Perspect Biol Med 2006; 49(2): 209-19 (Read article online)

Silverstein AM, Ruggere C

In 1894, Dr. Arthur Conan Doyle wrote "The Third Generation," a short story involving the transmission of congenital syphilis from generation to generation. Analysts of his writings have interpreted the pathogenetic mechanism involved in modern terms: infection of mother by father and then transplacental infection of the fetus. However, a review of the contemporary literature and the history of the concepts of congenital and "hereditary" syphilis demonstrates that the late 19th-century understanding of the process involved a Lamarckian transmission of paternal infection, via the sperm at the moment of conception. It was undoubtedly this concept that Doyle learned in medical school in the late 1870s and that provided the background to his story.

Cancer Epidemiol Biomarkers Prev 2006 May; 15(5): 939-45 (Read article online)

Sutcliffe S, Giovannucci E, Alderete JF, Chang TH, Gaydos CA, Zenilman JM, De Marzo AM, Willett WC, Platz EA

BACKGROUND: Although several previous case-control studies have investigated associations between sexually transmitted infections (STI) and prostate cancer, most have focused on gonorrhea and syphilis, two well-recognized, symptomatic STIs. Another STI of interest for prostate carcinogenesis is trichomonosis, a less well recognized and frequently asymptomatic STI with known prostate involvement. We investigated this infection in relation to incident prostate cancer in a nested case-control study within the Health Professionals Follow-up Study. METHODS: Prostate cancer cases were men diagnosed with prostate cancer between the date of blood draw (1993-1995) and 2000 (n = 691). Controls were men who had had at least one prostate-specific antigen test and who were free of prostate cancer and alive at the time of case diagnosis. One control was individually matched to each case by age (n = 691). Serologic evidence of a history of trichomonosis was assessed by a recombinant Trichomonas vaginalis alpha-actinin IgG ELISA. RESULTS: Thirteen percent of cases and 9% of controls were seropositive for trichomonosis (adjusted odds ratio, 1.43; 95% confidence interval, 1.00-2.03). This association persisted after additional adjustment for such factors as a history of other STIs, and was strongest among men who used aspirin infrequently over the course of their lives (odds ratio, 2.05; 95% confidence interval, 1.05-4.02, P(interaction) = 0.11). CONCLUSIONS: Serologic evidence of a history of trichomonosis was positively associated with incident prostate cancer in this large, nested case-control study of male health professionals. As this study is the first, to our knowledge, to investigate associations between T. vaginalis serology and prostate cancer, additional studies are necessary before conclusions can be made. (Cancer Epidemiol Biomarkers Prev 2006;15(5):939-45).

Sex Transm Dis 2006 May 15; (Read article online)

Newman LM, Warner L, Weinstock HS

OBJECTIVE/GOAL:: The objective of this study was to identify characteristics associated with subsequent infection in patients attending a sexually transmitted disease (STD) clinic. STUDY DESIGN:: Records were retrospectively reviewed for patients from public STD clinics in 4 cities for 12 months after their initial visit to assess subsequent infection with gonorrhea, chlamydia, mucopurulent cervicitis, nongonococcal urethritis, pelvic inflammatory disease, primary or secondary syphilis, or trichomoniasis. RESULTS:: Among 64,463 patients, 33.9% had an initial STD and 7.0% had a subsequent STD. Patients with an initial STD had significantly higher probability of a subsequent STD than patients without (12.0% vs. 4.4%). A subsequent STD was significantly more likely for both sexes for those with an initial STD, who were symptomatic at initial visit, reporting exchange of sex, or under age 20 as well as for men reporting sex with men. CONCLUSIONS:: Patients with an initial STD were more likely to return with a subsequent STD. Routinely collected information such as initial diagnosis or age can help identify patients at increased risk of a subsequent STD.

