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Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017–2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED.Methods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018–May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18–64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. Weanalyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics.Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (

Introduction: Syphilis presents with diverse clinical manifestations, posing challenges for diagnosis, especially in the fast-paced emergency department (ED) setting.Case Report: We report a rare case of unilateral syphilitic uveitis in an individual who had been sexually abstinent for 13 years. Using ocular point-of-care ultrasound in the ED, we successfully diagnosed this uncommon ocular manifestation.Conclusion: Our case highlights the diagnostic challenges of ocular syphilis and emphasizes the crucial nature of timely identification. Collaborative efforts with specialties such as ophthalmology are essential in overcoming these challenges.

Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.

This report details a case of neurosyphilis manifesting as concurrent ocular and otosyphilis, an uncommon presentation of the disease. Here, we describe the diagnosis and treatment of a 27-year-old immunocompetent Caucasian male who presented with uveitis and tinnitus. Physical exam was consistent with uveitis and audiometric testing revealed bilateral sensorineural hearing loss. Serum rapid plasma reagin (RPR) was reactive at 1:512 with a follow-up cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test likewise reactive at 1:2, confirming neurosyphilis. The patient was treated with intravenous penicillin G with improvement of symptoms and with subsequent improvement of serum and CSF RPR. However, he ultimately represented with recurrent symptoms and fluctuating serum RPR levels, necessitating repeat treatment and ongoing clinical monitoring. Neurosyphilis can occur at any point during the course of a syphilis infection and may present with a variety of nonspecific findings. This case documents a particularly uncommon instance of simultaneous ocular and otosyphilis, a presentation of neurosyphilis that has only been described a handful of times.

In this study, we examined the risk of sexually transmitted infections (STIs) among adolescents and young adults (AYAs) with borderline personality disorder (BPD). A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI during the follow-up period were identified. Cox regression analysis was conducted to examine the risk of contracting any STI among both patients and controls. A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI (ICD-9-CM code 042, 091–097, 087.11, 078.8, 078.88, 131, and 054.1) during the follow-up period were identified. Cox regression and sub-analyses stratified by sex, age, psychiatric comorbidity subgroups, and psychotropic medication usage were conducted to assess STI risk. AYAs with BPD were at a higher risk of contracting any STI (hazard ratio [HR] = 50.79, 95% confidence interval [CI] = 33.45–77.11) in comparison with controls, including HIV, syphilis, genital warts, gonorrhea, chlamydia, trichomoniasis, and genital herpes. The association of BPD with an increased risk of any STI was prevalent in both sexes, adolescents, and young adult patients. BPD with or without psychiatric comorbid subgroup were all associated with an elevated risk of contracting any STI relative to the control group. AYAs with BPD are highly susceptible to contracting STIs. Future studies should examine the role of the core symptoms of BPD, sexual orientation, risky sex behaviors, depressive and anxiety symptoms, and substance use before sex in the risk of STIs among AYAs with BPD. [ABSTRACT FROM AUTHOR]

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade. [ABSTRACT FROM AUTHOR]

The incidence of syphilis has been steadily rising throughout the United States over the past decade, including Rhode Island. Neurosyphilis is a manifestation of syphilis involving the central nervous system and can present with a multitude of symptoms. We evaluated all cases of syphilis at a single healthcare system in Rhode Island over a 10.5-year period and identified 33 cases of neurosyphilis (24 confirmed and 9 diagnosed clinically). Neurosyphilis was more common in females, older patients, White/Caucasian patients, and non-Latino patients. Patients with neurosyphilis confirmed by cerebral spinal fluid analysis were more likely to have a higher RPR than patients who did not have neurosyphilis. Six patients with HIV were diagnosed with neurosyphilis and were similar to those with HIV and syphilis except for lower rates of drug use. Given increasing trends, clinicians should be familiar with the diagnosis and management of neurosyphilis. [ABSTRACT FROM AUTHOR]

Syphilis, once in decline, is seeing a rapid re-emergence throughout the United States. A sexually transmitted infection caused by the spirochete Treponema pallidum, syphilis infection in pregnancy can result in serious complications and have a profound impact on maternal and neonatal health. As rates of syphilis have increased among people of reproductive age, so too have cases of congenital syphilis. In 2021, congenital syphilis rates in the United States reached a 30-year high.¹ This article provides a review of syphilis in pregnancy and congenital syphilis to help clinicians respond to this emerging public health concern. [ABSTRACT FROM AUTHOR]

