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Volume 29, Number 10—October 2023
Research

Treponema pallidum Detection at Asymptomatic Oral, Anal, and Vaginal Sites in Adults Reporting Sexual Contact with Persons with Syphilis

Ei T. AungComments to Author , Christopher K. Fairley, Deborah A. Williamson, Francesca Azzato, Janet M. Towns, Rebecca Wigan, Eric P.F. Chow1, and Marcus Y. Chen1
Author affiliations: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia (E.T. Aung, C.K. Fairley, J.M. Towns, R. Wigan, E.P.F. Chow, M.Y. Chen); Central Clinical School, Monash University, Melbourne (E.T. Aung, C.K. Fairley, J.M. Towns, E.P.F. Chow, M.Y. Chen); The Doherty Institute for Infection and Immunity, Melbourne (D.A. Williamson); Victorian Infectious Diseases Reference Laboratory, Melbourne (D.A. Williamson, F. Azzato); Melbourne School of Population and Global Health, The University of Melbourne, Melbourne (E.P.F. Chow)

Main Article

Table 2

Characteristics of 9 syphilis patients without signs or symptoms of syphilis who had PCR detection of Treponema pallidum from oral, anal, or vaginal sites in retrospective study of men and women who visited the Melbourne Sexual Health Centre, Melbourne, Victoria, Australia, during November 2018–March 2020*

Group by sexual practice HIV/PrEP status Signs on examination Mucosal PCR sites (value if positive†)
 Serologic test results
 Previous serologic test results (RPR titer if reactive) Staging of syphilis
Oral cavity Vagina Anal Current RPR titer Previous syphilis serologic test
Woman‡ Neg No – + (31) ND 1:8 8 y Negative Primary
Woman§ Neg ND – + (36) ND 1:2 None NA Primary
Woman‡ Neg No + (33) ND ND 1:128¶ None NA Primary
Woman‡ Neg ND + (32) + (37) ND 1:16 None NA Early latent
Bisexual man Neg ND – NA + (35) Nonreactive# 8 mo Negative Early latent
MSM Neg No – NA + (26) 1:32 12 mo Negative Early latent
MSM HIV No + (30) NA – 1:256¶ 10 mo + (1:8) Primary
MSM HIV No + (36) NA – 1:128¶ 10 mo Negative Primary
MSM PrEP No + (36) NA + (32) 1:32 2 mo Nonreactive Primary

*MSM, men who have sex with men; NA, not applicable; ND, not done; neg, HIV-negative and not taking PrEP; PrEP, preexposure prophylaxis for HIV; RPR, rapid plasma reagin; woman, heterosexual woman; –, negative by T. pallidum PCR; +, positive by T. pallidum PCR. †Cycle threshold value of T. pallidum PCR. ‡The regular partners (of >1 year duration) had early syphilis (primary and secondary) diagnosed. §The casual partner had secondary syphilis diagnosed. ¶These 3 patients had high RPR titers with oral PCR detection. We attribute oral PCR detection to shedding after dissemination of T. pallidum on the basis of the high RPR titer, although this finding could be attributable to occult lesions in the oral cavity. #Positive T. pallidum–specific antibodies and nonreactive RPR with negative T. pallidum–specific antibodies 8 months prior.

Main Article

1These senior authors contributed equally to this article.

Page created: August 31, 2023
Page updated: September 20, 2023
Page reviewed: September 20, 2023
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