Home Medizin Unerfahrenheit bei der Diagnose von Syphilis trägt zu höheren Raten bei

Unerfahrenheit bei der Diagnose von Syphilis trägt zu höheren Raten bei

von NFI Redaktion

As syphilis rates continue to rise rapidly in the United States and elsewhere, doctors must do their best when it comes to diagnosing and treating an infection they may not be paying enough attention to.

According to the latest data from the Centers for Disease Control and Prevention (CDC), in 2022, over 200,000 cases of syphilis were reported in the United States, marking the highest number since 1950 and a 17.3% increase from 2021. The infection rate has been steadily increasing almost every year since hitting a historical low in 2001.

And the trend is not limited to the United States. Last year, the infection rate in the United Kingdom reached its highest level in 50 years, as reported by David Mabey, BCh, DM, from the London School of Hygiene and Tropical Medicine. Syphilis and other sexually transmitted infections are also a significant problem in low- and middle-income countries, he added, although good data may not always be available.

„Many of today’s healthcare professionals have little experience with the disease,“ shared Ina Park, MD, a specialist in sexually transmitted infections at the University of California, San Francisco. „An entire generation of doctors – myself included – didn’t see cases until well into our careers,“ Park recounted. „We are really playing catch-up.“

An age-old disease

At the 2024 Annual Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Park offered advice on the challenges of diagnosing a potentially elusive infection. This advice boiled down to a simple rule: „Test, test, test.“

Since syphilis can mimic many other conditions and have long latency periods, experienced physicians may easily overlook or misdiagnose it, Park said. Doctors must keep this in mind and set a lower threshold for testing, even in the absence of obvious symptoms.

Adhering to the new CDC recommendations for syphilis screening will be helpful, she noted; any sexually active patient between the ages of 15 and 44 living in a county with a syphilis infection rate of 4.6 per 100,000 residents or higher should undergo testing. And doctors should remain vigilant even in areas with lower prevalence. „If you can’t explain new symptoms in a sexually active patient, order a test,“ Park advised.

Complex cases

The lack of experience with syphilis not only affects diagnosis but also treatment, especially in complex cases, explained Khalil Ghanem, MD, PhD, from the Johns Hopkins University School of Medicine in Baltimore. „When you haven’t dealt with something for a while, you forget how to handle it,“ he added.

At CROI, Ghanem provided recommendations on managing complex cases of ocular syphilis, otic syphilis, and neurosyphilis, as well as interpreting test results when a patient’s antigen titers are „recalcitrant.“

In cases of possible ocular or aural syphilis, Ghanem advised not to wait for consultation by a specialist such as an ophthalmologist but to refer the patient directly to the emergency room, as there is a risk of irreversible symptoms leading to permanent blindness or deafness. „You don’t want to mess around with these conditions,“ Ghanem emphasized.

Monitoring a patient’s rapid plasma reagin closely and the antigen levels in the sexually transmitted disease research laboratory is the only way to treat syphilis and determine whether the infection is responding to treatment, he noted, but sometimes „these titers don’t behave as expected“ and do not decrease after treatment or even increase.

„You don’t know if they’ve gone up because the patient has been re-infected, if they’ve developed neurosyphilis, or if there’s a problem in the lab,“ he said. „Interpretation can be difficult.“
To decipher confusing test results, Ghanem recommended taking a detailed patient history to understand if there is a risk of reinfection, signs of neurosyphilis or other complications, the possibility of pregnancy, and more. „Based on the responses, you can determine the most rational treatment approach,“ he shared.

Drug shortage

Efforts to control the infection have become more complicated. Last summer, Pfizer announced it had run out of Penicillin G Benzathine (Bicillin), an injectable, long-acting medication that is one of the mainstays for syphilis treatment and the only one that can be given to pregnant individuals. By the end of June 2023, stocks were depleted for children, and by the end of September, stocks were exhausted for adults.

Since Pfizer is the sole manufacturer of Penicillin G Benzathine, there is no one who can fill the gap in the short term, so the shortage is expected to persist at least until mid-2024.

In response, the US Food and Drug Administration temporarily approved the use of Benzylpenicillin Benzathine (Extencillin), a French formulation not approved in the United States, until the supply of Penicillin G Benzathine stabilizes.

The shortage has shed light on the critical issue of the lack of alternatives for syphilis treatment during pregnancy, increasing the risk of congenital syphilis. „Hopefully, this will push the National Institutes of Health and others to intensify their studies on alternative medications for use in pregnancy,“ Ghanem said.

Related Posts

Adblock Detected

Please support us by disabling your AdBlocker extension from your browsers for our website.