Background In the recent decade resurgence of syphilis was noted in a global scale, especially in high-risk communities like men who have sex with men (MSM) and commercial sex workers (CSW). Syphilis co-infection is important in people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) because of their similar transmission routes, mutual interactions at pathophysiology level, relation to socioeconomic factors and public health implications. Methods Retrospective analysis of syphilis co-infections among the HIV/AIDS patients who have been under the care of the AIDS Clinical Service, Queen Elizabeth Hospital of Hong Kong which has served as a tertiary referral center since the beginning of the AIDS epidemic. Details of syphilis co-infection including their clinical stages on diagnosis, evidence of central nervous system (CNS) invasion and recurrence were analyzed. Results In the 1,567 subjects studied 223 (14.2%) had HIV/syphilis co-infection. There are significantly more MSM in the HIV/syphilis co-infected group (P < 0.001). Among the coinfected, 111 (49.8%) had undiagnosed and untreated syphilis at the time of HIV/AIDS diagnosis. Sixty two subjects (27.8%) acquired syphilis as totally new infections after followed up for HIV/AIDS, with a median time of 284.6 weeks (range 3.7-862.3 weeks). Twenty subjects (9.0%) showed evidence of neurosyphilis on cerebrospinal fluid study. Thirty two (14.3%) had recurrent syphilis infections and more than 80% of them occurred in MSM. The total follow up duration was 8616.58 person-years. By Poisson regression, the adjusted total syphilis incidence was 7.07 cases per 100 person-years. MSM had the highest syphilis incidence of 20.25 cases per 100 person-years. In addition syphilis incidence in MSM recruited after the year 2000 was higher than those MSM recruited before. When Comparing subjects with HIV infection diagnosed before 2000 with those having HIV infection diagnosed after 2000, latter have higher cumulative incidence of first syphilis events (P < 0.001). Using Cox regression analysis, MSM (hazard ratio 3.26, 95% CI 1.93 – 5.51, P < 0.0005), bisexual contact (hazard ratio 2.95, 95% CI 1.49 – 5.82, P < 0.005) and infection with HIV-1 subtype B (hazard ratio 1.65, 95% CI 1.08 – 2.53, P = 0.02) were associated with development of first event of syphilis infection during follow up. Conclusions The result of this study corresponded to the global trend of HIV/syphilis syndemic. New and recurrent syphilis infections continued to appear after combination antiretroviral therapy (cART) initiation. MSM, bisexual subjects and infection by HIV-1 subtype B were risk factors for syphilis events. MSM contained the highest syphilis burden. Urgent attention and measures are needed to target syphilis and HIV infection in the Hong Kong MSM population. / published_or_final_version / Public Health / Master / Master of Public Health