Over the past 10 years, sexually transmitted infections (STIs) have seen a significant resurgence in the United States despite the availability of effective treatments and reliable prevention methods. Rhode Island has experienced a similar uptick in the incidence of syphilis, chlamydia and gonorrhea, with many cases occurring among gay, bisexual, men who have sex with men (GBMSM), which coincides with a recent concerning rise in congenital syphilis cases. We reviewed the most recent STI trends for the state of Rhode Island in 2022. During this year, 6,883 cases of STIs were reported to the Department of Health (N=5,199 chlamydia, 1,444 gonorrhea, and 240 infectious syphilis cases). Compared to 2012, this represented a 21%, 185%, and 253% increase in chlamydia, gonorrhea, and syphilis infections, respectively. Since 2020, eight cases of congenital syphilis have been reported. Prior to 2020, no cases of congenital syphilis were reported since 2009. This resurgence is mainly attributed to shifting social and behavioral trends, particularly among younger individuals and shared sexual networks across diverse groups.1 Further efforts and resources are needed to effectively address these concerning trends in STIs. [ABSTRACT FROM AUTHOR]

Syphilis is a systemic infection caused by the spirochete Treponema pallidum. It is transmitted during pregnancy or through sexual contact. Signs and symptoms vary depending on the clinical stage of the disease. Syphilis has been well-studied, and the introduction of penicillin has resulted in a decline in the number of new cases and deaths. Recently, however, there has been a surge in new cases in young people, especially those with human immunodeficiency virus (HIV). This epidemiological shift has been attributed to increased sexual activity, risky sexual behaviors, and immunodeficiency. There is a paucity of data on gastrointestinal (GI) manifestations of syphilis owing to its rarity and lack of physician awareness. T. pallidum can seed to any part of the GI tract, resulting in esophagitis, gastritis, hepatitis, pancreatitis, or proctocolitis. Depending on the affected part of the GI tract, syphilis can present with nausea, vomiting, painless esophageal ulcers, dysphagia, abdominal pain, weight loss due to early satiety, diarrhea, melena, hematochezia, dyschezia, or anorectal ulcers. Given its indolent clinical course and vague presentation, GI syphilis can mimic other GI disorders, which can delay diagnosis and treatment. A detailed medical history, physical examination, serological tests, and endoscopy can provide a definitive diagnosis. Syphilis and its GI complications are usually treated with long-acting intramuscular penicillin benzathine, and rarely with a 14-day course of intravenous penicillin. Herein, we describe the clinical features, etiopathogenesis, diagnosis, and treatment of GI syphilis. This primer should aid clinicians in timely diagnosis and treatment of various presentations of GI syphilis. [ABSTRACT FROM AUTHOR]

Background: Cerebral syphilitic gummas are rare. However, numerous case reports on them have been published recently, consistent with the resurgence of syphilis and its accompanying atypical manifestations. We here present a patient with a cerebral syphilitic gumma and an unusual clinical course and review recent case reports. Case Presentation: A 49-year-old woman had a generalised seizure and was found by computed tomography and magnetic resonance imaging to have a brain mass that mimicked a brain abscess or malignant tumour. Further imaging with magnetic resonance spectroscopy and positron emission tomography did not contribute further to the differential diagnosis. Because treatment with ceftriaxone was ineffective, the lesion was resected. Serological tests on serum and cerebrospinal fluid were positive for syphilis and histopathological examination of the operative specimen revealed a syphilitic gumma. Antibiotic treatment is preferred over invasive interventions for cerebral syphilitic gumma. However, as in our case, radical resection is required when antibiotic treatment is ineffective. Conclusions: It has recently been reported that the prevalence of syphilis is increasing in older individuals, including in patients without HIV infection or prior treatment for early syphilis. Though advanced imaging and molecular biological techniques are often used to help make a diagnosis, they are of limited value. Because the clinical and imaging features are nonspecific, some neurosurgeons do not include cerebral syphilitic gummas in their differential diagnoses. It is vital that this possibility be considered when a patient has a tumour-like cerebral mass and serum positivity for syphilis. [ABSTRACT FROM AUTHOR]

