These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.
Cellular migration, over simple surfaces or through complex stromal barriers, requires coordination between detachment/re-adhesion cycles, involving structural components of the extracellular matrix and their surface-binding elements (integrins), and the precise regulation of the pericellular proteolytic microenvironment. It is now apparent that several proteases and protease inhibitors, most notably urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type-1 (PAI-1), also interact with several cell surface receptors transducing intracellular signals that significantly affect both motile and proliferative programs. These events appear distinct from the original function of uPA/PAI-1 as modulators of the plasmin-based proteolytic cascade. The multifaceted interactions of PAI-1 with specific matrix components (i.e., vitronectin), the low-density lipoprotein receptor-related protein-1 (LRP1), and the uPA/uPA receptor complex have dramatic consequences on the migratory phenotype and may underlie the pathophysiologic sequalae of PAI-1 deficiency and overexpression. This paper focuses on the increasingly intricate role of PAI-1 as a major mechanistic determinant of the cellular migratory phenotype.
HIV-positive patients: Treat as appropriate for stage of infection, that is, HIV-positive patients are treated with the same regimens as HIV-negative patients † Management of sexual partners: Recognition that partner notification may be difficult in context of current syphilis outbreaks and achieving 60% partner notification rates is not always possible and screening in high-risk venues may be appropriate. † Auditable outcomes: Measuring rapid plasma reagin test (RPR)/Venereal Diseases Research Laboratory (VDRL) at commencement of therapy introduced as an auditable outcome. † Appendices:-Reference to sources of procaine penicillin G-Use of lidocaine as diluent for Benzathine penicillin G DIAGNOSIS History and examination † Symptoms of early syphilis † Details of previous treatment (place of treatment, diagnosis made, treatment given, RPR/VDRL titre at discharge) † Obstetric history, potential complications of syphilis e.g. miscarriages, stillbirths † Blood donation and antenatal screening history † Other treponemal infections; yaws, pinta and a history of living in countries where these conditions are endemic † In early infection examination of the genitals, skin, mucosal surfaces and lymph nodes for signs of primary and secondary syphilis. † In late and congenital syphilis a thorough clinical examination should be undertaken for the clinical manifestations of syphilis. This should include a full systems review including skin and mucosal surfaces, lymph nodes, cardiovascular and neurological systems.
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