azevedo ◽  
Carmen Lisboa
Keyword(s):  
Infected Patient ◽  
False Negative ◽  
Previous History ◽  
Syphilis Infection ◽  
Flocculation Test ◽  
History Of ◽  
Antibody Titers ◽  
Lattice Network ◽  
Antigen Antibody ◽  
Prozone Phenomenon

We report a case of early syphilis, presenting as balanitis and papular syphilides in an HIV-infected patient, with a previous history of syphilis infection, which demonstrated a false negative VDRL testing due to a prozone phenomenon. This false negative response results from overwhelming antibody titers, which interfere with the proper formation of the antigen-antibody lattice network, necessary to visualize a positive flocculation test.

scholarly journals Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

2021 ◽  
Vol 12 (e) ◽  
pp. 1-3
Author(s):  
Hafssa Chehab ◽  
Bertrand Richert
Keyword(s):  
Hair Loss ◽  
Previous History ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Laboratory Evaluation ◽  
History Of ◽  
High Level

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

Treponemal infection rates, risk factors and pregnancy outcome in a rural area of Senegal

2003 ◽  
Vol 14 (3) ◽  
pp. 208-215 ◽  
Author(s):  
Emmanuel Lagarde ◽  
Emmanuelle Guyavarch ◽  
Jean-Pierre Piau ◽  
AÏssatou Gueye-Ndiaye ◽  
Karim Seck ◽  
...  
Keyword(s):  
Treponema Pallidum ◽  
Population Based ◽  
Cross Sectional Study ◽  
High Rate ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of ◽  
Treponemal Infection ◽  
Active Syphilis

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved.

Unusual presentation of secondary syphilis: membranoproliferative glomerulonephritis andmuco-cutaneous lesions

2017 ◽  
Vol 29 (4) ◽  
pp. 410-413 ◽  
Author(s):  
Linda Tognetti ◽  
Elisa Cinotti ◽  
Sergio Tripodi ◽  
Guido Garosi ◽  
Pietro Rubegni
Keyword(s):  
Membranoproliferative Glomerulonephritis ◽  
Congenital Syphilis ◽  
Renal Involvement ◽  
Treponema Pallidum ◽  
Membranous Glomerulonephritis ◽  
Secondary Syphilis ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Cutaneous Manifestations ◽  
Nephritic Syndrome

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected.

scholarly journals Characterization and Serologic Analysis of the Treponema pallidum Proteome

2010 ◽  
Vol 78 (6) ◽  
pp. 2631-2643 ◽  
Author(s):  
Melanie A. McGill ◽  
Diane G. Edmondson ◽  
James A. Carroll ◽  
Richard G. Cook ◽  
Ralph S. Orkiszewski ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Immunoblot Analysis ◽  
Serum Samples ◽  
Syphilis Infection ◽  
Two Dimensional Gel Electrophoresis ◽  
Ionization Time ◽  
Sexually Transmitted ◽  
Human Sera

ABSTRACT Treponema pallidum subsp. pallidum is the causative agent of syphilis, a sexually transmitted disease characterized by widespread tissue dissemination and chronic infection. In this study, we analyzed the proteome of T. pallidum by the isoelectric focusing (IEF) and nonequilibrating pH gel electrophoresis (NEPHGE) forms of two-dimensional gel electrophoresis (2DGE), coupled with matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis. We determined the identity of 148 T. pallidum protein spots, representing 88 T. pallidum polypeptides; 63 of these polypeptides had not been identified previously at the protein level. To examine which of these proteins are important in the antibody response to syphilis, we performed immunoblot analysis using infected rabbit sera or human sera from patients at different stages of syphilis infection. Twenty-nine previously described antigens (predominantly lipoproteins) were detected, as were a number of previously unidentified antigens. The reactivity patterns obtained with sera from infected rabbits and humans were similar; these patterns included a subset of antigens reactive with all serum samples tested, including CfpA, MglB-2, TmpA, TmpB, flagellins, and the 47-kDa, 17-kDa, and 15-kDa lipoproteins. A unique group of antigens specifically reactive with infected human serum was also identified and included the previously described antigen TpF1 and the hypothetical proteins TP0584, TP0608, and TP0965. This combined proteomic and serologic analysis further delineates the antigens potentially useful as vaccine candidates or diagnostic markers and may provide insight into the host-pathogen interactions that occur during T. pallidum infection.

scholarly journals Imunopatogenesis Treponema pallidum dan Pemeriksaan Serologi

2014 ◽  
Vol 3 (3) ◽  
Author(s):  
Efrida Efrida ◽  
Elvinawaty Elvinawaty
Keyword(s):  
Clinical Symptoms ◽  
Early Stage ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Major Health Problem ◽  
Sexually Transmitted ◽  
Tertiary Syphilis ◽  
History Of ◽  
Latent Syphilis