Sex Transm Dis 2006 May 15; (Read article online)

Ruan Y, Cao X, Qian HZ, Zhang L, Qin G, Jiang Z, Song B, Hu W, Liang S, Chen K, Yang Y, Li X, Wang J, Chen X, Hao C, Song Y, Xing H, Wang N, Shao Y

OBJECTIVE:: The objective of this study was to investigate the prevalence and risk factors of syphilis infection among female sex workers in a southwestern Chinese city along a drug trafficking route. METHODS:: From December 2004 to January 2005, 343 female sex workers (FSWs) were recruited through community outreach and peer referring. Confidential questionnaire interviews were administered to collect information on sexual and other sexually transmitted diseases/HIV risk behaviors. Cervical and blood samples were collected to test for syphilis and HIV antibodies and Neisseria gonorrhoeae infection; Condyloma acuminatum infection was diagnosed clinically. RESULTS:: Of 343 FSWs, 15.7% were infected with syphilis. The prevalence of HIV, gonorrhea, and C. acuminatum was 0.6%, 2.0%, and 1.5%, respectively. The subtype of 2 HIV-1 infections was both CRF 07BC. Nearly 10% of FSWs reported using illicit drugs. Consistent use, inconsistent use, and never use of condoms with commercial sex clients in the last month were reported by 53.9%, 38.5%, and 7.6% FSWs, respectively. Longer duration of sex work (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.08-3.62), working at low-end establishments (OR = 2.03; 95% CI = 1.10-3.76), and if primary sex partners had sex with other women in the past 6 months (OR = 2.06; 95% CI = 1.08-3.91) were independently associated with syphilis infection. CONCLUSIONS:: High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread.

Eye Contact Lens 2006 May; 32(3): 124-127 (Read article online)

Sanchez P, Heck E, Rivera C, Sanchez A, Cavanagh HD

PURPOSE.: To identify potential medical and behavioral risk factors associated with infectious disease seropositivity in potential corneal donors using an extensive questionnaire completed by the next of kin. METHODS.: Retrospective review of medical history and behavioral risk assessment questionnaire and microbiology data for potential corneal donors seropositive for hepatitis B, hepatitis C, human immunodeficiency virus, human T-cell leukemia virus and syphilis as compared to controls. RESULTS.: Tobacco use, cigarette smoking, chest pain and heart disease are each associated with corneal donor seropositivity (P < 0.05). Vaccination in the last twelve months is inversely associated with infectious disease (P < 0.05). Statistically significant factors associated with hepatitis C positive donors include: cigarette use, illicit drug use, chest pain, cardiac medications, kidney stones and lung disease (P < 0.05). Factors most often associated with transmission of this disease panel (such as intravenous drug use, sexual contact with prostitutes and history of blood transfusion) are often not identified by the next of kin in the questionnaire. CONCLUSIONS.: While there are questionnaire identified risk factors associated with seropositivity in this study, their clinical usefulness is unclear. Many factors crucial to the elimination of potentially infectious donor tissues are not identified in the posthumous history typically completed by next of kin. These questionnaires alone do not provide exclusion criteria for elimination of potentially infectious tissues from the donor pool.

J Pak Med Assoc 2006 Jan; 56(1 Suppl 1): S17-21 (Read article online)

Baqi S, Shah SA, Baig MA, Mujeeb SA, Memon A

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention (Int J STD AIDS 1990;10:300-4).

Am J Trop Med Hyg 2006 May; 74(5): 922-5 (Read article online)

Zunt JR, LA Rosa AM, Peinado J, Lama JR, Suarez L, Pun M, Cabezas C, Sanchez J

Human T-cell lymphotropic virus type-II (HTLV-II) infection is endemic in indigenous groups in the Americas and injection drug users (IDUs) worldwide. In Peru, HTLV-II infection was previously identified in two indigenous Amazonians. We examined risk factors for HTLV-II infection in 2,703 Peruvian men who have sex with men (MSM): 35 (1.3%) were HTLV-II positive. HTLV-II infection was associated with syphilis, HSV-2 infection, unprotected receptive anal intercourse, and older age. This is the first report of HTLV-II in a non-indigenous non-IDU population in Peru. Additional studies are needed to determine if HTLV-II is a sexually transmitted infection in this and other sexually active populations.

