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.
Agglutination ; Automation ; Budgets ; Epidemiology ; Female ; Humans ; Immunoassay ; Latex ; Male ; Mass Screening* ; Plasma ; Syphilis* ; Syphilis, Latent ; Treponema pallidum

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.
Anti-Bacterial Agents ; Cornea ; Diagnosis ; Doxycycline ; Edema ; Female ; Fluorescent Treponemal Antibody-Absorption Test ; Humans ; Immunoglobulin G ; Keratitis* ; Patient Rights ; Serologic Tests ; Sexually Transmitted Diseases ; Slit Lamp ; Steroids ; Syphilis* ; Syphilis, Latent ; Treponema pallidum ; Vision Disorders ; Visual Acuity ; Young Adult

No abstract available.
Serologic Tests* ; Syphilis, Latent*

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.
Brain ; Brain Neoplasms ; Ceftriaxone ; Dysarthria ; Exanthema ; Female ; Fever ; Humans ; Immunoglobulin G ; Neurosyphilis ; Recurrence ; Skin ; Syphilis ; Syphilis, Latent ; Thorax

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.
Absorption ; Anterior Chamber ; Antibodies, Monoclonal, Humanized ; Chorioretinitis ; Communicable Diseases ; Eye ; Female ; Humans ; Penicillins ; Recurrence ; Retinaldehyde ; Serologic Tests ; Sexually Transmitted Diseases ; Syphilis ; Syphilis, Latent ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab

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.
Humans ; Incidence ; Korea ; Penicillins ; Prevalence ; Public Health ; Skin ; Syphilis ; Syphilis, Latent ; Treatment Failure

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.
Amyloidosis ; Colon ; Dilatation ; Duodenum ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Jejunum ; Laparoscopy ; Middle Aged ; Rectum ; Serum Amyloid A Protein ; Stomach ; Syphilis ; Syphilis, Latent

OBJECTIVETo summarize the clinical features and analyze the serologic test results of latent syphilis.

METHODSThe 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.

RESULTSOf 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).

CONCLUSIONEducation and awareness raising on syphilis should be strengthened to lower the prevalence of latent syphilis.

Adult ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syphilis, Latent ; blood ; diagnosis ; immunology ; therapy ; Young Adult

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.
Age Distribution ; Humans ; Incidence ; Prevalence ; Skin ; Syphilis ; Syphilis, Latent

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.
Alopecia ; Chronic Disease ; Female ; Humans ; Incidence ; Korea ; Male ; Prevalence ; Retrospective Studies ; Skin ; Syphilis ; Syphilis, Cutaneous ; Syphilis, Latent ; Treponema pallidum