Consensus by Chinese Expert Panel on Chlamydia trachomatis-Resistant and Chlamydia trachomatis-Persistent Infection

Chlamydia trachomatis （Ct） genital infection is the most common sexually transmitted disease （STD） in China and the US. The morbidity of Ct genital infection in China has increased from 32.48/100,000 in 2008 to 37.18/100,000 in 2015.[1] The major areas of Ct infections are concentrated in the Zhujiang Delta, Changjiang Delta, Minjiang Area, and West China. In these areas, the highest incidence of Ct infection reaches 615.99/100,000 citizens. In the US, there are 1,441,789 reported Ct, which include 627.2 females and 278.4 males per 100,000 population. It is now the most prevalent STD, with its rate increasing to 22% in males and 6% in females.[2] Ct genital infection can cause epididymitis, prostatitis, cervicitis, annexitis, infertility, and atopic pregnancy, which have been identified as the major public health problems.

2019 Chinese expert consensus statement on diagnosis and treatment of syphilis

Syphilis,caused by Treponema pallidum subsp pallidum(T.pallidum),is a chronic,systemic human disease transmitted through sexual contact.The incidence and prevalence of syphilis is still high in China.[1]To guide the prevention measures and management of this disease,we renew the guidelines on diagnosis and treatment of syphilis[Supplementary file,http://links.lww.com/CM9/A292].Manifestations and diagnosis of all stages of syphilis are presented in Table 1,and management in Table 2.

National Guidelines on Diagnosis and Treatment of Gonorrhea in China (2020)

Gonorrhea is one of the main sexually transmitted diseases in China.It mainly affects the genitourinary tract,and its clinical manifestations vary from asymptomatic to complicated types.The diagnosis of gonorrhea should be based on the patient's epidemiologicai history,clinical manifestations,and laboratory examination results.Treatment should be prompt and standardized and should involve the recommended treatment regimens.Patients should be appropriately followed up after treatment.The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical concern.In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers,the authors developed the guidelines based on the version of 2014,which will be of important in the standardizing medical care of gonorrhea,and further facilitating control and prevention of the disease.

Clinical Features and Corrected Factors with Neurosyphilis in HIV/Syphilis Co-Infected Patients Based on Stage of Syphilis

Objective: Neurosyphilis is challenging to diagnose, especially in patients with human immunodeficiency virus (HIV)/syphilis co-infection. The aim of this study was to profile the clinical features of neurosyphilis and evaluate the correlation between neurosyphilis and clinical or laboratory factors among patients with HIV/syphilis co-infection.Methods: We retrospectively analyzed the data of 479 HIV/syphilis co-infected patients examined between August 2009 and September 2018. A multivariate logistic regression model was used to identify factors correlated with neurosyphilis.Results: The overall prevalence of neurosyphilis was 21.7%. The prevalence of neurosyphilis differed among patients with primary (11.1%), secondary (20.1%), and latent syphilis (29.1%). The prevalences of neurosyphilis in patients with serological non-response and serofast patients were 26.1% and 6.3%, respectively, while 12.5% of patients with serological relapse had neurosyphilis. Patients with secondary and latent syphilis had serum rapid plasma reagin (RPR) titers (per unit) of 1.44-fold [95% confidence interval (CI): 1.08-1.93,P= 0.014] and 2.73-fold (95%CI: 1.49-5.00,P= 0.001), respectively, which increased the risk of confirmed neurosyphilis. Among patients with latent syphilis, a serum RPR titer of ≥1:32 and peripheral blood CD4 cell count of ≤350/mL were significantly associated with neurosyphilis, with adjusted odds ratios of 9.45 (95%CI: 1.86-48.03,P= 0.007) and 3.75 (95%CI: 1.11-12.66,P= 0.033), respectively.Conclusion: A serum RPR titer of ≥1:32 and a peripheral blood CD4 cell count of ≤350/mL have predictive value in screening for neurosyphilis among HIV-positive patients with latent syphilis.

Circulating MicroRNAs as Potential Biomarkers in the Diagnosis of Neurosyphilis: A Case Control Study

Objective:Laboratory diagnosis of neurosyphilis(NS)remains a great challenge.This study was the aimed to identify miRNA candidates as biomarkers to distinguish between NS,non-neurosyphilis,and healthy controls(HCs).Methods:We analyzed miRNA expression profiles in peripheral blood mononuclear cells(PBMCs)from six patients with NS,eight patients with secondary syphilis(SS),and five HCs using microarray technology.The differentially expressed miRNAs were validated in 33 NS samples,31 SS samples,and 30 HC samples using TaqMan miRNA real-time qPCR(qRT-PCR).Results:Thirty-nine miRNAs were differentially expressed in SS and NS patients compared with HCs.Thirteen miRNAs were randomly selected to validate their expression levels in the same samples used in microarray assay by qRT-PCR.All miRNAs were upregulated in SS and NS samples compared with HC.qRT-PCR analysis of the expression of the 13 miRNAs in a second cohort(76 samples)showed that the average expression levels of nine miRNAs were higher in SS than in NS(SS:0.185,NS:0.136,P=3.8E-10),while the expressions of the other four miRNAs were lower in SS than in NS(SS:0.000757,NS:0.000873,P=0.022).ROC curve analysis of the 13 miRNAs showed the area under the curve value to be 1.00 for distinguishing SS patients from HCs,1.00 for distinguishing NS patients from HCs,1.00 for distinguishing SS and NS patients from HCs,and 0.968 for distinguishing NS from SS patients.Conclusion:The present study is the first one that identified differentially expressed miRNAs in PBMCs from patients with NS.Our results suggest that the 13 candidate miRNAs in PBMCs may be novel noninvasive biomarkers for NS diagnosis.

Co-occurrence of tabes dorsalis with diplopia: an unusual combination caused by Treponema pallidum

Introduction Syphilis is a sexually transmitted disease caused by Treponema pallidum (T.pallidum),and involves in almost all of the body.When the nervous and vision system[1] is involved,neurosyphilis occures.T.pallidum can invade any part of the neuraxis,and neurosyphilis can occur at any stage of syphilis.Neurosyphilis has been divided into five major categories,including asymptomatic meningeal,meningovascular,parenchymatous,and gummatous neurosyphilis[2].These entities represent a continuum and frequent overlap[4].