SANTRAUKA Serologinių sifilio ir Laimo boreliozės reakcijų kryžminis reaktyvumas Darbo autorė: Tatjana Subočiūtė Darbo vadovas: med. m. dr. Andrius Vagoras Darbo tikslas: nustatyti VULSK diagnostikos centre rutiniškai naudojamų serologinių sifilio ir Laimo boreliozės testų galimai klaidingai teigiamų rezultatų dažnumą dėl kryžminio viena iš šių infekcijų užsikrėtusiųjų pacientų kraujo serumų reaktyvumo. Darbo metodai: Tyrimai buvo atlikti Vilniaus universiteto ligoninės Santariškių klinikos (VULSK) Laboratorinės diagnostikos centro Mikrobiologijos laboratorijos Infekcijų žymenų tyrimų padalinyje. Serumai buvo surinkti ir ištirti nuo 2005 m. vasario iki 2006 m. kovo mėn. Tyrimo medžiagą sudarė 40 serumų. 23 serumai dėl sifilio tyrimų buvo gauti iš VULSK Dermatovenerologijos centro. 8 serumai dėl Laimo ligos tyrimų buvo gauti iš VULSK Dermatovenerologijos centro. UAB „Endemik” atrinkti 9 serumai ištirti dėl Laimo ligos. Visi į tyrimą įtraukti serumai buvo ištirti šiomis reakcijomis: 1) RPR su titru, 2) TPHA, 3) Treponema pallidum ELISA, 4) Treponema pallidum imunofluorescencija, 5) Borrelia burgdorferi imunofluorescencija. Tyrimo rezultatai: Ištyrus penkiomis reakcijomis serumus (RPR, TPHA, Treponema pallidum IFR, Treponema pallidum IFA bei Borrelia burgdorferi IFR), buvo pastebėtas kryžminis serologinis reaktyvumas tarp Borrelia burgdorferi IFR ir Treponema pallidum IFR reakcijų. Mūsų darbo duomenimis, tiriant 17 serumų (teigiamus dėl Laimo ligos) kryžminis reaktyvumas... [toliau žr. visą tekstą] / SUMMARY Cross - reactivity in serological test for Lyme disease and syphilis Author: Tatjana Subočiūtė Supervisor: Andrius Vagoras, MD Work purpose: to determine the incidence of possibly false positive results of serological syphilis and Lyme borreliosis tests, routinely used in VULSK Diagnostics centre, occurring because of cross reactivity of patients, having one of these disease, blood. Work methods: the research was carried out in Vilnius University Hospital Santariškių Klinikos (VULSK) Infection Markers Research Department of Microbiological Laboratory in Laboratory Diagnostics Centre. Serum samples were collected and tested from February, 2005, till March, 2006. The investigation material was composed of 40 serum samples. 23 serum samples for syphilis test came from VULSK Centre of Dermatovenereology. 8 serum samples for Lyme borreliosis test were received from VULSK Centre of Dermatovenereology. 9 serum samples for Lyme borreliosis test were picked by UAB “Endemik”. All the samples, included into the research, were tested by following reactions: 1) RPR with titer, 2) TPHA, 3) Treponema pallidum ELISA, 4) Treponema pallidum immunofluorescence, 5) Borrelia burgdorferi immunofluorescence. Research results: After testing the serums by five reactions (PRP, TPHA, Treponema pallidum FTA – ABS, Treponema pallidum ELISA and Borrelia burgdorferi immunofluorescence), a serological cross reactivity between Borrelia burgdorferi immunofluorescence and Treponema pallidum FTA - ABS... [to full text]

Syphilis is a global public health concern with 36.4 million cases worldwide and 11 million new infections per year. It is a chronic multistage disease caused by the spirochete bacterium Treponema pallidum and is transmitted by sexual contact, direct contact with lesions or vertically from an infected mother to her fetus. T. pallidum is a highly invasive pathogen that rapidly penetrates tight junctions of endothelial cells and disseminates rapidly via the bloodstream to establish widespread infection. Previous investigations conducted in our laboratory identified the surface-exposed adhesin, pallilysin, as a metalloprotease that degrades the host components laminin (major component of the basement membrane lining blood vessels) and fibrinogen (primary component of the coagulation cascade), as well as fibrin clots (function to entrap bacteria and prevent disseminated infection). Furthermore, pallilysin expressed on the surface of the non-invasive spirochete Treponema phagedenis conferred upon this bacterium the ability to degrade fibrin clots. It was hypothesized that pallilysin is integral to the process of T. pallidum dissemination, and interference with its functioning will prevent spread throughout the host and establishment of chronic infection. To test this hypothesis, a two-pronged approach was undertaken during my thesis research. Bioinformatics analyses were used to trace the evolutionary history of pallilysin in an attempt to gain further insight into its role in the pathogenesis of T. pallidum. The sequence conservation of pallilysin was analyzed in the context of its homologues. The bioinformatics analyses revealed homologues in three spirochete genera, namely Treponema, Spirochaeta, and Borrelia, presented in decreasing order of the degree of sequence conservation. The HEXXH motif, part of the active site of the pallilysin metalloprotease, was fully conserved only in T. pallidum and T. paraluiscuniculi, both of which are systemic pathogens. However, the flanking sequences showed a high degree of conservation, especially in the Treponema and Spirochaeta genera. The minimum laminin-binding region of pallilysin identified previously was partially conserved among the treponema and spirochaeta homologues with the highest degree of conservation observed with the homologues from T. paraluiscuniculi and T. phagedenis, as well as among the homologues from the human oral pathogens. In vitro dissemination studies were performed to investigate the dissemination capacity of T. phagedenis heterologously expressing pallilysin. Human Umbilical Vein Endothelial Cells were seeded and grown to confluence on permeable inserts coated with growth factor-reduced Matrigel to create an artificial endothelial barrier. Wild type T. phagedenis, and T. phagedenis transformed either with the pallilysin open reading frame or its empty shuttle vector, were incubated with the barriers under anaerobic conditions. Dissemination across the barrier was assessed as percent traversal by both dark-field microscopic counts of treponemes and real-time quantitative PCR of genomic DNA extracted from the treponemes. The results were inconclusive. However, a traversal trend suggested heterologous expression of pallilysin may facilitate traversal of T. phagedenis across the artificial endothelial barrier. This study presented the first step towards elucidating the role of pallilysin in endothelial monolayer traversal and provided supporting evidence for the role of pallilysin in the widespread dissemination of T. pallidum in vivo. / Graduate