J Clin Nurs 2006 Jun; 15(6): 735-41 (Read article online)

Bodkin C, Klopper H, Langley G

Aim. The aim of the study was to compare HIV positive and negative pregnant women with respect to maternal and neonatal outcome to inform the development of clinical practice guidelines. Background. HIV infection in pregnancy places an added burden on the physical ability of the woman's body to cope with pregnancy. As a result HIV causes an exaggeration of the problems related to pregnancy. Method. Data were collected by means of a retrospective record review conducted on 212 stratified randomly selected HIV positive and 101 matched HIV negative pregnant women. The two sample t-test and Fisher exact test were used to compare the maternal and neonatal outcomes of HIV positive and negative pregnant women. Results. HIV positive pregnant women had a significantly lower haemoglobin (10.85 vs. 11.48 g/dl; P = 0.001), attended significantly fewer antenatal clinic appointments (4.03 vs. 4.63; P = 0.04), weighed significantly less (72.07 vs. 76.69 kg; P = 0.02) and were significantly more likely to present with an abnormal vaginal discharge (32.55 vs. 24.75%; P = 0.02) than HIV negative pregnant women. The difference in the prevalence in HIV positive pregnant women of pregnancy induced hypertension (16.98 vs. 9.90%; P = 0.06), syphilis infection (5.95 vs. 0.99%; P = 0.062) and urinary tract infection (15.53 vs. 7.92%; P = 0.06) approached significance when compared with HIV negative pregnant women. HIV positive pregnant women were significantly more likely to present with intrauterine growth retardation (4.72 vs. 0%; P = 0.03), significantly more likely to deliver earlier (37.92 vs. 38.51 weeks; P = 0.03) and significantly more likely to deliver neonates weighing less (2969.98 vs. 3138.43 g; P = 0.01) than HIV negative pregnant women. Conclusion. The Department of Health attributes the high rate of HIV and AIDS related maternal morbidity and mortality in South Africa to the absence of accepted and practical guidelines for midwives' antenatal assessment and management of HIV positive pregnant women. Relevance to clinical practice. This study identifies maternal and neonatal outcomes related to HIV infection in pregnancy and provides evidence required to inform the development of clinical practice guidelines.

Tidsskr Nor Laegeforen 2006 May 11; 126(10): 1345-8 (Read article online)

Løkken P, Skoglund LA

Syphilis was previously termed "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. This role has been taken over by drugs, and this also applies to adverse drug reactions in the oral region. Accordingly, a careful drug history, including identification of any prescription, over-the-counter, or herbal medicines used, may give an important clue to the differential diagnosis of oral diseases when the aetiology is not apparent. Virtually all drugs have the potential to cause oral adverse reactions, but some have a greater ability to do so than others. Among the numerous adverse oral manifestations are xerostomia, taste disturbances and ulceration. The reactions are often non-specific, but they may mimic specific disease states such as erythema multiforme, lichen planus and pemphigus. Drug-induced gingival hyperplasia is an example of a quite characteristic and easily recognisable oral side effect. This article briefly describes some of the presentations and mechanisms of oral manifestations of drug therapy and the drugs that most commonly are responsible. Just like approved pharmaceuticals, herbal medicines are also associated with adverse oral manifestations. Finally we comment on some of the more recent reports on osteonecrosis of the jaws associated with the use of bisphosphonates.

J Pak Med Assoc 2006 Jan; 56(1 Suppl 1): S60-5 (Read article online)

Rehan N

BACKGROUND: To evolve effective prevention and efficient treatment strategies for sexually transmitted infections (STIs) in a country, comprehensive understanding of the prevalent STI and their modes of transmission is needed. The aim of this present study was to generate such data for Pakistan. METHODS: The study was conducted between June 1999 and September 1999 in four provincial capitals. In each city, data was collected from one or more teaching hospitals and a number of general practitioners. During this period, 465 men suffering from STIs were interviewed. RESULTS: The mean age of study population was 31.9 +/- 8.6 years, 60% were married, 58.3% urbanites, 81.7% living with their families and 83.3% smokers. Only 10.5% were drug addicts. Out of 465 cases, 27.5% cases had gonorrhea, 31.6% syphilis, 17.2% chancroid, 18.3% herpes, 5.2% chlamydial infections while only one case (0.2%) was HIV positive. Most men (55%) acquired the infection heterosexually, 11.6% through homosexuality, 18.4% through bisexual relations and 2 men (0.5%) reported bestiality. Among 78.1% of those contracting the infection heterosexually, the source of infection was a sex worker. None acquired infection through his wife. The knowledge about STIs was very poor. Wrong notions were prevalent. CONCLUSIONS: The pattern of STIs is different from developed countries. Those acquiring STIs in Pakistan were older, married and living with their families whereas in developed countries most men acquiring STIs are younger, unmarried and living alone.

