2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Unusual presentations • T. pallidum PCR+ 1° anogenital lesions (Towns et al.STI 2016) • Anal lesions were more common in HIV+ (34.2%) vs. HIV- (11.6%). • 49.2% of 1° anal or genital lesions were painful , 37.7% were multiple . Of n=37 with painful and multiple lesions, only 8% had concurrent HSV

Slide16of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

Slide17of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

Syphilis serologic screening algorithms

Traditional

Reverse sequence

RPR (Sensitivity)

EIA orCIA

Quantitati veRPR

Primary 62-78% Secondary 97-100% EL 82-100% Tertiary 47-64%

EIA/CIA+

EIA/CIA-

RPR+

RPR-

Early primary, requires RPR (active), false +

Quantitative RPR

TP-PAor other trep. test

RPR+ Syphilis (pastorpresent)

TP-PA+ Syphilis (pastorpresent)

TP-PA- Syphilis unlikely

RPR-

TP-PA

Active infection, F+, miss early

TP-PA+ Syphilis (pastorpresent)

TP-PA- Syphilis unlikely

MMWR 60(5);2011

Slide18of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.