Evaluation of SD BIOLINE Syphilis 3.0 for Rapid Diagnosis of Syphilis: Report from a Regional Sexually Transmitted Infection Reference Laboratory in North India

BACKGROUND:

Serology is considered the mainstay of syphilis diagnosis. The limitations of the traditional serological methods and the advent and availability of novel immunochromatographic assays have led to the widespread application of rapid point-of-care procedures as screening tools for syphilis. However, these tests have not been extensively evaluated. This study was designed to evaluate the performance of a rapid syphilis diagnostic test known as SD BIOLINE Syphilis 3.0 (SD Biostandard Diagnostics Private Limited, Gurgaon, Haryana, India).

MATERIALS AND METHODS:

A panel comprising of 50 venereal disease research laboratory reactive and 50 nonreactive sera was tested using SD BIOLINE Syphilis 3.0. The performance of the test was evaluated using IMMUTREP Treponema pallidum hemagglutination assay (TPHA) (OMEGA Diagnostics Limited, Scotland, United Kingdom) as the reference standard and sensitivity, specificity, and negative and positive predictive values were calculated.

RESULTS:

The sensitivity, specificity, and positive and negative predictive values of SD BIOLINE Syphilis 3.0 were 92.86% (confidence interval of 95%: 80.52-98.50%), 98.28% (90.76-99.96%), 97.50% (86.84-99.94%), and 95.00% (86.08-98.96%), respectively, compared to TPHA as the gold standard.

CONCLUSION:

Keeping in view the high sensitivity and specificity of SD BIOLINE Syphilis 3.0, we conclude that the test can be used as a tool for rapid on-site diagnosis of syphilis and as an alternative to TPHA for detection of antibodies to Treponema pallidum.

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By:  Mehra B1, Bhattar S1, Saxena S1, Rawat D1, Bhalla P1.

• 1Department of Microbiology, Maulana Azad Medical College, New Delhi, India. 
• J Lab Physicians. 2016 Jan-Jun;8(1):36-40. doi: 10.4103/0974-2727.176239.

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Sexually Transmitted Infections: Experience in a Multidisciplinary Clinic in a Tertiary Hospital in Spain (2010-2013)

INTRODUCTION:

The number of consultations for sexually transmitted infections (STIs) is increasing in Spain. The aim of this study was to describe and analyze the epidemiological, behavioral, clinical, and microbiological characteristics of patients registered at the STI unit of a tertiary hospital.

METHODS:

This was a retrospective, single-center descriptive study carried out between 2010 and 2013 in a multidisciplinary unit specialized in STIs, situated in a tertiary hospital. Epidemiological, clinical, and behavioral data were gathered using a face-to-face interview and a standardized questionnaire. Samples were collected for microbiology analysis.

RESULTS:

The study included 546 patients: 96% were men, 41% had human immunodeficiency virus (HIV) infection, and 56% were men who have sex with men. The reasons for consultation were the following: urethritis; genital, anal, or perianal ulcers; proctitis; oral ulcers; sexual contact with a person with a known STI; and high-risk sexual contact. The most common microbiological diagnoses were Neisseria gonorrhoeae in urethritis, Treponema pallidum in genital and anal or perianal ulcers, and Chlamydia trachomatis lymphogranuloma venereum serovars in proctitis. The highest prevalences of the main STIs studied occurred in homosexual men with HIV infection.

CONCLUSION:

This study confirms the increase in the incidence of STIs in recent years and the epidemiological characteristics of the HIV/STI epidemic in Spain.

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By:   Moreno-Ribera N¹, Fuertes-de Vega I¹, Blanco-Arévalo JL², Bosch-Mestres J³, González-Cordón A², Estrach-Panella T¹, García-de Olalla P⁴, Alsina-Gibert M⁵.

¹Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

²Servicio de Enfermedades Infecciosas, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

³Servicio de Microbiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

⁴Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, Barcelona, España.

⁵Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España. Electronic address: malsina@clinic.ub.es.

