Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been a steady increase in the number of cases of syphilis in the United States since the middle 1980s, with a dramatic rise in incidence among heterosexual men and women and of congenital syphilis. There also have been changes in geographic distribution of cases and an association with cocaine use. The ophthalmologic manifestations of syphilis are broad. There is anecdotal evidence that the natural history of syphilitic infection is altered by coinfection with human immunodeficiency virus. The potential of coinfection with HIV makes the clinical evaluation, treatment, and assessment of therapeutic outcome of syphilitic infection more confounding and controversial. This article provides a review of the changing demographics and ophthalmic manifestations of syphilis, the current status of laboratory testing techniques, and management approaches to various types of ocular syphilis.
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PMID:Ocular syphilis. 147 54

Sexually transmitted diseases (STDs) are now the most common group of identifiable infectious diseases in many countries, especially among those ages 15-50 and in infants. Their control is important considering the high incidence of acute infections, complications and sequelae, their socioeconomic impact, and their role in increasing transmission of the human immunodeficiency virus (HIV). THe worldwide incidence of major bacterial and viral STDs is estimated to be over 125 million cases yearly. STDs are hyperendemic in many developing countries. However, in industrialized countries, the bacterial STDs such as syphilis, gonorrhea, chancroid declined from their peak during WW II until the late 1950s, increased during the 1960s and early 1970s, and have again decreased since that time. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses, and HIV are now more significant than the classical bacterial ones; both groups remain major health problems in most developing countries. Infection rates are similar in both men and women, but women and infants bear the major burden of complications and serious sequelae. Infertility and ectopic pregnancy are often a result of pelvic inflammatory disease and are preventable. STDs in pregnant women can result in prematurity, stillbirth, and neonatal infections. In many areas, 1-5% of newborns are at risk of gonococcal ophthalmia neonatorum, a disease that blinds and congenital syphilis causes up to 25% of perinatal mortality. Genital and anal cancers (especially cervical cancer) are associated with viral STDs (genital human papillomavirus and herpes virus infections). Urethral stricture and infertility are frequent sequelae in men. (author's modified)
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PMID:Epidemiology of sexually transmitted diseases: the global picture. 228

The incidence of infectious syphilis is increasing in the United States, particularly among women. Not surprisingly, congenital syphilis rates have also risen. These have led to a rekindling of interest in the manifestations and treatment of primary, secondary, and latent syphilis. Coinfection with human immunodeficiency virus may alter clinical presentations and response to therapy.
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PMID:Early and congenital syphilis. 268 43

The incidence of syphilis is increasing, predominantly among urban heterosexuals. Early recognition is important in preventing progression of the disease and transmission of Treponema pallidum to the fetus. Untreated primary syphilis is characterized by intervals of active disease punctuated by periods of latency. Not all patients progress through each phase, and the physician must be alert to varying presentations. Cutaneous lesions are the hallmark of syphilis. However, diagnosis can be difficult, because the lesions can be asymptomatic or transient. The course of syphilis is accelerated in patients infected with the human immunodeficiency virus, and these patients frequently exhibit atypical lesions. The incidence of congenital syphilis is increasing, and efforts to control fetal morbidity depend on prompt recognition and treatment of infection during pregnancy. The definitive diagnosis of any stage of syphilis is based on historical and clinical findings supported by serologic testing.
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PMID:Dermatologic and systemic manifestations of syphilis. 794

From 1980 through 1990, 45 cases of congenital syphilis, i.e., 15.5/10,000 births, were reported in French Guyana. Epidemiological and clinical characteristics of these cases were analyzed retrospectively. Most mothers were immigrants (32%) or members of the traditional Maroni community (60%). Congenital infections were often severe (symptomatic in 85% of cases and fatal in 33%). Treatment should be especially aggressive in patients infected with the human immunodeficiency virus.
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PMID:[Retrospective study of 45 cases of congenital syphilis in French Guiana from 1980 to 1990]. 812 31

Between 1986 and 1990, rates of primary and secondary syphilis increased 134% in rural counties in the South. Reasons for the increases are speculative. During the 14 months ending in October 1992, outbreaks in four eastern Texas counties provided an opportunity to characterize syphilis in rural Texas. We reviewed records for 118 patients and 339 sex partners. Three outbreaks were concentrated in neighborhoods where crack cocaine dealers conducted business and exchange of sex for drugs or money was common; the fourth outbreak involved out-of-town prostitutes who visited undocumented alien workers. Among the 118 syphilis cases, 15 (13%) were primary, 35 (30%) were secondary. Most patients were black (105, 89%); the male-female ratio was 1:1. One woman gave birth to an infant with congenital syphilis. Almost half of the sex partners were infected. HIV pretest counseling was completed for only 55 patients (47%), and only 23 (19%) were tested for the human immunodeficiency virus. These four rural outbreaks of syphilis associated with crack cocaine and the exchange of sex for drugs or money mirror recent urban syphilis outbreaks. Patients in these rural syphilis outbreaks are at risk for HIV infection, but HIV testing has not been emphasized by public health workers.
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PMID:Outbreaks of syphilis in rural Texas towns, 1991-1992. 815 78

