Syphilis shocker (original) (raw)
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Reading this exhaustive account of the quest to develop a vaccine against AIDS, I'm not sure whether to laugh or cry. It's not as if Jon Cohen, a veteran writer for Science magazine and a darling of the AIDS establishment, hasn't assembled a thoroughly gripping detective mystery, documenting all the twists and turns HIV science has taken over the last 16 years. But every good detective story needs a denouement, and here Cohen can't deliver the goods. We still have no HIV vaccine, despite the untold billions of dollars and great scientific minds directed toward developing one. For readers who question the assumptions driving the vaccine initiative, Cohen's tract will only serve to confirm the futility of this massive effort, which has seen thousands of people injected with experimental vaccines that seem to produce strong immune responses against the virus but don't appear to offer any protection against AIDS itself. It would help researchers if HIV-1 (the vir...
2013
This review argues that syphilis has been underdiagnosed and undertreated, a problem that goes back to the beginning of the Wassermann era, and indeed long before. Non-treponemal tests do not detect the larger pool of persons with latent syphilis, the immunological consequences of which have not been systematically investigated in the context of HIV infection and progression to AIDS. Recent efforts to confirm the prevalence of syphilis in high-risk patients by reverse sequence screening, i.e. using a treponemal test first, as the screening test, have revealed untreated syphilis at higher rates than expected. Further testing using PCR discovered even more previously undetected cases. We suggest that latent syphilis is a chronic active immunological condition that drives the AIDS process and cannot be managed with the older Wassermann-based algorithm, and that non-treponemal tests have failed to associate syphilis with immune suppression since this screening concept was developed in 1906. In light of the overwhelming association between a past history of syphilis and HIV seroconversion, more sensitive tools, including recombinant antigen-based immunological tests and direct detection (PCR) technology, are needed to adequately assess the role of latent syphilis in persons with HIV/AIDS. Repeating older syphilis reinoculation studies may help establish a successful animal model for AIDS, and resolve many paradoxes in HIV science.
Deja Vu: AIDS in Historical Perspective (CBC Radio 1996 documentary)
"A mysterious epidemic, hitherto unknown, which had struck terror into all hearts by the rapidity of its spread, the ravages it made, and the apparent helplessness of the physicians to cure it." A quote about AIDS? No. It's about the appearance of syphilis in the early sixteenth century. Writer Colman Jones finds the two diseases share issues, from science and public health to civil liberties and sexuality. This two-part radio program places the current responses to AIDS, from both socio-cultural and medical standpoints, in historical perspective. Using interviews with historians and scientists, archival public health films, radio broadcasts, and readings from classical texts, the series traces the history of venereal diseases from the 1600s to the present, and shows how many of today's concerns have clear precedents in past epidemics. The programs underline how a whole series of biological, psychological and social factors shape the public's perception of disease, and society's response to it. The strengths and limits of past approaches to detecting sexually transmitted diseases are explored, in order to shed light on approaches that could be used to control AIDS today. Déja Vu: AIDS in Historical Perspective is divided into two 1-hour episodes: Part 1, "The Social Construction of Disease", compares the public reaction to AIDS with past reactions to other sexually transmitted diseases, especially syphilis. We hear about the medical approaches - then and now - which used toxic and ineffective drugs, about blaming the victims, about contact tracing and laws designed to regulate sexual conduct, and about the education campaigns - then and now - which were reluctant to focus on the real risk groups, or to give straightforward advice on self-protection, for fear of offending public taste. Part 2, "New Questions About an Old Killer", explores the wealth of medical and scientific evidence from the history of sexually transmitted diseases, evidence that sheds considerable light on AIDS today. It suggests we may be living through an extraordinary episode of déja vu, not only as far as the social, cultural, and political responses to AIDS are concerned, but in terms of the actual medical syndrome itself: the program examines evidence that AIDS, as we understand it today, has been around for a long time, and examines the growing questions being raised over the possible hidden role of syphilis in sexually-acquired AIDS. Over a dozen experts in the fields of infectious diseases, immunology, epidemiology, and medical history were interviewed during the preparation of these programs, including: -Edward Shorter, Professor of the History of Medicine at the University of Toronto -Jay Cassel, Professor of History at Toronto's York University, author of "The Secret Plague: VD in Canada 1838-1939" -Robert Root-Bernstein, Associate Professor of Physiology at Michigan State University, author of "Rethinking AIDS: The Tragic Cost of Premature Consensus" -Allan Brandt, Kass Professor of the History of Medicine and Medical Ethics at Harvard University, author of "No Magic Bullet", a study of the history of sexually transmitted diseases in the United States in the 20th century -Daniel Musher, Head of Infectious Diseases at the Baylor College of Medicine and the Veterans Affairs Medical Centre in Houston, Texas -Jadwiga Podwiñska, Associate Professor