Tumori 2006 Jan-Feb; 92(1): 79-82 (Read article online)

Saftic M, Batinac T, Zamolo G, Coklo M, Simat M, Mustac E, Bosnar A, Grahovac B

Keratoacanthoma (KA) is a clinically distinct, rapidly growing lesion that generally presents as a solitary crateriform nodule in sun-exposed areas in elderly, fair-skinned individuals. A KA larger than 20-30 mm is referred to as giant keratoacanthoma, a relatively rare lesion especially in young patients. Such lesions grow rapidly with possible destruction of underlying tissues. In addition to ultraviolet exposure, KAs have also been associated with chemical carcinogens, chemical peels, genetic factors, chronic skin conditions that produce scarring, trauma and thermal burns. Immunosuppressed patients, especially after transplantation, also develop KAs. A viral etiology has been suggested but not confirmed. We encountered a case of giant keratoacanthoma (greater than 50 mm in diameter) with induration of underlying structures on the upper lip of a 39-year-old male sailor. The patient reported sudden appearance and rapid enlargement of the lesion in only three weeks. Biopsy of the cutaneous lesion and the characteristic clinical history suggested the diagnosis of keratoacanthoma. Total excision with primary closure of the defect by a nasolabial advancement flap was performed. Histological examination of the tumor mass confirmed the diagnosis of KA with infiltrative growth and perineural invasion. Immunosuppression was excluded by blood analyses, as were HIV, syphilis and hepatitis infections. Only low-risk genital HPV type 6 was detected in the lesion, suggesting a possible cocarcinogenic effect of HPV and UV light in a chronically sun-exposed patient.

J Pak Med Assoc 2006 Jan; 56(1 Suppl 1): S31-3 (Read article online)

Khandwalla HE, Luby S, Rehman S

OBJECTIVES: To determine the knowledge, attitudes and practices regarding diagnosis and treatment of sexually transmitted infections (STIs) among specialists that is, dermatologist, gynecologists and urologists and general practitioners (GPs) in Karachi, Pakistan. METHODS: Interviewers administered structured questionnaires to doctors conducting outpatient clinics at tertiary hospitals and/or private clinics in Karachi. All private clinics within a 10 km radius of the Aga Khan University and all tertiary hospitals having more than 100 inpatient beds were included in the study. RESULTS: One hundred doctors (54 specialists and 46 GPs) responded. Eighty doctors reported seeing at least one STI patient/month. The most commonly diagnosed STI the doctors reported was urethritis/cervicitis syndrome. 50% of the doctors knew the recommended antibiotics for gonorrhea though only 46% of these knew the correct dosage. Specialists were three times more likely to recognize the clinical presentation of herpes and twice as likely to treat chlamydia, syphilis and herpes with appropriate antimicrobials than GPs. 85% of the doctors advised their STI patients regarding condom usage; 36% thought that STI patients had loose sexual morals, 43% believed STI patients were drug addicts. Over 90% of the physicians were willing to attend educational sessions and follow a national STI treatment protocol. CONCLUSION: Doctors in Karachi, especially GPs, are deficient in appropriately managing and counseling STI patients. Among the specialists, urologists and dermatologists were more likely to manage STIs correctly than gynecologists. Karachi doctors should be educated in the correct management and counseling of STIs to prevent further spread of STIs including AIDS (Sex Transm Inf 2000;76:383-85).

Klin Mikrobiol Infekc Lek 2006 Apr; 12(2): 63-68 (Read article online)

Rozsypal H, Staňková M, Machala L, Bru�ová M

Goal: To assess the efficacy of prophylactic measures intended to reduce vertical transmission of HIV infection and to evaluate the predictive value of demographic, immunological and virological factors for determination of the risk of HIV transmission to fetus and neonate. Methods: 56 pregnancies of 53 HIV-positive women were included in this retrospective study. The women have been in the care of the AIDS Centre of the Dpt. of Infectious Diseases, University Hospital Na Bulovce over the past 15 years. Cellular immunity tests and HIV RNA viral load in all subjects were regularly determined. In line with our present knowledge and the patients compliance, we introduced prophylactic measures, which included the administration of antiretroviral agents, delivery by Caesarean section and breast-feeding avoidance. 58 children were born from these pregnancies and repeated blood tests were performed to detect the presence or absence of HIV RNA. Results: 58 infants were born from 56 pregnancies-and 3 of them (5.17%) were infected with HIV. In two mothers, we diagnosed HIV positivity few hours before delivery; another woman was diagnosed early, however, the failure of treatment was due to her insufficient compliance. In addition, premature amniorrhoea was present in two women. Moreover, one of them presented with untreated syphilis. The other 55 children stayed uninfected. In six of them, however, prophylactic measures were not fully followed, mainly because the patients disregarded them. Conclusions: The study fully confirms the high efficacy of prophylactic measures, which substantially reduce the risk of vertical transmission of HIV infection. Routine blood tests are neccessary in all pregnant women by law. The failure of prophylaxis is in most cases due to inadequate compliance with the treatment. However, we cannot rule out the possible resistance to antiretroviral agents. Key words: HIV infection, vertical transmission, pregnancy, prophylaxis, zidovudine, Caesarean section.