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Syphilis and HIV Co-Infection - Denmark

The studies included in this PhD thesis examined the interactions of syphilis, which is caused by Treponema pallidum, and HIV. Syphilis reemerged worldwide in the late 1990s and hereafter increasing rates of early syphilis were also reported in Denmark. 

The proportion of patients with concurrent HIV has been substantial, ranging from one third to almost two thirds of patients diagnosed with syphilis some years. Given that syphilis facilitates transmission and acquisition of HIV the two sexually transmitted diseases are of major public health concern. Further, syphilis has a negative impact on HIV infection, resulting in increasing viral loads and decreasing CD4 cell counts during syphilis infection. 

Likewise, HIV has an impact on the clinical course of syphilis; patients with concurrent HIV are thought to be at increased risk of neurological complications and treatment failure. Almost ten per cent of Danish men with syphilis acquired HIV infection within five years after they were diagnosed with syphilis during an 11-year study period. Interestingly, the risk of HIV declined during the later part of the period. 

Moreover, HIV-infected men had a substantial increased risk of re-infection with syphilis compared to HIV-uninfected men. As one third of the HIV-infected patients had viral loads >1,000 copies/ml, our conclusion supported the initiation of cART in more HIV-infected MSM to reduce HIV transmission. 

During a five-year study period, including the majority of HIV-infected patients from the Copenhagen area, we observed that syphilis was diagnosed in the primary, secondary, early and late latent stage. These patients were treated with either doxycycline or penicillin and the rate of treatment failure was similar in the two groups, indicating that doxycycline can be used as a treatment alternative - at least in an HIV-infected population. During a four-year study period, the T. pallidum strain type distribution was investigated among patients diagnosed by PCR testing of material from genital lesions. In total, 22 strain types were identified. HIV-infected patients were diagnosed with nine different strains types and a difference by HIV status was not observed indicating that HIV-infected patients did not belong to separate sexual networks. 

In conclusion, concurrent HIV remains common in patients diagnosed with syphilis in Denmark, both in those diagnosed by serological testing and PCR testing. Although the rate of syphilis has stabilized in recent years, a spread to low-risk groups is of concern, especially due to the complex symptomatology of syphilis. However, given the efficient treatment options and the targeted screening of pregnant women and persons at higher risk of syphilis, control of the infection seems within reach. Avoiding new HIV infections is the major challenge and here cART may play a prominent role.

Full (PDF) article at:  http://goo.gl/ixrJbZ

By:  Kirsten Salado-Rasmussen

Correspondence: Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen. Denmark E-mail: ksalado@hotmail.com

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Seroprevalence of the Hepatitis B, Hepatitis C, and Human Immunodeficiency Viruses and Treponema pallidum at the Beijing General Hospital from 2010 to 2014: A Cross-Sectional Study

The hepatitis B, hepatitis C, human immunodeficiency viruses and Treponema pallidum are important causes of infectious diseases concern to public health.

Between 2010 and 2014, we used an automated chemiluminescence microparticle immunoassay to detect the hepatitis B, hepatitis C, and human immunodeficiency viruses as well as Treponema pallidum (the rapid plasma regain test was used in 2010–2011). Positive human immunodeficiency virus tests were confirmed via western blotting.

Among 416,130 subjects, the seroprevalences for hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and Treponema pallidum were 5.72%, 1.23%, 0.196%, and 0.76%, respectively. Among 671 patients with positive human immunodeficiency virus results, 392 cases were confirmed via western blotting. Hepatitis B and human immunodeficiency virus infections were more frequent in men (7.78% and 0.26%, respectively) than in women (4.45% and 0.021%, respectively). The hepatitis B and C virus seroprevalences decreased from 6.21% and 1.58%, respectively, in 2010, to 5.37% and 0.988%, respectively, in 2014. The human immunodeficiency virus seroprevalence increased from 0.04% in 2010 to 0.17% in 2014, and was elevated in the Infectious Disease (2.65%), Emergency (1.71%), and Dermatology and Sexually Transmitted Diseases (1.12%) departments. The specificity of the human immunodeficiency virus screening was 71.4%. The false positive rates for the Treponema pallidum screening tests increased in patients who were 60–70 years old. The co-infection rates for the hepatitis C and human immunodeficiency viruses were 0.47% in hepatitis C virus-positive patients and 7.33% in human immunodeficiency virus-positive patients.