at the Institute of Immunology and Experimental Therapy of the Polish Academy of Sciences in Wroclaw, Poland -István Horváth, Doctor of Science, Department Head for syphilis serology, National Center for Dermatology and Venereology, Budapest, Hungary -Bruno Schmidt, Laboratory Chief at the Ludwig Boltzmann Institute for Dermato-venerological Sero-diagnosis in Vienna, Austria -Justin Radolf, Director, Center for Microbial Pathogenesis, and Professor of Microbiology at the University of Connecticut Health Center -Konstantin Borisenko, General Director of Moscow's Association Against Sexually Transmitted Diseases (SANAM), and a top Russian syphilis expert -Robert Rolfs, former medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDCP), now Director of the Bureau of Surveillance and Analysis, Utah Department of Health -Nikolai Chaika, Director of Information for the Ukraine's Pasteur Institute in St. Petersburg -Nils Strandber Pedersen, Director of the Statens Serum Institute in Copenhagen, covering all syphilis diagnostic services in Denmark. -Barbara Romanowski, Director of Sexually Transmitted Disease Services for the province of Alberta, and also Professor of Infectious Disease at the University of Alberta -Stephen Caiazza, (now deceased) New York physician who treated his AIDS patients with penicillin, suspecting they were dying from syphilis. -John Scythes, independent investigator and owner of Glad Day Bookshop in Toronto. For more information, visit the extensive web site created to accompany the program, an archive of which is available at http://web.archive.org/web/20030228013741/http://cbc.ca/ideas/features/Aids/index.html
A New Gold Standard For Syphilis? (co-authored with John B. Scythes and Robert H. Notenboom)
Novel PCR screening on whole blood has found T. pallidum DNA in erythrocytes of young gay men in Budapest who are repeatedly negative in all other standard syphilis tests, including treponemal antibody screening (TPHA). This follows on historical evidence suggesting syphilis has been under-diagnosed ever since screening with non-specific anti-lipoidal antigens began in 1906. The first half of the 20th century saw the development of complement fixation and precipitation/flocculation assays, which were often used together to increase sensitivity and specificity, because many cases proved difficult. Syphilis sequelae often occurred despite lifelong negative anti-lipoidal serology. The arrival of treponemal tests (TPI in 1949) further increased the sensitivity, and also excluded many false positives, although this class of test lacked sensitivity in primary syphilis. Vienna's teaching hospitals have also confirmed over many years that the TPHA finds nearly twice as many undetected cases as the VDRL. The avidity/affinity index as a surrogate for IgM antibody (Boltzmann Institute for Serodiagnosis, Vienna) found many active cases with no VDRL reactions. Despite these refinements, Ontario's Public Health Laboratory has documented the selective loss of treponemal antibody among HIV antibody(+) gay men, making it difficult - if not impossible - to assess the prevalence of syphilis. Since the early 1990s, recombinant antigens have provided even greater sensitivity, confirmed again in Toronto by reactive immunoblots - both IgG and IgM - among men at high risk for syphilis. Yet these VDRL(-) and often TPHA(-) persons remain undiagnosed. Using the PCR in South Africa, the CDC's Multiplex assay has proven that the VDRL misses most primary syphilis when the DNA of other ulcerative STDs is present. The increased sensitivity of newer tools will allow a better assessment of the true morbidity and mortality caused by syphilis, and suggests the gold standard for screening select populations will ultimately require gene amplification.
A New Gold Standard for Syphilis?
Journal of the European Academy of Dermatology and Venereology
Novel PCR screening on whole blood has found T. pallidum DNA in erythrocytes of young gay men in Budapest who are repeatedly negative in all other standard syphilis tests, including treponemal antibody screening (TPHA). This follows on historical evidence suggesting syphilis has been under-diagnosed ever since screening with non-specific anti-lipoidal antigens began in 1906. The first half of the 20th century saw the development of complement fixation and precipitation/flocculation assays, which were often used together to increase sensitivity and specificity, because many cases proved difficult. Syphilis sequelae often occurred despite lifelong negative anti-lipoidal serology. The arrival of treponemal tests (TPI in 1949) further increased the sensitivity, and also excluded many false positives, although this class of test lacked sensitivity in primary syphilis. Vienna's teaching hospitals have also confirmed over many years that the TPHA finds nearly twice as many undetected c...
Transcript excerpt: "Déja Vu: AIDS in Historical Perspective" (IDEAS, CBC Radio, January 1996)
"A mysterious epidemic, hitherto unknown, which had struck terror into all hearts by the rapidity of its spread, the ravages it made, and the apparent helplessness of the physicians to cure it." A quote about AIDS? No. It's about the appearance of syphilis in the early sixteenth century. Writer Colman Jones finds the two diseases share issues, from science and public health to civil liberties and sexuality. This two-part radio program places the current responses to AIDS, from both socio-cultural and medical standpoints, in historical perspective. Using interviews with historians and scientists, archival public health films, radio broadcasts, and readings from classical texts, the series traces the history of venereal diseases from the 1600s to the present, and shows how many of today's concerns have clear precedents in past epidemics. The programs underline how a whole series of biological, psychological and social factors shape the public's perception of dise...