We sought to ascertain the reasons why virgins might attend sexually transmitted disease (STD) clinics. The medical records of 31 patients (18 males and 13 females) attending a major public STD clinic and who declared no lifetime sexual partners were examined. Nine subjects were concerned about genital anatomical variation while 3 had non-STD genital pathology (urinary tract infection, non-specific genital dermatosis, vaginismus). Six attended for human immunodeficiency virus antibody testing and 3 for hepatitis-related reasons. Of 6 children, 5 were screened for congenital syphilis and the other had genital warts. Three older patients (aged 34-38) presented with genital symptoms as part of a previously diagnosed psychosis. One prostitute who attended for a 'certificate' had never had penetrative sex. Most attendances in this study were appropriate and reflect the increasing recognition of STD clinics as appropriate centres for a wide range of non-STD genital and sexual problems.
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PMID:Why virgins attend sexually transmitted disease clinics. 839 5

To determine whether the US Centers for Disease Control guideline of 1 injection of 2.4 million U of benzathine penicillin G is sufficient treatment for early syphilis in pregnant women, this regimen was tested in 180 human immunodeficiency virus-negative urban Black women with syphilis presenting to Kalafong Hospital in Pretoria, South Africa, during 1988-90. A favorable pregnancy outcome was recorded in 108 women who received 2 or 3 weekly intragluteal injections. On the other hand, 1 injection was associated with lower birth weight, increased prematurity and total preterm birth rate, and increased total pregnancy loss and neonatal mortality. These outcomes were reanalyzed after exclusion of women treated with oral penicillin derivatives and adjusted for the estimated duration of treponemicidal levels at 3 weeks post-injection. Birth weight was significantly lower for treponemicidal coverage of 3 weeks or less compared to coverage lasting more than 3 weeks (2748 and 3130 grams, respectively). Also increased when coverage was less than 3 weeks were the relative risks for prematurity (8.5), perinatal mortality (20.5), and congenital syphilis (2.0). Impaired outcome associated with short treatment was clustered in women who attended prenatal care before the 28th week of gestation and those whose initial rapid plasma reagin titer exceeded 16. These findings indicate that the standard protocol is not adequate in areas where syphilis is endemic. Recommended is administration of 2 injections of 2.4 million U benzathine penicillin at least 1 week apart, preferably 4 weeks or more before delivery.
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PMID:Apparent failure of one injection of benzathine penicillin G for syphilis during pregnancy in human immunodeficiency virus-seronegative African women. 911 55

Testing for syphilis during pregnancy reveals a positive serologic status in 0.02% of cases. However, a 66% rate of stillbirths is noted in women who are infected and who have not benefited from any treatment. Routine screening is at present performed during the early stages of pregnancy but a second serologic test during the third trimester is useful in the diagnosis of a late infection especially in drug users or HIV (human immunodeficiency virus) positive patients. Congenital syphilis is diagnosed in utero when a positive maternal serologic status is associated with ultrasound images showing fetal abnormalities; these include hepatosplenomegaly, hyperechogenic bowel, signs of bowel obstruction or fetal hydrops. Maternal syphilis is treated by delayed action penicillin and is indicated even for patients allergic to the antibiotic which in this particular case is delivered after desensitization. First line therapy by intravenous penicillin is indicated when confronted with the following high risk factors of congenital syphilis: an elevated titre of VDRL (venereal disease research laboratory) at the time of diagnosis or delivery, unknown date of the precise onset of the infection, the appearance of a rash or of a chancre during pregnancy, ultrasound fetal abnormalities or late therapy during the third trimester. Treatment of the new-born child will depend on the results of clinical, serologic and X-ray evaluation. Long term follow-up for at least a year is mandatory.
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PMID:[Maternal and congenital syphilis]. 959 61

Rates of primary and secondary (P&S) syphilis have been declining in the United States since the last national epidemic in 1990. Syphilis causes substantial morbidity and mortality in the form of cardiac and neurologic disease, stillbirth and developmental disability from congenital syphilis, and by facilitating transmission of human immunodeficiency virus. Syphilis is both preventable and curable and has been successfully controlled in most developed countries. In the United States, declines in P&S syphilis have been followed by epidemics occurring approximately every 7-10 years. During 1960-1990, these cyclical epidemics resulted in progressively higher peaks in morbidity. To evaluate the epidemiology of syphilis in the United States, CDC analyzed notifiable disease surveillance data for 1998. This report summarizes the results of that analysis, which indicate that in 1998 P&S syphilis declined to the lowest rates ever reported in the United States and that syphilis transmission increasingly is concentrated in fewer geographic areas.
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PMID:Primary and secondary syphilis--United States, 1998. 1055 37


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