J Acquir Immune Defic Syndr 2006 Apr 15; 41(5): 671-4 (Read article online)

Sirivongrangson P, Bollen LJ, Chaovavanich A, Suksripanich O, Jirarojwat N, Virapat P, Charoenwatanachokchai A, Lokpichat S, Pobkeeree V, Chantharojwong N, Supawitkul S, Tappero JW, Levine WC

OBJECTIVES: As Thailand scales up its antiretroviral treatment program, the role of sexually transmitted infection (STI) services to prevent HIV transmission has not been addressed. We provided STI services for HIV-infected women as a component of HIV care and assessed STI prevalence and risk behaviors. METHODS: HIV-infected women attending an infectious disease clinic and an STI clinic in Bangkok were screened for the presence of genital ulcers by visual inspection, for gonorrhea and chlamydial infection by polymerase chain reaction, for trichomoniasis by wet mount, and for syphilis by serology. Women were asked about sexual risk behavior and use of antiretroviral treatment. Risk-reduction counseling, condoms, and STI treatment were provided. RESULTS: Two-hundred ten HIV-infected women at an infectious disease clinic (n = 150) and an STI clinic (n = 60) received STI services from July 2003 through February 2004. The prevalence for any STI was 8.0% at the infectious disease clinic and 30.0% at the STI clinic (P < 0.01). Of the 116 (55.2%) sexually active women, 42 (36.2%) reported sex without a condom during the last 3 months. Women receiving antiretroviral treatment reported condom use during last sex more often compared with those not receiving antiretroviral treatment (82.2% vs. 58.8%; P = 0.03). CONCLUSION: STIs and sexual risk behavior were common among these HIV-infected women, and STI services for HIV-infected persons have been expanded to more clinics in Thailand. Further analysis of HIV transmission risk is necessary for developing a national strategy for prevention of HIV transmission among HIV-infected persons.

Acta Neurochir Suppl 2006; 96: 91-6 (Read article online)

Nanda A, Vannemreddy P, Willis B, Kelley R

BACKGROUND: Cocaine and other vasoactive substances are known causes of cerebrovascular disease. Ictus during drug intake adversely affects outcome. MATERIALS AND METHODS: A retrospective review revealed 42 patients with cocaine abuse and stroke. Aneurysmal bleed occurred in 15 patients; the rest had stroke. The outcome of stroke because of cocaine intoxication was analyzed. RESULTS: Mean age for stroke was 38 (+/- 8.5 SD) years; males out-numbered females (20 : 7) similar to the pattern seen in subarachnoid hemorrhage (SAH) following aneurysm rupture. Nine had intracerebral hematomas, 6 had SAH with intracerebral hemorrhage (ICH)/ infarct, I had transverse myelopathy. Transient ischemic attack was identified in 4. Carotid occlusion was found in 2, and slow-flow in the vertebrobasilar system in 1. Fifteen were known hypertensives. Cocaine was the principal substance in all patients; 7 used other substances including marijuana and heroin. Three patients had HIV, 3 had hepatitis, 2 had syphilis, and 1 had tuberculosis. Urinalysis was positive for cocaine metabolites in 15; 2 had late analysis. Nine had ICH or SAH with poor neurological status at admission and died. Cocaine intoxication correlated with fatal cerebrovascular accident (CVA) (p < 0.001) and poor Glasgow Outcome Score (GOS) (p < 0.001). CONCLUSION: Stroke and cocaine use correlated with fatal CVA and poor outcome. Prompt diagnostic intervention may reveal the incidence of CNS injury with cocaine abuse.

