Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Treatment and outcomes of polymerase chain reaction-confirmed early syphilis

Phillip J. Read A B C H , Rebecca Guy B , Neisha Jeoffreys D , David Baker E , Matthew Shields F and Basil Donovan B G
+ Author Affiliations
- Author Affiliations

A Kirketon Road Centre, PO Box 22, Kings Cross, NSW 1340, Australia.

B Sexual Health Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.

C Holdsworth House Medical Practice, 32a Oxford Street, Darlinghurst, NSW 2010, Australia.

D Centre for Microbiology and Infectious Diseases – Public Health, Institute for Clinical Pathology and Medical Research, Pathology West, NSW 2145, Australia.

E East Sydney Doctors, 102 Burton Street, Darlinghurst, NSW 2010, Australia.

F Taylor Square Private Clinic, 393 Bourke Street, Darlinghurst, NSW 2010, Australia.

G Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia.

H Corresponding author. Email: Phillip.Read@sesiahs.health.nsw.gov.au

Sexual Health 12(6) 506-511 https://doi.org/10.1071/SH15043
Submitted: 12 March 2014  Accepted: 6 July 2015   Published: 10 August 2015

Abstract

Background: Syphilis is resurgent among gay and bisexual men (GBM) despite effective treatment and widely available diagnostic serology. The polymerase chain reaction assay for Treponema pallidum (TP-PCR) is available, but little is known about the clinical features and outcomes for patients testing positive by TP-PCR. Methods: Clinical data were collected from four medical practices for patients recording a positive TP-PCR result between 2004 and 2011. Demographic, serological, treatment and reinfection details were obtained. Results were stratified by HIV status and whether treatment conformed to international guidelines. Results: 220 patients were positive for TP-PCR, of whom 92% were GBM. Seventeen (8.1%) were positive by TP-PCR before seroconversion. Almost one-third (32.1%) received treatment beyond that recommended in guidelines, and this was associated with HIV status (40.3% HIV positive vs 22.4% HIV negative, P < 0.01). All but one patient with adequate follow up achieved serological cure. There was no significant difference in time to serological cure between the groups receiving standard therapy or enhanced therapy (95 vs 108 days; P = 0.67) or between HIV positive and negative patients (93 vs 104 days, P = 0.06). Nineteen patients were reinfected during follow up. Conclusion: TP-PCR aids early diagnosis of syphilis and may be reactive before conventional serological tests. Treatment outcomes for TP-PCR-positive early infection were excellent, but a significant proportion of patients received non-standard therapy. Expanded use of syphilis PCR testing in at-risk populations is recommended since early identification and treatment is likely to be important in controlling the current epidemic in GBM.


References

[1]  Read P, Fairley C, Chow E. Increasing trends of syphilis among men who have sex with men in high income countries. Sex Health 2015; 12 155–63.
Increasing trends of syphilis among men who have sex with men in high income countries.CrossRef |

[2]  National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2008. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2008.

[3]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2013. Sydney: The Kirby Institute, The University of New South Wales; 2013.

[4]  Read P, Donovan B. Clinical aspects of adult syphilis. Intern Med J 2012; 42 614–20.
Clinical aspects of adult syphilis.CrossRef | 1:STN:280:DC%2BC38jhs1ylsg%3D%3D&md5=20ead462b1bef997d165dbe065e8dc92CAS | 22697151PubMed |

[5]  Solomon MC, Mayer KH, Gidden DY, iPrEx Study Team Syphilis predicts HIV incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial. Clin Infect Dis 2014; 59 1020–6.
Syphilis predicts HIV incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial.CrossRef |

[6]  Down I, Wilson D, McCann P, Gray R, Hoare A, Bradley J, Donovan B, Prestage G. Increasing gay men’s testing rates and enhancing partner notification can reduce the incidence of syphilis. Sex Health 2012; 9 472–80.
Increasing gay men’s testing rates and enhancing partner notification can reduce the incidence of syphilis.CrossRef | 23380198PubMed |

[7]  Templeton D, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11 217–29.
Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence.CrossRef | 24690473PubMed |

[8]  Gayet-Ageron A, Lautenschlager S, Ninet B, Perneger T, Combescure C. Sensitivity, specificity and likelihood ratios of PCR in the diagnosis of syphilis: a systematic review and meta-analysis. Sex Transm Infect 2013; 89 251–6.
Sensitivity, specificity and likelihood ratios of PCR in the diagnosis of syphilis: a systematic review and meta-analysis.CrossRef | 23024223PubMed |