During 2010–2014, hepatitis B virus and human immunodeficiency virus infections were more frequent among men at our institution. Although the seroprevalences of hepatitis B and C viruses decreased, the seroprevalence of human immunodeficiency virus infection increased (with higher seroprevalences in high-risk departments). Older patients were more likely to exhibit false positive findings for syphilis.

Below: Seroprevalences of HBV, HCV, HIV, and TP According to Age. HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; TP, Treponema pallidum; RPR, rapid plasma regain test.

Below: Sex-related Differences in the Seroprevalence of HIV According to Age. HIV, human immunodeficiency virus; M, male; F, female.

Below: Seroprevalence of TP via the RPR Test and anti-TP According to Age. TP, Treponema pallidum; RPR, rapid plasma regain test.

Full article at: http://goo.gl/Kj9TtP

By: 

Shaoxia Xu, Qiaofeng Wang, Weihong Zhang, Jingtao Cui, Wenjuan Yan, Anping Ni

Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Zhifeng Qiu

Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

   

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Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Treponema pallidum Infections among Blood Donors on Bioko Island, Equatorial Guinea

Regular screening of transfusion-transmissible infections (TTIs), such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C virus (HBV and HCV, respectively), and Treponema pallidum, in blood donors is essential to guaranteeing clinical transfusion safety. This study aimed to determine the seroprevalence of four TTIs among blood donors on Bioko Island, Equatorial Guinea (EG).

A retrospective survey of blood donors from January 2011 to April 2013 was conducted to assess the presence of HIV, HBV, HCV and T. pallidum. The medical records were analyzed to verify the seroprevalence of these TTIs among blood donations stratified by gender, age and geographical region.

Of the total 2937 consecutive blood donors, 1098 (37.39%) had a minimum of one TTI and 185 (6.29%) harbored co-infections. The general seroprevalence of HIV, HBV, HCV and T. pallidum were 7.83%, 10.01%, 3.71% and 21.51%, respectively. The most frequent TTI co-infections were HBV-T. pallidum 60 (2.04%) and HIV-T. pallidum 46 (1.57%). The seroprevalence of HIV, HBV, HCV and T. pallidum were highest among blood donors 38 to 47 years, 18 to 27 years and ≥ 48 years age, respectively (P<0.05). The seroprevalence of TTIs varied according to the population from which the blood was collected on Bioko Island.

Our results firstly provide a comprehensive overview of TTIs among blood donors on Bioko Island. Strict screening of blood donors and improved hematological examinations using standard operating procedures are recommended.

Below:  The geographic location of research population.

Malabo city was divided into eight regions including the old city center (A), the presidential office and residential area (B), the public residential area from previous planning (C), the modern residential area with a low population density (D), the modern residential area with a high population density (E), the un-planned residential area with a different population density (F) and the un-planned residential area with a high population density (G). The rural area included Luba, Moka, Riaba and Baney on Bioko Island.

Below:  The distribution of the TTI seroprevalence rates among the blood donors

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By: Xie DD1, Li J2, Chen JT3, Eyi UM4, Matesa RA4, Obono MM4, Ehapo CS4, Yang LY5, Yang H5, Yang HT5, Lin M5.

• 1Laboratory Medical Center, The People's Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People's Republic of China.
• 2Department of Infectious Diseases, Renmin Hospital; Department of Parasitology, College of Basic Medicine, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China.
• 3Laboratory Medical Center, The People's Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People's Republic of China; Laboratory Medical Center, Huizhou Municipal Central Hospital, Guangdong, Huizhou, Guangdong, People's Republic of China.
• 4Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea.
• 5Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People's Republic of China.  

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