Background and Aims: Meningitis in immunocompromised patients is a significant cause of mortality and morbidity. In HIV-infected cases, it is majorly of infectious origin, with Cryptococcus neoformans and Mycobacterium tuberculosis being two opportunistic pathogens together accounting for about 75% of meningitis cases. However, other variants like bacterial, aseptic, fungal or acanthamoeba meningitis can also occur in patients with HIV. The present study aimed to observe the clinical profile and aetiology of different types of meningitis in HIV-infected patients. Methods: A cross-sectional observational study included HIV-infected patients with symptoms and signs suggestive of meningitis. Patients were then assessed according to clinical, blood and CSF biochemical, blood and CSF microbiological and/special test parameter and/or radiological parameters. Data was statistically analysed. Results: Of 120 patients included, a majority belonged to the age group 26–49 years. Common presenting features included headache, fever, photophobia, neck stiffness and altered mental status. Various aetiologies of the cases included 55% cases of cryptococcal meningitis, 38.33% cases of tubercular meningitis, 3.33% cases of tubercular/cryptococcal co-infection meningitis and 1.66% cases of syphilis and pyogenic infection each. CSF findings suggested elevated opening pressure in 64.16% cases, followed by positive serum CrAg in 63.33% cases. CSF CrAg and India ink were positive, and budding yeast cell was seen in 58.33% cases. Conclusion: Tuberculosis and cryptococcal meningitis continue to be the prevailing culprits of meningitis in individuals with HIV. As treatment is readily available for these infections, early suspicion and prompt diagnosis coupled with effective early initiation of treatment can improve the lifespan of these patients. [ABSTRACT FROM AUTHOR]

Bacterial sexually transmitted infections (BSTIs) are largely preventable, yet their rates remain high across the U.S., particularly among sexual minority men (SMM) living with HIV (LWH). We explored longitudinal factors associated with BSTI acquisition in a national online sample of SMM LWH with recent suboptimal adherence to antiretroviral therapy (ART) or virologic non-suppression, such as spread within sexual networks, drug use in a sexual context (chemsex), and mental health issues. Participants completed online surveys over 12 months as part of an eHealth intervention. Over 12 months, 30% of participants self-reported at least one BSTI, with 28–45% reporting recurrent infections in consecutive surveys. Using generalized estimating equations with a binomial distribution and an exchangeable correlation structure, we found that BSTI accumulation was associated with chemsex, a higher number of anal sex partners, participation in exchange sex, and depressive symptoms. To reduce the burden of BSTIs among SMM LWH, public health initiatives and clinical settings should adopt a comprehensive sexual health approach, addressing chemsex, exchange sex, and associated mental health conditions. Addressing these factors can mitigate BSTI recurrence and improve overall sexual health among SMM LWH. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the fetal and neonatal morbidity and mortality in pregnant women with syphilis during their pregnancy in Reunion Island, population benefiting from early and well-conducted screening and treatment. Methods: This is a retrospective observational study conducted in the four Reunion hospital centers between 2017 and 2022. The included patients were all pregnant patients with a biologically proven syphilitic infection and having given birth in one of the four centers mentioned. Results: 108 patients were included, with 113 fetuses and newborns. Fetal mortality rate was 2.7%, neonatal mortality rate was 1.8% and congenital syphilis rate was 7%. Despite 37% of patients with a vulnerable psycho-social context, 72% were screened early, 13% in the second trimester, 44% had received optimal treatment and 48% optimal syphilis monitoring. We found 43% of obstetric complications with 12% of IUGR and 4.6% of pre-eclampsia. 21% of newborns were preterm and 17% small for gestational age. There was a significant trend between psycho-social vulnerability and congenital syphilis. Conclusions: Fetal and neonatal morbidity and mortality is low in our Reunion Island population where screening and treatment of syphilis are early and well conducted, although a vulnerable group of patients remain who require specific antenatal care. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018.This study evaluates the management of women diagnosed with syphilis in pregnancy in South‐East Queensland (SEQ) after release of this guideline.This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline.Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early‐stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage‐appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four‐fold reduction in rapid plasma reagin at time of delivery.Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women. [ABSTRACT FROM AUTHOR]

The letter to the editor discusses a case of a patient with large B-cell lymphoma who experienced severe toxicity but achieved long-term complete remission after treatment with nivolumab and axicabtagene ciloleucel (CAR T-cell therapy). The patient's CAR T cells persisted for 6 years after infusion, representing the longest documented persistence in large B-cell lymphoma. The combination of CAR T cells with immune checkpoint inhibitors has been proposed to enhance efficacy and overcome resistance in cancer treatment. The case highlights the potential benefits and challenges of combining these therapies for improved outcomes in lymphoma patients. [Extracted from the article]