[9]  Heymans R, van der Helm J, de Vries H, Fennema H, Coutinho R, Bruisten S. Clinical value of Treponema pallidum real-time PCR for diagnosis of syphilis. J Clin Microbiol 2010; 48 497–502.
Clinical value of Treponema pallidum real-time PCR for diagnosis of syphilis.CrossRef | 1:CAS:528:DC%2BC3cXkt1SjtLk%3D&md5=16d5ac55c3963cfa632aa5fbc1f5160dCAS | 20007388PubMed |

[10]  Gayet-Ageron A, Sedanoui P, Lautenschlager S, Ferry T, Toutou-Trellu L, Cavassini M, Yassir F, Martinez de Tejada B, Emonet S, Combescure C, Schrenzel J, Perneger T. Use of Treponema pallidum PCR in testing of ulcers for diagnosis of primary syphilis. Emerg Infect Dis 2015; 21 127–9.
Use of Treponema pallidum PCR in testing of ulcers for diagnosis of primary syphilis.CrossRef | 25531672PubMed |

[11]  Shields M, Guy R, Jeoffreys N, Finlayson R, Donovan B. A longitudinal evaluation of Treponema pallidum PCR testing in early syphilis. BMC Infect Dis 2012; 12 353
A longitudinal evaluation of Treponema pallidum PCR testing in early syphilis.CrossRef | 23241398PubMed |

[12]  Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR Morb Mortal Wkly Rep 1997; 46 1–55.
| 9011775PubMed |

[13]  Medicines and Healthcare products Regulatory Agency UK. Ten syphilis EIAs 04109. London: MHRA-UK; 2004.

[14]  Botham S, Ressler K, Maywood P, Hope K, Bourne C, Conaty S, Ferson M, Mayne D. Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance. Sex Health 2013; 10 291–8.
Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance.CrossRef | 23639847PubMed |

[15]  Taylor M, Aynalem G, Olea L, He P, Smith L, Kerndt P. A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001–2004. Sex Transm Dis 2008; 35 430–4.
A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001–2004.CrossRef | 18446083PubMed |

[16]  McMillan A, Young H. Qualitative and quantitative aspects of the serological diagnosis of early syphilis. Int J STD AIDS 2008; 19 620–4.
Qualitative and quantitative aspects of the serological diagnosis of early syphilis.CrossRef | 1:STN:280:DC%2BD1crktlWhtg%3D%3D&md5=190c777abafa4dca115416b2dd7e93bcCAS | 18725554PubMed |

[17]  Jun L, Zheng H. Characteristics of patients with primary and late latent syphilis patients who were initially non-reactive to the rapid plasma reagin test. Jpn J Infect Dis 2013; 66 36–40.
Characteristics of patients with primary and late latent syphilis patients who were initially non-reactive to the rapid plasma reagin test.CrossRef | 23429083PubMed |

[18]  Liu L, Lin L, Tong M, Zhang H, Huang S, Chen Y, Guo X, Xi Y, Liu L, Chen F, Zhang Y, Zhang Q, Yang T. Incidence and risk factors for the prozone phenomenon in serologic testing for syphilis is a large cohort. Clin Infect Dis 2014; 59 384–9.
Incidence and risk factors for the prozone phenomenon in serologic testing for syphilis is a large cohort.CrossRef | 1:CAS:528:DC%2BC2cXhtlSrurnP&md5=e14e2b209028e3f0e04df62357b1105eCAS | 24803377PubMed |

[19]  Kingston M, French P, Goh B, Goold P, Higgins S, Sukthankar A, Stott C, Turner A, Tyler C, Young H. UK National Guidelines on the Management of Syphilis 2008. Int J STD AIDS 2008; 19 729–40.
UK National Guidelines on the Management of Syphilis 2008.CrossRef | 1:STN:280:DC%2BD1cnnt1ylsw%3D%3D&md5=a021d87e0cb319b780d9e7bbd1810e93CAS | 18931264PubMed |

[20]  Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59 26–36.

[21]  Australian Sexual Health Alliance. Australian STI management guidelines. Available online at: http://www.sti.guidelines.org.au/sexually-transmissible-infections/syphilis [verified 20 December 2014].

[22]  Dowell D, Polgreen P, Beekmann S, Workowski K, Berman S, Peterman T. Dilemmas in the management of syphilis: a survey of infectious diseases experts. Clin Infect Dis 2009; 49 1526–9.
Dilemmas in the management of syphilis: a survey of infectious diseases experts.CrossRef | 19845476PubMed |



Rent Article (via Deepdyve) Export Citation Cited By (1)

View Altmetrics