2000
We have been working in AIDS co-factor research for over a decade, collaborating with physicians and hospital specialists in both Canada and Eastern Europe, and presenting our findings at international HIV/STD meetings (including five international AIDS conferences). We are cautiously encouraged by the recent steps taken by South African President Thabo Mbeki to establish an expert advisory panel to re-assess various aspects of HIV/AIDS science as they pertain to his country. In our view, this initiative is very timely, given the growing uncertainties surrounding how to deal with the disease, especially in developing countries with limited resources. But we are somewhat concerned reading the Minority Statement and Recommendations to the Government of South Africa, dated May 7, 2000, which we feel limits the AIDS debate to a non-infectious model, seemingly as immutable a position as the HIV orthodoxy that the dissidents are seeking to dethrone. We have privately communicated many of the concerns outlined below to President Mbeki and his health minister. But we also feel compelled to issue a public response to the statements of the minority panel so far, as we fear that entrenching yet another flawed AIDS paradigm, i.e. an exclusively noninfectious model, will not serve the interests of people at risk for this syndrome, whether they be in South Africa or anywhere else. Below is our point-by-point response to the Minority Statement by the ten panel members listed below. We sincerely hope the concerns expressed herein will be taken into consideration during the upcoming closed Internet discussions.
Can We Reliably Diagnose Syphilis? (co-authored with John B. Scythes)
"Objectives: To ascertain if syphilis screening reliably detects latent disease, including in the HIV context, by comparing standard syphilis testing with newly-developed techniques, using either recombinant antigen based treponemal serology or direct detection by DNA amplification. Methods: (1) 500 patients at a downtown Toronto HIV clinic were screened from 1988-1992 with both RPR and quantified treponemal tests, including MHA-Tp (TPHA). (2) Serum aliquots from a further 250 patients from the University of Toronto's AIDS Epi-Study were similarly tested in 1992. (3) 557 patients from another downtown HIV/STD clinic were screened in 2000 as above, and also monitored with the Trep-Chek, a more sensitive, FDA-approved, recombinant ag-based EIA test. (4) Recently, 183 patients from two dermatology clinics in Budapest were tested for T. pallidum DNA with a nested PCR. Results: (1) None of 500 patients were RPR(+), while 60/500 were TPHA (+), 11 of whom had no syphilis history. Six with a syphilis history were TPHA (-) with CD4 < 80/ul. (2) Of 125/250 Epi-Study patients with HIV, 24 had dropping treponemal titres during B-cell polyclonal activation, while only one HIV(-) case lost treponemal antibody selectively in this way. (3) Of 557 clinic patients, none were RPR(+), while 27 had evidence of syphilis by Trep-Chek, 24 of whom were WB (+) or equivocal. Nine were TPHA(+). Only 4/27 had ever been followed up. (4) 13/183 of the Budapest group were syphilis PCR(+), while only four had ever been treated. These four were the only TPHA (+) persons in the group. Conclusions: Diagnostically, early acute syphilis is one thing and latent syphilis is quite another. RPR(+) findings were extremely rare among these nearly 1500 high-risk patients. Screening for syphilis with anti-lipoidal tests, based on a 1906 concept, is inappropriate. The persistence of treponemal antibody may indicate ongoing syphilis infection despite therapy, and such patients may need re-treatment and follow-up using gene amplification. Some patients with latent syphilis seem to have little or no treponemal antibody. It is therefore unclear to what extent undetected latent syphilis overlaps with HIV, and HIV/AIDS."
Field evaluation of a dual rapid diagnostic test for HIV infection and syphilis in Lima, Peru
Objectives Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-ofcare tests that can detect multiple infections with a single fingerprick whole blood specimen using a single device are gaining popularity. We evaluated the field performance of a rapid dual HIV and syphilis test in people at high risk of HIV and syphilis infections. Methods Participants included men who have sex with men and transgender women recruited in Lima, Peru. Reference standard testing for detection of HIV and syphilis infections, conducted using blood samples from venipuncture, included Treponema pallidum particle agglutination and fourth-generation HIV enzyme immunoassay for which positive results had a confirmation HIV Western blot test. For the evaluation test, SD BIOLINE HIV/Syphilis Duo test (Standard Diagnostics, Korea), a fingerprick blood specimen was used. Sensitivity and specificity were calculated and the exact binomial method was used to determine 95% CIs. Results A total of 415 participants were recruited for the study. The dual test sensitivity for detection of T. pallidum infection was 89.2% (95% CI 83.5% to 93.5%) and specificity 98.8% (95% CI 96.5% to 99.8%). For detection of HIV infection, the sensitivity of the dual test was 99.1% (95% CI 94.8% to 100%) and specificity 99.4% (95% CI 97.7% to 99.9%). Conclusions This high performing dual test should be considered for the use in clinical settings to increase uptake of simultaneous testing of HIV and syphilis and accelerate time to treatment for those who need it.