Serological Criteria for Early Syphilis Treatment Efficacy
Serological Criteria for Early Syphilis Treatment Efficacy
From May 2000 to April 2010, 17 secondary syphilis patients who fulfilled the following criteria were included in our case series: (1) serum rapid plasma reagin (RPR) titres showed a fourfold decrease within 3 months but failed to revert to negative at least 24 months following treatment; (2) reactive cerebrospinal fluid (CSF)–VDRL and CSF–Treponema pallidum Particle Agglutination Test (TPPA) at the time of neurosyphilis diagnosis; (3) no history of high-risk sexual behaviours following initial syphilis treatment and (4) negative HIV antibody testing.
The criteria for initial secondary syphilis diagnosis were (1) reactive serum RPR confirmed by reactive TPPA and (2) skin or mucocutaneous lesions consistent with secondary syphilis. The criteria for neurosyphilis were the reactive CSF–VDRL and CSF–TPPA tests in the absence of substantial contamination of CSF with blood with or without (1) elevated CSF leucocyte count (normal: white blood cells <8×10/l) and/or (2) elevated CSF–proteins (normal: 150–450 g/l).
Lumbar punctures were performed if patients had (1) neurological or psychiatric signs or symptoms, (2) more than 2 years' serofast state and (3) patients are anxious regarding their serofast state. Of the 17 cases, 11 patients had their lumbar puncture performed in other hospitals and CSF was sent to our hospital for analysis. After neurosyphilis was diagnosed, the patients were referred to our hospital. The other six patients were from our hospital.
To better assess the scope of the problem, during the same period, we also performed lumbar punctures on 106 treated patients with secondary syphilis whose titres remained serofast.
Charts of all syphilis cases were reviewed for patient's demography, history of prior syphilis, sexual behaviours and sexual partner's syphilis diagnosis and treatment. Clinical manifestations were recorded, and laboratory tests included HIV antibody, RPR and TPPA before and after treatment. The study was approved by the Shanghai Skin Disease Hospital Ethical Review Board. All participants provided informed consent.
Methods
From May 2000 to April 2010, 17 secondary syphilis patients who fulfilled the following criteria were included in our case series: (1) serum rapid plasma reagin (RPR) titres showed a fourfold decrease within 3 months but failed to revert to negative at least 24 months following treatment; (2) reactive cerebrospinal fluid (CSF)–VDRL and CSF–Treponema pallidum Particle Agglutination Test (TPPA) at the time of neurosyphilis diagnosis; (3) no history of high-risk sexual behaviours following initial syphilis treatment and (4) negative HIV antibody testing.
The criteria for initial secondary syphilis diagnosis were (1) reactive serum RPR confirmed by reactive TPPA and (2) skin or mucocutaneous lesions consistent with secondary syphilis. The criteria for neurosyphilis were the reactive CSF–VDRL and CSF–TPPA tests in the absence of substantial contamination of CSF with blood with or without (1) elevated CSF leucocyte count (normal: white blood cells <8×10/l) and/or (2) elevated CSF–proteins (normal: 150–450 g/l).
Lumbar punctures were performed if patients had (1) neurological or psychiatric signs or symptoms, (2) more than 2 years' serofast state and (3) patients are anxious regarding their serofast state. Of the 17 cases, 11 patients had their lumbar puncture performed in other hospitals and CSF was sent to our hospital for analysis. After neurosyphilis was diagnosed, the patients were referred to our hospital. The other six patients were from our hospital.
To better assess the scope of the problem, during the same period, we also performed lumbar punctures on 106 treated patients with secondary syphilis whose titres remained serofast.
Charts of all syphilis cases were reviewed for patient's demography, history of prior syphilis, sexual behaviours and sexual partner's syphilis diagnosis and treatment. Clinical manifestations were recorded, and laboratory tests included HIV antibody, RPR and TPPA before and after treatment. The study was approved by the Shanghai Skin Disease Hospital Ethical Review Board. All participants provided informed consent.