A case of syphilis with an extremely high RPR titer

It remains unidentified why this patient has an extremely high Rapid Plasma Reagin Titer (RPR) 1: 2048. A false positive result was ruled out by a Treponemal test. To ensure accuracy, repeat tests were requested for both the Non-Treponemal and Treponemal Tests in the same laboratory, and the results came back the same. In the Traditional Algorithm, Positive Nontreponemal Syphilis screening tests are confirmed by Treponemal tests, although the latter is not quantitative. The lack of full sensitivity in the Traditional Algorithm Testing has led the CDC and some other centers to adopt Reverse Sequence Testing. The resurgence of syphilis after 20 years could lead to mutagenic strain thus making it relevant for a need for heightened awareness.

Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series

Background Despite an otherwise robust national antenatal clinic program, maternal and congenital syphilis remains an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with congenital syphilis in Lusaka, Zambia. Case presentations The cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using rapid plasma reagin test. From a cohort of 214 mother–infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, four (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive rapid plasma reagin test result. The mean age at diagnosis was 4.5 months (1.3 months standard deviation), and the common presenting features included coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and underweight (5/7). Three of the seven infants were exposed to human immunodeficiency virus. Following diagnosis, all seven cases received standard treatment according to national treatment guidelines. That is, 6/7 cases received inpatient care with benzylpenicillin for 10 days, while 1/7 was treated as an outpatient and received daily procaine penicillin for 10 days. Conclusion These findings suggest that, though screening for syphilis is part of the standard antenatal care in Zambia, it is not offered optimally. There is urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms, regardless of the mother’s human immunodeficiency virus status.

Antibody responses to two recombinant treponemal antigens (rp17 and TmpA) before and after azithromycin treatment for yaws in Ghana and Papua New Guinea.

WHO and its partners aim to interrupt yaws transmission in endemic countries and to certify others as being yaws-free. Transmission can be assessed using rapid plasma reagin (RPR) tests, reflecting current or recent infection, but RPR is operationally impractical. We evaluated changes in antibody levels against two recombinant treponemal antigens, rp17 (also known as Tp17) and TmpA, after antibiotic treatment given as part of a randomized controlled trial for yaws in Ghana and Papua New Guinea. Paired serum samples from children aged 6–15 years with confirmed yaws, collected before and after treatment, were tested for antibodies to rp17 and TmpA using a semi-quantitative bead-based immunoassay. Of 344 baseline samples, 342 tested positive for anti-rp17 antibodies and 337 tested positive for anti-TmpA antibodies. Six months after treatment, the median decrease in anti-rp17 signal was 3.2%, whereas the median decrease in anti-TmpA was 53.8%. The magnitude of change in the anti-TmpA response increased with increasing RPR titer fold-change. These data demonstrate that responses to TmpA decrease markedly within 6 months of treatment whereas (as expected) those to rp17 do not. Incorporating responses to TmpA as a marker of recent infection within an integrated sero-surveillance platform could provide a way to prioritize areas for yaws mapping.

Penile annular and scrotal eczematoid syphilids with penile chancre redux

We describe a 17-year-old man who developed penile annular and scrotal eczematoid syphilids with penile chancre redux. Dermoscopy showed linear-irregular and hairpin vessels with white scales in annular lesions. Histopathology displayed psoriasiform hyperplasia with perivascular lymphoplasmacytic dermal infiltrate. Rapid plasma reagin and Treponema pallidumparticle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin.

