Unexpectedly high prevalence of Treponema pallidum infection in the oral cavity of human immunodeficiency virus-infected patients with early syphilis who had engaged in unprotected sex practices
Journal
Clinical Microbiology and Infection
Journal Volume
21
Journal Issue
8
Pages
787.e1-787.e7
Date Issued
2015
Author(s)
Yang C.-J.
Wu B.-R.
Yang S.-P.
Liu W.-C.
Wu P.-Y.
Zhang J.-Y.
Luo Y.-Z.
Abstract
Between 2010 and 2014, we obtained swab specimens to detect Treponema pallidum, with PCR assays, from the oral cavities of 240 patients with 267 episodes of syphilis who reported engaging in unprotected sex practices. The detected treponemal DNA was subjected to genotyping. All of the syphilis cases occurred in men who have sex with men (MSM), and 242 (90.6%) occurred in human immunodeficiency virus-infected patients. The stages of syphilis included 38 cases (14.2%) of primary syphilis of the genital region, 76 (28.5%) of secondary syphilis, 21 (7.9%) of primary and secondary syphilis, 125 (46.8%) of early latent syphilis, and seven (2.6%) others. Concurrent oral ulcers were identified in 22 cases (8.2%). Treponemal DNA was identified from the swabs of 113 patients (42.2%), including 15 (68.2%) with oral ulcers. The most common genotype of T. pallidum was 14f/f. The presence of oral ulcers was associated with identification of T. pallidum in the swab specimens (15/22 (68.2%) vs. 98/245 (40.0%)) (p = 0.01). In multivariate analysis, secondary syphilis (adjusted OR 6.79; 95% CI 1.97-23.28) and rapid plasma reagin (RPR) titres of ?1: 32 (adjusted OR 2.23; 95% CI 1.02-4.89) were independently associated with the presence of treponemal DNA in patients without oral ulcers. We conclude that detection of treponemal DNA in the oral cavity with PCR assays is not uncommon in MSM, most of whom reported having unprotected oral sex. Although the presence of oral ulcers is significantly associated with detection of treponemal DNA, treponemal DNA is more likely to be identified in patients without oral ulcers who present with secondary syphilis and RPR titres of ?1: 32. ? 2015 European Society of Clinical Microbiology and Infectious Diseases.
SDGs
Other Subjects
bacterial DNA; adult; Article; female; genotype; human; Human immunodeficiency virus infected patient; major clinical study; male; men who have sex with men; mouth cavity; mouth ulcer; oral mucosal disease; prevalence; priority journal; secondary syphilis; sexually transmitted disease; syphilis; Treponema pallidum; treponematosis; unprotected sex; classification; complication; genetics; genotyping technique; Human immunodeficiency virus infection; isolation and purification; male homosexuality; mouth; pathology; prospective study; syphilis; Treponema pallidum; unsafe sex; young adult; Human immunodeficiency virus; Human immunodeficiency virus; Treponema pallidum; Treponema pallidum; Adult; DNA, Bacterial; Genotype; Genotyping Techniques; HIV Infections; Homosexuality, Male; Humans; Male; Mouth; Prevalence; Prospective Studies; Syphilis; Treponema pallidum; Unsafe Sex; Young Adult
Type
journal article