The Critical Need to Modernize Syphilis Screening

Tuddenham, Susan; Ghanem, Khalil G.

doi:10.1001/jama.2022.15227

Cited by 3 publications

(2 citation statements)

References 17 publications

(18 reference statements)

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“…The extent of sexually risky behaviour over time is the strongest risk factor for repeated syphilis episodes when compared to other indicators (antiretroviral regimen or immunological status) [26]. The identification of at-risk adults and adolescents is crucial to improve syphilis screening strategies, as recommended by the latest USPSTF (US Preventive Services Task Force) statements [27][28][29]. While the interpretation of the indirect methods for syphilis diagnosis is relatively straightforward in patients without a prior history of syphilis, it becomes more complex in the case of reinfections, as treponemal antibodies mostly remain positive for their entire life cycle, tests lack sensitivity in early infection (as well as when patients are contagious), and non-treponemal titres often lead to difficult-to-interpret serological responses after treatment [29].…”

Section: Discussionmentioning

confidence: 99%

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study

Marchese

Tiecco

Storti

et al. 2022

JCM

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Background: Syphilis infection does not confer definitive and protective immunity against reinfection, and crucial aspects of repeated episodes of syphilis are far from being understood, especially among people living with HIV (PLWH). Methods: In order to explore the burden of syphilis in a large cohort of HIV-negative patients and PLWH, this retrospective study describes the demographics, clinical presentation and treatment outcome of patients with syphilis treated at our clinic from 2013 to 2021. Results: Within the study period, 1859 syphilis episodes (827, 44.5% first infections and 1032, 55.5% reinfections) were recorded. A total of 663 patients, of whom 347 (52%) had PLWH, were considered. Syphilis was mostly diagnosed in males (77%) and European (79%) patients. More than half of syphilis episodes were recorded during the late latent stage (64%) or during follow-up/screening visits for other diseases, while symptomatic stages led to a diagnosis in almost half of HIV-negative patients (p < 0.001). PLWH with syphilis infection were predominantly homo/bisexual (p < 0.001). A significantly higher rate of syphilis reinfection was observed in PLWH, who also demonstrated a higher range of subsequent episodes. The serofast state was found to be similar at the 6- and 12-month follow-up visits. The multivariate analysis carried out in the HIV-positive group showed that an RPR titre >1:16 was an independent predictor for serological non-response. Conclusions: Syphilis reinfections are predominantly diagnosed in HIV-positive MSM. The high rate of asymptomatic presentation among PLWH supports the role of periodical syphilis screening. In PLWH, the only baseline factor associated with an increased risk of non-response was an RPR titre >1:16, while assessment at 12 months after treatment increased the possibility of detecting a serological response, indicating that PLWH have a slower serological response to treatment.

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Section: Discussionmentioning

confidence: 99%

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study

Marchese

Tiecco

Storti

et al. 2022

JCM

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“…There were 24 cases of syphilis in pregnant women at the WRSU in 2022, representing 15.9% of all female syphilis cases and 6% of all patients with a positive pregnancy test over the same period. Although syphilis in pregnancy and among women of childbearing age has increased nationally, 1,22 it is difficult to find data comparing percentage of women with positive pregnancy tests and new syphilis cases nationally or in other jurisdictions. The rates of syphilis in pregnancy at the WRSU are similar to what was reported during an outbreak from 2013 to 2015 in an Arizona reservation 14 …”

Section: Discussionmentioning

confidence: 99%

Integrated Response to Address a Resurgent Syphilis Epidemic in a Rural American Indian Community, Whiteriver, Arizona, January 2022 to June 2023

Close,

Weigle,

Thompson

et al. 2023

Sexual Trans Dis

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Background The United States has seen a significant rise in syphilis over the past twenty years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic. Methods We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of over 18,000. Testing data was extracted from 2017-2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and non-parametric methods where appropriate. Results Among 5,888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women ages 30-34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%) and no congenital syphilis cases during the observation period. Conclusions We observed significantly elevated syphilis rates in AI/AN persons compared to the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables and our experience may serve as a model to other communities.

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Determinantes sociais de saúde relacionados ao desfecho de sífilis congênita: regressão logística

Ferreira,

De Melo,

Alves

2024

Rev enferm UFPE on line

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Objetivo: Verificar se determinantes sociais de saúde de genitoras são preditores do desfecho de sífilis congênita de recém-nascidos. Método: Estudo transversal, realizado em maternidade de nível terciário, que incluiu os casos notificados de sífilis congênita no Sistema Nacional de Agravos de Notificação, entre os anos de 2012 e 2017. A coleta de dados ocorreu em janeiro de 2018 e excluiu os casos em que a sífilis congênita foi descartada durante a investigação. Realizou-se regressão logística binária para investigar em que medida o desfecho de sífilis congênita (óbito ou vivo) poderia ser adequadamente previsto pelos determinantes sociais de saúde, conforme o modelo de Dalhgreen e Whitehead. Resultados: O modelo da regressão logística foi estatisticamente significativo, capaz de prever adequadamente 96,1% dos desfechos. O modelo final da regressão incluiu quatro variáveis, todavia, destas, apenas a variável idade teve relação estatisticamente significante (p=0,013), demonstrando que um ponto no escore da idade da genitora eleva 1.145 vezes as chances de o recém-nascido evoluir para óbito por sífilis congênita. Conclusão: Dentre os determinantes sociais de saúde investigados, a idade mais avançada da genitora foi a variável com maior chance de predizer um desfecho negativo de sífilis congênita.

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The Critical Need to Modernize Syphilis Screening

Cited by 3 publications

References 17 publications

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study

Integrated Response to Address a Resurgent Syphilis Epidemic in a Rural American Indian Community, Whiteriver, Arizona, January 2022 to June 2023

Determinantes sociais de saúde relacionados ao desfecho de sífilis congênita: regressão logística

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