Phase-specific network differences associated with the syphilis epidemic in Baltimore city, 1996-2000

OBJECTIVES: The objective of this study was to determine whether the syphilis epidemic in Baltimore City during the mid-1990s was associated with changes in sexual networks. METHODS: Data on index cases of syphilis and their partners were collected from 1996 to 2000 and entered into CDC STD*MIS software. Unique pairs of dyads were used to create networks using SAS Interactive Matrix Language. PAJEK and UCINET were used to analyze the largest component from all years (1996-2000), during the epidemic (1997-1998), and after the epidemic (1999-2000). RESULTS: Between 1996 and 2000, there were 3343 components containing 18,709 nodes. The 2 largest components were comprised of 1103 nodes and 125 nodes, respectively. From the period during the epidemic to after the epidemic, the average distance among reachable pairs, network centralization, number of n-cliques (n = 2, size = 3), and number of k-plexes (k = 2, n = 3) declined, whereas the block densities increased. CONCLUSIONS: Important differences exist between the sexual networks during and after the syphilis epidemic.     

Contraceptive practices of women attending the Sexually Transmitted Disease Clinic in Nashville, Tennessee

The decision to be sexually active involves two health risks for women: unwanted pregnancy and sexually transmitted diseases. Use of contraception affects both these risks. Data from the Metropolitan Health Department in Nashville, Tennessee, were examined to determine the effects of particular contraceptive methods on gonococcal infection in women. The results suggest that not only barrier methods but also other types of contraception were associated with protection against gonorrhea in females. The use of contraception was unusually high (87%) among the study population of 1,303 women. Five hundred eighteen (40%) of these clinic attendees were infected with Neisseria gonorrhoea. Infected women tended to be younger than those not infected and were significantly more likely to be black than white and somewhat more likely to be single. Contraceptors tended to be younger and were more likely to be black than were noncontraceptors.     

Primary and secondary syphilis, 20 years'' experience. 3: Diagnosis, treatment, and follow up.

The methods of diagnosis (dark ground microscopy and serology), treatment, and follow up of 946 patients with primary and 854 with secondary syphilis who presented to a London STD clinic between 1965 and 1984 were reviewed retrospectively. On dark ground microscopy spirochaetes typical of Treponema pallidum were seen in 673 (78%) of 884 patients with primary syphilitic chancres. Of the patients with primary syphilis, 137 (14.5%) had negative serology results at presentation. Eight (0.9%) of the patients with secondary syphilis had negative results at presentation, but seven of these gave positive results one month later. Procaine penicillin was the treatment used most, and erythromycin the commonest alternative. The Jarisch-Herxheimer reaction occurred more often after treatment with penicillin than with erythromycin or tetracycline (p less than 0.005). In most patients the Venereal Diseases Research Laboratory (VDRL) test showed a consistent fall in titre after treatment; a small proportion, however, continued to give positive results (some at a high titre) with no other evidence of reinfection or treatment failure.     

The syphilis epidemic in Connecticut: relationship to drug use and prostitution

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.     

The re-emergence of syphilis in the United Kingdom: the new epidemic phases

OBJECTIVE: The objective of this study was to characterize the resurgence of infectious syphilis in the United Kingdom between 1997 and 2003. STUDY: The authors conducted a retrospective analysis of routine surveillance data from genitourinary medicine clinics and data collected through enhanced surveillance. RESULTS: Between 1997 and 2002, diagnoses of primary, secondary, and early latent syphilis made at genitourinary medicine clinics increased by 213% in heterosexual males, 1412% in men who have sex with men (MSM), and 22% in females. These increases have been driven by a series of outbreaks, the largest of which were seen in Manchester (528) and London (1222) up to the end of October 2003. All the outbreaks have been geographically localized and the majority of cases occurred in MSM. A high percentage of concurrent HIV infection was reported, and oral sex was often reported as a route of transmission. CONCLUSIONS: Syphilis has re-emerged in response to behavior change, probably driven by changes in the HIV epidemic. The future course of the epidemic is difficult to predict and control remains elusive.     