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [63]-80).

Thesis (Ph.D.)--McMaster University, 2005. / Advisor: Helen Ostovich. Includes bibliographical references (p. 248-259). Also available via World Wide Web.

Made available in DSpace on 2014-12-17T14:46:37Z (GMT). No. of bitstreams: 1 JammilliCD.pdf: 1430027 bytes, checksum: fdf99e39213187cd63342d6cb1ae9dee (MD5) Previous issue date: 2008-04-17 / The objective of this exploratory descriptive quantitative study was to analyze the behaviors in the detection, treatment and followup of the pregnant woman with syphilis, by health professionals that conduct the pre-natal consultation in the Family Health Strategy, as to the adherence to the recommendations of the Ministry of Health. The study was conducted in nine municipalites of the Trairi region in the state of Rio Grande do Norte. Data were collected during the months of July through September 2007, by means of a questionnaire with a population of 53 health professionals, 30 nurses and 23 physicians. Data were analyzed by descriptive statistics. The results were organized in three major items: knowledge of the health professionals about the symptomatology of syphilis and their actions in the detection of the disease; actions in the treatment of the pregnant woman with syphilis; and the actions of followup of the desease. We identified that 81,2% of the professionals have knowledge about the symptomatology of syphilis in the pregnant woman;79,2% request the VDRL exam in the adequate intervals and approximately 50% conduct the treatment in conformity with the recommendations of the Ministry of Health. For the followup care of the infected woman, 79,2% request a monthly VDRL examination, 69,8% explain the disease to the pregnant woman, and 20,7% affirm that they conduct a proper reception to the woman.We conclude that the majority of the health professionals have knowledge of the detection, treatment and followup of the pregnant woman with syphilis. However, the actions of some professionals diverge from the conduct procedures recommended by the Ministry of Health, as to the requesting of the examinations, medication prescription and notification of the iesease. This indicates the need for improved / Estudo descritivo explorat?rio com abordagem quantitativa, que tem como objetivo de verificar atendimento das recomenda??es do MS para a detec??o, tratamento e acompanhamento da gestante com s?filis nas condutas assistenciais realizadas pelos profissionais que atuam na consulta pr?-natal na ESF nos munic?pios da regi?o Trairi no Estado do Rio Grande do Norte. A pesquisa foi desenvolvida nos nove munic?pios desta regi?o. Os dados foram coletados atrav?s de um question?rio, em uma popula??o de 53 profissionais, sendo 30 enfermeiros e 23 m?dicos. Para a an?lise de dados, utilizamos freq??ncias absolutas e percentuais. Os resultados da an?lise dos dados foram organizados em tr?s grandes itens: conhecimento dos profissionais sobre a intomatologia da s?filis e suas a??es de detec??o, na gestante; a??es dos profissionais no tratamento da s?filis na gestante; a??es dos profissionais no acompanhamento de uma gestante com s?filis. Identificamos, nas afirmativas desses profissionais, que 81,2% t?m conhecimentos sobre a sintomatologia da s?filis na gestante; 79,2% solicitam o VDRL em per?odos adequados e em torno de 50% efetuam o tratamento conforme o orientado pelo Minist?rio da Sa?de; para acompanhamento da gestante infectada,79,2% solicitam o VDRL mensal, 69,8% explicam a doen?a ? gestante e 20,7% garantem a realiza??o do acolhimento a essa mulher. Conclu?mos que as a??es de alguns profissionais divergem do recomendado pelo Minist?rio da Sa?de e que necessitam de um melhor embasamento cient?fico para realizar tais a??es