An Sist Sanit Navar 2006 Jan-Apr; 29(1): 13-26 (Read article online)

Castilla J, Sobrino P, Lorenzo J, Moreno C, Izquierdo A, Lezaun M, López I, Núñez D, Perucha M, R'kaina Liesfi C, Zulaika D

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time.

Arch Iran Med 2006 Apr; 9(2): 153-5 (Read article online)

Vahdani P, Hosseini-Moghaddam SM, Gachkar L, Sharafi K

Street children are among vulnerable people in the world. They are one of the main groups in the society who affect the pattern of health. To determine the prevalence of hepatitis B, hepatitis C, human immunodeficiency viruses (HIV), and syphilis among street children residing in southern Tehran, Iran. In a cross-sectional study, we selected 102 children aged below 15 years from southern Tehran. The selected children had an interview and were examined. From each child a blood sample was taken and tested for anti-HIV (ELISA), anti-HCV (ELISA), HBsAg (ELISA), anti-HBs, anti-HBc (radioimmunoassay [RIA]), rapid plasma reagin (RPR), and fluorescent treponema antibody absorption (FTA-ABS). We studied 39 (38%) boys and 63 (62%) girls, including 79 (77%) Afghan and 16 (16%) Iranian children. The nationality of 8 children could not be identified. The children were negative for syphilis, HIV, and HCV. Nevertheless, 3 of them were positive for HBsAg and 15 were HBsAb positive (>10 MIU/mL). The majority of street children are immigrants. Although these children did not have syphilis, HIV, and HCV, they are at risk of HBV.

Am J Med 2006 May; 119(5): 448.e21-5 (Read article online)

Balba GP, Kumar PN, James AN, Malani A, Palestine AG, Welch JN, Timpone JG

BACKGROUND: From October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic. METHODS: We conducted a retrospective chart and patient database review. RESULTS: From 1997 to 2002, 455 patients in our clinic were screened for syphilis; 320 were screened from 2001 to 2002; 7.3% of patients (33/455) were diagnosed with syphilis. During the past year, syphilis was diagnosed in 7.5% of patients (24/320), of whom 13% (3/24) had ocular syphilis. We estimate the prevalence of ocular syphilis in HIV+ patients on highly active antiretroviral therapy screened for syphilis to be 9% (3/33). Presenting symptoms included blurred vision, loss of vision, central scotomas, and bilateral ocular involvement. The most common ocular manifestation of syphilis was posterior chamber uveitis; one patient also had a retinal detachment. All patients demonstrated reactive rapid plasma reagin and fluorescent treponemal antibody absorption test results, cerebrospinal fluid pleocytosis, and elevated total protein. Each patient received a 21-day course of intravenous penicillin G (24 million units daily) with improvement of visual symptoms. CONCLUSION: Our data demonstrate an unexpectedly high incidence of ocular syphilis in our HIV+ patients receiving highly active antiretroviral therapy during the past year. A diagnosis of ocular syphilis should be considered in any HIV+ patient who presents with visual symptoms, irrespective of the patient's CD4 count.

Klin Mikrobiol Infekc Lek 2006 Apr; 12(2): 44-50 (Read article online)

Zákoucká H, Křemenová S, Křemen J

Since 1990 there is an upward trend in the incidence of both acquired and congenital syphilis in the Czech Republic. A similar situation exists in other European countries as well. Higher incidence of syphilis is clearly associated with urban agglomerations and sexual tourism destinations. The only way to reduce the number of cases is a consistent application of mandatory preventive and diagnostic measures. These important measures against the spreading of the infection include mandatory serological testing of pregnant women and newborns (from umbilical blood), antibiotic treatment and systematic follow-up of HIV-positive mothers and children. This paper describes the current epidemiological situation of syphilis in the Czech Republic and presents a review of available diagnostic tests and their significance for diagnosis. Key words: syphilis, congenital syphilis, incidence, direct tests, indirect tests.

Arch Esp Urol 2006 Mar; 59(2): 189-92 (Read article online)

Jalón Monzón A, San Martín Blanco A, García Rodríguez J, Martín Benito JL, Rodríguez Faba O, González Alvarez RC, Alvarez Múgica M, Rodríguez Robles L, Regadera Sejas FJ

OBJECTIVES: Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia. METHODS/RESULTS: 51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study. CONCLUSIONS: The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.