Resistance of Neisseria gonorrhoeae epidemic strains to antibiotics: report of resistant isolates and surveillance in Zhanjiang, China: 1998 to 1999

BACKGROUND: Antibiotics are widely used to treat gonorrhea. Changes in the susceptibility of Neisseria gonorrhoeae to these agents may influence their use. GOAL: To measure the antibiotic susceptibility of N gonorrhoeae epidemic strains in Zhanjiang (Guangdong) and to evaluate the prevalence of strains with reduced susceptibility. STUDY DESIGN: A total of 98 gonococcal isolates obtained from 1998 through 1999 in Zhanjiang were tested for antibiotic susceptibility based on the systemic identification. The inhibitory zone diameters (mm) and the MICs of penicillin, tetracycline, spectinomycin, ceftriaxone, and ciprofloxacin were determined using disk-diffusion and agar-dilution methods, respectively. The susceptibilities of these isolates were defined using criteria of the National Committee for Clinical Laboratory Standards. RESULTS: The percentages of gonococci-resistant strains to penicillin, tetracycline, spectinomycin, ceftriaxone, and ciprofloxacin were 32.65%, 69.39%, 8.16%, 13.27%, 82.65% by disk-diffusion method and 23.91%, 49.46 %, 11.11%, 16.48%, 59.34% by agar-dilution method, respectively. CONCLUSIONS: The resistant strains of contemporary gonococci in Zhanjiang were serious, especially for ciprofloxacin resistance. Continued active surveillance is needed to detect and control the spread of ceftriaxone-resistant and spectinomycin-resistant N gonorrhoeae.     

Primary cutaneous epithelioid rhabdomyosarcoma: a rare,recently described entity with review of the literature

We report a case of a primary cutaneous epithelioid rhabdomyosarcoma that presented as a single raised pink‐purple lesion (3.3 × 2.2 cm) on the left base of neck in a 75‐year‐old man. Histopathologic examination revealed an exophytic, nodular tumor within the dermis and superficial subcutis with overlying ulceration. The tumor exhibited sheet‐like growth, infiltration of adjacent structures, and was composed of uniform epithelioid cells with abundant eosinophilic cytoplasm and eccentrically placed vesicular nuclei with irregular nuclear contours and prominent central nucleoli. Numerous mitotic figures were present [28/10 high power fields (HPF)] but only mild cytologic pleomorphism was identified. By immunohistochemistry, tumor cells were diffusely and strongly positive for desmin and MYOD1. Focal positive staining for myogenin and cytokeratin CK903 was identified. Stains for Melan‐A, S‐100, SOX10, p63 and CK5/6 were negative. These histopathologic and immunophenotypic features support a diagnosis of epithelioid rhabdomyosarcoma. No evidence of a deep soft tissue primary lesion was identified. In summary, epithelioid rhabdomyosarcoma can present as a primary cutaneous lesion and dermatopathologists should be aware of this entity.     

Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002

BACKGROUND: In the United States, there is a high rate of HIV coinfection in persons with syphilis. GOAL: The goal of this study was to estimate the rate of primary and secondary (P&S) syphilis in persons living with HIV in the United States in 2002. STUDY: We approximated the number of new cases of P&S syphilis in HIV-infected persons and divided this by the estimated number of persons living with HIV. Values for the calculations were obtained from national syphilis and HIV/AIDS surveillance reports and other published sources. RESULTS: We estimated the rate of new cases of P&S syphilis at 186 per 100,000 persons living with HIV in 2002, 25 per 100,000 HIV-infected women, 60 per 100,000 HIV-infected men who have sex with women only, and 336 per 100,000 HIV-infected men who have sex with men. Of the 6862 reported cases of P&S syphilis in 2002, an estimated 1718 (25%) occurred in persons coinfected with HIV. CONCLUSIONS: The estimated rate of P&S syphilis in persons with HIV is considerably higher than that of the general population. These findings highlight the importance of providing sexually transmitted disease prevention and control services to HIV-infected persons.