Üçüncü basamak bir hastanede sifilizin ayak izleri

Öz

Amaç: Günümüzde hala cinsel yolla bulaşan hastalıklar içinde önemli bir sağlık sorunu oluşturan sifilizin erken teşhisi hastalığın tedavisi ve kontrolü için temeldir. Çalışmamızda sifiliz tanı ve izleminde kullanılan testlerin istem nedenlerini ve sonuçlarını değerlendirmek amaçlanmıştır. Yöntem: 1 Ocak 2019-31 Aralık 2019 tarihleri arasında, treponemal testleri pozitif olan 88 hastanın tanı, tedavi ve takibi açısından istenen serolojik testleri, şikayetleri ve koinfeksiyonları retrospektif olarak incelendi. Bulgular: Hastaların yaş ortalaması 41±17.97, en fazla seropozitiflik oranı cinsel aktif yaş grubu olan 18-44 yaşta olup ve %69.3’ü erkek hastaydı. 33 hastada (%37.5) doğrulama testi olan TPHA testinin hiç istenmediği, 40 hastada (%45.4) tedavi öncesi veya sonrası CMIA testinin fazladan tekrarlandığı, 33 hastada (%37.5) tedavi takibinde gereksiz TPHA titre istendiği ve sadece 13 hastada tedavi takibinde gerekli olan VDRL titre çalışıldığı saptanmıştır. CMIA test sonucu 1.00-2.00 s/co değerleri arasında yalancı pozitifliğin %90 (9/10) olduğu, 12 s/co ve üzerinde ise yalancı pozitifliğe hiç rastlanılmadığı görülmüştür. Sonuç: Klinisyenlerin laboratuvarlarında kullanılan tanı algoritmalarını bilmeleri laboratuvar ile iş birliği içinde olması, gereksiz ve yetersiz test istemlerinin önüne geçilmesi, sifilizin doğru tanısı ve tedavi takibinin uygun şekilde yapılması önem arz etmektedir.

Anahtar Kelimeler

• Sifiliz
• algoritma
• koenfeksiyon
• serolojik testler

Footprints of syphilis in a tertiary hospital

Öz

Objectives: Early diagnosis of syphilis, which is still an important health problem among sexually transmitted diseases, is the basis for the treatment and control of the disease. In our study, it was aimed to evaluate the reasons and results of the tests used in the diagnosis and follow-up of syphilis. Methods: Between January 1, 2019 and December 31, 2019, the serological tests, complaints and coinfections requested in terms of diagnosis, treatment and follow-up of 88 patients with positive treponemal tests were analyzed retrospectively. Results: The mean age of the patients was 41±17.97 years, the highest rate of seropositivity was 18-44, the sexually active age group, and 69.3% of them were male patients. It was observed that TPHA test, which is a confirmatory test, was not requested at all in 33 patients (37.5%), CMIA test was repeated before or after treatment in 40 patients (45.4%), and unnecessary TPHA titer was requested in 33 patients (37.5%) during treatment follow-up. It was determined that the VDRL titer required in the treatment follow-up was studied only in 13 patients. It was observed that the false positivity was 90% (9/10) between 1.00 and 2.00 s/co values in the CMIA test result, and no false positivity was observed at 12 s/co and above. Conclusion: It is important for clinicians to know the diagnostic algorithms used in their laboratories, to cooperate with the laboratory, to prevent unnecessary and insufficient test requests, to make the correct diagnosis of syphilis and to follow the treatment properly.

Anahtar Kelimeler

• Syphilis
• algorithms
• coinfection
• serologic tests

Kaynakça

1. 1. Pala S, Conti C, Goldoni P, Silvaggio D, Nicolai M, Schiariti E, et al. A five year retrospective study on Syphilis in the Sexual Transmitted Disease Centre (STDC) of the teaching Hospital Umberto I in Rome. Ann Ig. 2018;30:66–70.
2. 2. Stamm L V. Syphilis: Re-emergence of an old foe. Microb Cell. 2016;3(9):363.
3. 3. Prevention C for DC and. Sexually transmitted disease surveillance 2019. 2021. Atlanta, GA Dep Heal Hum Serv Available online https//www cdc gov/std/syphilis/stdfact-msm-syphilis htm [Google Sch. 2021;
4. 4. Detailed STD Facts - Syphilis [Internet]. [cited 2023 Jun15].Availablefrom:https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm
5. 5. Vermund SH, Geller AB, Crowley JS. Sexually trans-mitted infections. Sex Transm Infect. 2020 Jan 1;1–750.
6. 6. Organization WH. Prevalence and incidence of selected sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis and Trichomonas vaginalis: methods and results used by WHO to generate 2005 estimates. World Health Organization; 2011.
7. 7. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatology Venereol. 2021;35(3):574–88.
8. 8. Peeling RW, Mabey D, Kamb ML, Chen X-S, Radolf JD, Benzaken AS. Syphilis (Primer). Nat Rev Dis Prim. 2017;3(1).