Background Single-dose benzathine penicillin G (BPG) is the preferred therapy for early syphilis, but poorer serologic responses have been observed among people with human immunodeficiency virus (PWH). No enhanced regimen has previously been shown to improve serologic outcomes of early syphilis. Methods We conducted a retrospective study to compare the treatment responses to single-dose BPG combined with 7-day doxycycline versus BPG alone in PWH who presented with early syphilis. Rapid plasma reagin (RPR) titers were determined every 3–6 months for all included PWH. Serologic response was defined as at least a 4-fold decline in RPR titers at month 12. Results During January 2018 to March 2022, 223 PWH with 307 episodes of early syphilis received single-dose BPG plus doxycycline and 347 PWH with 391 episodes received BPG alone. The median age was 36 years and baseline CD4 count was 600 cells/mm3. In the intention-to-treat with last-observation-carried-forward analysis, PWH receiving BPG plus doxycycline had a significantly higher serologic response rate at 12 months of treatment than those receiving BPG alone (79.5% vs 70.3%, respectively; P =.006). The factors associated with 12-month serologic response were RPR titer (per 1-log2 increase, adjusted odds ratio [AOR], 1.25; 95% confidence interval [CI], 1.15–1.35) and receipt of BPG plus doxycycline (AOR, 1.71; 95% CI, 1.20–2.46). In the subgroup analyses, BPG plus doxycycline was consistently associated with a better serologic response than BPG alone at month 12. Conclusions Among PWH with early syphilis, single-dose BPG plus doxycycline achieved higher serologic responses than BPG alone during a 12-month follow-up period. [ABSTRACT FROM AUTHOR]

The document provides a comprehensive overview of donor- and recipient-triggered lookback procedures for traditional transfusion-transmitted infections in various countries, including Singapore, Japan, the United States, France, and Australia. It emphasizes the importance of testing protocols, individual assessments, and adherence to regulatory requirements in managing the process. Feedback from stakeholders and the low incidence of confirmed infections through lookback investigations are also discussed, highlighting ongoing efforts to improve and streamline procedures. The document includes data on testing procedures, demographics, and specific protocols for HBV, HCV, HIV, syphilis, and HTLV, showcasing the diverse approaches taken by different countries in managing transfusion-transmitted infections. [Extracted from the article]

The article delves into the history and current practices of donor- and recipient-triggered lookback for traditional transfusion-transmitted infections (TTIs) like HIV, HBV, HCV, HTLV, and syphilis. It stresses the importance of refining uniform criteria based on risk-based decision-making and notes the diminishing effectiveness of lookback programs due to advancements in testing and donor selection. The study underscores the necessity for policy adjustments and consensus on factors to consider before proceeding with lookback procedures, while also offering insights into the yield of such programs and the importance of periodically evaluating resources and ethical concerns. Additionally, it explores studies and analyses on hepatitis B virus reactivation, transmission, and screening in patients with hematological malignancies and immunocompromised hosts, as well as the transmission of hepatitis C virus through blood components in Germany despite mandatory screening. The document further includes information on healthcare-associated hepatitis B and C outbreaks reported to the CDC from 2008 to 2019, along with instances of rare transmission of hepatitis B virus by donors with occult infection in the Netherlands, concluding with a method for tracing back transfusion-related infections. [Extracted from the article]

Introduction: Syphilis is a systemic bacterial infection caused by the spirochete Treponema pallidum. Head and neck mucosal manifestations of syphilis can be observed in each and all of primary, secondary and tertiary syphilis, especially in the secondary one. Therefore, oropharynx is an unusual localization of syphilitic lesions, mainly represented by ulcerous lesions, tissue hypertrophy, mucosal patches and cancer-like lesions. Serology is routinely considered the gold standard for the screening and diagnosis of syphilis. However, direct detection is routinely used during polymerase chain reaction (PCR) of oropharyngeal tissue and suspicious cervical lymphadenopathies. Methods: PRISMA 2020 guidelines were applied to make a systematic literature review with the aim to make an overview of clinical manifestations and diagnostic tools of oropharyngeal syphilitic infection. A computerized MEDLINE search was performed using the PubMed, Web of Science and Cochrane databases. Results: The intended analysis was based on 38 papers, including a total of 55 cases. The main localization of oropharyngeal infection was the tonsil (71%), followed by lateral and posterior wall of oropharynx (16%). Ulcerous lesions were the most frequently encountered lesions in the primary syphilis (56%) and secondary syphilis (36%), whereas gumma's lesions were encountered in the tertiary syphilis (57%). Diagnosis based on serological assays was used in combination with non-treponemal methods to determine disease activity (80% cases). Conclusions: Oropharyngeal syphilis has historically been referred to as the "great imitator" due to its highly variable manifestations, which can resemble malignancies. Physicians have to recognize oropharyngeal luetic features early, in order to set up an effective diagnostic and therapeutic work-up. [ABSTRACT FROM AUTHOR]

