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Volume 18, Number 6—June 2012

Dispatch

Local Transmission of Imported Endemic Syphilis, Canada, 2011

Sergio FanellaComments to Author , Kamran Kadkhoda, Michelle Shuel, and Raymond Tsang
Author affiliations: University of Manitoba, Winnipeg, Manitoba, Canada (S. Fanella); Cadham Provincial Laboratory, Winnipeg (K. Kadkhoda); National Microbiology Laboratory, Winnipeg, (M. Shuel, R. Tsang)

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Table 1

Serologic testing results for Treponema pallidum subspecies endemicum and clinical findings for a symptomatic patient and family members, Canada, 2011*

Family member† Age, y/sex VDRL result TPPA result Clinical findings Molecular detection/PCR
Parent 40/F Negative Negative None ND
Parent 49/M Negative ND None ND
Child 1/F 1:32 4+‡ Skin papules, perianal condylomata –§
Child 3/M 1:32 4+ Oral ulcer, hoarse voice, drooling, adenopathy
Child 5/F Weakly reactive 4+ None ND
Child 7/F 1:2 4+ None ND
Child 10/F 1:8 4+ None ND
Child 11/M 1:4 4+ None ND
Child 14/M 1:16 4+ None ND
Child 16/F Weakly reactive 4+ None ND
Child 19/F 1:16 4+ None ND

*VDRL, Venereal Disease Research Laboratory test; TPPA, T. pallidum particle agglutination assay; ND, not done.
†All family members received intramuscular benzathine penicillin (1.2 million U if >10 y old, 0.6 million U if <10 y old) after confirmatory PCR results for the 3-year-old child.
‡Positive reactions were measured on a scale of 1–4, with 4 as the highest value.
§Oral swab specimen. Child had history of oral ulcer but had received a full course of azithromycin followed by oral lesion resolution before PCR was performed. She was born in Canada, had no travel history, and although the PCR result was negative, the test was performed after the patient received treatment. The patient had positive serologic test results for T. pallidum, a history of lesions characteristic of endemic syphilis, and no other plausible explanation for findings.
¶Oral ulcer swab specimen.

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