9. 9. Hook EW. Syphilis. Lancet. 2017;389(10078):1550–7.
10. 10. Oğrum A, Karataş A, İzol B, Güngör E, Ekşioğlu HM. Bir Eğitim Araştırma Hastanesinde Tanı Alan Sifiliz Olgularının Demografik Bulguları. Van Tıp Derg. 2019;26(3):279–84.
11. 11. Karaosmanoğlu N, Baskovski IGİ, Karaaslan E, Kıratlı E, Ekşioğlu HM. Dermatoloji kliniğine son iki yılda başvuran sifiliz olgularının değerlendirilmesi. Ankara Eğitim ve Araştırma Hastan Tıp Derg. 2019;52(1):69–73.
12. 12. Seña AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis. 2010;51(6):700–8.
13. 13. Lee S, Yu H-J, Lim S, Park H, Kwon M-J, Woo H-Y. Evaluation of the Elecsys syphilis electrochemiluminescence immunoassay as a first-line screening test in the reverse algorithms for syphilis serodiagnosis. Int J Infect Dis. 2019;80:98–104.
14. 14. Ozbek OA, Doğan Y. Evaluation of a syphilis testing algorithm using a treponemal test for screening. Mikrobiyol Bul. 2011;45(1):93–103.
15. 15. Binnicker MJ, Jespersen DJ, Rollins LO. Treponema-specific tests for serodiagnosis of syphilis: comparative evaluation of seven assays. J Clin Microbiol. 2011;49(4):1313–7.
16. 16. Karaca Y, Cöplü N, Gözalan A, Oncül O, Akin L, Esen B. Establishment of an algorithm for serological testing of syphilis identification. Mikrobiyol Bul. 2010;44(1):35–45.
17. 17. Sifiliz İstatistik [Internet]. [cited 2023 Jun 16]. Available from:https://hsgmdestek.saglik.gov.tr/tr/bulasici-hastaliklar/sifiliz/sifiliz-liste/sifiliz-istatistik.html
18. 18. Stratton KL, Culkin DJ. A contemporary review of HPV and penile cancer. Oncol (willist Park NY). 2016;30(3):245–9.
19. 19. Aksoy HZ, Yayli S, Yilmaz G, Ertunç B, Kaya S, Aksoy F, et al. ÜCD Güncelleme Serileri. 2017;
20. 20. Sarigül F, Sayan M, İnan D, Deveci A, Ceran N, Çelen MK, et al. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health. 2019; Sep;27(3):223-228. doi: 10.21101/cejph.a5467. PMID: 31580558
21. 21. Yetim A, Sahin M. Hepatitis C Virus (HCV) Infec-tion in Youth With Illicit Drug Use: Sociodemographic Evaluation and HCV Genotype Analysis/Intravenoz Madde Bagimlisi Genclerde Hepatit C Virusu (HCV) Infeksiyonu: Sosyodemografik Degerlendirme ve HCV Genotip Analizi. KLIMIK J. 2018;31(3):190–5.
22. 22. Karabaev BB, Beisheeva NJ, Satybaldieva AB, Ismailova AD, Pessler F, Akmatov MK. Seroprevalence of hepatitis B, hepatitis C, human immunodeficiency virus, Treponema pallidum, and co-infections among blood donors in Kyrgyzstan: a retrospective analysis (2013–2015). Infect Dis poverty. 2017;6:1–9.
23. 23. Boubker S, Zerrouki N, Sidqi Z, Moussi M, El Mekkaoui A, Khannoussi W, et al. Prevalence of hepatitis B and C in blood transfusion center, Oujda Morocco (2013-2015). Pan Afr Med J. 2019;33.
24. 24. Naz A, Mukry SN, Naseer I, Shamsi TS. Evaluation of efficacy of serological methods for detection of HCV infection in blood donors: A single centre experience. Pakistan J Med Sci. 2018;34(5):1204.
25. 25. Binnicker MJ, Jespersen DJ, Rollins LO. Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol. 2012;50(1):148–50.
26. 26. Janier áM, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potočnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatology Venereol. 2014;28(12):1581–93.