Background: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective: This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: A Web-based notification system and patient-delivered partner referral cards. Methods: During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results: The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions: Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. / Revisión por pares / Revisión por pares

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Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-06-25T14:57:51Z No. of bitstreams: 1 Diss MP. Leila R. Oliveira. 2012.pdf: 1281491 bytes, checksum: 160dfe6a92867d8ebff6fad1efbc861a (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-06-25T14:58:25Z (GMT) No. of bitstreams: 1 Diss MP. Leila R. Oliveira. 2012.pdf: 1281491 bytes, checksum: 160dfe6a92867d8ebff6fad1efbc861a (MD5) / Made available in DSpace on 2013-06-25T14:58:25Z (GMT). No. of bitstreams: 1 Diss MP. Leila R. Oliveira. 2012.pdf: 1281491 bytes, checksum: 160dfe6a92867d8ebff6fad1efbc861a (MD5) Previous issue date: 2012 / A Sífilis Congênita é um importante problema de saúde em vários países. No Brasil, em 2007, foi lançado o Plano Operacional para redução da transmissão vertical da Sífilis visando reduzir a ocorrência da Sífilis Congênita. Para avaliar a efetividade das ações para prevenção e controle da transmissão vertical da Sífilis em Cuiabá e Mato Grosso, realizou-se estudo de série temporal da incidência desta doença e avaliou-se a evolução de alguns indicadores de assistência à saúde das gestantes com Sífilis. SINAN e SINASC foram as fontes de dados. A efetividade das ações foi avaliada pela comparação da evolução de indicadores de resultados, 2001-2006 e 2007-2011, e pela Fração Prevenível. Não foram observadas melhorias dos indicadores de resultados referentes à assistência a saúde das gestantes. A Fração Prevenível pelas ações em Mato Grosso foi de 0,0950 (IC95% -0,3370; 0,3875) e em 0,4372 (IC95% -0,0018; 0,6839). A não efetividade das ações sugere que as mesmas não estão sendo desenvolvidas ou estão sendo implementadas de forma inadequada e/ou insuficiente. / Salvador

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-06T18:48:12Z No. of bitstreams: 1 Diss MP.Cristiana.Brasileiro. 2014.pdf: 971304 bytes, checksum: 729a7bab9a445ad86d56df8088146f7f (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-15T14:07:19Z (GMT) No. of bitstreams: 1 Diss MP.Cristiana.Brasileiro. 2014.pdf: 971304 bytes, checksum: 729a7bab9a445ad86d56df8088146f7f (MD5) / Made available in DSpace on 2015-04-15T14:07:19Z (GMT). No. of bitstreams: 1 Diss MP.Cristiana.Brasileiro. 2014.pdf: 971304 bytes, checksum: 729a7bab9a445ad86d56df8088146f7f (MD5) / A sífilis congênita (SC) pode ser prevenida por ações realizadas no pré-natal, contudo, é a doença infecciosa de transmissão materno-fetal de maior incidência no mundo. O objetivo deste estudo foi estimar a incidência da SC nos municípios da Bahia entre 2005 e 2012 e investigar sua correlação com fatores sociais, econômicos e relacionados à oferta de serviços de saúde. Foi realizado um estudo ecológico, de distribuição temporal e espacial, com caráter descritivo e analítico. Com base nos registros do Sinan e do SIM, identificou-se 2.656 casos de SC na Bahia no período. A incidência da SC no estado cresceu de 1,2 para 2,7 casos por 1.000 nascidos vivos (NV), de 2005 a 2012. Dos 417 municípios, 146 (35,0%) apresentaram incidência média anual acima da meta de 0,5 casos por 1.000 NV para o triênio 2010-2012 e 56 (13,4%) apresentaram incidência maior que cinco vezes acima da meta. Pelo método de captura e recaptura, observou-se elevado subregistro de casos e óbitos por SC no Sinan e no SIM (48,8% e 88,7%, respectivamente). A incidência de SC nos municípios baianos apresentou fraca correlação negativa com o coeficiente de Gini (r: 0,17, p: 0,028), que pode refletir pior qualidade dos sistemas de informação nos municípios com maior desigualdade de renda. Esses achados alertam para o crescimento da SC e reforçam a necessidade de ampliar os investimentos na vigilância e controle da SC na Bahia.