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Syphilis serology in men at an andrology clinic in South Africa.


 Much attention has recently been given to the serious health implications of AIDS, hepatitis B infection and the human papillomavirus. In spite of these, syphilis/gonorrhea are still the most common of the "old" sexually transmitted diseases (STDs) and syphilis is, with the exception of AIDS, the STD with potentially the most destructive sequelae. Recent observations indicate that syphilis may be an important cofactor in facilitating transmission of HIV. A history of syphilis or a positive serologic test for syphilis is associated with HIV seropositivity in men. Although the incidence of syphilis in the UK is 1 of the lowest in the world, syphilis is increased in most countries. In several areas of the US there has been a dramatic increase in the prevalence of syphilis and in some first-world areas congenital syphilis is now considered epidemic. Syphilis is considerably more common in Africa than in Europe/US. Syphilis is also prevalent in most developing countries. The worldwide resurgence of syphilis has a serious implication on neonatal morbidity. The aim of this study was to evaluate the seroprevalence of syphilis in men attending and infertility clinic. Blood samples from 782 males were screened using the titrated RPR/TPHA tests. If either of these tests was positive, FTA-Abs IgG was performed. The RPR was positive in 63 (8%) cases. In 24 (3%) patients the titer was or= 1/8 with positive TPHA and FTA-Abs IgG tests and these were regarded as current infections. 39 (5%) cases had RPR titers 1/8 with positive specific tests (Table 1). These were probably patients either treated inadequately, or in the early stage of primary syphilis. In addition 92 (2%) patients were RPR negative but TPHA and FTA positive. This was evidence of previous exposure to syphilis. The overall seropositivity in this group was 20% (155 cases). 627 (80%) tested negative with RPR and TPHA. Syphilis may still have a major impact on health in Southern Africa. Since syphilis is significantly associated with HIV seropositivity, efforts to prevent and control syphilis may also be important in limiting HIV spread. The 3-8% incidence of active disease among an asymptomatic group of men, referred for evaluation of infertility underlines the statement that "serologic screening should be done at the least indication". A community-based program with continuous adequate screening and treatment would be of great help. While the absolute yield for such screening may be low, the potential for reducing the morbidity and mortality of congenital syphilis is great. (full text)