AbstractObjectiveStudy designMethodsResultsConclusionOur objective was to assess trends in three sexually transmitted infections (STIs) – gonorrhoea, chlamydia and syphilis – in Spain, by age group and sex from 2016 to 2022.Retrospective observational studyData from epidemiological surveillance system were used to calculate the incidence rate for each STIs by age group and sex. Poisson regression was employed to examine the trends for 2016 to 2022.For gonorrhoea, higher incidence rates were observed among men than women for all period. The incidence rate ratio (IRR) varied between 1.14 (95% CI 1.12–1.16) for the 15–19 age group to 1.24 (1.23–1.25) for the 35–44 age group among men, and between 1.14 (1.09–1.19) for 55 years or more to 1.27 (1.24–1.29) for the 15–19 age group among women. For chlamydia, women showed higher incidence rate for all age groups than men during the period. Individuals aged 55 years and over showed the highest increase, IRR = 1.30 (1.27–1.34) for men, while it was the lowest for women, IRR = 1.22 (1.16–1.27). The incidence rates for syphilis were lower than for the other STIs. IRR values varied between 1.04 (1.02–1.06) in the 20–24 age group and 1.15 (1.14–1.16) in the 35–44 age group for males; and between 1.13 (1.06–1.16) for the 25–34 age group and 1.18 (1.13–1.25) for the 25–34 age group for females.STIs are more frequent in people aged 25–34 and are increasing in all age groups. However, the rise is most pronounced among older men and among younger women. [ABSTRACT FROM AUTHOR]

The major human spirochetal pathogens (Leptospira, Borrelia, and Treponema) are difficult to diagnose and lack vaccines to prevent infections. Infection by these spirochetes does not generate general protective immunity, allowing reinfection by different strains to occur. These stealth pathogens have uncommon physiology, pathogenesis, and clinical presentations and possess unique immune evasion mechanisms to facilitate their host adaptation and persistence. Collectively, host–spirochete interactions orchestrate systemic infections in a manner distinct from organ- and tissue-specific diseases caused by many bacterial pathogens. Difficulties in growing and genetic manipulation of infectious spirochetes have hindered the full understanding of their virulence factors despite decades to centuries of research. This article highlights the current understanding of the intricacies of spirochetal pathogenesis and diseases. Our comprehensive review of the progress versus gaps in knowledge lays a foundation for researchers to direct their studies toward the development of effective diagnostics and vaccines to protect patients from serious, chronic spirochetal diseases. [ABSTRACT FROM AUTHOR]

In clinical trials, once-daily oral tenofovir-based pre-exposure prophylaxis (PrEP) significantly reduced HIV-1 acquisition risk; however, this was highly dependent on medication adherence and persistence. We report clinical characteristics, PrEP usage patterns, first evidence of HIV-1, and associated risk factors among adults with commercial insurance using oral PrEP in the United States using health plan claims from the IQVIA PharMetrics® Plus database between January 1, 2015, and March 31, 2020, from individuals who newly initiated emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or FTC/tenofovir alafenamide (TAF) for daily PrEP. Overall, 25,419 individuals were included (FTC/TDF, n = 24,232; FTC/TAF, n = 1187), with generally similar characteristics reported during the 6-month baseline period across cohorts. Mean follow-up length was 504 and 77 days for FTC/TDF and FTC/TAF, respectively, corresponding with the 2019 approval of FTC/TAF for PrEP. Similarly, mean PrEP use duration was 354 and 68 days for FTC/TDF and FTC/TAF, respectively. PrEP breaks (>90-day gap) were observed in 11.1% of individuals using FTC/TDF, with a mean break duration of 249 days; 20.0% of individuals using FTC/TDF and 7.3% using FTC/TAF had ≥1 sexually transmitted infection diagnosis during follow-up. From 6 to 12 months of follow-up, mean FTC/TDF proportion of days covered (PDC; 0.74 vs. 0.67) and persistence (70.2% vs. 57.4%) decreased; real-world PDC and persistence were lower than reported in globally conducted clinical trials. First evidence of HIV-1 was infrequent among individuals using FTC/TDF (0.6%), though 60.3% had PrEP on hand when HIV-1 definition was met; high-risk sexual behavior, syphilis, and gonorrhea were the most important risk factors. [ABSTRACT FROM AUTHOR]