Efektivitas Pemeriksaan Serologis Sifilis

High prevalence of syphilis can be reduced by doing screening. Tests used for screening and diagnosis of syphilis are serological tests of syphilis consisting of nontreponemal tests and treponemal tests. Nontreponemal tests consist of Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) meanwhile Treponemal tests consist of Treponema Pallidum Haemagglutination Assay (TPHA) and Treponema Pallidum Rapid (TP Rapid). This study was aimed to determine the effectiveness of syphilis serological tests. This was a literature review study using the keywords namely serology OR serological OR serologic AND syphilis in PubMed and ClinicalKey. The literatures were written in English and/or Indonesian, published in the last 10 years (2011-2020), and can be accessed in full text. The results obtained 25 literatures. High sensitivity was found in RPR of 9.1%-100%, VDRL of 44.4% -100%, and TP Rapid of 50.0%-100%. High specificity was found in TPHA of 99.7% and TP Rapid of 85.3% -100%. In conclusion, effective syphilis screening is performed with RPR and VDRL, while effective syphilis diagnostic is performed with TP Rapid and TPHA.Keywords: syphilis, serology tests, effectiveness of tests Abstrak: Prevalensi kasus sifilis yang tinggi dapat diturunkan dengan adanya skrining. Pemeriksaan yang digunakan untuk skrining dan diagnosis sifilis ialah pemeriksaan serologis sifilis, terdiri atas pemeriksaan serologis non spesifik treponema dan pemeriksaan serologis spesifik treponema. Pemeriksaan serologis non spesifik treponema antara lain Rapid Plasma Reagin (RPR) dan Venereal Disease Research Laboratory (VDRL). Pemeriksaan serologis spesifik treponema antara lain Treponema Pallidum Haemagglutination Assay (TPHA) dan Treponema Pallidum Rapid (TP Rapid). Penelitian ini bertujuan untuk mengetahui efektivitas pemeriksaan serologis sifilis. Jenis penelitian ialah literature review menggunakan kata kunci serology OR serological OR serologic AND syphilis di PubMed dan ClinicalKey. Literatur yang digunakan memiliki bahasa Inggris dan/atau bahasa Indonesia, terbitan 10 tahun terakhir (2011-2020), dan dapat diakses teks lengkap. Sensitivitas tinggi ditemukan pada RPR sebesar 9,1%-100%, VDRL sebesar 44,4%-100%, dan TP Rapid sebesar 50,0%-100%. Spesifisitas tinggi ditemukan pada TPHA sebesar 99,7% dan TP Rapid sebesar 85,3%-100%. Simpulan penelitian ini ialah skrining sifilis efektif dilakukan dengan RPR dan VDRL, sedangkan diagnostik sifilis efektif dilakukan dengan TP Rapid dan TPHA.Kata kunci: sifilis, pmeriksaan serologis, efektivitas pemeriksaan

Sonographic appearance of syphilitic induration mimicking squamous cell carcinoma in the lower lip: a case report

Background Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. Recently, its incidence has been increasing worldwide. We encountered a young woman who presented with induration mimicking squamous cell carcinoma in the lower lip, without major medical conditions. Case presentation A 25-year-old Japanese woman presented with a 1-month history of a painless induration in her lower lip. Because squamous cell carcinoma was suspected, a preoperation work up was performed, including laboratory tests, an ultrasonographic examination, and a biopsy. The ultrasonography findings showed an oval-shaped 17 × 11 × 12 mm tumor-like lesion with heterogeneous internal echo and an indistinct border. A pressure test and color Doppler sonography revealed that the lesion was soft with a very abundant blood flow. These findings suggested the possibility of underlying inflammatory causes rather than a neoplastic tumor. Serology tests for syphilis, including the anti-Treponema pallidum antibody and reactive rapid plasma reagin tests, were positive. The biopsy revealed no malignancy. Finally, she was diagnosed as having primary syphilis and treated with amoxicillin for 28 days. The rapid plasma reagin value gradually decreased and the initial induration in her lower lip disappeared. Conclusion This case highlights the need for prompt examinations for possible underlying infective causes, such as syphilis, when seeing a painless induration with ulcer in the lip. Ultrasonography was helpful in the differential diagnosis of a tumor-like lesion and should be included in addition to syphilis serology tests, such as anti-Treponema pallidum antibody and rapid plasma reagin tests.

Syphilitic pemphigus

A 34-week premature newborn, child of a mother without prenatal controls, a marijuana user, with gestational syphilis with a positive rapid plasma reagin test (RPR) titer 1:16, did not receive treatment during pregnancy. The newborn presented congenital syphilis, RPR titer 1: 256 positive test.

Investigation of the rapid immunochromatographic test performance in the diagnosis of syphilis; comparison of four serological methods

ObjectivesTo test the performance of the newly available rapid test for syphilis, we compared it with Treponema pallidum hemagglutination assay (TPHA). Additionally, we investigated the performance of rapid plasma reagin (RPR) and chemiluminescence microparticle immunoassays (CMIA) at our laboratory using TPHA as a gold standard.MethodsThe serum samples of 595 patients with the pre-diagnosis of syphilis were studied by four serological methods. The sensitivity, specificity, and predictive values of RPR, CMIA, and syphilis rapid test were assessed by utilizing TPHA as a gold standard for the diagnosis of syphilis.ResultsOf the patients, 6.2% (37/595) had positive RPR, 5.5% (33/595) had positive CMIA, 5.5% (33/595) had a positive rapid immunochromatographic method and 5% (30/595) had positive TPHA. When TPHA results were taken as the reference, the sensitivity of the rapid test for syphilis was 100%, the specificity was 99.5%, PPV was 90.9%, and NPV was 100.0%.ConclusionsIt was observed that the rapid test for syphilis used in the study was quite successful, its cost was appropriate, and the test was very fast and easy to apply. At the same time, the agreement between syphilis rapid test and TPHA was found to be excellent.