AbstrakSifilis adalah penyakit menular seksual yang sangat infeksius, disebabkan oleh bakteri berbentuk spiral, Treponema pallidum subspesies pallidum. Penyebaran sifilis di dunia telah menjadi masalah kesehatan yang besar dengan jumlah kasus 12 juta pertahun. Infeksi sifilis dibagi menjadi sifilis stadium dini dan lanjut. Sifilis stadium dini terbagi menjadi sifilis primer, sekunder, dan laten dini. Sifilis stadium lanjut termasuk sifilis tersier (gumatous, sifilis kardiovaskular dan neurosifilis) serta sifilis laten lanjut. Sifilis primer didiagnosis berdasarkan gejala klinis ditemukannya satu atau lebih chancre (ulser). Sifilis sekunder ditandai dengan ditemukannya lesi mukokutaneus yang terlokalisir atau difus dengan limfadenopati. Sifilis laten tanpa gejala klinis sifilis dengan pemeriksaan nontreponemal dan treponemal reaktif, riwayat terapi sifilis dengan titer uji nontreponemal yang meningkat dibandingkan dengan hasil titer nontreponemal sebelumnya. Sifilis tersier ditemukan guma dengan pemeriksaan treponemal reaktif, sekitar 30% dengan uji nontreponemal yang tidak reaktifKata kunci: sifilis, Treponema pallidum, serologiAbstractSyphilis is a sexually transmitted disease that is highly infectious, caused by a spiral -shaped bacterium, Treponema pallidum subspecies pallidum. The spread of syphilis in the world has become a major health problem and the common, the number of 12 million cases per year. Infectious syphilis is divided into early and late-stage syphilis. Early-stage syphilis is divided into primary, secondary, and early latent. Advanced stage of syphilis include tertiary syphilis (gumatous, cardiovascular syphilis, and neurosyphilis) and late latent syphilis. Primary syphilis is diagnosed by clinical symptoms of the discovery of one or more chancre (ulcer). Secondary syphilis is characterized by the finding of localized mucocutaneous lesions or with diffuse lymphadenopathy. Latent syphilis without clinical symptoms of syphilis with a nontreponemal and treponemal reactive examination, history of syphilis therapy in nontreponemal test titer increased compared with the results of previous nontreponemal titers. Tertiary syphilis is found guma with reactive treponemal examination, approximately 30% of the non- reactive nontreponemal testKeywords: syphilis, Treponema pallidum, serologi

scholarly journals Assessment of syphilis infection among pregnant women and its associated risk factors at Sovu health center in Rwanda

2020 ◽  
Vol 1 (3) ◽  
Author(s):  
Augustin Nshimiyimana ◽  
Joseph Mucumbitsi ◽  
Callixte Yadufashije ◽  
Francois N. Niyonzima
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Health Center ◽  
Sexual Behaviors ◽  
Treponema Pallidum ◽  
Health Concern ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of ◽  
Associated Risk Factors

Syphilis in pregnant women caused by Treponema pallidum remains a major cause of reproductive morbidity and poor pregnancy outcomes in developing countries. Severe neonatal infections, stillbirths, perinatal deaths, and low birth weight babies are common among mothers with syphilis infection. The aim of the study was to assess the prevalence and risk factors associated to syphilis in pregnant women. A cross-sectional and retrospective studies were conducted among pregnant women who attended the prenatal service at the Gisovu health center. Participants were pregnant women who tested positive for syphilis based on lab results and responses collected from anonymous questionnaires completed with sexual behaviors, demographics, sexual partners, history of abortion, and knowledge about STDs. The prevalence of syphilis was 5.74%. Syphilis was associated to the history of previous abortion (P = 0.005 < 0.05), a low level of education (P = 0.049 < 0.05), and marital status (P = 0.044 < 0.05). The main associated behavioral factor was women who had sex with different partners using condom and did not acquire syphilis infection (P = 0.00 < 0.05). Syphilis is still a public health concern in patients and especially in pregnant women as shown by the findings of this study. It is very important to screen all pregnant women for syphilis and to strengthen the existing antenatal care services and health education on transmission and prevention of the disease.

Treponema pallidum PCR testing for diagnosis of mucocutaneous ulcers suspicious for syphilis

2021 ◽  
pp. sextrans-2021-055192
Author(s):  
Muhammad Hyder Junejo ◽  
Mark Collery ◽  
Gary Whitlock ◽  
Alan McOwan ◽  
Victoria Tittle ◽  
...  
Keyword(s):  
Demographic Data ◽  
Treponema Pallidum ◽  
Added Value ◽  
Contact Tracing ◽  
Bisexual Men ◽  
Electronic Patient Records ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

scholarly journals Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
R. M. Ngwanya ◽  
B. Kakande ◽  
N. P. Khumalo
Keyword(s):  
Past History ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Rapid Progression ◽  
Tertiary Syphilis ◽  
History Of ◽  
Generalized Lymphadenopathy ◽  
Immunodeficiency Syndrome ◽  
Cluster Of Differentiation

Background. Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation. A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion. Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.

scholarly journals Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Robert Jame ◽  
Yousif Al-Saeigh ◽  
Leo L. Wang ◽  
Kevin Wang
Keyword(s):  
Undetectable Viral Load ◽  
Secondary Syphilis ◽  
Warning Signs ◽  
Penicillin G ◽  
Hiv Positive ◽  
Ocular Infection ◽  
Blurred Vision ◽  
Syphilis Infection ◽  
Transmitted Infection ◽  
History Of

Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.

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